Grouping organizations and member affiliations.

[Alex]

One thing that I am sure has been discussed here is to manage to group multiple organizations into single ones where possible. I really don't know how (i.e. partial name matching, mailing address).

Another interesting aspect is how to associate members (individuals) to parent organizations. This is something similar to the CMS physician compare dataset (https://data.medicare.gov/data/physician-compare)

What are your opinions/suggestions?

[Janos G. Hajagos]

Alex,

I don't think there is a single solution to this. A provider may have multiple affiliations. As an example, a full time ER doc may moonlight at another ER once a month. Also such moonlighting relationships may change over time.  I would think the most accurate method to assess this is if the provider's tax filings were made available. It is unlikely that this will ever happen.

This is not to say that a solution cannot be developed to group providers into affiliations. If you are curious about one solution check out http://docnpi.com which uses mailing address, phone, and fax numbers to connect providers.

-Janos

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[Alex]

Janos,

Thanks for the reply. I agree with you in regards to your points. It seems that a "good" solution is finding members belonging to organizations based on same mailing address, phone, and fax numbers. 

However NPPES database doesn't help associating organizations with different NPIs that share the same/similar names and making sure they are the same organization. The only criteria that I can think of is the use of "Authorized Person" on NPPES dataset. It seems that there might be a "good" assumption on merging different organizations (different NPIs) based on the same "Authorized Person" column. Nevertheless, I think it could be a nice feature to have some sort of super-organization notion in newer version of NPPES.

[Alan Viars]

Alex:

Understanding groupings of NPI's per organization (since they share a tax ID) is something many people (and especially Fred Trotter) are asking for.  I'm working on getting something like that made public, but I cannot release that information.  I'll be sure and post a link to it here when it becomes available.

As far as answering the question, "Which organizations does a provider works for", that is tricky.  That information is not collected in NPPES. It is collected inside PECOS, but only for providers who participate in medicare. It is my understanding that some of this information will become public in a few months but I am not directly involved.  Claims data, when you have both a facility NPI and an individual provider might be the best source of knowing who a provider works for.

Hope that helps,

Alan

[Loran Cook]

One of the things we are asked most frequently for is whether a physician is employed by a practice/group/hospital or is just affiliated. Not sure where to find that information - with CMS' interest in physician-owned hospitals, you'd think they'd care about hospital-owned physicians or groups of physicians. If anyone knows of a source, I'd be elated.

Thanks,
Loran

[Alan Viars]

Loran:

Sorry for the slow reply.  These relationships are not in NPPES but do exist in PECOS.  Getting some of this PECOS data out and part of the public API would be a huge help I think. I'm working on that internally.

More to come later this week.

Would you like to do a 30 minute stakeholder interview?

Sincerely,

Alan

[Loran Cook]

Sure; if it'll help inform the process.

I'm also on the hunt for a data file that covers physician health plan status, even if it only covers plans in the federal Exchange.

[Mark Silverberg]

Hi Loran – on the topic of the physical health plan status data file, do let the list know if you find one.. I haven’t been able to. My suggestions would be to use an API such as eligibleAPI.com or platform.pokitdok.com. Perhaps they can do a data dump for you but I have a feeling they are doing ad-hoc queries and caching them and aren’t working off of a single file. 

You might also try to make your request on http://opendata.stackexchange.com where I’ve seen some great people even in our niche of healthcare respond to complex questions about health and open data.

Mark

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Mark Silverberg, BBA, MS

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[Loran Cook]

Thanks, Mark! This was a huge missed opportunity for the federal exchange to lead the way in open data, IMHO. I've looked into eligibleAPI.com but came to the same conclusion.

data.healthcare.gov looked promising, but they have nothing at the individual provider level (yet) :)

Thanks again!
Loran

[James Derrickson]

Hi Loran,

Nationally there is a state by state adoption of the All Payer Claims Database.  This database does include Provider Plan information and uses the National Plan ID from CMS.  About 30 states have already implemented this or in the process of implementing it.  

Does anyone know if CMS has any intentions to publish National Plan information as they have with the National Provider ID data?