CMS Physician Billing Data Dump – Historic Insight Into The LTPAC Service Market

April 24th, 2014 by Rod Baird

On April 9th, 2014, CMS released the “complete” 2012 Medicare Part B billing history for Physicians & Extenders. This blog post from Rod Baird provides some insight on what he has been able to glean in the data thus far regarding the LTPAC market.

 
All we want are the facts….” – Stg. Joe Friday.

Last week CMS released the ‘complete’ 2012 Medicare Part B billing history for Physicians & Extenders. It’s safe to predict this trove of information will have repercussions beyond anyone’s imagination. Understanding LTPAC physician metrics is critical to my businesses – here are some facts mined from that database.

Note: – there are over 880,000 physicians & other providers enumerated in the Public Use File [PUF]. The records ONLY cover Medicare Part B FFS claims – Medicare Advantage payments are not included. That can cause significant under-reporting of activity.

The following values being reported are based on copying 100% of any provider’s data in the PUF who was listed as having billed for a LTPAC CPT® Code:

  • 99304-99318 – Nursing Facility
  • 99324 – 99337 – Assisted Living/Rest Home

Total number of providers reporting any LTPAC E&M activity:

52,426

Total number of providers listed with any SNF/NF service:

46,579

SNF/NF encounters:

24,660,090

SNF Admission Encounters (99304:99306):

2,640,031

Number of providers required to deliver the 50th percentile encounter (12,330,000):

4,831

Annual number of SNF/NF encounters provided by the 4,831st Provider:

1,390

Percent of Encounters by those 4,831 providers that were in a:

 

SNF/NF:

83%

ALF/Resthome:

4%

Hospital:

8%

Other:

5%

Some conclusions are pretty obvious:

  • Only 6% of all providers report any LTPAC encounters.
  • About ½% of the provider universe delivers 50% of all Nursing Facility Encounters
  • Those providers focus on Nursing Facilities and little else

Individuals receiving LTPAC care consume the highest portion of healthcare expenditures by any measure. Politicians, and Policy Makers, who want to improve the cost effectiveness of Medicare & Medicaid programs might want to consider the benefits collaborating with this tiny sliver of the provider universe.

We’ll publish additional insights into this tiny universe of providers with disproportionate economic impact in the months to come.

Rod Baird
Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

We're ready to help you. Contact us today by phone at (828) 348-2888, or get in touch via our contact form.