Data analysis of Medicare claims is figuring prominently in a bitter takeover battle between two of the country's largest for-profit hospital systems.
In a recent filing with the Securities and Exchange Commission, Tenet Healthcare Corp., Dallas, included a summary of allegations in a lawsuit it filed against corporate suitor Community Health Systems, Franklin, Tenn.
The 19-page summary features several graphs drawn from what Tenet said was the analysis by two consulting firms—one unnamed and the other Avalere Health of Washington—using data gathered from the CMS' Inpatient Prospective Payment System Standard Analytic Files and Outpatient Standard Analytic Files.
The summary alleges that Community's use of lower-paying "observation status" is below "half the national average rate for U.S. hospitals."
In its summary, Tenet said most hospitals use one of two vendor-developed sets of "independent, evidence-based clinical criteria to determine whether a patient qualifies for inpatient admission"—InterQual Criteria, developed by McKesson Corp., or Milliman Care Guidelines, developed by Milliman. Tenet notes in the SEC summary that Community, however, uses its own guidelines.