Sorting Out Practice Group Data

Starting with the November 2011 distribution, CMS began including 15 new fields in the NPPES database related to practice groups. These are actually taxonomy codes; the taxonomy code set includes two group codes: 193200000X Multi-Specialty Group and 193400000X Single Specialty Group. The definition of the single specialty code is "A business group of one or more individual practitioners, all of who [sic] practice with the same area of specialization." That should clear it all up, right? Oh, no.

So these are not necessarily physician groups. That's fine, but additional questions remain, like Why aren't these taxonomy codes reported in the taxonomy codes section of the NPPES? The documentation from CMS is mum. And why is it that individual (Type 1) practitioners can call themselves a "group" when the NPI regulation says that a Type 1 provider is a single human being ? There are more than 1,000 of these in the data. So, a group can be physicians or not, or a mix, and a group can be one guy. And these two taxonomy codes aren't in the providers' taxonomy code data. Oh, and providers can report these same two codes up to 15 times (presumably having some relation to the up to 15 taxonomy codes in that other section of the data?) And, given 15 fields to play with, they can report being both a single specialty group and a multi-specialty group.

Hrrmph.

And there just happens to be many more group practices out there than are reported via these codes.

Using the new group codes data to actually identify groups, then, is somewhat less than doable. So we've taken a different tack.

Many of our clients need to know the group status of an individual practitioner. Let's take some really common examples. Let's say you are putting together a clinical trial for a new drug, or a marketing campaign for a new device. By phone, fax, and/or mail, you plan to contact a few thousand physicians in this state, a few thousand in that state, etc. You don't want to deluge a practice with 50 letters or phone calls all at once (and some practice locations are that big and bigger), so you need to know the practice group for the physicians on your list, so you can stagger your communications. Or, let's say, you just want to reach the CEO or medical director for a given group. Well, as it happens, the CEOs isn't always the record that indicates a group practice; it's sometimes the office manager, credentialing coordinator, or just a young doc who can pilot the laptop. How do you sort all this out? Well, frankly, you couldn't, until now.

Beginning this month the CarePrecise Access dataset contains a new feature called a "CoLoCode" (co-location code). The CoLoCode is derived from deeply conformed practice location data, and each provider record gets one. Look up a group (using the CMS Group codes or by looking for a number of physicians co-located at the same practice address), then plunk that CoLoCode into a query to show you all the providers practicing at that location. Voila!

To make it even easier, we are releasing a new version of our CP ListMaker software, with new group features that take full advantage of the CoLoCodes and new CMS group data.