Jackpot! Why Winning the Lottery Won’t Change Our Data

With the three big winners in last night’s lottery splitting such a large pot, the income-level demographic data for where they live will be effected. However, depending on the way you look at this effect, there will either be slight changes if any, or there will be a large change. The reason for this difference is that demographic datasets supply both mean and median household incomes.LottreryBalls_Clipped

The lottery winners provide us with a great example of why we run median household income rather than average household income. This is because using a mean generally works well for data with normal distributions while medians are generally used on data with skewed distributions. And as you can probably guess, income data is quite the skewed dataset. Since a mean is so heavily influenced by outliers, we use a median. The median value will provide the value in the middle of the data (when sorted in ascending order).


To illustrate this, let’s pretend that one of the lottery winner’s home ZIP code has 10,000 people. Let’s also pretend that, by some kind of freak chance, every one of these people has an income of exactly $50,000. That would mean that that ZIP code has an average and median household income of $50,000. But, the lottery winner has now changed that. With their income changing from $50,000 to somewhere around $500,000,000, the new mean household income would be $99,995 and the median income would remain $50,000.

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Stratasan Training 2016

Objective: Attendees should be able to navigate the tool, access Gallery, run Canvas reports, and run Blackbird queries after attending both sessions.

Timeframe: Two consecutive days, the second Tuesday and Wednesday of each month; day one covering an overview of the tool, Gallery and Canvas and the next day covering Blackbird.  Each session will be one hour.


January 12, 13

February 9, 10

March 8, 9

April 12, 13

May 10, 11

June 14, 15

July 12, 13

August 9, 10

September 13, 14

October 11, 12

November 8, 9

December 6, 7



See the Stratasan App for Registration Links

StrataNews: November 2015

Check out our latest newsletter from November 2015. Highlights include our December webinar announcement, Excel tips and tricks, and a preview of our upcoming new product, Pathways. Read the newsletter here.


Achieving More with Less: Working Smarter, Not Harder

It might seem like ages ago, but do you remember a time before e-mail?  There are likely some of you who can, and some of you who can’t.

When I first entered into the healthcare industry, computers were making their way into just about every healthcare setting, but emailing had yet to come.  You would type a MEMORANDUM interoffice envelopeusing a word processing program, print it, place it in an interoffice envelope and write the recipient’s name on the outside of the envelope.  You would then place the envelope in an outgoing mail box in your office.

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Introducing: Hospital Market Share Dominance Maps

We are constantly searching for new, effective ways to present intelligence from data. In order to accomplish this, the Stratasan team uses tables, charts, graphs and maps instead of raw data tables alone. Pairing these visual tools with raw data increases the efficacy of our products and adds a necessary element of excitement to the black and white world of data for our customers. The most common requests we fulfill are those around market share. This report specifically benefits from converting the data into visuals. Our goal is to present market share data in a way that clearly displays a hospital’s (and their competitors’) presence in a market. We wanted it to be visually interesting while still providing a useful picture of a market area. So, Stratasan is pleased to introduce the Market Dominance Map.

Market Dominance Map

Map illustrating market share leader by ZIP; color gradient illustrates how strong their market share is within each ZIP.

The Market Dominance Map (above) shows hospital reach by color and the significance of that reach by color saturation. If a hospital has a majority market share in a ZIP code, that ZIP is filled with the hospital’s color according to the map legend. Depending on how high the hospital’s leading market share is, the color is shaded from dark (high market share) to light (lower market share). We refer to this visual representation of reach as “dominance” of a ZIP code.  The percentage number in each ZIP represents the leading hospital’s market share. As you can see in the example above, only the leading hospital per ZIP is represented. This is a quick and clear picture of the market’s major providers and what portions of the market these providers have cornered. “But what about our competition within ZIPs?”

Market Dominance, Highly Contested ZIPs

ZIPs with less than 10% market share separating the two leaders are cross-hatched

To increase the value of this project, including the top competitor is the obvious move. To maintain the clarity of the map, we put a limit on what constitutes “competition.” In each ZIP code, if the dominant hospital has market share less than ten percentage points higher than the next hospital; the second leading hospital’s color will cross-hatch through the ZIP.

Highly Contested ZIPs

Limiting map to only those ZIPs that are “highly contested”, defined as the top two market share leaders being within 10% of each other.

The final view for this project is to give the hospital strategic planning team a view of the ZIP codes in their service area where the market leader is in a “highly contested” market share race with another facility. The percentage listed in each ZIP code is the market share percentage of the second facility. Market share is an undeniable part of hospital strategy. For a clear, concise portrait of dominance in your market, contact us today.

Community Health Needs Assessment – Implementation, Monitoring and Evaluation

Your Community Health Needs Assessment is complete with lots of community involvement.  Your community has assisted in prioritizing the most important health issues.  Your hospital has selected and prioritized the health issues and goals that it will work on, and has justifications for the issues it will not work on.  There is still one more requirement to be met: an implementation plan with monitoring and evaluation of efforts.  Stratasan suggests creating a Health Issues dashboard containing as much of the following information as possible.

  • Your hospital’s prioritized health issues
  • Action items related to health issues
  • Measurable goal statements
  • Pre-CHNA health indicator score
  • Your hospital’s goal for the health indicator
  • National or state median for comparison
  • Best practice or national benchmark for the health indicator
  • Healthy People 2020 goal
  • Source of the data
  • Timeframe for update of the indicator

For example, if the hospital selects diabetes as a community issue to improve, it may have an action of increasing exercise in the population through community exercise programs, a fitness center, and physicians’ offices prescribing exercise for their patients.  The health indicator score may be physical inactivity defined as the percent of adults aged 20 and over reporting no leisure time physical activity.

The pre-CHNA score was 26% and the current year’s available data may indicate 27% physical inactivity.  This is in comparison to national and state benchmarks of 21% and 30% respectively.  The Healthy People 2020 goal is a 10% improvement, so the goal would be set to reduce down to 24%.  The source of the data is the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) survey.  The current year available is 2010.

A concern relative to the implementation plan is the efficacy of initiatives that hospitals and other community organizations are undertaking.  Are they actions proven to result in health improvement? HealthyPeople.gov contains interventions and resources to assist hospitals select evidence-based actions.

The drawback to many of the health indicators it he lag time in measurements.  Unless the hospital is performing its own survey of the population, many of the national surveys, BRFSS and National Health Interview Survey or American Community Survey, will lag behind at least one year.

According to a report form the CDC regarding Best Practices for Community Health Needs Assessment and Implementation Strategy, “A key concern in the community benefit arena is the relative capacity of hospitals to monitor and evaluate the effectiveness of programs and activities.  This becomes more important in the context of health reform, with the anticipation of a reduced demand for charity medical services, and increased emphasis on addressing the underlying causes of persistent health problems.”

The key is to select actions that are evidence-based and will result in actual health improvement and to measure the results even if the measure lags behind the efforts. The IRS allows a hospital to keep the same implementation plan for three years.  The measures will eventually reflect the actions of the hospital and the community.  If the hospital finds its actions are not improving the measure, they may make adjustments to the implementation plan.

For help with your Community Health Needs Assessment and Implementation Plan, give us a call: 866-628-5051 or visit Stratasan.com.

2012 Medicare Statistics

Medicare accounts for 38.4% of the total U.S. discharges based on the latest Stratasan projection of 38,919,778 inpatient discharges. The ability to understand who, and where your Medicare patients are coming from is critical to all providers who accept Medicare as a payor. Below are some key statistics from the 2012 Medicare Provider Analysis and Review (MedPAR) claims file.

Table 1: Top 10 DRGs sorted by total number of discharges for Medicare inpatients

Table 1: Top 10 DRGs sorted by total number of discharges for Medicare inpatients

The top DRG by volume in 2012 was 470, Major joint replacement or reattachment of lower extremity w/o MCC (Major Complications or Comorbidities), passing Psychoses by nearly 100,000 discharges. The average length of stay for DRG 470 is three-days, which is two days less than the overall average.

Figure 1: Medicare rate per 1,000 persons by age group

Figure 1: Medicare rate per 1,000 persons by age group

Figure 1 (above) illustrates an increase of Medicare use rates as the age group increases. As expected, the 85+ age group has the highest use rate, with 514 Medicare discharges for every 1,000 people. This is more than 80% higher than the rate of the total population 65 years and older. Table 2 (below) shows the number of discharges and total population for each age group over 65.

Table 2

Table 2

The map below illustrates Medicare use rates by ZIP code per 1,000 people, age 65 and older. Due to this being a rate per 1,000 people, there is a natural adjustment for low population.

There are concentrated areas of high Medicare rates throughout the southeast. As you move west across the country, Medicare use rates decrease significantly. A few exceptions exists in areas such as Tucson and Albuquerque, where Medicare use rates are high compared to the region.



Table 3

Table 3

Table 4

Table 4

Table 3 (above) lists the top 5 states by Medicare discharges. California is leading the country by volume, with 8% of total Medicare discharges. However, because of such a high population, California’s use rate is not as high in comparison to other states such as Kentucky or West Virginia, as you can see in table 4 (above).

At Stratasan, we work with our clients to help them gain a better understanding of the patients they serve. Contact us today for more information.


What’s Going on inside the Heart of Cardiac Services?

Recently, we performed an analysis for a customer on cardiac services trends.  Based on previous studies, we knew cardiac inpatient services were declining overall.  However, we discovered that inside cardiac services many of the sub-service lines behave quite differently; many declining but some actually increasing.  We analyzed all-payer data from Florida, Texas and California alongside full U.S. Medicare data and discovered a deeper understanding than “inpatient cardiac services are declining.”

The first step was to define sub-categories for Cardiology and Cardiovascular/Thoracic Surgery (CVT surgery) service lines for a clearer picture of where declines are occurring.

Cardiology Product Line

Cardiovascular/Thoracic Surgery Product Line

Total Medicare Cardiac Services inpatient cases declined, -8.6% from 2009 to 2011.  Cardiology inpatient cases declined, -7.6% from 2009 to 2011.  Cardiovascular/Thoracic Surgery inpatient cases also declined but at a much larger rate, -11.2% from 2009 to 2011.

Screen Shot 2013-03-12 at 8.32.55 AM

Looking inside Cardiology, we can see that the largest decline in Electrophysiology (EP)/Devices (pacemaker replacements and revisions).  This decline was followed by Cardiac Catheterizations, Other Cardiology and Acute Myocardial Infarctions (Acute MI).  Acute MIs declined the least, -6.5% from 2009-2011.

Screen Shot 2013-03-12 at 8.33.09 AM

Although Cardiovascular/Thoracic Surgery declined more than Cardiology, some subservice lines actually increased in volume. Heart and lung transplant MS-DRGs increased 32% from 2009 to 2011.  Valve surgeries increased 3.9% from 2009 to 2011.  Major chest trauma increased 6.4% from 2009-2011.  The largest declines in the CVT Surgery service line were Cardiac defibrillator implants with cardiac catheterization, declining 23% from 2009 to 2011.  This decline was followed by EP/Devices declining 18%.  Cardiac bypass surgery is down 13% and Cardiac interventions are also down 13%.

Screen Shot 2013-03-12 at 8.34.54 AM

Looking even further inside the Transplants sub-service line (MS-DRGs 001, 002, and 007).  MS-DRG 001, Heart transplant or implant of heart assist system with major complications or comorbidities increased 51.7% from 2009 to 2011.  The proliferation of heart assist systems has propelled this tremendous growth, not necessarily heart transplants.

State Data Comparisons

In California and Florida we analyzed the same time period, 2009 to 2011 for trends.

In California, the Cardiology trends are the same as for Medicare, declining 5.8%.  The highest decline was in EP/Devices (-17%), and the lowest decline in Acute MI (-1.5%).  In CVT Surgery, again the same trends, total volume down 6.2% with increases in transplants (21.9%), trauma (11.6%) and valve surgery (9.5%) while EP/Devices with Cath (-13.2%) and EP/Devices (-11.8%) declined the most.

In Florida, Cardiology declined 5.4% while CVT surgery declined 8.5%.  In Cardiology, Cardiac Caths (-8.2%) edged out EP/Devices (-7.2%) for the highest declines in Cardiology.  Other Cardiology (-4.2%) declined less than Acute M.I (-6.2%).  In CVT Surgery, the same trends appeared, transplants (21.6%), trauma (13.5%) and valve surgery (13.5%) increased while the EP/Devices with Cath (-23%) led the decliners followed by EP/Devices (-14.8%).

In Texas, we analyzed 2010 and 2011 data.  All of the Cardiology sub service lines declined  for a total 2.7% decline, and EP/Devices (-9.3%) led the way.  CVT surgery declined 3.5%, but the trends within CVT surgery shifted slightly, transplants were down (-17.8%), but Other CVT surgeries increased 4% from 2010 to 2011, trauma (8.6%) and valve surgery (4.1%) also increased.  The decliners were led by EP/Devices with Cath (-27.1%) and EP/Devices (-10.2%).

If you would like a cardiac services analysis for your market, give us a call. Phone: 615-500-3497, Fax: 615-208-9657, Email: tod@stratasan.com, www.stratasan.com

Sources:  Center for Medicare & Medicaid Services, Medicare Provider Analysis and Review (MedPar) hospital discharge data, 2009-2011. State of California Office of Statewide Health Planning and Growth, 2009-2011 hospital inpatient discharge data.  State of Florida Agency for Health Care Administration 2009-2011 hospital inpatient discharge data.  Texas Department of State Health Services, Texas Health Care Information Collection 2010-2011 hospital inpatient discharge data.


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