Modus Methodology, Disclaimer, and Perceived Error Reporting

Modus Clinical Intelligence (MCI) produces ratings of certain medical specialists based on the results of its algorithms. MCI enters publicly available data, published by Medicare  (CMS LDS and Data. CMS) on an annual basis retrospective to the previous years, into our algorithms 

The ART (OUR SUBJECTIVE OPINION and OUR FIRST AMENDMENT RIGHT) of determining a Modus Rating is based on clinical intelligence that stems from our experience at the “front line” of daily patient care as well as scientific insights provided by robust Data Analysis. These data analysis algorithms used are structured based on Modus’ efforts to create transparent outcome measures and accurate doctors’ profiles utilizing practice metrics for the specialties and procedures being performed. Others may disagree with the metrics that have been chosen or the algorithm methodology used by Modus; however, the raw data used to determine the Modus ratings were not manipulated in any way, and the results are reproducible and verifiable with numerators and denominators using the same source.

Doctor-level outcome metrics were determined based on the doctor’s patterns of care as reflected in quality outcomes (specific to the doctor’s specialty and the types of procedures performed by this doctor). Capturing what actually happened to a doctor’s patients by answering relevant questions:

Doctors’ practice pattern: How aggressive, conservative, and expensive are they?

  • Surgery types / Patient
  • Cost and opioids Rx / Patient

Patient-level outcome metrics were computed by longitudinally tracking individual claims. This means sorting the claims timeline in chronological order for any particular patient before computing relevant outcome measures. Which answers are a given doctor’s patients better or worse off after surgery or interventional procedure? (an industry-first)

  • Mortality rate in 1 year
  • Hospital days following surgery
  • Repeated surgery on the same body part

The goal of providing the Modus Rating is to answer relevant questions commonly asked by patients, payors, and stakeholders. Modus believes it is essential that the metrics being used are understood by our customers, the third-party payors, and individual stakeholders who could be financially responsible for healthcare outcomes. These metrics are incorporated into the Clinical Intelligence and analytics algorithms to provide a rating for each physician. The ratings are based solely upon the results of the Modus Clinical Intelligence & Analytics algorithms that reflect healthcare outcomes.

The ultimate determination of how to use these ratings is left to the end user. Modus guides its clients to select the most highly rated doctors but does not endorse or recommend the use of any specific doctor. Modus does not endorse the use of terms such as best or worst performing doctor. The Modus metrics and specifications are not clinical guidelines and do not establish a standard of medical care. Modus makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance ratings and metrics and Modus has no liability to anyone who relies on such metrics and ratings.

Modus determine best practice using guidelines from multiple resource examples listed below but not limited to:

Reporting a perceived error: We completely understand that sometimes data used by Modus can be subject to influences beyond its control. If this happens, and a metric score provided by Modus doesn’t seem right, we want to help address this with you. Please review the Frequently Asked Questions (below) as this may help you understand your query. If not, Modus has a simple and transparent process for you to address any perceived errors with a score provided by Modus.

If you believe there is an error with a score provided by Modus, we will investigate this for you. You can request this by following the link provided HERE.