An IT guy at heart whose passion lies in healthcare analytics, primarily focused on: healthcare payments, healthcare analysis, and data warehousing.

CMS Bundled Payments

The American Hospital Association released this issue brief, titled “Moving Towards Bundled Payment” earlier this year. It provides a great overview of the CMS bundled payment models, how bundled are formed, what is included in the bundles, and approaches to manage care under a bundled payment arrangement.

Reference Pricing, Here We Come

Referencing pricing is getting more (possibly gated) and more coverage lately. The recent piece in Forbes, Warning To Orthopedic Hospitals: Your Fees Are No Match For Reference Pricing, by Peter Ubel describes how CalPers was able to bring high-priced hospitals inline with their lower-priced competitors by applying the price difference directly to consumer price sharing.

California public employees were told they could use any hospital, and any orthopedic surgeon, they wanted to, but with the understanding that their insurance would cover only $30,000 of hospital expenses for their hip or knee replacement procedures. So if a patient chose a hospital that charged $40,000 for such a procedure, that patient would be financially responsible for that extra $10,000.

This strategy caused a significant increase in business to the lower-priced hospitals and, eventually price concessions from the higher-priced hospitals.

This reference pricing program not only influenced where people received their procedures, but how much they paid for them. In response to this lost business, high-priced hospitals dramatically reduced their fees … Remarkably (sarcasm alert) their new fees came in just under $30,000.

If you’re not looking into this contracting strategy, you should.


Great post about bitmap indexes

Kelly Sommers posted a great article on the internals of bitmap indexes.  Unless you understand how bitmap indexes are used in a dimensional model, your instincts will be wrong about performance tuning and the right data structures to use for a given data set.

Highly recommended reading for data warehouse folks:

Is Hand-Coded ETL the Way to Go? Absolutely Yes, or Absolutely No, Depending…

This article originally ran in May 31, 2003 edition of Intelligent Enterprise magazine, written by Gary Nissen, edited by Ralph Kimball.

Recently, there was a question posted on a data warehousing e-mail list that is frequently asked, yet always surprises me. The question asked whether it is acceptable or recommended to hand-code the Extract-Transform-Load (ETL) logic for a data warehouse or if tool-based ETL is always preferred.

My standard answer is that it is perfectly appropriate to custom develop the ETL code. In the right situation, custom developed ETL can be cheaper and more maintainable. But in other situations, a tool-based approach is better. Just like any other technology decision, it depends. It all comes down to understanding the scope and requirements of the project.

I guess what surprises me is that this decision is no different than any other technology decision in any other development project. You simply consider all significant requirements, balance your options and make a business decision. In other words, just follow your standard project plan and it will lead you to the right decision. MORE>