Tea Buzz



Easing Concerns Around Claims Data

Posted February 12, 2018

Recently, an article was released detailing a lawsuit brought against Via Christi Health, claiming they defrauded Medicare and engaged in a scheme to maximize Medicare reimbursements through their cardiac referral program. According to Becker’s Hospital Review and KCUR.org, part of the complaint alleges, “that Via Christi has a bonus program that it uses to incentivize physicians to make referrals to its hospitals.”

The case has raised concerns about referral patterns and how those are affected by claims data with CFOs across the country, and has created a less-than-positive buzz around using data to help drive referrals.

Tea Leaves Health’s Physicianology™ solution (and most other physician referral management solutions in the healthcare industry) digests claims data to help our users understand whether physicians are referring to specialists within their organization, or to specialists outside of it. The intention is to provide insights to hospitals and health systems so they can understand the referral patterns of their physicians and maintain volume within their systems. It is never to encourage providers to refer patients to other organizations for unnecessary procedures.

Our clients, and all healthcare organizations, take the care of their patients very seriously. They use the data to build partnerships to provide the best possible, seamless care. Physicians referring to specialists is a common component of the healthcare continuum, and it’s important that both patients and primary care providers have information about the specialists in their network – so they can make informed decisions – which is what this data provides.

To ease concerns around the use of claims data within our databases, we want to make it known that Tea Leaves Health very purposefully does not tie any financial information to our claims-based data, and we never use any patient-identified claims-based data. The claims data we receive for our users is absolutely HIPAA/PHI compliant.

The success of healthcare organizations across the country is dependent on data – on using that data to provide answers to questions, resolve challenges, make predictions and sustain growth in an ever-evolving landscape. It is our hope that this case does not deter organizations from using data to better understand its business.

If you or anyone at your organization has further questions around how claims data is used in the referral process, feel free to contact our experts who can help shed further light on its uses and results.