Clear Rates

Dialysis Centers in Clear Rates

Source: PR #5128

Steps in provider.sql:

• Array associated NPIs from the two spines tables to the provider_id level.

dialysis_center_array_npi as (
    SELECT
        provider_id,
        ARRAY_SORT(ARRAY_AGG(DISTINCT cast(npi as varchar))) as npi
    FROM (
        SELECT provider_id, npi
        FROM {{ cld_params.Tables.SPINES_PROVIDER_DIALYSIS_CENTER.value }}
        UNION
        SELECT provider_id, npi
        FROM {{ cld_params.Tables.SPINES_PROVIDER_DIALYSIS_CENTER_ADDITIONAL_NPIS.value }}
    )
    WHERE npi IS NOT NULL
    GROUP BY provider_id
),

• The dialysis_centers CTE reads directly from the spines table and joins arrayed NPIs, geo lookups (state, CBSA), and NUCC taxonomy. Unlike Labs, there is no Komodo encounter filtering — all spines providers are included.

dialysis_centers AS (
    SELECT
        p.provider_id,
        CASE
            WHEN npis.npi[1] IS NULL THEN NULL
            ELSE npis.npi
        END as npi,
        p.provider_name as provider_name,
        p.provider_city AS city,
        p.provider_state AS state,
        p.provider_cbsa_code AS cbsa,
        p.provider_parent_system as health_system_name,
        p.provider_type as provider_type,
        p.taxonomy_code,
        p.national_payer_coverage
        -- ...
    FROM {{ cld_params.Tables.SPINES_PROVIDER_DIALYSIS_CENTER.value }} p
    LEFT JOIN dialysis_center_array_npi as npis
        ON p.provider_id = npis.provider_id
    LEFT JOIN nucc ON p.taxonomy_code = nucc.taxonomy_code
    LEFT JOIN geo_state ON p.provider_state = geo_state.state_abbreviation
    LEFT JOIN geo_cbsa ON p.provider_cbsa_code = geo_cbsa.cbsa_id
),

• The result is unioned into the final df CTE alongside hospitals, ASCs, labs, PGs, infusion centers, etc.
• In lookback runs, Dialysis Centers are excluded from the state filter (same as ASCs and PGs).

Codeset (Rate Object Space)

• A dedicated dialysis_center_codeset table defines which billing codes are plausible for Dialysis Centers. Codes include:

  • Hemodialysis procedures: 90935, 90936, 90937
  • ESRD monthly management: 90960–90966
  • EPO / Erythropoiesis-stimulating agents: J0882, J0885
  • Iron preparations: J1756, J1439, J1437, J1443
  • Vitamin D analogs: J0636, J1270, J2501

• In the rate object space, Dialysis Center codes are filtered to bill_type = 'Professional' and matched against the codeset:

SELECT DISTINCT
    cs.bill_type,
    cs.billing_code_type,
    cs.billing_code,
    cs.facility,
    'Dialysis Center' as provider_type,
    NULL as provider_subtype,
    NULL as provider_id,
    '' as billing_code_modifier
FROM {{ schema_name }}.tmp_ref_code_spine_{{ sub_version }} cs
WHERE cs.bill_type = 'Professional'
    AND cs.billing_code IN (
        SELECT billing_code
        FROM {{ cld_params.Tables.DIALYSIS_CENTER_CODESET.value }}
    )

Accuracy Scoring

• Dialysis Centers use the standard medical accuracy scoring method.
• QA thresholds: minimum 3.0% of providers must have rates (same as Imaging Centers).