Free Provider Tool: Risk based on Medicare Utilization by Providers

May 15, 2014

As most of us have either heard or seen by now, CMS released a data dump of Medicare utilization by NPI number last month and since then, newspaper articles have flourished about how physicians are simply making too much money off of Medicare. The facts are this — only around 70% of the utilization data were published and they did not include such important information as payer mix, patient acuity and the like. Without these critical data points, the raw numbers are all but useless. But that hasn’t stopped the barrage of negative press

Since its release, I have been working with the data to figure out a way to work it so that physicians could use it to both defend themselves against unwarranted attacks and to better understand their utilization patterns. What I came up with was a proportional distribution model that results in a more realistic view of utilization and payment patterns that are agnostic to payer mix and other missing critical data points mentioned above.

I have created a web page where a physician can go, type in their NPI and view these data. To better help understand the idea of risk, I created a percentile ranking of critical ratios by specialty, allowing the physician to see where they rank compared to their peer group.

Check out your Medicare Risk.

If you have any questions, please feel free to contact me at your convenience.