Quick Guide to Reviewing Your Medicare Field Test Report

I know this stuff is frustrating and boring, but I really need your help. Below are some specific instructions for looking at your field test report. There are a lot of things I am worried about. So far, I have seen THREE reports. Yes, Medicare is working at a method to assess each wound care practitioners’ spending (to determine if it is too high) and so far, three doctors in the USA have pulled their reports to understand if the “cost measure” is accurate.

(Was it Thomas Jefferson who said that people get the government they deserve? We are going to get the payment system we deserve.)

Start By Looking at Table 1 in the PDF

Here is a comparison of 2 doctor’s Table 1. WHY IS THE NATIONAL AVERAGE COST MEASURE SCORE DIFFERENT? If it’s a “national average” why isn’t it the same? Is your “national average” different from these?

Now Look at Table 3 in the PDF:

Here again is a comparison of 2 reports. Why are the “national averages” different? Are your numbers different from these?

Now Look at Table 4 of the PDF, Clinicians Contributing to Your Episode costs:

• Are the “NPIs” within your TIN actually within your TIN (are these doctors in your group?)
• Are the NPIs OUTSIDE your TIN on the right, NOT in your group? (In one doctor’s report, some of the doctors INSIDE her TIN were listed  “Outside the TIN”)
• Do you know/refer/collaborate with the doctors on the right hand column?
  • The right hand column are the doctors associated with your most expensive patients. I did not know ANY of the 5 doctors associated with my highest cost patient which means the patient left my care and went to see those doctors, but I am being held responsible for the associated costs

Open the Excel Spreadsheet and Check the Following Things:

• Look at all the doctors in column “W”
  • How many of them do you know and have referral relationships with?
    • If there are doctors you do not know, understand you are being held accountable for the cost of all their care of the patient that pertain to the ulcer(s)
• Look at Column “E” (costs)
  • Find your most expensive patient in column E
  • You can use the Date of birth in Column K to look that patient up in your records
    • If you can, look up the patient in your EHR, and see when your last date of service was for this patient
    • Now look at Column “M” which is the episode START date, and Episode “N” which is the episode stop date
      • Were you caring for this patient between the start and stop date of the episode, and how much of that time were you caring for the patient?
        • In my  case, many episodes START on the LAST day that I saw the patient (even though I might have been seeing the patient for months prior to that)
  • You might want to check your second most expensive patient and repeat the process above. It is time consuming since you have to look up visit dates

Other Things to Check in the Excel:

• Check your specialty designation in column P
  • What is it, and is the specialty designation correct?
• Look at Column T – hospitals
  • Do you have privileges at those hospitals? Are they even in your city?
• Look at Column U which are other healthcare services
  • Do you see anything odd in that list?
    • In my case, Quest Diagnostics is listed as a TIN that I work with
    • Do you refer to the home care companies listed?
• Ancillary costs:
  • Column AN is is SNF cost – how many patient’s SNF costs were allocated to you?
  • Column AL is Home Health cost – does that seem right?
  • Column AD is DME cost – does that seem right?
  • Column AJ is inpatient surgery cost – How many inpatient surgeries are allocated to you and do you think that makes sense?
  • AH is inpatient Medical cost-  How many medical admissions are allocated to you and do you think that makes sense?
  • Column Z is Emergency department cost – how many ED visits were allocated to you?

As we find more issues with questions, we will pass them on. Email me at Cfife@intellicure.com with your observations. The deadline to make comments is March 14^th.