By Jason McCormick Vice President, Partner Services at Fusion5

The truth is that, until a few years ago, medical practices were not usually considered the ideal environment for statisticians or anyone who knew what pivot or V-Lookup tables were used for. You were usually hard-pressed to find anyone outside of the accounting department that had Microsoft Excel installed on his/her computer, much less an employee whose job responsibilities included reviewing data and identifying opportunities for process improvement. The changes to the health care system and the method in which services are being reimbursed has created a need for a new role in the medical practice, and that role can play a huge part in the success your organization can have in the bundled payment arena.

As I mentioned in last week’s blog, data review serves as the anchor in the process of forming a bundled payment program. Your entire program needs to be created based on the findings of your initial data review and the opportunities that were identified. But if you are early in the process of forming a bundled payment, you may not know what data is available and what types of information can be identified once you have received the data.

Most, if not all, of the data that is going to be available is claims data. This data is usually made available in a very raw format, but can be extremely helpful once the correct formatting is put in place. For example, participants in the Centers for Medicare and Medicaid Services’ (CMS) Bundled Payment for Care Improvement – Advanced (BPCI-A) initiative received a large data dump that included each claim that CMS received for services that were rendered to a patient who would have been included in the BPCI program during the years 2014 – 2016. The initial data had to be scrubbed and grouped into buckets to determine the type of services that were being reimbursed. Once the data was formatted correctly, pivot tables were used to further analyze the data.

The initial data review is instrumental in determining baseline cost and utilization data, regardless of type of bundle offering you are creating. For programs such as BPCI-A and the Comprehensive Care for Joint Replacement (CJR) program, the average cost per DRG episode, inpatient rehabilitation, skilled nursing, and home health utilization rate and average days per episode, and readmission rate all offer a glimpse of where potential savings can be identified. If you are considering outpatient surgical bundles in an ambulatory surgery center, the data review can help you to determine a per case cost that includes the costs of the surgeon, anesthesia, surgeon, facility, implant, and post-op follow-up visits.

Many self-insured employers are looking for ways to reduce costs, and bundled payment options offer the potential savings that are in high demand. If your initial review demonstrates that you could offer an overall savings by bundling the services an employer is currently paying for in an inpatient setting, you have an immediate value to the employer. Many organizations are utilizing this data as a basis for establishing value of a type of medical tourism that offers larger employers the ability to arrange travel and medical care for their employees.

Regardless of the type of bundled payment program you are trying to implement in your practice, the initial data review is extremely important and helps determine cost that can be beneficial to all the parties involved. The review can also help to identify services that need to be more thoroughly reviewed to determine is utilization is appropriate. Other potential issues that may present themselves during the data review are facilities or service providers that are outliers based on cost or length of stay. These variances can explain higher average costs and can be immediate targets for practices that are looking to make significant improvement.

If you or your practice is considering entering into a bundled payment program, or you are already participating in one but not realizing the potential savings that you had hoped for, a data review may help to identify areas to focus on going forward. If you need help with your data review, or any other services regarding bundled payments or quality improvement activities, please feel free to reach out to me through LinkedIn, or email

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