Working With NPI Numbers in Cancer Registries Jerri Linn Phillips, M.A. National Cancer Data Base Commission on Cancer American College of Surgeons Chun Chieh Lin, Ph.D. American Cancer Society

Purpose This presentation will provide Guidelines for manual and automated searches for NPI numbers Recommendations for identifying incorrect numbers Examples of administrative and research uses of NPI numbers

NPI = National Provider Identifier Organizational Individual

Organizational NPI: Hospitals Electronic linkage by hospital name to NPPES NPI files –Most fail to find matches –“Multiple listings” per hospital Manual look-up –Not as flexible –But can usually interpret best match visually –Useful for generating rules for linkage

Problems Matching by Name Problem Names differ, but recognizable to manual review Example CoC: Provena Saint Joseph Medical Center Official: Presence Hospitals PRV DBA: Presence Saint Joseph Medical Center

Problems Matching by Name Problem How many ways can one write the same thing? –Saint –St. –St (no period) Example CoC: Northwest Healthcare Official: Kalispell Regional Medical Center Inc DBA: NW Healthcare

Does the NPI Refer to a Hospital? For hospitals, CoC requests that they report the NPI for the full hospital –Not the campus, department, or network 95% of NPIs cleared by NCDB are identified as a hospital as their principle category –Another 3% identify hospital as a category, but not their principle one –CoC has a handful of free-standing non- hospital clinic programs

Secrets for Selecting the Best NPI Obvious: the hospital name and address match, at least to the human mind –Separate address for administration, practice What is the title of the authorized official? –A highly-ranked official President, CEO, vice president or CEO Billing, finance officer, or similar designation Never: Resident, chief surgeon, nurse Exception: VA

But if Multiple Options Remain I look for the NPI that identifies billing codes for: –The most providers –Both Medicaid and Medicare –At least Medicare –A small number of CoC-accredited programs appear not to accept either Medicaid or Medicare, but have NPI numbers

Tracking It Down When Name Totally Fails Manually: –Zip Code is the narrowest identifier if name does not work –Play detective: Karmanos example

Electronic Recommendations Check both legal and DBA name fields Use your case-linkage software to discover similar names –Subset by ZIP Code, perhaps by organization type OR Strip punctuation, perhaps spaces, put “Saint” into constant form across the board If nothing else works, consider looking for “contains” key portion of hospital name Check taxonomy codes (Maximum of 4 in April 2013 organization entities)

As For Any Record Linkage … Visual Check

Individual NPIs: Physicians Primary Surgeon NPI Radiation Oncologist NPI Medical Oncologist NPI

Completeness for each NPI field (Lung) Prim SurgPhys 3: Rad Onc Phys 4: Med Onc

For Surgery (Lung Cancer) Top 3 specialties relevant to lung surgery (> 90%) –Thoracic Surgery (64.16%) –Surgery (18.77%) –Specialist (7.52%) Examples of clearly bad NPI –Internal Medicine (0.27%) –Student in education/training program (0.22%) –Dermatology (0.07%) –OB/GYN (0.02%) –Sleep Medicine (0.01%) –Psychologist (0.01%)

For Radiation Therapy (Lung Cancer) For radiation given in reporting facilities –18,306(87%) relevant to lung radiation Radiation Oncology (83%) Therapeutic Radiology (4%) Radiation Therapy (0.03%) –228(1.08%) relevant to medical oncology For radiation given outside reporting facilities –5877(83.7%) relevant to lung radiation Radiation Oncology (80%) Therapeutic Radiology (3.62%) Radiation Therapy (0.19%) –243(3.46%) relevant to medical oncology

For Chemotherapy (Lung Cancer) 12,795(81.2%) relevant to medical oncology –Hematology & Oncology –Medical Oncology –Hematology 144(1%) relevant to radiation

For Coded NPI: Was the Treatment Actually Given? (Lung Cancer) Treatment GivenTreatment Not Given Primary Surgeon25965(45.4%)¹31221(54.6%) Physician 3 - Radiation Oncologist 43072(80.9%)²10168(19.1%) Physician 4 – Medical Oncologist 29267(35.67%)52790(64.33%) ¹Surgical treatment includes any surgical procedures (biopsy, resection or NOS) ²Radiation treatment includes radiation therapy was given either in reporting facility or outside reporting facility

For Surgery Received: Top NPI Categories by Stage Stage IStage IIStage III Thoracic Surgery (64.93%) Thoracic Surgery (63.63%) Thoracic Surgery (64.25%) Surgery (19.2%)Surgery (19.5%)Surgery (18.64%) Specialist (7.26%)Specialist (8.03%)Specialist (8.33%) Vascular Surgery (4.75%) Vascular Surgery (5.08%) Vascular Surgery (3.84%) Surgical Oncology (0.56%) Cardiovascular Disease (0.57%) Pulmonary Disease (0.81%)

We continue to dig for more information …