Medicare is telling the world about your practice Print
Written by Accountable Care Options, LLC   
Thursday, 15 September 2016 07:49

Do you know what’s being said?

Medicare is publishing on the web an enormous amount of data on every practice that bills for its services. The information at could either be very exciting or very scary. 
Medicare is telling the world how many Medicare beneficiaries each practice has, their demographics, the actual risk for the patient population and how sickly the patients are. The agency drills down to average spending and average amount billed per patient per year, the total amount of money the practice received for providing Medicare services, and so on. Practices can essentially Google themselves and their medical neighbors.

Data are now available for 2013, 2014, and 2015, so it’s possible to see short-term trends and identify characteristics of the patient population and the practice.

Big-data companies are diving into the numbers and creating snapshots that show the number of patients, total billing, etc. Others are rating practices based on their ability to perform in certain types of contractual arrangements.

A practice can learn a lot about itself and improve its finances by analyzing the numbers, usually with the help of one of the number crunchers. A large practice that’s highly efficient with certain disease types definitely has stronger negotiating power when it comes to contractual arrangements.

A practice that’s developing a strategy for a risky business venture can look at the data for a demographic, medical condition and geographic area and use the analysis to help determine whether it should go forward.

For example, a practice may be considering a cardiac program but finds in the data that it has very few cardiac patients. But it has a large amount of COPD patients, so maybe the investment should go toward serving that patient population, especially in light of pay-for-performance interventions.

However, the greatest value for a practice is knowing what it looks like in Medicare's eyes. Sometimes that matches the practice’s self-perception and sometimes it doesn't. It’s all a matter of perspective. 

A practitioner may think, "I am very efficient. I have very sick patients and I know they cost a lot, but I do well with them." But Medicare data may present the practice as having a relatively healthy population with certain disease states that are manageable and high cost. Then, it’s time to rethink the practice and its operations.

Similarly, a practice can look at risk scores. For example, if two practices provide skilled nursing at the same hospitals but their risk scores are considerably different, in-depth analysis is needed. What’s the case mix?  How many patients are end-stage renal versus disabled versus regular Medicare age? Depending on arrangements such as an advanced-payment or any new Medicare model, the practice will see a difference in its baseline funding. 

Ultimately, a practice will gain insights about itself. If the practice and its neighbor have the same number of patients and similar risk scores but costs are significantly different, it’s time to investigate why. What is the other practice doing that's more or less different? Where does the practice stand in the market as to efficiency? The answers could change the entire practice.

Last Updated on Thursday, 15 September 2016 07:55