Using TEAM Performance Year Data — 5 Pitfalls & How to Avoid Them
- Steven Weiss
- 6 days ago
- 2 min read
Ignoring claims lag & making conclusions too early. CMS TEAM data is provided monthly during the performance year, but recent episodes may be missing claims, and previously submitted claims may still be updated. Using this early, incomplete data can lead to inaccurate episode spending estimates. Wait at least 8–12 weeks after an episode ends before incorporating spending into performance calculations.
Comparing episode spending to target prices without risk adjusting. Target prices are risk-adjusted at reconciliation based on each beneficiary’s risk profile. Adjust your target price for each beneficiary risk factor (e.g., hierarchical condition categories, demographics, economic risk variables) by multiplying your target price by the correct risk adjustment factor. Relying only on preliminary target prices may overstate or understate performance.
Equating standardized dollars with actual paid amounts. The standardized payment fields in your CMS files remove payment adjustments for geography, wage indices, and quality programs. They are useful for making comparisons across providers or to target prices, but they don’t represent what Medicare actually paid. To calculate actual payment amounts, make sure to use the Medicare paid variables (for example, the variable “Total Raw Allowed Amount of the Episode”).
Drawing conclusions from too few cases. Small sample sizes can make results highly volatile and misleading. For episode types or surgeons with low episode counts, aggregate across similar procedures or surgeons, or expand the time frame of analysis.
Overlooking insights hidden in the claim-level data. Episode summaries alone can mask key drivers of variation. Dive into the claim-level detail to pinpoint cost drivers, such as post-acute destination and duration, readmissions, or emergency department visits. These granular insights often reveal actionable opportunities for improving care coordination and reducing costs.
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Ready to use your TEAM data to maximize model performance? Contact Steven Weiss - SWeiss@Mathematica-MPR.com
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