Suggestions on Taxonomy Codes and Fields

[eric_...@jsi.com]

We work with the NPI data alone and in combination with Medicaid claims files, licensure lists, and national professional association files for a range of state and federal projects. I'll post thoughts on other areas of the data separately but we see many opportunities in the way the taxonomy codes are used.  Here are some suggestions:

1. Enforce that taxonomy codes meant for individuals (e.g. 207R00000X - Internal Medicine) can only be selected by individual providers, and likewise that taxonomy codes  meant for organizations can only be selected by organizations (e.g. 261QF0400X - Federally Qualified Health Center (FQHC)).  Currently you find providers and organizations that select a combination (i.e., an Internist at an FQHC or an FQHC that provides internal medicine care selecting both).
   
2. Enforce taxonomy codes consistent with the degree/license/credential currently listed for the provider (ie. NPs to chose amongst NP related codes).  Alternately, leave those codes but add the ability to flag older and lower-level codes that are not now being used – i.e. a Nurse Practitioner goes on to get an  MD degree but still has NP taxonomies listed.  This may not technically be wrong but it is not helpful for identifying current status and making provider selections from the NPI list based on taxonomy codes within a particular category (i.e. trying to select Internists that don’t have any other specialty, but you wouldn’t want to exclude those that used to be NPs). 
   
3. Expand the Taxonomies within Physician Assistants – currently only Medical and Surgical are the only sub-categories, though many PAs practice many different specialties within the realm of ‘Medical’ – some of which are primary care and some that are not. 
   
4. Clarify for providers the definition of the ‘Primary’ taxonomy code.  Is this the specialty obtained first, the specialty that they practice the most currently, or the most advanced specialty they are certified in?  How should a Cardiologist that maintains a small cardiology practice but is mostly doing general internal medicine code, vs a Cardiologist that only does Cardiology?... which should be flagged as primary in the first instance?  Many examples are available.  This makes it hard to separate out categories like basic primary care.  Unclear what guidance is given on this.  The suggestion would be to specify the taxonomy that best represents the largest portion of the provider’s current practice.
   
5. The Primary Taxonomy Code flag should have to be in the same state as the providers’ listed Practice Address.
   
6. Clarify that providers do not need to select every taxonomy that remotely applies to them. Consider limiting them to listing only those taxonomy codes that they actually use for some portion (10%, 25%, etc.) of their time or more.
   
7. Eliminate the “00000X” level general category and add it as a ‘general practice’ specialty equivalent to the sub specialties below it.  Example:  Nurse Practitioner - 363L00000X can be selected, instead of selecting from the sub-taxonomies within that heading.  We suggest that this code should be redefined as “Nurse Practitioner – General Practice” and presented as an option at the same level as Acute Care - 363LA2100X, etc.  The “00000X” level should be a heading but not a code that can be selected.
   
8. Some providers have the same taxonomy code in the same state with different license numbers – often one is listed as Primary and the other is not.  Unclear why/how this happens.  See NPI# 1407010705 as an example.
   
9. Consider a limited selection at a level above the Taxonomy codes that allows providers to categorize themselves at a more general level, as to their role in the system.   Our particular need would be the ability for the individual provider to identify themselves as ‘Primary Care’, as opposed to “Specialist”.
   
10. (Acknowledging the difficulties)  Enforce license number format for the state selected.  (eg. MA158508 vs MA-158508 vs 158508)…. Allowing free text makes it difficult to match to state licensure data using this field

[Alan Viars]

Eric:

Wow what great insight!  We've are thinking along the same lines.  I agree there is ambiguity in what primary taxonomy even means.  Splitting the taxonomy code list up  up so folks can't enter incorrect data would be a big help.  

I've attached a couple interesting a related files.  The first is a specialty/taxonomy crosswalk and the other list is an list of license types.  (Notice how many license types there are.)  I can't guarantee these are complete, official, or up to date.

The specialty/taxonomy crosswalk could be used to allow a user to select a specialty and then use have the associated taxonomy code populated automatically.

With respect to licenses,  I think it would be great if licenses were consistent across state lines.  To that end I wrote a proposal that combines the state code, the license type, and the number together in a consistent way.  Here is where I have documented the idea.  (Input and feedback welcome.) https://github.com/HHSIDEAlab/mlvs

Would you be willing to speak by phone as part of a stakeholder interview? My email is alan DOT viars AT cms DOT hhs  DOT gov

 

Best,

Alan 

[Eric Turer]

Hi Alan:

 

We were very grateful to see that you had organized this forum as we were not sure where to go with the issues and opportunities we were seeing in this important data resource as we worked with it.  I'm glad that you found the comments useful and to hear that you are already working on solutions to some of these things. 

 

It's funny that you ask about setting up an interview as I saw your offer on the post and was going to respond and see if you wanted to talk to us about any of this.  We have some thoughts that lie ambiguously in the NPI file or the claims themselves but we tried to limit things to what we thought was in the realm of the NPI.  Let me know when you might want to set that up.

 

On the license number validation, I get the gist of the service you are proposing and it would be great if licensing authorities would put their lists up in this way.  I presume the idea would be for the system to probe the list when a provider enters the license number and either warn or restrict if the entry doesn't match?  I'm not sure if you are aware of the HRSA National Center for Health Workforce Analysis and the 'Minimum Data Set' they have been working to develop and promote.  See http://bhpr.hrsa.gov/healthworkforce/data/minimumdataset/index.html   This may be a good place for a combined effort in the future.

 

Last, you mentioned that you had attached two files but there were not part of the email I received.  I'm wondering if you can resend them.   I also noticed that you mention a `ProviderLicenseUniverseFeb2014.csv`  file in the repository.  Is that part of the specialty/taxonomy crosswalk?  If not, where can I find it?

 

Thanks again for reaching out and for providing the forum for the flow of ideas.

 

ET

 

 

 

 

 

 

Eric S. Turer

Senior Health Services Consultant

John Snow, Inc. (JSI)

501 South St.

Bow, NH 03304

(603)573-3307

>>> Alan Viars <alan.c...@gmail.com> 3/7/2014 2:17 PM >>>

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[Alan Viars]

Great resource link.  

Let's discuss by phone.  Tomorrow Tuesday AM workDo you work for HRSA?

I'l be in DC/Baltimore next week.  I'm seeking to provide demonstrations of what I have thus far.  "The idea of a "Primary" taxonomy is not in the NPI Final rule.  Furthermore my supervisor has given me permission to remove that altogether so in the new system we will just have taxonomy.  I don't know why the attachments didn't work before. They should be attached to this message.

Best,

Alan