The CORE Reporter: New perspective, better data

Ken BellSkilled NursingLeave a Comment

Medicare claims (UB-04s) are an invaluable source of SNF data. CMS releases quarterly “LDS” claim files which allow for Medicare utilization and market analysis. Third-party vendors offer useful tools that quantify referral patterns and performance metrics, but the data falls short in two critical ways. The first is timeliness; healthcare evolves rapidly but we must wait up to a year for a complete record of utilization activity.

Do not be fooled by marketing; this data has been commoditized – no one has “early access” to the file, and “most up to date” refers to the LDS release date – not the data it contains. The other shortcoming is that only FFS Medicare claims are included, a population that no longer represents the plurality of coverage in many markets.

Relying on such outdated information has always been subject to qualification, but to do so now is strongly ill-advised. The pandemic (and 1135 Waiver) distorts outcomes to the point of damaging a provider’s data profile. Worse, because claims are up to a year old when released, the public data may suffer from pandemic bias until 2023. The LDS is useful but can be dangerous as well.

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