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physician referral data

CMS Physician Referral Data

Have you ever wanted to ask your major referring physicians what percentage of their patients they send to your practice vs. your competitors?  CMS releases data that tracks providers who treat common patients.  If a patient is seen by two providers within a specific period, CMS reports the initial and subsequent provider.  Savvy practices can use this data as a proxy for referral information.  The physician referral data can also be used to estimate the market share of referrals from providers and groups of providers.  I have access to these datasets and can provide a customized analysis for your practice.  If you’ve spent much time on this site, you won’t be surprised to learn that the customized analysis comes as a Pivot Table.  Download the Sample Analysis below to see what your spreadsheet might look like.

The Data

CMS assumes a shared relationship between physician A and physician B when a claim for physician B follows a claim for physician A within 30, 60, 90 or 180 days for the same beneficiary.  The 2014 dataset of matching NPI data within 30 days is over 55 million rows of shared patient relationships.  CMS data includes the NPI number of the first provider, the NPI number of the second provider, and the number of unique patients shared by the two providers.  To protect patient privacy, CMS excludes any shared relationships with fewer than eleven distinct beneficiaries.  Even though CMS will look at intervals of 30, 60, 90, or 180 days between the dates of service for the two providers, to filter out some of the noise in the data the groups I work with generally start with a 30 day interval.  Just because two providers treated the same patient within 30 days does not mean that the first provider referred the patient to the second provider.  Correlation does not equal causation.  The data can, however, show care patterns that can help a practice better understand where patients are being referred.

Reducing Noise in the Data

CMS data often includes labs, DME providers, hospitals, and other healthcare providers that may not matter to practices trying to use the data to understand referral patterns.  To reduce that noise and focus more on shared relationships that indicate referrals, practices can send me a list of their providers’ NPI numbers and their competitors’ NPI numbers.  By filtering the data to only focus on referrals to a specific set of NPI numbers, referral patterns are much easier to identify.  I can also filter the referring providers to specific states, zip codes, or a list of taxonomy codes.

What do I need to get Started?

The physician referral data analysis will be most useful if you send me an Excel spreadsheet.  Enter your practice’s NPI numbers and your competitors’ NPI numbers in column A.  Provide the group name of the practice or competitor’s practice in column B.  Tell me whether the group is a competitor (Y/N) in column C.  Other optional information you can send in additional columns includes the providers’ first and last names, their specialty/sub-specialty, the main hospital or facility where they practice, geographic information, or any other information that would be helpful to analyze referrals and market share.  A sample NPI spreadsheet is included below.  Contact me using the form below.  I’ll arrange to get a copy of your NPI spreadsheet.


I charge $2,500 for the first dataset and $1,500 for additional datasets.  CMS releases datasets by year and by the interval between the two providers’ interactions with the patient.  For example, 2015 data with a 30 day interval costs $2,500.  Additional analyses of other years (2009 – 2014) or intervals (60, 90, 180 days) are $1,500.  The cost includes uploading and including the custom NPI data described above and an hour of my time to talk live and begin to interpret the data.  More customization time is available for an additional charge.

The Sample Analysis spreadsheet below gives you a feel for what your spreadsheet will look like.  The demo data uses additional fields in the NPI spreadsheet like specialty and provider type to add power and flexibility to the analysis.  Additional fields are optional and are shown in yellow on the Sample NPI spreadsheet.


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