v2_4_0 → v2_4_1
Generated: 2026-02-17 09:11:49.
Filter: canonical_rate_score > 1.
1. Summary Statistics
Overview
- Total ROIDs: 423,563,165 → 642,842,847 (+219,279,682, +51.8%)
By Provider Type and Bill Type
| provider_type | bill_type | new_distinct_roids | old_distinct_roids | new_distinct_networks | old_distinct_networks | new_distinct_providers | old_distinct_providers | new_distinct_billing_codes | old_distinct_billing_codes |
|---|---|---|---|---|---|---|---|---|---|
| Imaging Center | Professional | 4,037,494 | 2,964,629 | 163 | 159 | 2,930 | 2,898 | 171 | 171 |
| Hospital | Outpatient | 248,960,622 | 182,556,632 | 180 | 176 | 5,999 | 5,708 | 7,512 | 7,512 |
| ASC | Outpatient | 21,462,464 | 14,469,409 | 145 | 137 | 5,578 | 5,533 | 3,154 | 3,154 |
| Hospital | Inpatient | 59,364,628 | 44,262,161 | 177 | 173 | 5,968 | 5,630 | 1,711 | 1,711 |
| Laboratory | Professional | 12,774,428 | 11,292,016 | 171 | 167 | 3,711 | 3,710 | 916 | 916 |
| Physician Group | Professional | 296,243,211 | 168,018,318 | 177 | 174 | 21,740 | 21,113 | 3,830 | 3,790 |
Click to see SQL
WITH
new AS (
SELECT
provider_type,
bill_type,
COUNT(DISTINCT roid) AS distinct_roids,
COUNT(DISTINCT payer_id) AS distinct_payers,
COUNT(DISTINCT network_id) AS distinct_networks,
COUNT(DISTINCT provider_id) AS distinct_providers,
COUNT(DISTINCT billing_code) AS distinct_billing_codes
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
),
old AS (
SELECT
CASE
WHEN provider_type LIKE '%Hospital%' THEN 'Hospital'
ELSE provider_type
END AS provider_type,
bill_type,
COUNT(DISTINCT roid) AS distinct_roids,
COUNT(DISTINCT payer_id) AS distinct_payers,
COUNT(DISTINCT network_id) AS distinct_networks,
COUNT(DISTINCT provider_id) AS distinct_providers,
COUNT(DISTINCT billing_code) AS distinct_billing_codes
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1, 2
)
SELECT
provider_type,
bill_type,
new.distinct_roids AS new_distinct_roids,
old.distinct_roids AS old_distinct_roids,
new.distinct_networks AS new_distinct_networks,
old.distinct_networks AS old_distinct_networks,
new.distinct_providers AS new_distinct_providers,
old.distinct_providers AS old_distinct_providers,
new.distinct_billing_codes AS new_distinct_billing_codes,
old.distinct_billing_codes AS old_distinct_billing_codes
FROM new
JOIN old USING (provider_type, bill_type)
2. Rate Object Space Dropoffs
Provider Dropoffs
Count: 174 dropped
Click to see SQL
WITH
new AS (
SELECT DISTINCT provider_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT provider_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
provider_id
FROM new
FULL OUTER JOIN old USING (provider_id)
WHERE new.source IS NULL AND old.source IS NOT NULL
Payer Dropoffs
Count: 0 dropped
No dropoffs detected.
Click to see SQL
WITH
new AS (
SELECT DISTINCT payer_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT payer_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
payer_id
FROM new
FULL OUTER JOIN old USING (payer_id)
WHERE new.source IS NULL AND old.source IS NOT NULL
Network Dropoffs
Count: 2 dropped
Click to see SQL
WITH
new AS (
SELECT DISTINCT network_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT network_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
network_id
FROM new
FULL OUTER JOIN old USING (network_id)
WHERE new.source IS NULL AND old.source IS NOT NULL
Provider-Network Combination Dropoffs
Count: 7269 dropped
Click to see SQL
WITH
new AS (
SELECT DISTINCT provider_id, network_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT provider_id, network_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
provider_id,
network_id
FROM new
FULL OUTER JOIN old USING (provider_id, network_id)
WHERE new.source IS NULL AND old.source IS NOT NULL
Bill Type-Billing Code Combination Dropoffs
Count: 0 dropped
No dropoffs detected.
Click to see SQL
WITH
new AS (
SELECT DISTINCT bill_type, billing_code, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT bill_type, billing_code, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
bill_type,
billing_code
FROM new
FULL OUTER JOIN old USING (bill_type, billing_code)
WHERE new.source IS NULL AND old.source IS NOT NULL
3. Large Rate Swings (>10% change)
Bill Type + Provider Level
Count: 19139 entities with significant rate changes
| bill_type | provider_id | new_avg_pct_of_medicare_rate | old_avg_pct_of_medicare_rate | new_avg_canonical_rate | old_avg_canonical_rate | medicare_rate_pct_change | canonical_rate_pct_change | new_roid_count | old_roid_count |
|---|---|---|---|---|---|---|---|---|---|
| Professional | -497507422268688027 | 3.14 | 0.93 | 1,261.17 | 687.54 | 238.0% | 83.4% | 35,761 | 4,407 |
| Professional | 72977 | 3.29 | 1.1 | 417.00 | 139.08 | 200.3% | 199.8% | 925 | 625 |
| Professional | 3197309463706723792 | 2.77 | 0.94 | 1,529.77 | 202.51 | 194.9% | 655.4% | 19,361 | 5,384 |
| Professional | 2348343882328603116 | 2.29 | 0.8 | 806.43 | 156.12 | 185.4% | 416.5% | 43,061 | 1,700 |
| Professional | -6087829591143767549 | 2.87 | 1.05 | 1,368.71 | 382.16 | 173.8% | 258.1% | 28,114 | 4,697 |
| Professional | 6706650634653838980 | 2.8 | 1.05 | 968.88 | 253.81 | 166.3% | 281.7% | 28,127 | 3,706 |
| Professional | 8452609278095661910 | 1.79 | 0.68 | 718.73 | 143.08 | 163.4% | 402.3% | 36,757 | 3,316 |
| Professional | -3245206910240182907 | 2.01 | 0.8 | 700.53 | 268.65 | 151.4% | 160.8% | 34,867 | 2,773 |
| Professional | -1668630353830312289 | 3.07 | 1.22 | 1,383.16 | 402.70 | 151.0% | 243.5% | 54,665 | 1,029 |
| Inpatient | 9042 | 5.04 | 2.07 | 124,484.89 | 61,298.12 | 143.1% | 103.1% | 1,656 | 1,710 |
| Outpatient | 9229 | 3.98 | 1.64 | 4,112.55 | 3,529.52 | 142.2% | 16.5% | 3,285 | 652 |
| Professional | -6135834785170660572 | 2.14 | 0.89 | 1,010.34 | 1,203.41 | 140.3% | -16.0% | 36,304 | 4,429 |
| Professional | -7981684897601570688 | 3.02 | 1.27 | 923.55 | 296.17 | 138.9% | 211.8% | 25,570 | 786 |
| Professional | -481835967384438876 | 2.07 | 0.87 | 760.57 | 257.80 | 137.7% | 195.0% | 38,373 | 6,559 |
| Professional | 2181079439032466755 | 2.42 | 1.02 | 974.94 | 218.22 | 137.1% | 346.8% | 2,949 | 1,218 |
| Professional | -3148982206069435370 | 2.81 | 1.2 | 1,162.85 | 1,135.64 | 134.9% | 2.4% | 39,771 | 3,146 |
| Professional | 269308854051602210 | 1.96 | 0.85 | 916.82 | 158.17 | 131.4% | 479.6% | 36,077 | 2,432 |
| Professional | -1585322645111161870 | 2.13 | 0.92 | 668.15 | 172.24 | 131.1% | 287.9% | 28,296 | 2,268 |
| Professional | -9042619131261616552 | 1.92 | 0.84 | 743.28 | 161.73 | 130.1% | 359.6% | 28,128 | 3,180 |
| Professional | -4835358952042409261 | 2.09 | 0.92 | 739.32 | 386.50 | 127.4% | 91.3% | 25,503 | 1,628 |
| Professional | -7605361859288417447 | 3.21 | 1.44 | 1,175.66 | 1,946.57 | 124.0% | -39.6% | 20,574 | 2,609 |
| Professional | -871232198895717967 | 2.2 | 0.99 | 712.40 | 132.91 | 122.3% | 436.0% | 32,391 | 1,158 |
| Professional | 5013976330844736771 | 2.84 | 1.29 | 956.24 | 2,583.72 | 120.8% | -63.0% | 29,421 | 943 |
| Professional | 4419669643179954538 | 1.86 | 0.84 | 638.00 | 139.55 | 120.4% | 357.2% | 24,300 | 3,029 |
| Professional | -7439582313149223993 | 2.46 | 1.13 | 824.99 | 207.48 | 117.5% | 297.6% | 42,033 | 3,074 |
| Professional | -7259655293849955330 | 1.78 | 0.82 | 644.38 | 187.60 | 116.7% | 243.5% | 29,505 | 1,434 |
| Professional | 77431168054907305 | 1.97 | 0.91 | 804.18 | 780.75 | 115.6% | 3.0% | 32,301 | 3,634 |
| Outpatient | 26786 | 7.43 | 3.45 | 2,026.71 | 791.63 | 115.2% | 156.0% | 1,556 | 714 |
| Professional | 5494568643463806400 | 1.81 | 0.86 | 632.98 | 161.70 | 110.2% | 291.5% | 31,450 | 1,772 |
| Inpatient | 5969 | 2.15 | 1.02 | 26,918.90 | 16,458.15 | 109.8% | 63.6% | 308 | 18 |
| Professional | -4820926513593666878 | 1.95 | 0.93 | 758.43 | 1,134.59 | 109.5% | -33.2% | 39,945 | 4,680 |
| Professional | -6400922911578805274 | 1.89 | 0.91 | 691.99 | 2,502.50 | 108.2% | -72.3% | 16,076 | 891 |
| Professional | -7246600252420665856 | 2.09 | 1.01 | 761.53 | 207.47 | 107.6% | 267.1% | 27,795 | 1,516 |
| Professional | 847633022085053020 | 1.73 | 0.83 | 649.16 | 2,701.83 | 107.0% | -76.0% | 27,944 | 892 |
| Professional | 7990536601939131671 | 1.83 | 0.89 | 120.70 | 115.96 | 105.0% | 4.1% | 502 | 2,264 |
| Professional | -5886876689385235540 | 2.13 | 1.04 | 688.31 | 128.94 | 104.9% | 433.8% | 23,447 | 2,639 |
| Professional | -2988256152933249565 | 1.59 | 0.78 | 795.60 | 154.29 | 104.6% | 415.7% | 14,208 | 2,774 |
| Professional | 3727336487756877175 | 1.82 | 0.89 | 121.06 | 128.44 | 104.5% | -5.7% | 508 | 2,361 |
| Professional | 5786437384847345079 | 1.81 | 0.89 | 119.63 | 115.92 | 103.2% | 3.2% | 516 | 2,266 |
| Professional | -5935998671356214154 | 2.1 | 1.05 | 424.93 | 142.59 | 99.9% | 198.0% | 24,450 | 1,495 |
| Professional | -6010649751900700952 | 2.24 | 1.12 | 778.33 | 3,634.57 | 99.8% | -78.6% | 51,582 | 2,093 |
| Professional | -3682256659151263117 | 1.92 | 0.96 | 752.89 | 153.36 | 99.4% | 390.9% | 23,340 | 3,485 |
| Professional | 1286100398742578208 | 1.92 | 0.97 | 745.16 | 249.42 | 98.3% | 198.8% | 37,128 | 503 |
| Professional | -9021429009303548093 | 2.09 | 1.06 | 997.79 | 630.28 | 97.4% | 58.3% | 41,635 | 5,128 |
| Professional | -7968734964571683480 | 1.67 | 0.85 | 677.80 | 163.50 | 96.3% | 314.6% | 20,620 | 2,237 |
| Professional | 6744056187255001629 | 2.24 | 1.14 | 1,067.70 | 4,185.63 | 96.2% | -74.5% | 16,330 | 1,656 |
| Professional | -3765834510674975424 | 1.8 | 0.93 | 935.25 | 922.83 | 94.0% | 1.3% | 48,080 | 8,546 |
| Outpatient | 5243 | 6.16 | 3.24 | 1,258.45 | 7,717.44 | 90.5% | -83.7% | 892 | 11,934 |
| Professional | 6356772039186191744 | 2.45 | 1.29 | 869.97 | 177.35 | 89.5% | 390.6% | 34,420 | 3,926 |
| Professional | 1476457437666902992 | 1.74 | 0.92 | 628.27 | 217.60 | 89.4% | 188.7% | 31,303 | 2,197 |
Showing 50 of 19139 total rows
Click to see SQL
WITH
new AS (
SELECT
bill_type,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY bill_type, provider_id
),
old AS (
SELECT
bill_type,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY bill_type, provider_id
)
SELECT
bill_type,
provider_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (bill_type, provider_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
CASE
WHEN bill_type = 'Inpatient'
THEN new.roid_count > 10 AND old.roid_count > 10
WHEN bill_type = 'Outpatient'
THEN new.roid_count > 500 AND old.roid_count > 500
WHEN bill_type = 'Professional'
THEN new.roid_count > 500 AND old.roid_count > 500
END
)
ORDER BY ABS(medicare_rate_pct_change) DESC
Network + Provider Level
Count: 71558 entities with significant rate changes
| network_id | provider_id | new_avg_pct_of_medicare_rate | old_avg_pct_of_medicare_rate | new_avg_canonical_rate | old_avg_canonical_rate | medicare_rate_pct_change | canonical_rate_pct_change | new_roid_count | old_roid_count |
|---|---|---|---|---|---|---|---|---|---|
| 311,448,953,162,816,591 | 527 | inf | inf | 4,530.17 | 3,953.33 | 14.6% | 6,219 | 6,249 | |
| 8,361,580,493,441,765,265 | -497507422268688027 | 4.04 | 0.74 | 840.73 | 150.20 | 444.3% | 459.7% | 3,266 | 884 |
| 4,281,965,180,796,802,413 | -497507422268688027 | 3.93 | 0.74 | 735.19 | 150.20 | 428.6% | 389.5% | 3,070 | 884 |
| -3,776,001,016,975,145,508 | -1519822265826934383 | 4.02 | 0.77 | 2,243.78 | 157.56 | 420.8% | 1324.1% | 573 | 1,512 |
| 8,361,580,493,441,765,265 | -6135834785170660572 | 2.85 | 0.62 | 1,020.87 | 149.88 | 358.0% | 581.1% | 4,565 | 697 |
| 4,281,965,180,796,802,413 | -6135834785170660572 | 2.8 | 0.62 | 942.87 | 149.88 | 349.9% | 529.1% | 4,224 | 697 |
| -3,776,001,016,975,145,508 | 8452609278095661910 | 3.29 | 0.76 | 1,118.69 | 211.20 | 333.4% | 429.7% | 2,615 | 698 |
| 8,361,580,493,441,765,265 | -6087829591143767549 | 3.15 | 0.73 | 672.80 | 266.53 | 329.4% | 152.4% | 3,020 | 785 |
| 4,281,965,180,796,802,413 | -6087829591143767549 | 3.11 | 0.73 | 609.57 | 266.53 | 323.8% | 128.7% | 2,940 | 785 |
| 8,361,580,493,441,765,265 | 3197309463706723792 | 2.86 | 0.69 | 508.72 | 143.76 | 317.0% | 253.9% | 2,197 | 877 |
| 4,281,965,180,796,802,413 | 3197309463706723792 | 2.75 | 0.69 | 439.10 | 143.76 | 300.9% | 205.4% | 2,112 | 877 |
| -3,776,001,016,975,145,508 | -9042619131261616552 | 3.74 | 0.99 | 1,279.13 | 245.03 | 278.3% | 422.0% | 2,492 | 508 |
| -5,230,720,519,108,079,751 | 4023 | 5.04 | 1.46 | 20,510.04 | 26,912.89 | 245.5% | -23.8% | 7,824 | 1,710 |
| -3,776,001,016,975,145,508 | 5910532371753807288 | 4.11 | 1.2 | 502.97 | 288.35 | 242.8% | 74.4% | 1,247 | 1,278 |
| -3,776,001,016,975,145,508 | -9208786563063963982 | 4.11 | 1.2 | 502.57 | 288.55 | 242.8% | 74.2% | 1,248 | 1,277 |
| -3,776,001,016,975,145,508 | 1286100398742578208 | 3.17 | 0.97 | 1,044.50 | 249.42 | 226.9% | 318.8% | 2,123 | 503 |
| 8,361,580,493,441,765,265 | 7063415233901130033 | 2.18 | 0.67 | 583.02 | 262.25 | 225.0% | 122.3% | 4,485 | 780 |
| -3,776,001,016,975,145,508 | -3868263910251141097 | 4.87 | 1.52 | 1,727.29 | 1,425.24 | 221.4% | 21.2% | 845 | 909 |
| -3,776,001,016,975,145,508 | -7146320621286215096 | 3.72 | 1.16 | 2,038.21 | 471.23 | 220.3% | 332.5% | 656 | 758 |
| 4,281,965,180,796,802,413 | 6706650634653838980 | 2.81 | 0.88 | 846.15 | 265.33 | 217.3% | 218.9% | 4,501 | 1,388 |
| 8,361,580,493,441,765,265 | 6706650634653838980 | 2.8 | 0.88 | 839.83 | 265.33 | 216.1% | 216.5% | 4,514 | 1,388 |
| -3,776,001,016,975,145,508 | 5348453081036961437 | 3.93 | 1.27 | 252.88 | 164.72 | 208.6% | 53.5% | 617 | 575 |
| -2,162,498,661,799,343,237 | -4985828612566508868 | 3.17 | 1.03 | 1,625.67 | 270.98 | 208.5% | 499.9% | 3,071 | 773 |
| -2,162,498,661,799,343,237 | -5529235617482564817 | 3.14 | 1.03 | 922.29 | 270.98 | 205.2% | 240.3% | 949 | 773 |
| -3,776,001,016,975,145,508 | 8745986158877503234 | 4.17 | 1.37 | 1,470.02 | 1,455.11 | 205.1% | 1.0% | 1,306 | 948 |
| 7,616,836,552,481,822,175 | -497507422268688027 | 2.95 | 0.98 | 1,487.65 | 2,661.66 | 201.7% | -44.1% | 4,912 | 885 |
| -3,776,001,016,975,145,508 | -8086702650980756402 | 3.72 | 1.25 | 2,059.90 | 1,349.54 | 199.0% | 52.6% | 653 | 1,020 |
| 8,361,580,493,441,765,265 | 2348343882328603116 | 2.4 | 0.8 | 688.18 | 156.12 | 198.9% | 340.8% | 4,915 | 850 |
| 4,281,965,180,796,802,413 | 2348343882328603116 | 2.4 | 0.8 | 688.18 | 156.12 | 198.9% | 340.8% | 4,915 | 850 |
| -3,776,001,016,975,145,508 | 768677613229314287 | 3.87 | 1.3 | 241.73 | 161.92 | 197.3% | 49.3% | 608 | 644 |
| -3,776,001,016,975,145,508 | 1067587447723132204 | 3.82 | 1.29 | 220.72 | 868.84 | 197.1% | -74.6% | 720 | 924 |
| -3,776,001,016,975,145,508 | 3015510094204161181 | 3.82 | 1.29 | 220.72 | 868.84 | 197.1% | -74.6% | 720 | 924 |
| -3,776,001,016,975,145,508 | 7932838483455832294 | 3.43 | 1.16 | 400.62 | 268.10 | 196.7% | 49.4% | 1,462 | 1,459 |
| 8,361,580,493,441,765,265 | -4835358952042409261 | 2.69 | 0.92 | 652.22 | 386.50 | 192.8% | 68.7% | 4,665 | 814 |
| 8,361,580,493,441,765,265 | -9021429009303548093 | 2.21 | 0.75 | 716.11 | 151.56 | 192.4% | 372.5% | 4,832 | 884 |
| 4,281,965,180,796,802,413 | -9021429009303548093 | 2.21 | 0.75 | 716.11 | 151.56 | 192.4% | 372.5% | 4,832 | 884 |
| -3,776,001,016,975,145,508 | 1448230468311069262 | 2.88 | 0.99 | 1,050.58 | 250.28 | 190.9% | 319.8% | 1,881 | 501 |
| -3,776,001,016,975,145,508 | 5671012178851870288 | 4.47 | 1.54 | 417.54 | 264.89 | 189.8% | 57.6% | 1,006 | 617 |
| -3,776,001,016,975,145,508 | 9119600455817837599 | 3.23 | 1.12 | 357.42 | 604.44 | 188.8% | -40.9% | 1,448 | 1,860 |
| -3,776,001,016,975,145,508 | 340530510858151991 | 3.18 | 1.1 | 975.75 | 824.34 | 188.5% | 18.4% | 1,765 | 2,106 |
| -3,776,001,016,975,145,508 | 3892441238895982114 | 3.18 | 1.1 | 975.75 | 825.74 | 188.2% | 18.2% | 1,765 | 2,106 |
| -3,776,001,016,975,145,508 | -1967423625411999638 | 3.92 | 1.37 | 1,282.64 | 1,455.11 | 186.2% | -11.9% | 1,326 | 948 |
| -3,776,001,016,975,145,508 | 4376411467288635212 | 3.97 | 1.39 | 1,288.70 | 1,451.13 | 184.5% | -11.2% | 1,325 | 951 |
| -3,776,001,016,975,145,508 | -1129251442614503651 | 3.41 | 1.21 | 1,897.74 | 315.66 | 182.9% | 501.2% | 726 | 795 |
| -3,776,001,016,975,145,508 | 5046591772473192223 | 4.19 | 1.48 | 454.30 | 334.61 | 182.4% | 35.8% | 1,107 | 1,131 |
| 4,281,965,180,796,802,413 | 7063415233901130033 | 2.04 | 0.73 | 545.22 | 267.29 | 181.0% | 104.0% | 4,509 | 765 |
| 8,361,580,493,441,765,265 | 8525801659323831681 | 1.99 | 0.71 | 717.32 | 146.31 | 180.6% | 390.3% | 4,723 | 882 |
| -3,776,001,016,975,145,508 | 6246553284827218110 | 3.62 | 1.3 | 466.90 | 440.75 | 177.6% | 5.9% | 1,183 | 818 |
| -2,162,498,661,799,343,237 | -5587964766527951545 | 2.39 | 0.86 | 688.05 | 202.20 | 176.3% | 240.3% | 1,128 | 1,370 |
| -2,162,498,661,799,343,237 | -1994395531279373039 | 2.39 | 0.86 | 686.92 | 202.20 | 176.0% | 239.7% | 1,130 | 1,370 |
Showing 50 of 71558 total rows
Click to see SQL
WITH
new AS (
SELECT
network_id,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id
),
old AS (
SELECT
network_id,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id
)
SELECT
network_id,
provider_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id, provider_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
new.roid_count > 500 AND old.roid_count > 500
)
ORDER BY ABS(medicare_rate_pct_change) DESC
Network + Provider + Bill Type Level
Count: 73135 entities with significant rate changes
| network_id | provider_id | bill_type | new_avg_pct_of_medicare_rate | old_avg_pct_of_medicare_rate | new_avg_canonical_rate | old_avg_canonical_rate | medicare_rate_pct_change | canonical_rate_pct_change | new_roid_count | old_roid_count |
|---|---|---|---|---|---|---|---|---|---|---|
| 8,361,580,493,441,765,265 | -497507422268688027 | Professional | 4.04 | 0.74 | 840.73 | 150.20 | 444.3% | 459.7% | 3,266 | 884 |
| 4,281,965,180,796,802,413 | -497507422268688027 | Professional | 3.93 | 0.74 | 735.19 | 150.20 | 428.6% | 389.5% | 3,070 | 884 |
| -3,776,001,016,975,145,508 | -1519822265826934383 | Professional | 4.02 | 0.77 | 2,243.78 | 157.56 | 420.8% | 1324.1% | 573 | 1,512 |
| 8,361,580,493,441,765,265 | -6135834785170660572 | Professional | 2.85 | 0.62 | 1,020.87 | 149.88 | 358.0% | 581.1% | 4,565 | 697 |
| 4,281,965,180,796,802,413 | -6135834785170660572 | Professional | 2.8 | 0.62 | 942.87 | 149.88 | 349.9% | 529.1% | 4,224 | 697 |
| -3,776,001,016,975,145,508 | 8452609278095661910 | Professional | 3.29 | 0.76 | 1,118.69 | 211.20 | 333.4% | 429.7% | 2,615 | 698 |
| 8,361,580,493,441,765,265 | -6087829591143767549 | Professional | 3.15 | 0.73 | 672.80 | 266.53 | 329.4% | 152.4% | 3,020 | 785 |
| 4,281,965,180,796,802,413 | -6087829591143767549 | Professional | 3.11 | 0.73 | 609.57 | 266.53 | 323.8% | 128.7% | 2,940 | 785 |
| 8,361,580,493,441,765,265 | 3197309463706723792 | Professional | 2.86 | 0.69 | 508.72 | 143.76 | 317.0% | 253.9% | 2,197 | 877 |
| 4,281,965,180,796,802,413 | 3197309463706723792 | Professional | 2.75 | 0.69 | 439.10 | 143.76 | 300.9% | 205.4% | 2,112 | 877 |
| -3,776,001,016,975,145,508 | -9042619131261616552 | Professional | 3.74 | 0.99 | 1,279.13 | 245.03 | 278.3% | 422.0% | 2,492 | 508 |
| -3,776,001,016,975,145,508 | 5910532371753807288 | Professional | 4.11 | 1.2 | 502.97 | 288.35 | 242.8% | 74.4% | 1,247 | 1,278 |
| -3,776,001,016,975,145,508 | -9208786563063963982 | Professional | 4.11 | 1.2 | 502.57 | 288.55 | 242.8% | 74.2% | 1,248 | 1,277 |
| -3,776,001,016,975,145,508 | 1286100398742578208 | Professional | 3.17 | 0.97 | 1,044.50 | 249.42 | 226.9% | 318.8% | 2,123 | 503 |
| 8,361,580,493,441,765,265 | 7063415233901130033 | Professional | 2.18 | 0.67 | 583.02 | 262.25 | 225.0% | 122.3% | 4,485 | 780 |
| -3,776,001,016,975,145,508 | -3868263910251141097 | Professional | 4.87 | 1.52 | 1,727.29 | 1,425.24 | 221.4% | 21.2% | 845 | 909 |
| -3,776,001,016,975,145,508 | -7146320621286215096 | Professional | 3.72 | 1.16 | 2,038.21 | 471.23 | 220.3% | 332.5% | 656 | 758 |
| 4,281,965,180,796,802,413 | 6706650634653838980 | Professional | 2.81 | 0.88 | 846.15 | 265.33 | 217.3% | 218.9% | 4,501 | 1,388 |
| -6,972,129,921,516,377,126 | 6272 | Inpatient | 8.39 | 2.65 | 100,368.02 | 61,722.92 | 217.1% | 62.6% | 16 | 349 |
| 5,373,876,635,451,223,842 | 6272 | Inpatient | 8.39 | 2.65 | 100,368.02 | 61,722.92 | 217.1% | 62.6% | 16 | 349 |
| 8,361,580,493,441,765,265 | 6706650634653838980 | Professional | 2.8 | 0.88 | 839.83 | 265.33 | 216.1% | 216.5% | 4,514 | 1,388 |
| -3,776,001,016,975,145,508 | 5348453081036961437 | Professional | 3.93 | 1.27 | 252.88 | 164.72 | 208.6% | 53.5% | 617 | 575 |
| -2,162,498,661,799,343,237 | -4985828612566508868 | Professional | 3.17 | 1.03 | 1,625.67 | 270.98 | 208.5% | 499.9% | 3,071 | 773 |
| -2,162,498,661,799,343,237 | -5529235617482564817 | Professional | 3.14 | 1.03 | 922.29 | 270.98 | 205.2% | 240.3% | 949 | 773 |
| -3,776,001,016,975,145,508 | 8745986158877503234 | Professional | 4.17 | 1.37 | 1,470.02 | 1,455.11 | 205.1% | 1.0% | 1,306 | 948 |
| 7,616,836,552,481,822,175 | -497507422268688027 | Professional | 2.95 | 0.98 | 1,487.65 | 2,661.66 | 201.7% | -44.1% | 4,912 | 885 |
| -3,776,001,016,975,145,508 | -8086702650980756402 | Professional | 3.72 | 1.25 | 2,059.90 | 1,349.54 | 199.0% | 52.6% | 653 | 1,020 |
| 8,361,580,493,441,765,265 | 2348343882328603116 | Professional | 2.4 | 0.8 | 688.18 | 156.12 | 198.9% | 340.8% | 4,915 | 850 |
| 4,281,965,180,796,802,413 | 2348343882328603116 | Professional | 2.4 | 0.8 | 688.18 | 156.12 | 198.9% | 340.8% | 4,915 | 850 |
| -3,776,001,016,975,145,508 | 768677613229314287 | Professional | 3.87 | 1.3 | 241.73 | 161.92 | 197.3% | 49.3% | 608 | 644 |
| -3,776,001,016,975,145,508 | 3015510094204161181 | Professional | 3.82 | 1.29 | 220.72 | 868.84 | 197.1% | -74.6% | 720 | 924 |
| -3,776,001,016,975,145,508 | 1067587447723132204 | Professional | 3.82 | 1.29 | 220.72 | 868.84 | 197.1% | -74.6% | 720 | 924 |
| -3,776,001,016,975,145,508 | 7932838483455832294 | Professional | 3.43 | 1.16 | 400.62 | 268.10 | 196.7% | 49.4% | 1,462 | 1,459 |
| 8,361,580,493,441,765,265 | -4835358952042409261 | Professional | 2.69 | 0.92 | 652.22 | 386.50 | 192.8% | 68.7% | 4,665 | 814 |
| 4,281,965,180,796,802,413 | -9021429009303548093 | Professional | 2.21 | 0.75 | 716.11 | 151.56 | 192.4% | 372.5% | 4,832 | 884 |
| 8,361,580,493,441,765,265 | -9021429009303548093 | Professional | 2.21 | 0.75 | 716.11 | 151.56 | 192.4% | 372.5% | 4,832 | 884 |
| -3,776,001,016,975,145,508 | 1448230468311069262 | Professional | 2.88 | 0.99 | 1,050.58 | 250.28 | 190.9% | 319.8% | 1,881 | 501 |
| -3,776,001,016,975,145,508 | 5671012178851870288 | Professional | 4.47 | 1.54 | 417.54 | 264.89 | 189.8% | 57.6% | 1,006 | 617 |
| -3,776,001,016,975,145,508 | 9119600455817837599 | Professional | 3.23 | 1.12 | 357.42 | 604.44 | 188.8% | -40.9% | 1,448 | 1,860 |
| -3,776,001,016,975,145,508 | 340530510858151991 | Professional | 3.18 | 1.1 | 975.75 | 824.34 | 188.5% | 18.4% | 1,765 | 2,106 |
| -3,776,001,016,975,145,508 | 3892441238895982114 | Professional | 3.18 | 1.1 | 975.75 | 825.74 | 188.2% | 18.2% | 1,765 | 2,106 |
| -3,776,001,016,975,145,508 | -1967423625411999638 | Professional | 3.92 | 1.37 | 1,282.64 | 1,455.11 | 186.2% | -11.9% | 1,326 | 948 |
| -3,776,001,016,975,145,508 | 4376411467288635212 | Professional | 3.97 | 1.39 | 1,288.70 | 1,451.13 | 184.5% | -11.2% | 1,325 | 951 |
| 4,301,155,135,282,901,848 | 2909 | Inpatient | 3.18 | 1.12 | 43,481.08 | 11,686.52 | 184.2% | 272.1% | 1,659 | 107 |
| -3,776,001,016,975,145,508 | -1129251442614503651 | Professional | 3.41 | 1.21 | 1,897.74 | 315.66 | 182.9% | 501.2% | 726 | 795 |
| -3,776,001,016,975,145,508 | 5046591772473192223 | Professional | 4.19 | 1.48 | 454.30 | 334.61 | 182.4% | 35.8% | 1,107 | 1,131 |
| 4,281,965,180,796,802,413 | 7063415233901130033 | Professional | 2.04 | 0.73 | 545.22 | 267.29 | 181.0% | 104.0% | 4,509 | 765 |
| 8,361,580,493,441,765,265 | 8525801659323831681 | Professional | 1.99 | 0.71 | 717.32 | 146.31 | 180.6% | 390.3% | 4,723 | 882 |
| -3,776,001,016,975,145,508 | 6246553284827218110 | Professional | 3.62 | 1.3 | 466.90 | 440.75 | 177.6% | 5.9% | 1,183 | 818 |
| -6,972,129,921,516,377,126 | 6285 | Inpatient | 8.22 | 2.97 | 109,076.21 | 64,009.83 | 177.0% | 70.4% | 43 | 352 |
Showing 50 of 73135 total rows
Click to see SQL
WITH
new AS (
SELECT
network_id,
provider_id,
bill_type,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id, bill_type
),
old AS (
SELECT
network_id,
provider_id,
bill_type,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id, bill_type
)
SELECT
network_id,
provider_id,
bill_type,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id, provider_id, bill_type)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
CASE
WHEN bill_type = 'Inpatient'
THEN new.roid_count > 10 AND old.roid_count > 10
WHEN bill_type = 'Outpatient'
THEN new.roid_count > 500 AND old.roid_count > 500
WHEN bill_type = 'Professional'
THEN new.roid_count > 500 AND old.roid_count > 500
END
)
ORDER BY ABS(medicare_rate_pct_change) DESC
Network Level
Count: 117 entities with significant rate changes
| network_id | new_avg_pct_of_medicare_rate | old_avg_pct_of_medicare_rate | new_avg_canonical_rate | old_avg_canonical_rate | medicare_rate_pct_change | canonical_rate_pct_change | new_roid_count | old_roid_count |
|---|---|---|---|---|---|---|---|---|
| 8,361,580,493,441,765,265 | inf | inf | 4,880.15 | 5,697.73 | -14.3% | 75,306,728 | 62,102,719 | |
| 4,281,965,180,796,802,413 | inf | inf | 4,764.00 | 5,554.47 | -14.2% | 73,016,805 | 59,911,722 | |
| -3,776,001,016,975,145,508 | inf | inf | 9,972.13 | 7,713.05 | 29.3% | 38,334,136 | 50,351,926 | |
| -8,499,759,224,271,609,810 | 2.1 | 4.49 | 196.55 | 557.98 | -53.1% | -64.8% | 357,727 | 60,019 |
| 5,605,126,640,932,710,930 | 1.87 | 2.4 | 16,559.87 | 30,500.65 | -21.9% | -45.7% | 1,115,632 | 272,868 |
| 1,481,239,756,837,705,768 | 2.3 | 2.85 | 5,118.74 | 13,583.26 | -19.1% | -62.3% | 1,023,693 | 387,412 |
| 8,180,198,595,049,150,616 | 1.91 | 1.6 | 10,473.94 | 5,055.55 | 19.0% | 107.2% | 77,723 | 196,804 |
| 4,043,190,250,846,473,271 | 1.66 | 2.04 | 4,739.30 | 6,994.38 | -18.7% | -32.2% | 1,612,273 | 1,486,425 |
| -4,445,518,905,666,343,797 | 1.7 | 2.07 | 765.23 | 11,795.87 | -17.6% | -93.5% | 209,601 | 195,116 |
| 554,749,539,877,544,775 | 1.92 | 2.31 | 13,650.18 | 12,802.23 | -16.8% | 6.6% | 882,101 | 1,410,318 |
| -8,389,359,264,395,369,979 | 2.26 | 2.66 | 14,699.59 | 13,866.30 | -15.3% | 6.0% | 371,926 | 499,911 |
| -7,942,674,608,514,495,282 | 1.78 | 2.09 | 5,496.64 | 8,330.35 | -15.0% | -34.0% | 1,737,406 | 1,121,341 |
| -2,803,535,769,510,843,135 | 1.88 | 2.19 | 12,108.52 | 11,661.47 | -14.4% | 3.8% | 876,417 | 1,306,248 |
| -1,199,840,640,198,334,888 | 1.89 | 2.21 | 7,115.93 | 10,008.56 | -14.3% | -28.9% | 2,113,353 | 1,477,539 |
| 1,391,056,274,517,336,075 | 2.37 | 2.73 | 9,142.14 | 10,993.49 | -13.1% | -16.8% | 1,125,821 | 1,029,273 |
| -4,944,393,768,879,386,509 | 3.41 | 3.9 | 8,978.68 | 17,914.20 | -12.5% | -49.9% | 144,764 | 545,002 |
| 6,437,583,333,460,157,798 | 2.77 | 2.48 | 10,102.54 | 8,959.12 | 11.5% | 12.8% | 645,863 | 945,542 |
| -163,892,009,874,547,167 | 2.21 | 2.48 | 13,381.65 | 14,085.92 | -11.0% | -5.0% | 460,369 | 501,454 |
| 1,998,605,818,287,672,800 | 2.44 | 2.73 | 5,135.19 | 9,038.41 | -10.4% | -43.2% | 711,405 | 457,003 |
| 1,134,341,852,115,164,929 | 1.69 | 1.89 | 5,303.66 | 7,053.12 | -10.2% | -24.8% | 991,207 | 929,484 |
| 6,974,535,101,123,239,131 | 3.05 | 2.77 | 10,563.28 | 8,445.14 | 10.2% | 25.1% | 503,462 | 606,115 |
| 6,091,386,345,134,788,986 | 3.11 | 2.83 | 10,917.22 | 8,484.17 | 9.9% | 28.7% | 180,644 | 232,032 |
| 6,037,342,850,284,539,624 | 2.09 | 2.3 | 3,267.82 | 5,284.81 | -9.4% | -38.2% | 1,024,733 | 932,329 |
| 2,039,367,776,086,447,454 | 2.15 | 2.36 | 5,255.82 | 6,115.56 | -9.2% | -14.1% | 1,655,499 | 1,281,449 |
| -137,228,703,119,221,502 | 1.83 | 2.01 | 5,189.37 | 6,213.43 | -9.0% | -16.5% | 1,067,293 | 946,219 |
| 3,478,392,755,490,109,147 | 2.02 | 2.22 | 5,747.26 | 6,772.07 | -8.8% | -15.1% | 415,334 | 360,397 |
| -6,293,294,949,651,930,973 | 2.32 | 2.54 | 6,366.96 | 9,258.28 | -8.5% | -31.2% | 2,005,789 | 1,840,973 |
| -2,105,332,499,153,538,685 | 2.25 | 2.45 | 8,495.53 | 10,088.54 | -8.4% | -15.8% | 882,529 | 799,292 |
| -4,027,592,970,285,917,801 | 2.6 | 2.4 | 10,116.95 | 8,056.49 | 8.2% | 25.6% | 746,263 | 919,884 |
| 1,178,549,910,471,784,015 | 2.74 | 2.53 | 12,153.27 | 10,299.45 | 8.1% | 18.0% | 496,310 | 585,546 |
| -7,420,630,624,364,773,044 | 2.36 | 2.18 | 8,660.43 | 7,194.76 | 8.0% | 20.4% | 733,954 | 862,432 |
| 2,884,766,606,938,738,180 | 1.56 | 1.69 | 4,887.61 | 6,630.35 | -7.7% | -26.3% | 926,282 | 835,922 |
| 3,376,187,909,306,580,799 | 2.01 | 2.17 | 2,805.04 | 4,068.51 | -7.6% | -31.1% | 1,046,546 | 843,362 |
| 5,263,188,873,138,819,140 | 1.44 | 1.56 | 4,366.52 | 5,732.67 | -7.3% | -23.8% | 1,502,393 | 1,221,641 |
| 5,075,764,097,723,629,059 | 2.03 | 2.18 | 8,518.38 | 10,446.73 | -7.1% | -18.5% | 2,344,852 | 1,927,556 |
| 6,650,880,607,858,420,237 | 1.49 | 1.6 | 4,496.61 | 5,856.66 | -7.0% | -23.2% | 1,620,300 | 1,356,008 |
| -8,506,106,384,867,378,430 | 1.35 | 1.45 | 2,145.21 | 3,097.19 | -6.9% | -30.7% | 954,624 | 733,509 |
| 7,616,836,552,481,822,175 | 2.12 | 2.28 | 6,135.32 | 8,753.10 | -6.9% | -29.9% | 5,296,836 | 4,743,803 |
| -2,215,537,880,835,804,330 | 2.46 | 2.64 | 9,178.32 | 10,670.83 | -6.8% | -14.0% | 1,492,986 | 1,421,293 |
| -558,178,834,365,778,978 | 2.03 | 2.17 | 8,516.67 | 10,449.52 | -6.8% | -18.5% | 2,337,424 | 1,916,552 |
| 1,017,413,876,722,652,424 | 2.01 | 2.16 | 5,451.84 | 7,828.38 | -6.7% | -30.4% | 4,826,583 | 4,323,665 |
| -6,972,129,921,516,377,126 | 2.32 | 2.48 | 5,353.81 | 7,429.71 | -6.2% | -27.9% | 4,200,405 | 3,845,550 |
| 1,295,090,440,394,638,876 | 1.9 | 2.02 | 14,727.81 | 13,185.38 | -6.2% | 11.7% | 183,458 | 233,390 |
| -7,995,682,717,897,123,039 | 2.63 | 2.8 | 10,927.32 | 20,744.13 | -6.1% | -47.3% | 2,915,913 | 3,398,674 |
| 3,973,810,847,438,814,798 | 4.86 | 4.6 | 11,595.36 | 22,099.94 | 5.8% | -47.5% | 755,860 | 948,917 |
| -7,163,483,760,674,166,628 | 1.83 | 1.94 | 2,638.02 | 3,389.66 | -5.7% | -22.2% | 1,593,024 | 1,255,468 |
| 5,373,876,635,451,223,842 | 2.37 | 2.51 | 5,812.97 | 7,763.62 | -5.7% | -25.1% | 4,293,107 | 3,892,981 |
| -5,874,281,272,803,523,303 | 1.82 | 1.93 | 2,602.60 | 3,349.46 | -5.7% | -22.3% | 1,591,921 | 1,253,703 |
| -1,766,392,260,690,175,685 | 2.3 | 2.17 | 6,723.71 | 7,511.48 | 5.6% | -10.5% | 1,615,701 | 1,514,382 |
| -4,541,460,228,936,150,437 | 2.2 | 2.33 | 8,813.86 | 10,782.88 | -5.6% | -18.3% | 2,417,502 | 1,997,410 |
Showing 50 of 117 total rows
Click to see SQL
WITH
new AS (
SELECT
network_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id
),
old AS (
SELECT
network_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id
)
SELECT
network_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
new.roid_count > 500 AND old.roid_count > 500
)
ORDER BY ABS(medicare_rate_pct_change) DESC
4. Large ROID Count Swings (>10% change)
By Service Line
Count: 29 categories with significant ROID count changes
| service_line | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| Radiology | 100,675,630 | 42,612,257 | 58,063,373 | 136.3% |
| Pulmonology | 10,084,024 | 6,512,618 | 3,571,406 | 54.8% |
| Neurology | 24,221,460 | 16,100,154 | 8,121,306 | 50.4% |
| Lab/Path | 55,764,175 | 37,140,268 | 18,623,907 | 50.1% |
| Cardiovascular | 31,153,672 | 20,848,838 | 10,304,834 | 49.4% |
| Transplant | 97,655 | 67,023 | 30,632 | 45.7% |
| Ophthalmology | 18,656,403 | 12,834,682 | 5,821,721 | 45.4% |
| Urology | 13,439,244 | 9,256,999 | 4,182,245 | 45.2% |
| Gastrointestinal | 28,050,824 | 19,585,234 | 8,465,590 | 43.2% |
| Dermatology | 31,312,512 | 22,071,665 | 9,240,847 | 41.9% |
| Behavioral Health | 6,469,633 | 4,573,663 | 1,895,970 | 41.5% |
| Infectious Disease | 30,564,595 | 21,741,157 | 8,823,438 | 40.6% |
| Obstetrics | 8,721,317 | 6,270,693 | 2,450,624 | 39.1% |
| Rehab | 7,898,387 | 5,720,023 | 2,178,364 | 38.1% |
| MSK | 65,824,942 | 47,815,959 | 18,008,983 | 37.7% |
| Consultative and Preventative Care | 12,829,088 | 9,322,871 | 3,506,217 | 37.6% |
| Emergency | 996,117 | 724,297 | 271,820 | 37.5% |
| Reproductive | 11,125,621 | 8,094,687 | 3,030,934 | 37.4% |
| Trauma | 2,332,214 | 1,698,602 | 633,612 | 37.3% |
| ENT | 16,506,825 | 12,049,452 | 4,457,373 | 37.0% |
| Dental | 528,237 | 386,407 | 141,830 | 36.7% |
| DME and Supplies | 2,529,332 | 1,868,061 | 661,271 | 35.4% |
| Hematology | 2,333,792 | 1,726,285 | 607,507 | 35.2% |
| Surgery | 101,420 | 75,911 | 25,509 | 33.6% |
| Endocrinology | 2,252,143 | 1,690,257 | 561,886 | 33.2% |
| Nephrology | 1,494,526 | 1,123,458 | 371,068 | 33.0% |
| Anesthesia | 18,481,666 | 13,991,408 | 4,490,258 | 32.1% |
| Oncology | 13,740,835 | 10,422,074 | 3,318,761 | 31.8% |
| Diabetes | 376,663 | 289,841 | 86,822 | 30.0% |
Click to see SQL
WITH
new AS (
SELECT
service_line,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY service_line
),
old AS (
SELECT
service_line,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY service_line
)
SELECT
service_line,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (service_line)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Provider Type
Count: 5 categories with significant ROID count changes
| provider_type | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| Physician Group | 296,243,211 | 168,018,318 | 128,224,893 | 76.3% |
| ASC | 21,462,464 | 14,469,409 | 6,993,055 | 48.3% |
| Imaging Center | 4,037,494 | 2,964,629 | 1,072,865 | 36.2% |
| Hospital | 308,325,250 | 226,818,793 | 81,506,457 | 35.9% |
| Laboratory | 12,774,428 | 11,292,016 | 1,482,412 | 13.1% |
Click to see SQL
WITH
new AS (
SELECT
provider_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type
),
old AS (
SELECT
provider_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type
)
SELECT
provider_type,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By State
Count: 51 categories with significant ROID count changes
| state | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| WV | 3,336,283 | 1,815,330 | 1,520,953 | 83.8% |
| WY | 1,347,471 | 748,623 | 598,848 | 80.0% |
| CT | 5,291,400 | 3,091,402 | 2,199,998 | 71.2% |
| AK | 983,206 | 582,041 | 401,165 | 68.9% |
| SC | 7,208,551 | 4,280,548 | 2,928,003 | 68.4% |
| NE | 5,840,959 | 3,492,394 | 2,348,565 | 67.2% |
| DE | 1,491,596 | 893,174 | 598,422 | 67.0% |
| MD | 7,783,013 | 4,688,020 | 3,094,993 | 66.0% |
| KY | 8,712,093 | 5,263,435 | 3,448,658 | 65.5% |
| UT | 2,873,465 | 1,737,453 | 1,136,012 | 65.4% |
| DC | 4,558,292 | 2,756,542 | 1,801,750 | 65.4% |
| NJ | 18,524,980 | 11,208,368 | 7,316,612 | 65.3% |
| AL | 10,073,697 | 6,203,235 | 3,870,462 | 62.4% |
| NV | 4,764,858 | 2,936,794 | 1,828,064 | 62.2% |
| IN | 14,074,360 | 8,680,229 | 5,394,131 | 62.1% |
| MS | 7,572,722 | 4,696,350 | 2,876,372 | 61.2% |
| AZ | 12,429,536 | 7,731,320 | 4,698,216 | 60.8% |
| CO | 9,385,665 | 5,887,281 | 3,498,384 | 59.4% |
| OH | 22,519,974 | 14,139,693 | 8,380,281 | 59.3% |
| ID | 4,227,247 | 2,668,922 | 1,558,325 | 58.4% |
| LA | 14,012,195 | 8,882,236 | 5,129,959 | 57.8% |
| NC | 16,550,393 | 10,505,399 | 6,044,994 | 57.5% |
| FL | 34,509,788 | 22,075,310 | 12,434,478 | 56.3% |
| OR | 8,377,377 | 5,365,678 | 3,011,699 | 56.1% |
| RI | 1,539,821 | 987,014 | 552,807 | 56.0% |
| KS | 9,091,468 | 5,831,438 | 3,260,030 | 55.9% |
| VT | 760,033 | 487,698 | 272,335 | 55.8% |
| GA | 18,478,090 | 11,987,179 | 6,490,911 | 54.1% |
| MI | 19,479,730 | 12,657,171 | 6,822,559 | 53.9% |
| TN | 13,466,433 | 8,774,908 | 4,691,525 | 53.5% |
| OK | 9,969,421 | 6,568,659 | 3,400,762 | 51.8% |
| MT | 2,714,552 | 1,789,824 | 924,728 | 51.7% |
| NM | 2,809,656 | 1,857,949 | 951,707 | 51.2% |
| IA | 9,131,679 | 6,104,513 | 3,027,166 | 49.6% |
| AR | 7,084,294 | 4,748,620 | 2,335,674 | 49.2% |
| MO | 14,243,987 | 9,551,652 | 4,692,335 | 49.1% |
| PA | 27,955,670 | 18,785,308 | 9,170,362 | 48.8% |
| IL | 22,161,556 | 14,896,285 | 7,265,271 | 48.8% |
| WA | 14,281,060 | 9,620,803 | 4,660,257 | 48.4% |
| TX | 58,053,641 | 39,154,741 | 18,898,900 | 48.3% |
| WI | 13,219,960 | 8,968,630 | 4,251,330 | 47.4% |
| NY | 51,810,345 | 35,519,837 | 16,290,508 | 45.9% |
| ME | 3,254,071 | 2,239,616 | 1,014,455 | 45.3% |
| VA | 15,746,175 | 10,862,226 | 4,883,949 | 45.0% |
| ND | 1,983,412 | 1,373,546 | 609,866 | 44.4% |
| CA | 63,867,477 | 45,035,425 | 18,832,052 | 41.8% |
| NH | 3,280,899 | 2,329,791 | 951,108 | 40.8% |
| SD | 2,838,861 | 2,032,123 | 806,738 | 39.7% |
| MN | 12,672,920 | 9,089,397 | 3,583,523 | 39.4% |
| MA | 14,871,797 | 10,777,975 | 4,093,822 | 38.0% |
Showing 50 of 51 total rows
Click to see SQL
WITH
new AS (
SELECT
state,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY state
),
old AS (
SELECT
state,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY state
)
SELECT
state,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (state)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Payer Network Name
Count: 117 categories with significant ROID count changes
| payer_network_name | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| HealthSmart Preferred PPO | 357,727 | 60,019 | 297,708 | 496.0% |
| EmblemHealth GHI / Anthem CBP | 1,115,632 | 272,868 | 842,764 | 308.9% |
| Regence Blue Cross Blue Shield OR PPO | 1,023,693 | 387,412 | 636,281 | 164.2% |
| Kaiser Permanente Kaiser Health Plan Mid Atlantic | 144,764 | 545,002 | -400,238 | -73.4% |
| Harvard Pilgrim Health Care Choicenet PPO | 316,059 | 1,051,798 | -735,739 | -70.0% |
| Blue Cross Blue Shield of Rhode Island PPO | 77,723 | 196,804 | -119,081 | -60.5% |
| Blue Cross Blue Shield of Nebraska Networkblue PPO | 711,405 | 457,003 | 254,402 | 55.7% |
| Blue Cross Blue Shield of New Jersey (Horizon) OMNIA | 1,737,406 | 1,121,341 | 616,065 | 54.9% |
| Kaiser Permanente Kaiser Health Plan (CO) | 265,726 | 570,378 | -304,652 | -53.4% |
| Baylor Scott & White Health Plan PPO | 590,151 | 1,115,539 | -525,388 | -47.1% |
| Blue Cross Blue Shield of New Jersey (Horizon) PPO | 2,113,353 | 1,477,539 | 635,814 | 43.0% |
| Sanford Health Plan PPO | 536,633 | 933,593 | -396,960 | -42.5% |
| Kaiser Permanente Kaiser Health Plan Northwest | 379,570 | 618,318 | -238,748 | -38.6% |
| HealthLink PPO | 882,101 | 1,410,318 | -528,217 | -37.5% |
| Mass General Brigham Health Plan Commercial PPO | 265,615 | 193,744 | 71,871 | 37.1% |
| Blue Cross Blue Shield of Maryland & DC (CareFirst) Preferred Provider Network (PPO) | 1,455,337 | 1,062,628 | 392,709 | 37.0% |
| Aetna NC HMO | 1,529,548 | 1,125,285 | 404,263 | 35.9% |
| Ambetter HMO | 2,665,456 | 1,966,175 | 699,281 | 35.6% |
| The Alliance Comprehensive Network | 241,054 | 178,137 | 62,917 | 35.3% |
| Univera Healthcare PPO | 578,767 | 428,710 | 150,057 | 35.0% |
| Capital Health Plan PPO | 24,165 | 36,817 | -12,652 | -34.4% |
| HealthLink HMO | 876,417 | 1,306,248 | -429,831 | -32.9% |
| Blue Cross Blue Shield of Wyoming PPO | 340,966 | 257,047 | 83,919 | 32.6% |
| Avera Health Plans Avera Health | 99,381 | 146,232 | -46,851 | -32.0% |
| Blue Cross Blue Shield of Illinois HMO | 645,863 | 945,542 | -299,679 | -31.7% |
| Blue Cross Blue Shield of Maryland & DC (CareFirst) HMO | 954,624 | 733,509 | 221,115 | 30.1% |
| Aetna VA HMO | 1,655,499 | 1,281,449 | 374,050 | 29.2% |
| Blue Cross Blue Shield of New York (Excellus) Excellus Bluecross Blueshield | 1,576,867 | 1,223,283 | 353,584 | 28.9% |
| Harvard Pilgrim Health Care HMO | 1,284,439 | 1,010,603 | 273,836 | 27.1% |
| Sentara Health Plans HMO | 1,591,921 | 1,253,703 | 338,218 | 27.0% |
| Sentara Health Plans PPO | 1,593,024 | 1,255,468 | 337,556 | 26.9% |
| Premera Blue Cross Alaska Heritage Network | 250,460 | 197,656 | 52,804 | 26.7% |
| Medical Mutual Of Ohio SuperMed | 572,380 | 775,475 | -203,095 | -26.2% |
| Blue Cross Blue Shield of Pennsylvania (Independence) KHPE Commercial HMO/POS | 371,926 | 499,911 | -127,985 | -25.6% |
| Blue Cross Blue Shield of North Carolina HMO | 345,526 | 458,028 | -112,502 | -24.6% |
| EmblemHealth DC37 Med-Team | 1,845,678 | 1,482,664 | 363,014 | 24.5% |
| Cigna NH HMO | 174,877 | 231,409 | -56,532 | -24.4% |
| Cigna New England HMO | 1,022,228 | 1,350,059 | -327,831 | -24.3% |
| Cigna NC HMO | 842,142 | 1,110,403 | -268,261 | -24.2% |
| MVP Health Care HMO | 1,046,546 | 843,362 | 203,184 | 24.1% |
| Cigna National OAP | 38,334,136 | 50,351,926 | -12,017,790 | -23.9% |
| Aetna GA HMO | 1,635,883 | 1,320,925 | 314,958 | 23.8% |
| Health Alliance Plan (HAP) HMO | 1,502,393 | 1,221,641 | 280,752 | 23.0% |
| Aetna CA HMO | 5,206,929 | 4,258,596 | 948,333 | 22.3% |
| Cigna NJ HMO | 704,877 | 906,422 | -201,545 | -22.2% |
| Cigna ME HMO | 180,644 | 232,032 | -51,388 | -22.1% |
| Anthem CT HMO | 464,336 | 380,416 | 83,920 | 22.1% |
| Aetna IL HMO | 2,107,738 | 1,727,526 | 380,212 | 22.0% |
| Anthem Blue Access Gated EPO | 2,337,424 | 1,916,552 | 420,872 | 22.0% |
| Mass General Brigham Health Plan HMO | 938,454 | 769,553 | 168,901 | 21.9% |
Showing 50 of 117 total rows
Click to see SQL
WITH
new AS (
SELECT
payer_network_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY payer_network_name
),
old AS (
SELECT
payer_network_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY payer_network_name
)
SELECT
payer_network_name,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (payer_network_name)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Network + Canonical Rate Source (Check for New Pairs with 0 Rates)
Count: 10 categories with significant ROID count changes
| payer_id | payer_name | network_name | canonical_rate_source | n_old | n_new |
|---|---|---|---|---|---|
| 42 | Anthem | GHI / Anthem CBP | imputation | 56,571 | 0 |
| 97 | EmblemHealth | GHI / Anthem CBP | imputation | 33,944 | 0 |
| 317 | Tufts Health Plan | PPO MA | imputation | 56,608 | 0 |
| 456 | Blue Cross Blue Shield of Mississippi | Preferred Provider Network | imputation | 27,943 | 0 |
| 636 | SelectHealth | HMO | payer_hospital | 58,457 | 0 |
| 42 | Anthem | CA HMO | imputation | 297,336 | 0 |
| 42 | Anthem | WI Blue Access PPO | imputation | 128,753 | 0 |
| 43 | Blue Cross Blue Shield of Arizona | HMO | imputation | 22,162 | 0 |
| 799 | Quartz | Quartz Tiered Choice Plus (QHBPC WI): Quartz | imputation | 108,526 | 0 |
| 389 | Blue Cross Blue Shield of Illinois | HMO | imputation | 320,852 | 0 |
Click to see SQL
WITH
new AS (
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
count(distinct roid) AS n_new
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2,3,4
),
old AS (
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
count(distinct roid) AS n_old
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2,3,4
)
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
n_old,
COALESCE(n_new, 0) as n_new
FROM old
FULL OUTER JOIN new USING (payer_id, payer_name, network_name, canonical_rate_source)
ORDER BY COALESCE(n_new, 0) ASC
LIMIT 10
By Health System Name
Count: 783 categories with significant ROID count changes
| provider_type | health_system_name | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|---|
| Hospital | Vibra Healthcare | 310,464 | 48,607 | 261,857 | 538.7% |
| Hospital | Select Medical Corporation | 784,937 | 180,131 | 604,806 | 335.8% |
| Hospital | PAM Health | 338,214 | 142,222 | 195,992 | 137.8% |
| Physician Group | Billings Clinic Health System | 135,329 | 62,182 | 73,147 | 117.6% |
| Hospital | ScionHealth | 1,003,070 | 462,008 | 541,062 | 117.1% |
| Physician Group | WVU Medicine | 138,293 | 64,826 | 73,467 | 113.3% |
| Physician Group | Appalachian Regional Healthcare | 143,103 | 67,496 | 75,607 | 112.0% |
| Physician Group | Bryan Health | 190,970 | 92,332 | 98,638 | 106.8% |
| Physician Group | Asante | 138,954 | 68,433 | 70,521 | 103.1% |
| Hospital | Mosaic Life Care | 204,446 | 101,392 | 103,054 | 101.6% |
| Hospital | Spaulding Rehabilitation Network | 100,518 | 50,623 | 49,895 | 98.6% |
| Physician Group | St Charles Health System | 146,268 | 75,957 | 70,311 | 92.6% |
| Physician Group | SSM Health in Wisconsin | 117,068 | 60,834 | 56,234 | 92.4% |
| Physician Group | Marshall Health Network | 112,570 | 58,627 | 53,943 | 92.0% |
| Physician Group | ThedaCare | 142,190 | 74,936 | 67,254 | 89.7% |
| Hospital | Mon Health | 102,466 | 54,115 | 48,351 | 89.3% |
| Hospital | Physicians Regional Healthcare System | 210,405 | 111,568 | 98,837 | 88.6% |
| Physician Group | Novant Health | 464,100 | 247,065 | 217,035 | 87.8% |
| Physician Group | Providence Health & Services - Oregon and Southwest Washington | 268,990 | 143,978 | 125,012 | 86.8% |
| Physician Group | Ascension Wisconsin | 315,746 | 169,744 | 146,002 | 86.0% |
| Physician Group | SUNY Upstate Medical University | 217,664 | 117,873 | 99,791 | 84.7% |
| Physician Group | Baptist Health | 322,687 | 175,005 | 147,682 | 84.4% |
| Physician Group | Parkview Health | 144,059 | 78,474 | 65,585 | 83.6% |
| Physician Group | LifeBridge Health | 200,001 | 108,987 | 91,014 | 83.5% |
| Physician Group | Norton Healthcare | 102,486 | 55,947 | 46,539 | 83.2% |
| Physician Group | Bellin Health | 490,024 | 267,660 | 222,364 | 83.1% |
| Hospital | Wellstar MCG Health | 301,074 | 164,690 | 136,384 | 82.8% |
| Physician Group | Guthrie Clinic | 112,198 | 61,467 | 50,731 | 82.5% |
| Physician Group | TMC Health | 138,165 | 75,789 | 62,376 | 82.3% |
| Physician Group | Intermountain Health | 462,347 | 253,653 | 208,694 | 82.3% |
| Physician Group | Hartford HealthCare | 442,089 | 242,651 | 199,438 | 82.2% |
| Physician Group | Deaconess Health System | 233,243 | 128,085 | 105,158 | 82.1% |
| Physician Group | Adventist Health Hanford | 151,768 | 83,775 | 67,993 | 81.2% |
| Physician Group | Bon Secours Health System | 232,175 | 128,187 | 103,988 | 81.1% |
| Physician Group | Powers Health | 112,188 | 62,161 | 50,027 | 80.5% |
| Physician Group | AdventHealth | 641,716 | 355,878 | 285,838 | 80.3% |
| Physician Group | CommonSpirit Health | 131,423 | 73,144 | 58,279 | 79.7% |
| Physician Group | Indiana University Health | 116,722 | 65,071 | 51,651 | 79.4% |
| Physician Group | Surgery Partners | 107,024 | 59,777 | 47,247 | 79.0% |
| Physician Group | Legacy Health | 119,839 | 67,011 | 52,828 | 78.8% |
| Physician Group | Cooper University Health | 281,628 | 157,516 | 124,112 | 78.8% |
| Physician Group | Atlantic Health System | 229,021 | 128,397 | 100,624 | 78.4% |
| Hospital | Cape Fear Valley Health System | 202,751 | 113,938 | 88,813 | 77.9% |
| Physician Group | Allegheny Health Network | 202,675 | 114,120 | 88,555 | 77.6% |
| Physician Group | Providence Health & Services - Washington | 112,053 | 63,489 | 48,564 | 76.5% |
| Physician Group | UCHealth | 177,167 | 100,456 | 76,711 | 76.4% |
| Hospital | Infirmary Health System | 218,721 | 124,076 | 94,645 | 76.3% |
| Physician Group | St Lukes Health System | 165,098 | 93,893 | 71,205 | 75.8% |
| Physician Group | PeaceHealth | 510,377 | 290,379 | 219,998 | 75.8% |
| Physician Group | ProMedica Health System | 317,818 | 181,856 | 135,962 | 74.8% |
Showing 50 of 783 total rows
Click to see SQL
WITH
new AS (
SELECT
provider_type,
health_system_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
),
old AS (
SELECT
provider_type,
health_system_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
)
SELECT
provider_type,
health_system_name,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type, health_system_name)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
AND (
new.roid_count > 100000 OR old.roid_count > 100000
)
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Rate Score
Count: 4 categories with significant ROID count changes
| canonical_rate_score | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| 3 | 329,745,102 | 203,570,381 | 126,174,721 | 62.0% |
| 2 | 79,896,632 | 50,552,096 | 29,344,536 | 58.0% |
| 4 | 189,350,804 | 137,012,361 | 52,338,443 | 38.2% |
| 5 | 43,850,309 | 32,428,327 | 11,421,982 | 35.2% |
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_score
),
old AS (
SELECT
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_score
)
SELECT
canonical_rate_score,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_score)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Rate Score and Provider Type
Count: 15 categories with significant ROID count changes
| provider_type | canonical_rate_score | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|---|
| ASC | 4 | 21,047,569 | 14,078,360 | 6,969,209 | 49.5% |
| Hospital | 5 | 37,675,253 | 27,187,606 | 10,487,647 | 38.6% |
| Hospital | 4 | 160,789,302 | 117,210,186 | 43,579,116 | 37.2% |
| Hospital | 2 | 22,141,007 | 16,435,648 | 5,705,359 | 34.7% |
| Hospital | 3 | 87,719,688 | 65,985,353 | 21,734,335 | 32.9% |
| Imaging Center | 4 | 4,037,149 | 2,964,215 | 1,072,934 | 36.2% |
| Imaging Center | 3 | 268 | 325 | -57 | -17.5% |
| Imaging Center | 2 | 77 | 89 | -12 | -13.5% |
| Laboratory | 4 | 685,652 | 589,271 | 96,381 | 16.4% |
| Laboratory | 3 | 4,573,162 | 3,951,273 | 621,889 | 15.7% |
| Laboratory | 5 | 5,861,831 | 5,170,508 | 691,323 | 13.4% |
| Physician Group | 5 | 313,225 | 70,213 | 243,012 | 346.1% |
| Physician Group | 3 | 237,209,780 | 133,407,892 | 103,801,888 | 77.8% |
| Physician Group | 2 | 55,929,074 | 32,369,884 | 23,559,190 | 72.8% |
| Physician Group | 4 | 2,791,132 | 2,170,329 | 620,803 | 28.6% |
Click to see SQL
WITH
new AS (
SELECT
provider_type,
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type, canonical_rate_score
),
old AS (
SELECT
provider_type,
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type, canonical_rate_score
)
SELECT
provider_type,
canonical_rate_score,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type, canonical_rate_score)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY provider_type, ABS(roid_count_pct_change) DESC
By Canonical Rate Class
Count: 3 categories with significant ROID count changes
| canonical_rate_class | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| Raw | 513,920,816 | 326,470,730 | 187,450,086 | 57.4% |
| Impute | 94,980,880 | 70,612,086 | 24,368,794 | 34.5% |
| Transform | 33,941,151 | 26,480,349 | 7,460,802 | 28.2% |
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_class,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_class
),
old AS (
SELECT
canonical_rate_class,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_class
)
SELECT
canonical_rate_class,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_class)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Rate Source
Count: 4 categories with significant ROID count changes
| canonical_rate_source | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| payer | 414,135,609 | 257,041,952 | 157,093,657 | 61.1% |
| hospital | 89,876,049 | 63,480,800 | 26,395,249 | 41.6% |
| payer_hospital | 43,850,309 | 32,428,327 | 11,421,982 | 35.2% |
| imputation | 94,980,880 | 70,612,086 | 24,368,794 | 34.5% |
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_source,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_source
),
old AS (
SELECT
canonical_rate_source,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_source
)
SELECT
canonical_rate_source,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_source)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Contract Methodology
Count: 5 categories with significant ROID count changes
| canonical_contract_methodology | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| Fee Schedule | 377,413,105 | 229,527,061 | 147,886,044 | 64.4% |
| Unknown | 23,370,462 | 16,829,968 | 6,540,494 | 38.9% |
| Case Rate | 119,669,706 | 87,402,938 | 32,266,768 | 36.9% |
| Percent of Total Billed Charges | 117,880,424 | 86,292,030 | 31,588,394 | 36.6% |
| Per Diem | 4,509,150 | 3,511,168 | 997,982 | 28.4% |
Click to see SQL
WITH
new AS (
SELECT
canonical_contract_methodology,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_contract_methodology
),
old AS (
SELECT
canonical_contract_methodology,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_contract_methodology
)
SELECT
canonical_contract_methodology,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_contract_methodology)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Crosswalk Method
Count: 8 categories with significant ROID count changes
| canonical_crosswalk_method | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| Crosswalked From CSTM-ALL to MS-DRG | 1,227,480 | 617,095 | 610,385 | 98.9% |
| Crosswalked From CSTM-ALL to APR-DRG | 1,422,072 | 716,902 | 705,170 | 98.4% |
| Crosswalked From CSTM-ALL to HCPCS | 20,340,645 | 12,180,065 | 8,160,580 | 67.0% |
| Crosswalked From MS-DRG to APR-DRG | 26,399,689 | 19,166,623 | 7,233,066 | 37.7% |
| Crosswalked From RC-FAMILY to APR-DRG | 1,140,096 | 916,018 | 224,078 | 24.5% |
| Crosswalked From RC-FAMILY to MS-DRG | 837,809 | 695,804 | 142,005 | 20.4% |
| Crosswalked From NDC to HCPCS | 950,588 | 1,192,692 | -242,104 | -20.3% |
| Crosswalked From APC to HCPCS | 7,987,270 | 6,706,257 | 1,281,013 | 19.1% |
Click to see SQL
WITH
new AS (
SELECT
canonical_crosswalk_method,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_crosswalk_method
),
old AS (
SELECT
canonical_crosswalk_method,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_crosswalk_method
)
SELECT
canonical_crosswalk_method,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_crosswalk_method)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC
By Canonical Gross Charge Type
Count: 6 categories with significant ROID count changes
| canonical_gross_charge_type | new_roid_count | old_roid_count | roid_count_change | roid_count_pct_change |
|---|---|---|---|---|
| mrf_gross_charge_cbsa_median | 30,144,742 | 20,677,134 | 9,467,608 | 45.8% |
| mrf_gross_charge_provider | 71,356,967 | 51,301,044 | 20,055,923 | 39.1% |
| mrf_gross_charge_state_median | 131,887,833 | 97,588,552 | 34,299,281 | 35.1% |
| komodo_gross_charge_provider | 2,486,307 | 1,874,765 | 611,542 | 32.6% |
| komodo_gross_charge_state_median | 15,094,453 | 11,908,067 | 3,186,386 | 26.8% |
| komodo_gross_charge_cbsa_median | 2,717,231 | 2,251,854 | 465,377 | 20.7% |
Click to see SQL
WITH
new AS (
SELECT
canonical_gross_charge_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_gross_charge_type
),
old AS (
SELECT
canonical_gross_charge_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_gross_charge_type
)
SELECT
canonical_gross_charge_type,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_gross_charge_type)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC