Preliminary Year Two Physcian Services Analyses · 2 92014 Eye exam&tx estab pt 1/>vst 0 3 92340...
22
Introduction This document contains high-level, preliminary, rate comparison information, as well as access and utilization analysis information, related to the Physician Services under review in year two of the rate review process. These Physician Services are: x ophthalmology (pp.5-6); x speech therapy (pp.7-8); x cardiology (pp.9-10); x cognitive capabilities assessment (pp.11-12); x vascular (pp.13-14); x respiratory (pp.15-16); x ear, nose, and throat (ENT) (pp.17-18); x gastroenterology (pp.19-20); and x end-stage renal disease (ESRD) and dialysis (pp.21-22). Information and analyses presented in this document are subject to change. Further analyses will occur leading up to the publication of the 2017 Medicaid Provider Rate Review Analysis Report in May. For example, while the rate comparison information contained in this document compares Health First Colorado (Colorado’s Medicaid Program) rates to Medicare rates, the final benchmark used for comparison may include other comparator rates, such as other state Medicaid rates, as appropriate and for instances when a Medicare rate is not available. It is important to note that the information and analyses contained in this document do not indicate whether or not rates are sufficient, nor does it indicate whether or not access is sufficient. Rather, it guides the Department in understanding, for each service, where further investigation should occur. Brief descriptions of the information and analyses contained within this document is found below. Rate Comparison The rate comparison analysis is based on claims data for FY 2015-16 (July 1, 2015 – June 30, 2016). The above mentioned Physician Services encompassed 819 codes as of June 30, 2016, with Health First Colorado covering 792 of those codes (including 16 manually priced codes). Out of the 776 codes with an established Health First Colorado rate, 720 had a comparable Medicare Non-Facility rate. 1 An aggregated payment comparison to Medicare is shown in the top table, which accounts for specific service utilization. The next chart displays: x Vertical axis (y-axis) – the rate ratio between Health First Colorado rates and Medicare rates for each code. The dark horizontal line represents what the Department pays, on average, as a percent of Medicare, also referred to as the benchmark percent. x Horizontal axis (x-axis) – the total paid amount for each code. The dark vertical line represents the average paid amount. 1 For the remaining 56 codes, the average of other state Medicaid rates was used for comparison. While this comparison is not shown in this document, it will be incorporated in the 2017 Analysis Report. 1 5DWH 5HYLHZ 3URFHVV 3UHOLPLQDU\ <HDU 7ZR 3K\VLFLDQ 6HUYLFHV $QDO\VHV
Transcript of Preliminary Year Two Physcian Services Analyses · 2 92014 Eye exam&tx estab pt 1/>vst 0 3 92340...
Introduction This document contains high-level, preliminary, rate comparison information, as well as access and utilization analysis information, related to the Physician Services under review in year two of the rate review process. These Physician Services are:
ophthalmology (pp.5-6);speech therapy (pp.7-8);cardiology (pp.9-10);cognitive capabilities assessment (pp.11-12);vascular (pp.13-14);respiratory (pp.15-16);ear, nose, and throat (ENT) (pp.17-18);gastroenterology (pp.19-20); andend-stage renal disease (ESRD) and dialysis (pp.21-22).
Information and analyses presented in this document are subject to change. Further analyses will occur leading up to the publication of the 2017 Medicaid Provider Rate Review Analysis Report in May. For example, while the rate comparison information contained in this document compares Health First Colorado (Colorado’s Medicaid Program) rates to Medicare rates, the final benchmark used for comparison may include other comparator rates, such as other state Medicaid rates, as appropriate and for instances when a Medicare rate is not available.
It is important to note that the information and analyses contained in this document do not indicate whether or not rates are sufficient, nor does it indicate whether or not access is sufficient. Rather, it guides the Department in understanding, for each service, where further investigation should occur.
Brief descriptions of the information and analyses contained within this document is found below.
Rate Comparison The rate comparison analysis is based on claims data for FY 2015-16 (July 1, 2015 – June 30, 2016). The above mentioned Physician Services encompassed 819 codes as of June 30, 2016, with Health First Colorado covering 792 of those codes (including 16 manually priced codes). Out of the 776 codes with an established Health First Colorado rate, 720 had a comparable Medicare Non-Facility rate.1
An aggregated payment comparison to Medicare is shown in the top table, which accounts for specific service utilization. The next chart displays:
Vertical axis (y-axis) – the rate ratio between Health First Colorado rates and Medicare rates foreach code. The dark horizontal line represents what the Department pays, on average, as apercent of Medicare, also referred to as the benchmark percent.Horizontal axis (x-axis) – the total paid amount for each code. The dark vertical line representsthe average paid amount.
1 For the remaining 56 codes, the average of other state Medicaid rates was used for comparison. While this comparison is not shown in this document, it will be incorporated in the 2017 Analysis Report.
1
Circles – each circle represents a specific code and its location represents the total paid amount for that code and that code’s rate ratio. The size of the circle represents paid units, which is a proxy for utilization, for each code. Call-out boxes highlight a few specific codes.
The bottom table displays the top codes, in descending order, by expenditure (also referred to as total paid). This table includes total units, sometimes blinded to protect private health information (PHI), Health First Colorado rates, Medicare rates, and a rate ratio.
Access & Utilization The access & utilization analysis is based on claims data from FY 2014-15 and FY 2015-16 (July 1, 2014 through June 30, 2016). In an effort to improve upon the analyses in the 2016 Analysis Report, and in an effort to reach more meaningful conclusions, the Department is developing an Access to Care Index (preliminary index results are included here) combining five access-related metrics:
Penetration Rate – the ratio of the number of members who utilized a service compared to all full time-equivalent (FTE) members. Average Distance – the average distance traveled from the geographic center of a utilizer’s zip code to geographic center of provider’s zip code using the most direct route. Member to Provider Ratio – the ratio of FTE members compared to active providers.
Active Provider Months – the average number of months that providers billed Health First Colorado, displayed over a 24-month time frame. Panel Estimate – the average number of Health First Colorado members seen per rendering provider.
For the purpose of identifying regions for potential investigation, the Department attributed points to each of the 21 Health Statistics Regions (regions), based on performance in these metrics. For each metric, the Department assigned regions in the top quartile 20 points and regions in the bottom quartile 5 points. While the total possible points a region could receive equals 100 points, no region was attributed 100 points because no region was in the top quartile in all five metrics.
The following pages contain the resulting Access to Care Index scores, by service, for each region. They depict service utilizers by age, gender, and population. Metric-specific charts (bottom of each page) contain circles that represent each region; where each circle falls along a continuum represents that region’s actual performance on the metric. For the reader’s reference, the next page contains a Health Statistics Region map and list of counties.
2
Health Statistics Region Map Key
HSR 1: Logan, Morgan, Phillips, Sedgwick, Washington and Yuma
HSR 12: Eagle, Garfield, Grand, Pitkin and Summit
HSR 2: Larimer HSR 13: Chaffee, Custer, Fremont and Lake HSR 3: Douglas HSR 14: Adams HSR 4: El Paso HSR 15: Arapahoe HSR 5: Cheyenne, Elbert, Kit Carson and Lincoln HSR 16: Boulder and Broomfield HSR 6: Baca, Bent, Crowley, Huerfano, Kiowa, Las Animas, Otero and Prowers
HSR 17: Clear Creek, Gilpin, Park and Teller
HSR 7: Pueblo HSR 18: Weld HSR 8: Alamosa, Conejos, Costilla, Mineral, Rio Grande and Saguache
HSR 19: Mesa
HSR 9: Archuleta, Dolores, La Plata, Montezuma and San Juan
HSR 20: Denver
HSR 10: Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel
HSR 21: Jefferson
HSR 11: Jackson, Moffat, Rio Blanco and Routt
3
4
Rate Comparison Analysis: Ophthalmology Services
$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000
Total Paid Amount
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $561,796
Benchmark Percent =79.60%
Procedure Code: 92004Colorado to Medicare: 80.38%Paid Amount: $9,790,415Paid Units: 84,643
Procedure Code: 92286Colorado to Medicare: 125.27%Paid Amount: $1,699Paid Units: 37
Procedure Code: 92100Colorado to Medicare: 12.77%Paid Amount: $208Paid Units: 30
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare
1 92004 Eye exam new patient 0
2 92014 Eye exam&tx estab pt 1/>vst 0
3 92340 Fit spectacles monofocal 0
4 92012 Eye exam establish patient 0
5 92134 Cptr ophth dx img post segmt 0
6 92134 Cptr ophth dx img post segmt 26
7 92134 Cptr ophth dx img post segmt TC
8 92250 Eye exam with photos 0
9 92250 Eye exam with photos 26
10 92250 Eye exam with photos TC
11 92060 Special eye evaluation 0
12 92060 Special eye evaluation 26
13 92310 Contact lens fitting 0
14 92002 Eye exam new patient 0
15 92235 Eye exam with photos 0
16 92235 Eye exam with photos 26
17 92235 Eye exam with photos TC
18 92133 Cmptr ophth img optic nerve 0
19 92133 Cmptr ophth img optic nerve 26
20 92133 Cmptr ophth img optic nerve TC
21 92083 Visual field examination(s) 0
22 92083 Visual field examination(s) 26
23 92083 Visual field examination(s) TC
24 92136 Ophthalmic biometry 0
25 92136 Ophthalmic biometry 26
26 92136 Ophthalmic biometry TC
27 92341 Fit spectacles bifocal 0
80.38%150.79121.2084,643
80.47%125.58101.0578,603
0.00%0.0016.41125,575
80.80%86.6370.0012,315
74.58%45.8334.1813,775
76.95%29.1522.431,381
70.44%16.6811.75130
74.48%80.2459.768,537
213.77%24.4752.31391
13.30%55.777.4231
80.92%66.0353.435,540
112.74%38.8543.80431
0.00%0.00136.713,008
80.78%82.2766.463,177
74.91%111.5983.592,132
103.55%47.8549.55160
53.36%63.7434.0130
76.38%44.7534.184,913
78.90%28.4322.43626
72.00%16.3211.7588
62.22%65.3840.683,753
81.64%28.4323.21791
37.00%36.9513.6775
60.61%91.7955.631,261
63.53%31.6720.12900
59.08%60.1235.52132
0.00%0.0020.263,320
Top Ophthalmology Services Sorted by Total Paid
Paid Units1
20,000
40,000
60,000
84,643
5
DRR0 R0
0
egmt
DR26
ost segmt TC
photo DRotos DTC
0DRRRDRDRDRDDDDDRARARADRDR
84,643
78,60
5,57
12,315
13
DRRARARARDRDRDRDAFTAFTFT0
l Paid AmountFTFTTTTTTPP
FTRAFits (PHI) Colorado
RAtal Pa
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 45
45
80
65
7065
45
50
80
55
70
70
65
80
60
7570
60
60
60
80
Utilization and Access Analysis:Ophthalmology
ChildrenExpansion Adult
AdultDisabled
ElderlyOther
161,35865,325
28,71517,081
1,692193
Clients by Population, Age, and Gender
7565
55 4565
65
45
8060
6070
6080
70
70
80
7080
FY 2015 FY 2016Rendering Provider CountUtilizer Count 182,434
817157,848
791
Client age ba..
0K20K40K
Male Population
0K 20K 40K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 10 20 30 40 50 60 70 80 90 100
AverageDistance 05 080903 1317 0620 1201 11
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Panel Estimate 05 08 1903 0717 1020 02 12 01 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 0503 07 172014 12 01
0 50 100 150 200 250 300 350
Member toProvider Ratio 05 08 091903 0713 1610 0414020111
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 4.00% 8.00% 12.00% 16.00% 20.00% 24.00% 28.00% 32.00%
PenetrationRate 15 0809 1803 13 06041412 0111 21
6
DDDDDDDDD117 117DDDRDDDRDR8.00% 1DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
45
45
80
70
RFT
nAdultAdult
Dis
OFTTFTFTFTTTT1692
FTFTAFTClient age bF871-
61-70-60
413AFAFFF
DRDDDRDRRDRDR
Rate Comparison Analysis: Speech Therapy
$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000
Total Paid Amount
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $1,242,509
Benchmark Percent =71.00%
Procedure Code: 92507Colorado to Medicare: 75.15%Paid Amount: $13,128,612Paid Units: 222,563
Procedure Code: 97532Colorado to Medicare: 77.93%Paid Amount: $4,554,648Paid Units: 218,403
Procedure Code: 92626Colorado to Medicare: 16.68%Paid Amount: $3,303Paid Units: 218
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare RateColorado toMedicare
1 92507 Speech/hearing therapy 0
2 97532 Cognitive skills development 0
3 92609 Use of speech device service 0
4 92523 Speech sound lang comprehen 0
5 92526 Oral function therapy 0
6 92630 Aud rehab pre-ling hear loss 0
7 92606 Non-speech device service 0
8 92508 Speech/hearing therapy 0
9 92610 Evaluate swallowing function 0
10 92522 Evaluate speech production 0
11 92607 Ex for speech device rx 1hr 0
12 92524 Behavral qualit analys voice 0
13 92627 Eval aud status rehab add-on 0
14 92521 Evaluation of speech fluency 0
15 92626 Eval aud rehab status 0
16 92608 Ex for speech device rx addl 0
17 92611 Motion fluoroscopy/swallow 0
18 92612 Endoscopy swallow tst (fees) 0
19 92605 Ex for nonspeech device rx 0
20 92597 Oral speech device eval 0
75.15%80.3560.38222,563
77.93%27.0021.04218,403
69.97%112.4978.7121,958
78.58%197.19154.967,391
28.10%87.5824.6127,471
0.00%0.0049.723,139
0.00%0.0038.452,616
42.33%23.7910.079,750
32.95%86.9028.63931
79.27%94.0874.58322
74.23%128.7395.56197
85.24%91.1977.73232
67.00%22.7015.21421
81.42%112.8491.8769
16.68%91.1715.21218
80.11%53.7443.0533
38.24%88.7733.9532
61.75%190.49117.6330
0.00%0.00149.0430
80.83%73.5559.4530
Top Speech Therapy Services Sorted by Total Paid
d Unitsd UnitsPaidPaiddddd8
50,000
100,000
150,000
222,563
7
AFTFTFTT$8,000,000 $1
Paid AmountFTFTTFTTFT
DRAFer Paid Units (PH
RAment
RAe service
mprehen
DRA0
tion thera
b pre-ling hear lo
DR-speech device service
ech/hearing therapyDwallowing function
ch producti
vice
RARARARADRDRDRDDDDRARARA2
RARARARARA
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 65
60
75
75
6090
65
75
85
60
60
65
50
60
50
5560
45
75
55
65
Utilization and Access Analysis:Speech Therapy
ChildrenDisabled
Expansion AdultAdult
ElderlyOther
27,3558,073
1,9835307330
Clients by Population, Age, and Gender
6555
7545
5565 85
75
75
75 60
5060
50
60
6090
60
FY 2015 FY 2016Rendering Provider CountUtilizer Count 25,491
82725,168
817
Client age ba..
0K5K10K15K
Male Population
0K 5K 10K 15K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 5 10 15 20 25 30 35
AverageDistance 0515 081819 03 0713 0616 1020 12 1121
0K 1K 2K 3K 4K 5K 6K 7K 8K 9K 10K
Panel Estimate 05 08 091903 07 13 1014 02 01 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 05 0809 17 1004 12
0 100 200 300 400 500 600 700 800 900 1000 1100 1200
Member toProvider Ratio 05 08 091903 071316 100414 02 1201 11
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% 4.00% 4.50% 5.00% 5.50% 6.00%
PenetrationRate 05 150809 19031306 1610 2004 1402 21
8
DDDDDDDDDD5119 31DDRDDDR00% 1.50% 2.0DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
65
60
75
60
RFT
nbled
on Adult
OFTTFTFTFTTTT530
FTFTAFTClient age bF871-
61-70-60
413AFAFFFF
DRDDRRRDRDRDRDDDRDRDRRD0508 06 0 0
DR
Rate Comparison Analysis: Cardiology
$0 $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000
Total Paid Amount
0.00%
50.00%
100.00%
150.00%
200.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $47,768
Benchmark Percent =84.70%
Procedure Code: 93306Colorado to Medicare: 80.62%Paid Amount: $1,458,633Paid Units: 20,666
Procedure Code: 93000Colorado to Medicare: 119.76%Paid Amount: $488,885Paid Units: 23,673
Procedure Code: 92950Colorado to Medicare: 26.37%Paid Amount: $26,414Paid Units: 322
Procedure Code: 93270Colorado to Medicare: 200.64%Paid Amount: $6,826Paid Units: 374
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare
1 93306 Tte w/doppler complete 0
2 93306 Tte w/doppler complete 26
3 93306 Tte w/doppler complete TC
4 93010 Electrocardiogram report 0
5 93000 Electrocardiogram comple.. 0
6 93303 Echo transthoracic 0
7 93303 Echo transthoracic 26
8 93458 L hrt artery/ventricle angio 0
9 93458 L hrt artery/ventricle angio 26
10 92928 Prq card stent w/angio 1 vsl 0
11 93320 Doppler echo exam heart 0
12 93320 Doppler echo exam heart 26
13 92941 Prq card revasc mi 1 vsl 0
14 93325 Doppler color flow add-on 0
15 93325 Doppler color flow add-on 26
16 93325 Doppler color flow add-on TC
17 93015 Cardiovascular stress test 0
18 93653 Ep & ablate supravent arr.. 0
19 93308 Tte f-up or lmtd 0
20 93308 Tte f-up or lmtd 26
21 93351 Stress tte complete 0
22 93350 Stress tte only 0
23 93350 Stress tte only 26
24 93454 Coronary artery angio s&i 0
25 93454 Coronary artery angio s&i 26
82.28%232.44191.252,727
80.35%64.7952.0617,866
83.04%167.65139.2273
95.14%8.658.23129,059
119.76%17.3620.7923,673
65.89%243.30160.311,349
91.22%65.1559.434,248
73.05%1,104.86807.0930
73.04%327.90239.491,251
72.40%640.72463.89449
127.63%55.2670.531,520
101.02%18.7018.895,196
72.37%718.20519.75348
269.05%26.0470.062,180
109.60%3.233.547,699
146.58%22.8033.4233
123.26%77.6495.701,251
70.59%895.13631.85187
75.18%127.2995.70120
101.87%26.2726.763,849
71.82%276.48198.56514
78.49%245.77192.9030
101.44%72.6973.741,212
72.64%920.74668.8730
73.15%268.33196.28468
Top Cardiology Services Sorted by Total Paid
Paid UnitsU1
50,000
100,000
129,059
9
RAFAFTAF$800,0
Total Paid Amoun
AFTAFTTTTTTAFT
DRAPaid Units (PHI)
RR26
port
DR0
comple.. 0
racic DRc
o D026DRRDRDRDRDRDDDDDRARADRDRD
,727
17,866
DRRADRDRDRDRDDRAid
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 65
55
50
65
8070
55
55
80
55
80
50
50
70
55
6080
55
80
65
75
Utilization and Access Analysis:Cardiology
Expansion AdultAdult
ChildrenDisabled
ElderlyOther
25,99718,927
38,24492,681
1,894343
Clients by Population, Age, and Gender
7565
5555
55 55
65
6580
607050
50
80
80
70
8050
FY 2015 FY 2016Rendering Provider CountUtilizer Count 104,425
3,88594,5843,695
Client age ba..
0K5K10K15K20K
Male Population
0K 5K 10K 15K 20K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
AverageDistance 08 091903 13 171620 0414 02 120121
0 100 200 300 400 500 600 700 800 900 1000 1100
Panel Estimate 0508 0903 07 17 061620 02 12 01 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 050818 130620 0414 02 12
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140
Member toProvider Ratio 05 08 09 1803 0713 06 20 0414020111
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 20.00% 22.00%
PenetrationRate 1509 030710 200212 0111 21
10
DDDDDDDDD1 021 DDRDDRR4.00% 6.00%DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
65
55
50
80
RFT
ltAdult
ChildrenDis
OFTTFTFTFTTTT894
FTFTAFTClient age bF871-
61-70-60
413AFAFFFF
DRDDRRDR
Rate Comparison Analysis: Cognitive Capability Assessment
$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000
Total Paid Amount
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $169,827
Benchmark Percent =81.00%
Procedure Code: 96118Colorado to Medicare: 86.17%Paid Amount: $710,723Paid Units: 8,316Procedure Code: 96105
Colorado to Medicare: 40.93%Paid Amount: $134Paid Units: 30
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare1 96110 Developmental screen w/score 0
2 96118 Neuropsych tst by psych/phys 0
3 96111 Developmental test extend 0
4 96101 Psycho testing by psych/phys 0
5 G8510 Pt inelig neg scrn depres 0
6 G8431 Pos clin depres scrn f/u doc 0
7 96119 Neuropsych testing by tec 0
8 96116 Neurobehavioral status exam 0
9 96127 Brief emotional/behav assmt 0
10 96102 Psycho testing by technician 0
11 96105 Assessment of aphasia 0
0.00%0.0017.43101,755
86.17%99.3785.638,316
77.01%131.47101.253,154
79.35%80.9164.204,380
0.00%0.0010.5525,347
0.00%0.0029.274,693
53.10%81.6543.36692
75.64%94.3971.40368
75.09%5.464.102,750
45.64%64.6829.5230
40.93%109.2244.7030
Top Cognitive Capability Assessment Services Sorted by Total Paid
U3
2,000
4,000
6,000
8,316
11
RADRAodifier Paid Units (PH
R0
DR0
end
ych/phy
DR0
rn depres 0
n f/u d Dy tec 0
mD0
RRDRDRDRDDDDDRADRADRD
01,7
8
DRRARADRDRDRD
AFAFTFT$400,00
AmouFTFTTTFTces Sorted by T
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 70
50
80
55
7055
65
60
75
75
80
80
60
60
55
5070
60
80
50
50
Utilization and Access Analysis:Cognitive Capabilities Assessments
ChildrenExpansion Adult
AdultDisabled
OtherElderly
108,1497,855
5,4903,531
17865
Clients by Population, Age, and Gender
55
75
75
6555
55 5050
8060
70
506060
80
80
7080
FY 2015 FY 2016Rendering Provider CountUtilizer Count 89,654
1,53868,3681,354
Client age ba..
0K20K40K
Male Population
0K 20K 40K
Female Population
81-9071-8061-7051-6041-5031-4021-3011-200-10
0 10 20 30 40 50 60 70 80
AverageDistance 080903 07 13 17 061620 01
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200
Panel Estimate 05 0918 03 07 17 061014 12 01 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 05081907 13161402 01 11
0 50 100 150 200 250 300 350
Member toProvider Ratio 05 08 091803 0713 0610 04020111
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 20.00%
PenetrationRate 1508 09 19030706 16 102004 1402 1201 11 21
12
DDDDDDDDDDDDDDDDDDD113 09DDDRDDR4.00% 6.00%DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
70
50
80
70
RFT
nAdultAdult
Dis
ldFTTTFTFTFTTTT3,538
FTFTAFTClient age bF8761-7
51-6041-53AFAFFFF
DRDDRRDDRDDRDRRDR08 01
DR
Rate Comparison Analysis: Vascular
$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000
Total Paid Amount
0.00%
50.00%
100.00%
150.00%
200.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $111,059
Benchmark Percent =117.70%
Procedure Code: 93975Colorado to Medicare: 215.16%Paid Amount: $717,152Paid Units: 5,240
Procedure Code: 93926Colorado to Medicare: 69.13%Paid Amount: $28,230Paid Units: 591
Procedure Code: 93922Colorado to Medicare: 203.42%Paid Amount: $34,835Paid Units: 717
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare
1 93975 Vascular study 0
2 93975 Vascular study 26
3 93975 Vascular study TC
4 93970 Extremity study 0
5 93970 Extremity study 26
6 93970 Extremity study TC
7 93971 Extremity study 0
8 93971 Extremity study 26
9 93971 Extremity study TC
10 93976 Vascular study 0
11 93976 Vascular study 26
12 93976 Vascular study TC
13 93880 Extracranial bilat study 0
14 93880 Extracranial bilat study 26
15 93880 Extracranial bilat study TC
16 93923 Upr/lxtr art stdy 3+ lvls 0
17 93923 Upr/lxtr art stdy 3+ lvls 26
18 93923 Upr/lxtr art stdy 3+ lvls TC
19 93978 Vascular study 0
20 93978 Vascular study 26
21 93978 Vascular study TC
22 93925 Lower extremity study 0
23 93925 Lower extremity study 26
24 93925 Lower extremity study TC
25 93922 Upr/l xtremity art 2 levels 0
26 93922 Upr/l xtremity art 2 levels 26
138.48%214.15296.55234
219.13%59.55130.494,989
107.40%154.59166.0330
81.50%190.71155.431,320
213.18%35.7376.175,405
51.14%154.9879.2630
80.52%124.1299.941,923
65.58%23.1015.1511,250
83.93%101.0284.7930
102.51%167.81172.03296
117.25%41.0948.185,774
97.76%126.72123.8847
56.52%196.13110.85536
63.33%41.1526.061,538
54.71%154.9884.7930
82.37%142.64117.49361
198.05%23.1345.81339
59.98%119.5171.6830
97.08%196.19190.47284
118.27%41.2148.7460
91.43%154.98141.7030
105.80%194.99206.29143
122.50%40.4049.49248
101.41%154.59156.7730
82.70%91.6075.75262
273.43%13.0235.60454
Top Vascular Services Sorted by Total Paid
Paid UnitsU1
5,000
10,000
13,181
13
DRRTC
DR26
y DRC
dy DTCD0 RRRDRDRDRDDDDDRARADRDRD
23
4,98
30
1
DRRARARDRDRDRDAFAFTFT$400,000
aid AmounFTTFTTTTFTRAs (PHI) Color
RAd
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 60
55
60
50
8565
55
55
80
60
75
60
60
70
65
6080
65
70
60
60
Utilization and Access Analysis:Vascular
Expansion AdultAdult
DisabledChildren
ElderlyOther
15,26327,546
6,1084,451
47185
Clients by Population, Age, and Gender
6565
755565
85
6060
7080
607060
60
60
80
50
60
FY 2015 FY 2016Rendering Provider CountUtilizer Count 30,323
82926,677
793
Client age ba..
0K5K10K
Male Population
0K 5K 10K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 10 20 30 40 50 60 70 80 90 100
AverageDistance 0515 08091803 1317 061004 121121
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Panel Estimate 0508 1903 07 1316 102014 01 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 050809 13 170620 040121
0 50 100 150 200 250 300 350 400 450
Member toProvider Ratio 05 08 09 18 19 0717 16 10 0414021201
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% 4.00% 4.50% 5.00% 5.50% 6.00% 6.50%
PenetrationRate 05 15080919 0713 1710 200414020111 21
14
DDDDDDDDDD1030 DDRDDR0% 1.50% 2.00%DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
60
55
60
85
RFT
ltAdult
DisabledCh
OFTTFTFTFTTTT71
FTFTAFTClient age bF871-
61-70-60
413AFAFFFF
DRDDRRDRDRR1 10
DR
Rate Comparison Analysis: Respiratory
$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000
Total Paid Amount
0.00%
200.00%
400.00%
600.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio Average Paid Amount = $40,967
Benchmark Percent =73.8%
Procedure Code: 94642Colorado to Medicare: 692.16%Paid Amount: $902Paid Units: 30
Procedure Code: 94010Colorado to Medicare: 81.83%Paid Amount: $487,114Paid Units: 17,153
Procedure Code: 94760Colorado to Medicare: 73.86%Paid Amount: $197,162Paid Units: 81,951
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare
1 94010 Breathing capacity test 0
2 94010 Breathing capacity test 26
3 94010 Breathing capacity test TC
4 94060 Evaluation of wheezing 0
5 94060 Evaluation of wheezing 26
6 94060 Evaluation of wheezing TC
7 94640 Airway inhalation treatment 0
8 94760 Measure blood oxygen level 0
9 94375 Respiratory flow volume loop 0
10 94375 Respiratory flow volume loop 26
11 94729 Co/membane diffuse capacity 0
12 94729 Co/membane diffuse capacity 26
13 94726 Pulm funct tst plethysmograp 0
14 94726 Pulm funct tst plethysmograp 26
15 94762 Measure blood oxygen level 0
16 94664 Evaluate pt use of inhaler 0
17 94761 Measure blood oxygen level 0
18 94620 Pulmonary stress test/simple 0
19 94620 Pulmonary stress test/simple 26
20 94660 Pos airway pressure cpap 0
21 94727 Pulm function test by gas 0
22 94727 Pulm function test by gas 26
23 94150 Vital capacity test 0
24 94621 Pulm stress test/complex 0
25 94621 Pulm stress test/complex 26
26 94621 Pulm stress test/complex TC
27 94200 Lung function test (mbc/mvv) 0
28 94200 Lung function test (mbc/mvv) 26
81.50%36.9130.0816,144
87.40%8.657.56997
67.73%28.2619.1430
61.53%62.2138.285,772
82.13%13.3210.944,278
55.91%48.9027.3430
65.25%18.8512.3016,924
73.86%3.292.4381,951
83.62%40.1133.541,571
87.49%15.1113.222,708
74.99%55.7341.79748
67.63%9.366.332,434
77.97%53.8942.02464
75.71%12.609.542,128
103.96%25.0126.001,208
73.78%17.7713.112,180
90.20%5.104.603,908
95.23%57.4254.68216
89.40%31.3328.01220
79.03%64.6751.11286
76.64%43.0332.98263
75.71%12.609.54303
0.00%0.006.84995
40.42%166.9067.4630
41.88%70.5629.55106
39.33%96.3437.8930
53.17%25.7113.67321
70.93%5.784.1030
Top Respiratory Services Sorted by Total Paid
Paid Units1
20,000
40,000
60,000
81,951
15
DRR0
26
DRTC
ment 0
gen lev DR0
olume
me loo Dacity 0D26
RRRDRDRDRDDDDDRAFRARA
DRDRD6,144
997
3
5,77
,278
DRRARARARARDRDRDRDAFTFTFTT,000 $300,000 $35
aid A TTTTTTTTTTTTTTTTTTTAFnits (PHI) Colorad
AF
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 75
70
65
60
8055
65
65
60
70
90
65
40
65
65
5565
55
75
55
55
Utilization and Access Analysis:Respiratory
ChildrenExpansion Adult
AdultDisabled
ElderlyOther
18,12910,433
80,33439,072
119432
Clients by Population, Age, and Gender
5555
7555
65
5565
65
65
6555
65
40
90
70
60
80
60
FY 2015 FY 2016Rendering Provider CountUtilizer Count 84,320
2,69889,0002,682
Client age ba..
0K10K20K30K
Male Population
0K 10K 20K 30K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
AverageDistance 0508 091803 13 06100414 011121
0 200 400 600 800 1000 1200 1400 1600 1800
Panel Estimate 05 08 091903 07 1004 12 01 1121
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 05080919 0307 171402 12
0 20 40 60 80 100 120 140 160 180 200 220 240
Member toProvider Ratio 05 08 091903 0717 0616 10 0414011121
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00%
PenetrationRate 05 150809 0313 1706 10 20 04 140212 11 21
16
DDDDDDDDDDD18003DDRDDR4.00% 6.DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
75
70
65
80
RFT
nAdultAdult
Dis
OFTTFTFTFTTTT2FTFTAFTClient age bF871-
61-70-60
413AFAFFFF
DRDDRRRDR06
DR
Rate Comparison Analysis: Ear, Nose and Throat
$0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000
Total Paid Amount
0.00%
50.00%
100.00%
150.00%
200.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $18,136
Benchmark Percent =74.20%
Procedure Code: 92587Colorado to Medicare: 190.18%Paid Amount: $164,740Paid Units: 4,482
Procedure Code: 92552Colorado to Medicare: 32.56%Paid Amount: $46,530Paid Units: 4,503
Procedure Code: 92588Colorado to Medicare: 161.07%Paid Amount: $20,076Paid Units: 374
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare Rate Colorado to Medicare
1 92551 Pure tone hearing test air 0
2 92587 Evoked auditory test limited 0
3 92587 Evoked auditory test limited 26
4 92587 Evoked auditory test limited TC
5 92557 Comprehensive hearing test 0
6 92567 Tympanometry 0
7 92585 Auditor evoke potent compre 0
8 92585 Auditor evoke potent compre 26
9 92585 Auditor evoke potent compre TC
10 92552 Pure tone audiometry air 0
11 92511 Nasopharyngoscopy 0
12 92579 Visual audiometry (vra) 0
13 92556 Speech audiometry complete 0
14 92540 Basic vestibular evaluation 0
15 92540 Basic vestibular evaluation 26
16 92588 Evoked auditory tst complete 0
17 92553 Audiometry air & bone 0
18 92504 Ear microscopy examination 0
19 92550 Tympanometry & reflex thresh 0
20 92555 Speech threshold audiometry 0
21 92586 Auditor evoke potent limit 0
22 92584 Electrocochleography 0
23 92633 Aud rehab postling hear loss 0
24 92700 Ent procedure/service 0
25 92563 Tone decay hearing test 0
26 92602 Reprogram cochlear implt 7/> 0
0.00%0.0010.3817,411
177.18%22.0038.984,100
29.24%18.715.47266
1018.54%3.2933.51116
71.53%38.2227.345,161
77.15%14.7911.418,459
75.97%138.56105.27382
160.94%27.3744.05331
55.05%111.1861.2130
32.56%31.8810.384,503
100.58%114.98115.65407
77.32%42.9433.20927
81.26%38.0430.91783
54.38%103.4756.27308
57.32%81.0046.4373
161.07%33.5053.96374
82.65%38.0431.44603
40.03%30.7312.301,493
56.33%21.6412.191,274
82.23%23.9219.67782
61.08%87.2953.32237
60.71%74.9945.53148
0.00%0.0049.72115
0.00%0.0025.22188
84.11%31.5226.51177
68.57%91.2762.5866
Top Ear, Nose and Throat Services Sorted by Total Paid
a1
2,000
4,000
6,000
8,459
17
DRR0
26
DRTC
g test 0
ry DR0
ent co
compr Dmpre TCD0
RRRDRDRDRDDDDDRARADRDRD
17,41
4,10
266
DRRARARDRDRDRDAFAFTFFT80,000 $100
aid AmounFTTFTTTTTTTFTTFTTFTT%%
FTRAs (PHI) Color
RAby Total Paid
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 65
60
75
55
7060
65
60
70
60
65
80
60
60
60
4580
65
85
45
65
Utilization and Access Analysis:Ear, Nose, and Throat
ChildrenExpansion Adult
DisabledAdult
ElderlyOther
52,755
2,740
6,6043,794
38344
Clients by Population, Age, and Gender
6545
8565
45
65
65
55
75 80
6060
60
80
60
70
60
70
FY 2015 FY 2016Rendering Provider CountUtilizer Count 39,020
64237,801
612
Client age ba..
0K5K10K15K
Male Population
0K 5K 10K 15K
Female Population
90+81-9071-8061-7051-6041-5031-4021-3011-200-10
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
AverageDistance 080903 07 17 0616 1020 02 01 11
0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000
Panel Estimate 05 08 091903 0717 061002 1121
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 05 0809130614 01
0 50 100 150 200 250 300 350 400 450 500 550 600 650 700 750 800
Member toProvider Ratio 05 08 091803 071317 0610 04021201
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% 11.00% 12.00%
PenetrationRate 05 1509 0307 10200402 1211 21
18
DDD0DDDDDDDD107DDRDDDR00% 3.00% 4.00DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
65
60
75
70
RFT
nAdult
Disabled
OFTTTFTFTFTTTT2,743
FTFTAFTClient age bF871-
61-70-60
413AFAFFF
DRDDRRDRDRDRDDDRDRDD0402 RDR
Rate Comparison Analysis: Gastroenterology
$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000
Total Paid Amount
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $9,598
Benchmark Percent =61.60%
Procedure Code: 91010Colorado to Medicare: 31.47%Paid Amount: $5,621Paid Units: 194.0
Procedure Code: 91110Colorado to Medicare: 64.20%Paid Amount: $63,783Paid Units: 182.0
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare RateColorado toMedicare
1 91110 Gi tract capsule endoscopy 0
2 91110 Gi tract capsule endoscopy 26
3 91110 Gi tract capsule endoscopy TC
4 91035 G-esoph reflx tst w/electrod 0
5 91035 G-esoph reflx tst w/electrod 26
6 91038 Esoph imped funct test > 1hr 0
7 91038 Esoph imped funct test > 1hr 26
8 91120 Rectal sensation test 0
9 91120 Rectal sensation test 26
10 91037 Esoph imped function test 0
11 91037 Esoph imped function test 26
12 91010 Esophagus motility study 0
13 91010 Esophagus motility study 26
14 91112 Gi wireless capsule measure 0
15 91122 Anal pressure record 0
16 91122 Anal pressure record 26
17 91065 Breath hydrogen/methane test 0
18 91065 Breath hydrogen/methane test 26
19 91034 Gastroesophageal reflux test 26
20 91111 Esophageal capsule endosco.. 0
21 91111 Esophageal capsule endosco.. 26
22 91200 Liver elastography 0
23 91020 Gastric motility studies 0
67.36%899.30605.7685
61.27%194.49119.1695
69.04%704.81486.6030
67.14%489.86328.9139
67.04%86.2357.8134
19.63%458.0389.9230
68.83%58.7440.43238
73.16%433.50317.1730
69.68%51.5835.9433
64.41%163.40105.2430
68.83%51.8835.7186
30.44%179.6654.6842
31.76%68.8621.87152
84.41%1,101.75929.9630
29.94%231.7669.3930
54.87%92.7050.8654
73.35%79.6158.3930
91.29%10.459.54157
67.80%52.6735.7137
70.85%738.58523.2930
67.62%53.6836.3030
77.28%32.1724.8630
44.02%238.60105.0430
Top Gastroenterology Services Sorted by Total Paid
Paid UnitsdPaid Units1.0
50.0
100.0
150.0
200.0
19
AFTFTFFTT$35,000 $40,000 $45,00
Paid AmountFTFFTTTTFT
DRAFer Paid Units (PH
RAopy
RAoscopy T
lectrod
DRA0
tst w/electrod
ped funct test >
DRh imped funct test > 1hr
ctal se Dsensation test
function tes
ction
RARARARADRDRDRDDDDRARARARARARARARA
otal Paid
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 60
60
55
55
9570
55
50
80
65
70
45
65
55
55
6085
55
85
55
75
Utilization and Access Analysis:Gastroenterology
Expansion AdultChildren
AdultDisabled
ElderlyOther
1,239
377
514382
3030
Clients by Population, Age, and Gender
7555
8555
85
5555
65
45
65 5595
55
55
60
70
80
70
FY 2015 FY 2016Rendering Provider CountUtilizer Count 1,425
1421,146
128
Client age ba..
0100200300
Male Population
0 100 200 300
Female Population
71-8061-7051-6041-5031-4021-3011-200-10
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160
AverageDistance 05 0809 1903 0717 0616 1020 0402 1201 1121
0K 2K 4K 6K 8K 10K 12K 14K 16K 18K 20K
Panel Estimate 05 08 091903 07 0616 1020 04 02 01 1121
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 0519 03 07 13 17061620 14 12
0 500 1000 1500 2000 2500 3000 3500
Member toProvider Ratio 05 08 09 181903 0713 10 04140201
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.02% 0.04% 0.06% 0.08% 0.10% 0.12% 0.14% 0.16% 0.18% 0.20% 0.22% 0.24% 0.26% 0.28% 0.30% 0.32%
PenetrationRate 1508 18 03130610 2004 140212 11
20
D0DDDDDDDDDDD07717042 17DDRDDDRR0.06% 0.08% 0.10DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
60
60
55
95
RFT
ltdrenAdult
Dis
OFTFTFTFTTTT0FTFTAFTClient age bF761
51-601-50
31AFAFFFFDRDDDRRDDDR0612
DR
Rate Comparison Analysis: ESRD and Dialysis Services
$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000
Total Paid Amount
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Hea
lth F
irst C
olor
ado
to M
edic
are
Rat
e R
atio
Average Paid Amount = $50,025
Benchmark Percent =72.3%
Procedure Code: 90935Colorado to Medicare: 82.44%Paid Amount: $365,417Paid Units: 6,006
Procedure Code: 90945Colorado to Medicare: 25.57%Paid Amount: $14,144Paid Units: 633
Index Service Service Description Modifier Paid Units (PHI) Colorado Rate Medicare RateColorado toMedicare
1 90935 Hemodialysis one evaluation 0
2 90960 Esrd srv 4 visits p mo 20+ 0
3 90961 Esrd srv 2-3 vsts p mo 20+ 0
4 90966 Esrd home pt serv p mo 20+ 0
5 90945 Dialysis one evaluation 0
6 90962 Esrd serv 1 visit p mo 20+ 0
7 90965 Esrd home pt serv p mo 12-19 0
8 90964 Esrd home pt serv p mo 2-11 0
9 90957 Esrd srv 4 vsts p mo 12-19 0
10 90937 Hemodialysis repeated eval 0
11 90959 Esrd serv 1 vst p mo 12-19 0
12 90947 Dialysis repeated eval 0
13 90989 Dialysis training complete 0
14 90958 Esrd srv 2-3 vsts p mo 12-19 0
15 90970 Esrd home pt serv p day 20+ 0
16 90956 Esrd srv 1 visit p mo 2-11 0
17 90969 Esrd home pt srv p day 12-19 0
18 90967 Esrd home pt serv p day <2 0
19 90968 Esrd home pt srv p day 2-11 0
20 90993 Dialysis training incompl 0
82.44%73.8560.886,006
70.62%289.12204.171,547
67.77%243.00164.69664
67.22%242.25162.85204
25.57%87.6022.40633
63.45%187.50118.9791
67.62%461.02311.7534
67.64%484.49327.7130
69.84%656.75458.7030
94.29%105.9399.8862
67.34%301.72203.1730
78.90%126.4999.8046
0.00%0.00488.2530
69.73%444.06309.6630
71.66%7.945.69405
67.59%324.43219.2730
69.05%15.5110.71138
76.99%18.3814.15103
69.25%15.8710.9930
0.00%0.00488.2530
Top ESRD and Dialysis Services Sorted by Total Paid
Paid UnitsPPPPP7
2,000
4,000
6,006
21
AFTFTFT$200,000 $250,000
Paid AmountFTFTFTTFT
DRAFer Paid Units (PH
RA+
RAo 20+
o 20+
DRA0
evaluat
1 visit p mo 20+
DRme pt serv p mo 12-19
me pt serv p mo 2-11Dvsts p mo 12-19
epeated eva
o 12
RARARARADRDRDRDDDDRARARA6
RARARARARATotal Paid
Region 01 - Logan, Sedgwick, Phillips, Morgan, ..
Region 02 - Larimer
Region 03 - Douglas
Region 04 - El Paso
Region 05 - Elbert, Lincoln, Kit Carson, Cheyenne
Region 06 - Crowley, Kiowa, Otero, Bent, Prower..
Region 07 - Pueblo
Region 08 - Saguache, Mineral, Rio Grande, Ala..
Region 09 - Dolores, San Juan, Montezuma, La ..
Region 10 - Delta, Gunnison, Montrose, San Mig..
Region 11 - Moffat, Routt, Jackson, Rio Blanco
Region 12 - Garfield, Grand, Eagle, Summit, Pitkin
Region 13 - Lake, Chaffee, Fremont, Custer
Region 14 - Adams
Region 15 - Arapahoe
Region 16 - Boulder, Broomfield
Region 17 - Gilpin, Clear Creek, Park, Teller
Region 18 - Weld
Region 19 - Mesa
Region 20 - Denver
Region 21 - Jefferson 85
65
30
75
7575
75
75
75
75
60
35
35
60
75
5060
60
75
55
80
Utilization and Access Analysis:ESRD and Dialysis
Expansion AdultDisabled
AdultElderly
ChildrenOther
189444
742
4830
52
Clients by Population, Age, and Gender
55
75
75
35
35
75
75
7575
75
75 80
6060
5060
60
30
FY 2015 FY 2016Rendering Provider CountUtilizer Count 850.0
123.0791.0118.0
Client age ba..
0100200
Male Population
0 100 200
Female Population
81-9071-8061-7051-6041-5031-4021-3011-200-10
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140
AverageDistance 05 0809 1903 07 17 0616 1020 04 02 0121
0 5 10 15 20 25 30 35 40 45 50
Panel Estimate 05 150809 03 071710 041201 11
10 11 12 13 14 15 16 17 18 19 20 21 22
Active ProviderMonths 050819 030713 1710 14 02
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200 3400
Member toProvider Ratio 05 08 0918 1903 0717 06 10 0414 0201
Hsr Rgn Cd DescRegion 01 - Loga..
Region 02 - Lari..
Region 03 - Dou..
Region 04 - El P..
Region 05 - Elbe..
Region 06 - Cro..
Region 07 - Pue..
Region 08 - Sag..
Region 09 - Dolo..
Region 10 - Delt..
Region 11 - Moff..
Region 12 - Garfi..
Region 13 - Lake..
Region 14 - Ada..
Region 15 - Arap..
Region 16 - Boul..
Region 17 - Gilpi..
Region 18 - Weld
Region 19 - Mesa
Region 20 - Den..
Region 21 - Jeffe..
0.00% 0.02% 0.04% 0.06% 0.08% 0.10% 0.12% 0.14% 0.16% 0.18% 0.20% 0.22% 0.24%
PenetrationRate 150919 03 0610 2004 1402 1211
22
DDDDDDDD07 170705DDRDDDR04% 0.06% 0.08DRAFT
DRADRRARARARARARARAFRAFAFAFAFAFAFAF
85
65
30
75
RFT
ltbled
AdultE
OFTTFTFTFTTTT4852
FTFTAFTClient age bF8761-7
51-6041-53AFAFFF
DRDDRRDDRDRDRRDRDRDR19 0309 02000
DR
![0- 0$4 ]*-) $(] $J] TC=] '9TT=Q] L?] - SEC · -=ou=rtr] Üê[< l < < < < & < % < < d < 1#< (01#< < < < < !$ < < d < 0 #< (01)< $$ ] &=a9g] /t9j](https://static.fdocuments.us/doc/165x107/5fad811a87bc4553075c1f90/0-04-j-tc-9ttq-l-sec-ourtr-oe-l-.jpg)
![DOOSAN TC Cut Out System - BOSUNG490]20130326161241.pdf · Part Sales & Technical Service Team DOOSAN TC Cut Out System Rev. 0](https://static.fdocuments.us/doc/165x107/5b02d3457f8b9a84339035ff/doosan-tc-cut-out-system-49020130326161241pdfpart-sales-technical-service-team.jpg)
