Orthopedists Data Confidence

Data analysis is in the eye of the beholder, For the benefit of our client, we processed CMS data for 183 Million patients and analyzed it with a clinical lens.

CMS Bucket (<50 procedures):

This group represents doctors who have performed fewer than 50 procedures over three years. The value proposition for this bucket is low because the data is not robust enough to yield meaningful insights or trends. These doctors may be not accepting medicare patients, are new to practice, work part-time, or be in specialties that do not require frequent procedures. In terms of profiling, these doctors might not be prioritized because their low activity suggests limited data for analysis.

Bucket (50-2K procedures):

Doctors in this category have a moderate volume of procedures. While the data is more substantial than in the Black Bucket, it may still be insufficient for high-confidence profiling without augmentation from additional data sources. The value here lies in the potential to enhance the dataset with external information, which could make these doctors viable candidates for profiling and analysis. It’s a middle ground that could yield valuable insights with the right data enrichment.

Bucket (2k-14k procedures):

Only 8% of all Orthopedists in the US rated here, they are the best and most trusted, treating Medicare patients and applying great experience and judgment despite the system.

This bucket is the sweet spot for data analysts. It represents a balance between volume and potential for thoughtful practice. Doctors in this range likely have enough procedure volume to provide reliable data for profiling and trend analysis but not so much that it’s overwhelming. This could indicate experienced doctors with a steady flow of procedures, offering a rich dataset for deriving insights and making well-informed decisions.

Bucket (14k-Max procedures):

Rated Doctors here are doing high numbers of X-ray imaging and joint injections, but still have good quality and cost.

Doctors in the Red Bucket have a very high procedure count, suggesting they are highly active in their field. The value proposition here is twofold: on the one hand, there is ample data for robust analysis; on the other hand, the high volume may indicate less time per patient, potentially affecting the thoroughness or thoughtfulness of care. These doctors may be great for identifying high-demand services and efficiency patterns, but the data might require careful interpretation to account for the high-volume context.

Executive Summary

We hold Modus-rated doctors in very high regard, they excel in caring for Medicare patients, positing that their dedication and quality of care likely extend to all their patients, not just those covered by Medicare. This perspective emphasizes the importance of recognizing healthcare professionals who go above and beyond in their duties, showcasing exceptional commitment, skill, and empathy in their practice.

Doctors who excel with Medicare patients often deal with complex health issues that require medical expertise and a deep understanding of the socioeconomic factors affecting this patient group. These skills and qualities likely benefit all patients under their care, reflecting a high level of professionalism and dedication. Such doctors may also be more attuned to preventive care, patient education, and the management of chronic conditions, which are critical aspects of healthcare for the elderly and disadvantaged populations often covered by Medicare.

This recognition underscores the value of comprehensive, patient-centered care and the positive impact it can have across the healthcare system. By highlighting the work of these “super docs,” there’s an opportunity to learn from their approaches and potentially replicate their success in various healthcare settings, ultimately improving patient outcomes. It’s a call to acknowledge and celebrate healthcare professionals who set high standards of care and compassion, inspiring others in the field to strive for excellence in serving all patients, regardless of their insurance status or background.

This memorandum outlines Modus strategic approach to analyzing the Centers for Medicare & Medicaid Services (CMS) data, encompassing information from 183 million patients, through a clinical lens. The objective is to extract actionable insights that significantly benefit our clients across the healthcare spectrum. This analysis is crucial for understanding healthcare trends, patient care quality, policy implications, and identifying opportunities for cost-efficiency and quality improvement in patient outcomes.

Understanding CMS Data

CMS data is an invaluable asset in the healthcare industry, offering a comprehensive overview of healthcare utilization, cost, outcomes, and patient behavior trends among the Medicare and Medicaid populations. It includes detailed records on diagnoses, procedures, pharmaceutical prescriptions, and more, making it a goldmine for data-driven insights in healthcare.

Applying a Clinical Lens

Analyzing CMS data through a clinical perspective involves interpreting the information beyond statistical analysis. This approach considers the medical context, focusing on:

  • Disease Trends and Management: Identifying and understanding patterns in disease prevalence and the effectiveness of various treatment options.
  • Quality of Care: Evaluating healthcare provider performance and identifying potential areas for improvement.
  • Health Outcomes: Analyzing different treatment outcomes to guide best practice approaches.
  • Cost Efficiency: Identifying treatments that offer cost savings without compromising quality.

Benefits to Clients

The insights derived from this analysis serve a broad spectrum of clients, including healthcare providers, policymakers, insurance companies, and pharmaceutical companies, by:

  • Informing Strategic Planning: Guiding decision-making processes regarding service offerings, resource allocation, and policy adjustments.
  • Driving Quality Improvement: Highlighting care gaps and opportunities to enhance patient care and outcomes.
  • Facilitating Market Analysis: Providing a deeper understanding of the healthcare market, the patient needs, and areas ripe for investment.
  • Supporting Policy Development: Offering evidence-based insights to aid in the formulation of policies aimed at improving healthcare systems and patient welfare.

Challenges and Ethical Considerations

The analysis of CMS data, while offering substantial benefits, also presents challenges:

  • Data Privacy and Security; Ensuring compliance with privacy laws and regulations while maintaining data security.
  • Managing Data Volume and Complexity; The sheer volume and complexity of the data necessitate advanced data processing and analysis capabilities.
  • Interpretation and Application: Effectively translating data insights into actionable and context-specific strategies for clients.


We choose CMS data because of how large and challenging it is with the understanding that a doctor doing good work with CMS patients is worth highlighting to our clients.

The strategic analysis of CMS data through a clinical lens holds the potential to revolutionize healthcare delivery, and policy formulation, and enhance the quality and efficiency of patient care. By addressing the challenges and leveraging the insights derived from this data, we can offer significant value to our clients, shaping a more efficient, effective, and patient-centered healthcare landscape.

Ali Alhimiri, MD
Founder, CEO

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