Acute vs. Chronic HCC RAF

Summary Information from the Clinical Record

HCC_Summary <- function( pdftext )

LabMatch <- function( labstring, pdftext, ... )

ReportMatch = function( pdftext, reportdelims, … )

_Sample_Summary3Download

Extracting Patient Health Summary Information from the Continuity of Care Document (CCD)

HCC_Summary <- function( pdftext ) {

x <- getICD10( pdftext ) # returns a list of ICD10 codes found in the text

LabMatch <- function( labstring, pdftext ) {

sample_summary0-1Download

Summary of Medicare Payments to Ohio Internal Medicine Physicians

By quartile of total revenue and category of services.  Same analysis as applied to Family Physicians.  Internal Medicine physicians tend to perform a wider range of different types of services.

Summary of Medicare Payments to Family Physicians in Ohio

This graph breaks down the average billing category revenue amounts by Quartile of Total Revenues for Family Physicians in Ohio for 2012.  (This is not a “per provider” average, but an average revenue earned by providers providing that service in that category in that quartile.)

There are several interesting points:

1. Family Physicians in the higher Medicare Revenue bracket generally provide more patient care:
   • More Office visits
   • More Nursing Home visits
   • More Home Health visits
   • More Hospital and ER services
2. There are also some interesting outliers:
   • PathLab: DrugTst
     • A single physician provider providing Drug Confirmation Testing
   • MedP: OthrSvcs
     • A small number of physicians are providing Hyperbaric Oxygen Therapy
   • MedP: Neurol
     • About 34 physicians providing neuromuscular testing and sleep study services

I plan to refresh this analysis and look at average category revenues by quartile on a “per provider” basis.

This analysis was done in R & RStudio on an Ubuntu Linux platform using linked PostgreSQL to subset the 2012 Medicare Payments data by physician specialty and location.  A pattern match selection using regular expressions was used to supercategorize the CPT codes into broader categories (Critical Care, Home Health, Hospital Inpatient, …).

ggplot2 was used to generate the graphics.

Thank you to the Coursera Johns Hopkins Data Science Specialization series, the R & RStudio as well as the PostgreSQL communities for their great open source tools and guidance.

HCC Bucket Analytics by Risk Adjusting ICD10 codes from Clinical Text

HCC bucket analytics on HIE data

REPORT: Number of terms searched 105

Bucket Term Count

Diabetes Diabetes 23

CHF ECHO 2

PVD ABI 3
PVD Vascular 30
PVD PAD 1
PVD Atherosclerosis 2
PVD Ulcers 8
PVD calcification 3

MDD Depression 26

Substance Dependence Alcohol 44
Substance Dependence substance abuse 3

Angina Atherosclerosis 2
Angina Chest pain 17
Angina Stent 10

CKD Hyperparathyroidism 1

Cancer Cancer 42
Cancer Malignan 6
Cancer Neoplasm 5

Episodes of Care emergency 4

CMS-Immunization influ 8
CMS-Immunization immunization 6
CMS-Immunization zostavax 1

CMS-Cancer Screen colonoscopy 39
CMS-Cancer Screen colon polyp 29
CMS-Cancer Screen fit 10
CMS-Cancer Screen mammogram 26
CMS-Cancer Screen mamm 30
CMS-Cancer Screen mam 37
CMS-Cancer Screen bi-rad 2

CMS-Bone Density dexa 5
CMS-Bone Density bone density 31

Medicare Payments Profile for a Wound Care Practice

Wound_Care_Practice

Which States Are Friendliest to Independent Practice?

In choosing a state in which to set up a practice, physicians should study tax and regulatory policy, writes third-year family medicine resident Philip Eskew, D.O., J.D., M.B.A. The winter issue of the Journal of American Physicians and Surgeons features Dr. Eskew’s article — “Which State Best Suits Your Medical Practice–an Analysis and Reference Guide,” — in which states are ranked in order of friendliness to independent practices.
Only South Dakota and Wyoming make the top tier. In the second tier are Idaho, Wisconsin, Indiana, North Dakota, Texas, and Alaska.

At the bottom, in tier 6, are Massachusetts and New Jersey. Tier 5 includes Connecticut, Rhode Island, the District of Columbia, Oregon, Maryland, New York, California, Ohio, and Illinois.

http://www.aapsonline.org/index.php/site/article/which_states_are_rated_top_for_medical_practice/

http://www.jpands.org/vol19no4/eskew.pdf

Service Intensity and Physician Income

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Service Intensity and Physician IncomeConclusions From Medicare’s Physician Data Release ONLINE FIRST

Jonathan Bergman, MD, MPH^1,2,3; Christopher S. Saigal, MD, MPH^1,3,4; Mark S. Litwin, MD, MPH^1,5

[+] Author Affiliations

JAMA Intern Med. Published online December 08, 2014. doi:10.1001/jamainternmed.2014.6397

Text Size: A A A

http://archinte.jamanetwork.com/article.aspx?articleid=1984245

Results:

These data indicate that higher-earning physicians earn more not by treating more patients but by offering more services per beneficiary. The relationship between these additional services and any meaningful improvement in outcomes is undefined. Given the data on medical service utilization in the United States, it is likely that a substantial portion of these services is unrelated to improved outcomes. For each service offered by a physician in the bottom decile, 5 are offered by a physician in the upper decile. The 20th, 40th, 60th, and 80th deciles for the services to beneficiary ratios are 1.4, 2.2, 3.6, and 6.9 (demarcated as quintiles of services [dashed lines in the Figure]), respectively, highlighting tremendous overall variation in the number of services physicians offer each beneficiary. In Medicare’s fee-for-service system, some physicians are collecting large fees by ordering services munificently.

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Part of the point is… that if you *aren’t* offering some of those procedures, maybe you should be.  I have found from some of my analysis that higher Medicare revenue earning primary care docs tend to:

work hard (see lots of patients)
do nursing home care,
and do *home visits* which pay about twice as much as a nursing home visit

In an analysis of Ohio physicians, I did find one physician in Cleveland who billed for 5,420 home visits in 2012…  I am assuming that this might be some sort of proxy billing through midlevels, because 5,420 home visits would come to over 20 some visits per day for a 48-50 week 5 day year, and that wouldn’t seem possible *unless* maybe the physician was billing for “home visits” in a nursing/retirement care setting.