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Care Site table population

CDM Builders
#1

We have received data from WebMD and as per the data source there are Rendering, Billing and Referring provider details and we have a specific table provider facility,which has their individual ZIP codes, we are not sure whether we should include all the provider details in care_site table or only Provider_facility table. As per our understanding Rending provider should be the billing provider, but its not the case in the data source. So our approach was to include all the provider details in the care_site table. Any help would be appreciated.

Thanks
Ajinkya

#2

@Ajinkya_Patale:

What the claims usually call “provider” is really a mix of individual providers and institutional providers. The OMOP CDM splits them up. People providers (doctors, nurses, midwives etc.) are in the PROVIDER table, the institutions (hospitals, private group practices etc.) in CARE_SITE. This problem exists in all of the US claims data. You need to develop a heuristic of how to tell them apart. I am not an expert, but there are folks like @MNairn, @IYabbarova, @jenniferduryea, @Gowtham_Rao etc. who know this stuff really well.

#3

Generally speaking (is true in 99% of cases) in US claims data
Rendering - human being, provider, physician
Referring - human being, provider, physician
Billing - non-human being, care site, hospital/place

So in a record, rendering human provided care at billing hospital and was referred by referring human being. Referring is generally not reliable.

1 Like
#4

I can suggest 2 possible ways to distinguish between provider and care_site:

  1. if it is presented in data, use a flag indicating type of provider (there was a case when rendering provider field contained 3 types of providers - human being, facility and ‘other’)

  2. if it is presented in data, use specialty associated with rendering or referring provider, because in claims data values like ‘Pharmacy’, ‘General Practitioner’, ‘Hospital’ can be all stored in one specialty field.

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