Which Medicare Physician is the Best Doctor to Educate About Your Medication or Medical Device?

Ashish Patel

May 22, 2020

While pharma marketers continue to navigate their brand through COVID-19, non-personal promotion appears to be the best approach for the time being. In order to reach optimal efficiency, marketers will want to utilize the best list of providers for their brand.

Publicly available datasets, as well as commercially available datasets, are all over the internet. They will help you identify specific physicians to educate about your device or approved medication. You can combine different components, segmenting the masses into a succinct and powerful list. Looking at different data gives you access to new ways of identifying potential providers you might not have thought of previously.

1. Procedure Codes

In the course of a physician’s practice, a doctor performs dozens of procedures on hundreds of patients. Procedure codes starting with 99XYZ are often related to patients evaluated and managed by the doctor. They’re known as Evaluation and Management Codes (E&M). The number one factor to help determine whether or not this physician is right for your product is to look at their billing codes.

Ex: Looking for a physician that uses a scalpel, there are multiple HCPCS codes that are related to minor surgery. One of the best resources to get this kind of information at the physician level is the CMS Provider Utilization File.

2. Prescriptions

Look at prescriptions physicians are writing. If you know the indications associated with those drugs, you know their patients. Used in combination with procedure codes, this could be a good predictor for whether the physician would be responsive to your product.

3. Diagnosis Codes

There are public codes for D volumes by physicians, but we can provide you a commercially available file. We use this data regularly to determine specialty sub-typing; for example, neurologists can practice several subtypes of neurology. They could specialize in stroke, Parkinson’s, MS, or they’re generalists. When you study the ICD codes from their claims, sub-typing the physician becomes easy.

4. Explicit Referrals to Find KOLs

In the ambulatory care setting providers often use a claim form called the CMS-1500. When a claim is submitted using this form, specialists and imaging service providers and labs often include the NPI number of the referring physician. This is not because Medicare requires it, but because most other payers require a referral. CareSet can identify the physician who is mostly correlated with performing the service associated with a client’s new technology or medicine. Using either adjacent CPT, HCPCS, or ICD diagnosis codes, CareSet can identify the referring physician and overlay the previously mentioned methods to push that physician to the top when they appear to be highly referred.

5. Implicit Referrals

For the better half of the decade, CareSet has been working with Medicare claims data and we’ve learned to perform key opinion leaders (KOL) identification in multiple ways. In 2014, CMS released a public use file with physician-level data for the first time. We now maintain that dataset on behalf of CMS. In order to identify the KOL using this graph dataset, you would use measurements of centrality and cardinality. You’ll be able to identify which physicians to educate about your device or medicine.

6. Growth Rate

Over time, how many patients are being added to a physician’s practice?

We have an interesting phenomenon on our hands. The ratio of clinicians to patients (in Medicare) is shrinking. Does every physician have a growing practice? No. Some physicians are closer to retirement and aren’t interested in new or novel therapies. They aren’t activating new patients. In order to select the ideal initial partners for a launch, you have to identify the physicians who are the first to diagnose and the first to treat patients with the indication of your therapy treatments.

We look at the total number of evaluation and management claims the provider submits as a ratio to the total number of new patients the provider added to their practice. The highest ratio is your best opportunity.

7. Medical Group Affiliations

The practice of healthcare requires a group. Subgrouping and sub-specialization is a characteristic of the complex care regimen patients undergo on their path to improvement. Not only is there sub-specialization, often that sub-specialization clusters into medical groups that provide robust services by selecting several sub-specialists, that during their cross-section provides the breadth of treatment options a patient may require. When you identify the subspecialty group, they can make for an ideal audience because the members of the medical group themselves can act as a sounding board. Also, when these key medical groups learn about your products, they are incredibly influential amongst the group/s they participate, allowing you to market for care continuity…if you can get the big fish in the pond, then the other fish are easier to follow.

Find the most influential people. Ex: cardiology, the med group consists of general cardiology, nuclear cardiology, etc. That group will be critical to continuative care for many patients and will create enormous exposure.

8. Graduation Year

Something you might not have thought about is a physician’s graduation year. If someone is recently out of medical school, they are more likely to be responsive to new medical technology and medications. They’re going to have a growing practice rate. Physicians who are waning their practicing years are transferring patients out.

Healthcare is slow on the uptake of emerging and new technologies. In 2014, a physician was selling the benefits of EHRs. That same year, a Forbes article gave 5 things preventing technology adoption in healthcare. Just last year a survey showed the U.S. is below the curve in health tech adoption.

But as Millennials become trusted leaders, and Generation Z following behind them, the future could be different. There is an explosion of innovation in healthcare. The digital natives are all about adopting new technologies.

With CMS’ Physician Compare we can see when a physician graduated and from which school. When launching a new product in the market, it is important to know which academic site participated in the research and discovery phase. If a physician is related to those sites, it creates an initial entry point. If the physician was completing their residency at that site during the investigation, the likelihood that he or she is aware of this new therapy is even higher, making the physician and their affiliated ecosystem a more appropriate audience.

Ashish Patel

Ashish is co-founder of CareSet Systems. An entrepreneur and healthcare data transparency advocate, Ashish also founded the DocGraph Journal, bringing together the Healthcare Data Science community along with Politico and ProPublica to publish data sets for scientific advancement. Ashish is currently working to decode Medicare Claims data for Pharmaceutical companies, helping analyze provider teaming, and building robust networks.

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