Leveraging Neural Networks to Profile Health Care Providers with Application to Medicare Claims

TL;DR

This paper introduces a neural network-based generalized partially linear model for provider profiling, effectively capturing complex associations and variations, demonstrated through dialysis facility analysis during COVID-19 using Medicare data.

Contribution

It develops a novel neural network integrated GPLM with a stratified sampling optimization and exact testing for improved provider profiling accuracy.

Findings

Enhanced profiling accuracy demonstrated via simulations.

Effective identification of under- and over-performing facilities.

Application to Medicare data revealed COVID-19's impact on dialysis readmissions.

Abstract

Encompassing numerous nationwide, statewide, and institutional initiatives in the United States, provider profiling has evolved into a major health care undertaking with ubiquitous applications, profound implications, and high-stakes consequences. In line with such a significant profile, the literature has accumulated a number of developments dedicated to enhancing the statistical paradigm of provider profiling. Tackling wide-ranging profiling issues, these methods typically adjust for risk factors using linear predictors. While this approach is simple, it can be too restrictive to characterize complex and dynamic factor-outcome associations in certain contexts. One such example arises from evaluating dialysis facilities treating Medicare beneficiaries with end-stage renal disease. It is of primary interest to consider how the coronavirus disease (COVID-19) affected 30-day unplanned readmissions in 2020. The impact of COVID-19 on the risk of readmission varied dramatically across pandemic phases. To efficiently capture the variation while profiling facilities, we develop a generalized partially linear model (GPLM) that incorporates a neural network. Considering provider-level clustering, we implement the GPLM as a stratified sampling-based stochastic optimization algorithm that features accelerated convergence. Furthermore, an exact test is designed to identify under- and over-performing facilities, with an accompanying funnel plot to visualize profiles. The advantages of the proposed methods are demonstrated through simulation experiments and profiling dialysis facilities using 2020 Medicare claims from the United States Renal Data System.