Look for business guidance in claims data, expert says

Providers should take off their “X-ray goggles,” Gelburd says.
Providers should take off their “X-ray goggles,” Gelburd says.

Nursing home providers should use claims data to identify trends that may shift their business plans, one expert recommended in June.

Robin Gelburd, J.D., president of FAIR Health, encouraged attendees at the Long Term & Post Acute Care Health IT Summit to target diagnosis and other demographics relating to patient care.

“In a general sense, we're seeing tremendous changes that are happening in the way people are seeking their care,” Gelburd said.

She targeted specific conditions — such as the high rates of open wounds seen in Western states and Kentucky's high rate of acute kidney failure — that could help providers understand which referral sources tend to care for patients with high rates of certain conditions.

For example, home health providers typically see higher rates of open wounds.

“The data tell a story about where to allocate resources,” Gelburd explained, urging busy providers to take off their “X-ray goggles” and look at the bigger picture of care. Examining claims data can “allow you to identify areas of weakness” and find best practices, she said.

Analyzing claims data may be getting easier under a rule finalized by the Centers for Medicare & Medicaid Services in July. The rule allows certain CMS-approved organizations to buy Medicare claims data; combine it with information from providers and other companies; and sell it back to providers including skilled nursing facilities, doctors and nurses.

The finalized rule will boost providers' access to data that will “make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” said CMS Chief Data Officer Niall Brennan. 

The rule may also help open up data to improve care quality and delivery across the spectrum, CMS noted.