2) An experienced team can help interpret data, generate meaningful reports, and drive effective strategy decision-making.
For CJR, CMS will share retrospective hospital-specific data and performance period data with participating hospitals upon request on a quarterly basis. Performance period data will include raw beneficiary-level claims data and summary beneficiary claims data. Hospitals can analyze their own data or those without analysis capabilities can review the summaries.
I can tell you from experience, the raw beneficiary-level claims data is an overwhelming amount of information provided in an incomprehensible format. The ability to analyze and interpret your own data is invaluable for developing a care redesign strategy. It is essential to have IT professionals on your team who have experience working with CMS data files and data analysts who can interpret episode spending to help guide your decision-making.
Creating Reports with Data Sets That Contain Over One Billon Data Points
For BPCI, we work with many CMS raw data claims files. We receive multiple flat files containing patient information, episode codes, CPT codes, diagnosis codes, claims information, and costs. Our IT team developed a system to extract the relevant data from each file, incorporate their knowledge of BPCI rules, and import the data into a database that is used to generate reports to monitor spending and guide decision-making.
Downloading, compiling, and uploading information to a database seems straightforward, but in this case it is challenging. First, the files from CMS are too big to download in Microsoft Excel. Instead, programming languages, such as SQL, can be used or a third party agency who has previous experience working with CMS claims data can be utilized.
Second, multiple files contain information on the same patient and those files are not necessarily linked with the same patient identification information. It takes a fair amount of time to figure out this data puzzle to correctly piece together all of a patient’s information.
Third, CMS provided over 30-pages of BPCI rules defining what services are included in the initiative and which are excluded. A similar document has been released for CJR. For example, certain psychiatric services are excluded from the total cost of a patient’s 90-day clinical episode within the BPCI initiative. Although these costs may be included in the claims data, our data analysts incorporate the defined rules to extract the data for a more accurate portrayal of a patient’s total BPCI clinical episode cost by excluding these services and costs in an analysis report. An in-depth knowledge of the rules is necessary to accurately interpret CMS claims data and to find ways to reduce overutilization.
Ultimately, a hospital needs to decide whether they have the capacity and time to work with the CMS raw data claim files, understand CJR rules, and develop the reports necessary to interpret performance that will guide their CJR strategy. These reports can evaluate spending by physician, diagnosis codes, service utilization rates, the length of stay, readmission rates, and more. In our experience, the time needed to generate meaningful reports has been substantial, but the benefits are worthwhile.