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Canadian Institute for Health Information
cihi.ca @cihi_icis
Physician Information
June 2, 2017
Marc Comeau, CIHI
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Physician information – NPDB physician payments service utilization
fee code
Patient age
group
patient sex
physician unique id
fiscal period
services
payment
FFS
APP
shadow c l a i m s
salary
contracts
capitation
F F S claims
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National Grouping System Categories
CONSULTATIONS major consultation
MAJOR ASSESSMENT office assessment
MAJOR SURGERY rhinoplasty
DIAGNOSTIC & THERAPEUTIC PROCEDURES colonoscopy
OBSTETRICAL SERVICES caesarean section
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Current FTE Indicator
𝐹𝑇𝐸 = 1 + ln𝑃𝑎𝑦
𝑢𝑝𝑝𝑒𝑟 𝑏𝑚
l o w e r benchmark
u p p e r benchmark
𝐹𝑇𝐸 =𝑃𝑎𝑦
𝑙𝑜𝑤𝑒𝑟 𝑏𝑚 𝐹𝑇𝐸 = 1
FFS Payments
FTE Value
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What about Alternative Payments?
ADVISORY GROUP
MINISTRIES OF HEALTH
CFPC
RCPSC
HEALTH CANADA
AFMC
EXTERNAL EXPERTS
ICES
MEDICAL ASSOCIATIONS
CMA
MERG PROVINCIAL
EXPERTS
CIHI
PHYSICIAN INFORMATION
Canadian Institute for Health Information
cihi.ca @cihi_icis
Physician Scope of Practice
June 2, 2017 [email protected]
A statistical approach to profiling practice patterns
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Daily clinical activities that describe the health care being delivered
What is Scope of Practice?
• Consultations
• Assessments
• Surgical Procedures
• Therapeutic Procedures
• Diagnostic Procedures
• Etc.
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NGS Categories
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Describing Physician Activities
• Physician Specialty
• Precise description of skills and credentials
• Complete listing of clinical activities i.e. fee codes
• National Grouping System (NGS) categories
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Practice Areas
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The Idea
Reorganize NGS categories into homogenous groupings called practice areas
Measure participation within each practice area
Participation patterns define unique practice patterns for each physician
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The Practice Areas consultations
MAJOR CONSULTATIONS OTHER CONSULTATIONS
psychotherapy INDIVIDUAL PSYCHOTHERAPY GROUP PYSCHOTHERAPY COUNSELING
musculoskeletal surgery FRACTURES ARTHROPLASTY – HIP ARTHROPLASTY – KNEE OTHER MUSCULOSKELETAL
obstetrical services SERVICES AT TIME OF DELIVERY VAGINAL DELIVERY CAESAREAN SECTION THERAPEUTIC ABORTIONS OTHER OBSTETRICS
assessments OFFICE HOSPITAL INPATIENT NEWBORN HOSPITAL INPATIENT OTHER HOSPITAL OUTPATIENT HOSPITAL UNSPSECIFIED UNSPECIFIED etc...
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Scope of Practice Categories
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Basic assumption: physicians within a given specialty represent a group of like-behaving individuals the majority of who practise in similar ways.
Assigning a Scope of Practice – The Setup
• Choose a specialty, s
• Let PAi denote the ith practice area
• For each physician let pi represent their total payments for PAi
• We`ll associate a scope of practice category Π𝑠 to each specialty
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Assigning a Scope of Practice – the Math I
Dr. WHO Payments by Practice Area
• For each physician we define their participation rate sequence as follows: 𝑅 = (𝑅1, ⋯ , 𝑅25) where
𝑅𝑖 =𝑝𝑖𝑃
and 𝑃 = 𝑝𝑖𝑖 . • Each 𝑅𝑖 is a relative measure of
participation within the practice area PAi.
R1
R2
R3
R25
Think Pie
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Assigning a Scope of Practice – the Math II • Does Dr. WHO have a typical practice pattern for his specialty?
• Need to define what is the most typical participation rate sequence for the specialty
• In other words we want to define the most representative pie chart
For each specialty group s, we define the payment signature of s, denoted
𝑡𝑠 = 𝑡1,𝑠, ⋯ , 𝑡25,𝑠 as follows:
𝑡𝑖,𝑠 = 𝑚𝑖,𝑠 +1− 𝑚𝑖,𝑠𝑖
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where 𝑚𝑖,𝑠 = 𝑚𝑒𝑑𝑖𝑎𝑛 𝑅𝑖,1, ⋯ , 𝑅𝑖,𝑁 and where 𝑅𝑖,𝑗 denotes the
participation rate value in the ith practice area for the jth physician in specialty group s. The resulting point is the orthogonal projection of the median onto the hyperplane.
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Assigning a Scope of Practice – the Assignment
• Let 𝑹 = (𝑹𝟏, ⋯ , 𝑹𝟐𝟓) denote the participation rate sequence for Dr. WHO
• We say that their scope of practice is most similar to the specialty group s when
min𝒍∈𝒔𝒑𝒆𝒄
𝒅(𝑹, 𝒕𝒍) = 𝒅 𝑹, 𝒕𝒔
where 𝒅 𝑹, 𝒕𝒍 = 𝑹𝒊 − 𝒕𝒊,𝒍𝟐
𝒊 is the Euclidean distance between the tuples.
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Examples
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Scope of Practice as a Pie Chart – the Payment Signature
basic procedural 1%
consultations 1%
major assessments 10%
minor surgery 1%
other diagnostic 2%
psychotherapy 3% visits
71%
Family Medicine
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Scope of Practice as a Pie Chart – the Payment Signature
anesthesia 92%
consultations 4%
visits 1%
Anaesthesia
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Scope of Practice as a Pie Chart – the Payment Signature
consultations 23%
digestive system surgery
21% endoscopy
15%
major assessments 3%
minor surgery 2%
other diagnostic 2%
Breast and Skin surgery
3%
respiratory and cardiovascular
surgery 1%
urogenital surgery 3% visits
9%
General Surgery
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Scope of Practice as a Pie Chart – the Payment Signature
consultations 10%
digestive system surgery
1%
major assessments 2%
other diagnostic 2% respiratory and
cardiovascular surgery
57%
surgical assistance 2%
visits 6%
CVT Surgery
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Scope of Practice as a Pie Chart – the Payment Signature
consultations 27%
major assessments
31%
psychotherapy 2%
visits 22%
Pediatrics
consultations 37%
major assessments
24%
psychotherapy 2%
visits 30%
Geriatrics
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NPDB Specialty Family Medicine
Total Payments $405,000
Identifying Scope of Practice
visits 2%
anaes serv 96%
Dr. WHO
it’s a match!
… but anesthesia
92%
consultations 4%
visits 1%
Anaesthesia
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Next Steps
• Work at refining the practice areas
• Explore other options for defining the centroid of a scope of practice cluster
• Analyze the dissimilarity between clusters
• Develop a clinical description of the scope of practice categories
• Incorporate Alternative Payments
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