Traditional approaches to healthcare quality have long rested on a deceptively simple question: Who is a good provider?
But in high-stakes healthcare, particularly in medical tourism, international referrals, and employer-sponsored care, this question misses the mark entirely.The more accurate question is far more specific:
A good provider… for what procedure? For which diagnosis? For what complexity?
A clinician may be excellent at performing one type of surgery yet perform only sporadic volumes of another. A generalist may excel in managing broad categories of care but lack deep procedural experience. Even the most celebrated experts are never equally strong across all interventions.
Yet the majority of global rating systems, consumer-facing platforms, and enterprise analytics tools continue to group providers by broad specialty, assigning simplistic “good vs average vs poor” ratings without interrogating the actual mechanics of clinical expertise.
This is where specialty-level ratings fail, and where a new generation of data-driven intelligence is urgently needed.
Why Specialty-Level Ratings Fail: The Core Misalignment
1. Specialty Labels Don’t Reflect Actual Work
A surgeon may be classified as:
• Orthopedic Surgery
• Neurosurgery
• Gynecology
• Urology
• General Surgery
But these labels reveal nothing about what they actually do:
• Do they perform 200 knee replacements a year, or only five?
• Do they treat complex endometriosis or only mild stages?
• Do they perform minimally invasive spine procedures or only open operations?
• Are they adept at high-risk patients or only low-risk routine cases?
Specialty labels obscure the real driver of outcomes: procedure-specific repetition, mastery, and pattern recognition.
2. Ratings Often Reflect Patient Experience, Not Clinical Expertise
Many consumer-facing platforms over-index on items such as:
• Appointment availability
• Parking convenience
• Staff friendliness
• Waiting room time
These are important to patients but irrelevant to surgical competency.
Even patient experience surveys suffer from bias:
• Low response rates
• Feedback skewed toward very satisfied or very dissatisfied users
• Variability unrelated to clinical outcomes
• Subjective interpretation of care quality
A polished waiting room can easily mask suboptimal procedural experience.
3. Adverse Events Alone Don’t Tell the Full Story
Mortality, readmissions, and complications are often used as proxy indicators of quality. However:
• They require extensive risk adjustment to avoid penalizing providers who treat sick or complex patients.
• They highlight only extremes, such as top and bottom performers, while revealing little about the majority.
• They capture failure, not expertise.
• They vary dramatically based on patient demographics and underlying conditions.
In isolation, these metrics paint an incomplete, sometimes misleading picture.
4. Evidence-Based Practice Patterns Are Essential but Incomplete
Guideline adherence and documentation of medical necessity are valuable. Yet, without contextualizing:
• Procedure volumes
• Adverse event trends
• Comparisons to peers
• Longitudinal changes in practice
These measures represent only one part of a complex quality equation.
Some providers excel at documentation, not outcomes.
5. Claims-Based Systems Often Miss Procedure-Level Precision
Enterprise systems that analyze claims data sometimes fail to:
• Differentiate between occasional and high-frequency procedures
• Track year-over-year evolution of a provider’s practice
• Capture nuanced patterns of intervention
• Tie pricing data to actual performance
• Identify variation within the same specialty
As a result, they generate technically correct but practically useless specialty-wide quality labels.
The Consequence: Misguided Patient Navigation and Suboptimal Outcomes
Medical tourism facilitators, employers, insurers, and care navigators rely heavily on rating systems to recommend providers. When these ratings are overly broad, three major challenges arise:
1. False Confidence in Specialty-Level Rankings
A highly rated orthopedic surgeon may score well overall but perform very few:
• Hip procedures
• Shoulder repairs
• Ankle replacements
• Complex revision surgeries
This creates a dangerous assumption: If they’re good at one orthopedic procedure, they must be good at all.
2. Inefficient Referral Pathways
Patients may be routed to providers who:
• Don’t specialize in the required intervention
• Have inconsistent practice patterns
• Lack sufficient procedural volumes
• Demonstrate higher-than-average adverse event rates in the specific needed procedure
This reduces effectiveness, increases costs, and prolongs recovery time, particularly for cross-border patients.
3. Network Development Based on Incomplete Data
Insurers and employer-sponsored programs may build networks that are:
• Broad but not deep
• Geographically diverse but not expertise-aligned
• High-cost without measurable high performance
• Optimized to specialty lumps instead of procedure-level mastery
In an industry already strained by global inflation and rising healthcare costs, such misalignment is unsustainable.
The Solution: Why Procedure-Level Ranking Is the New Gold Standard
To evaluate true expertise, stakeholders need measurable intelligence that aligns:
• What a provider actually does
• How often they do it
• How well they do it
• How consistently they perform over time
• How their outcomes compare with peers
• How their costs align with their performance
This requires a holistic, evidence-based, and procedure-specific approach to provider evaluation, built not on anecdotes, reviews, or specialty-level assumptions, but on comprehensive longitudinal claims data and risk-adjusted patterns.
This is precisely the gap filled by Denniston Data’s methodology.
How Denniston Data Redefines Provider Quality: A Holistic, Evidence-Based Model
Denniston Data’s approach centers on the Provider Ranking System™ (PRS), a robust, scalable, and transparent methodology built on multi-source claims data. Its strength lies in its ability to map real-world performance at both specialty and, crucially, procedure-level granularity.
1. Multi-Source, Multi-Year Claims Intelligence
PRS incorporates:
• Commercial health claims
• Medicare Fee-for-Service
• Medicare Advantage
• Workers’ compensation datasets
The result: more than 2 million unique providers assessed with year-by-year clarity from 2012 onward.
2. Procedure-Level Ranking: The True Differentiator
Unlike specialty-level aggregates, PRS allows users to see:
• The exact procedures a provider performs
• Annual procedural volumes
• Evidence-based practice patterns
• Patterns of interventions
• Adverse event frequencies
• Adherence to medical necessity
• Longitudinal changes in performance
This is the only way to identify the right provider for the right procedure.
3. Composite Ranking Score (CRS)
A transparent, quality-only score that distills:
• Outcomes
• Practice patterns
• Adverse events
• Procedure-specific expertise
Unlike platforms influenced by advertising or pay-to-play strategies, CRS reflects pure performance.
4. Smart Score: Integrating Real Pricing Data
With Transparency in Coverage rules, pricing data is now available, yet most tools fail to connect cost with quality.
Smart Score does just that by integrating:
• Network-level pricing
• Billable vs. allowable costs
• Actual utilization patterns
• Variance in cost relative to outcomes
This bridges the price–quality divide, giving payers and navigators a powerful tool for value-based decisions.
5. Provider Profiles With Actionable Detail
Each provider profile includes:
• National, regional, and local rankings
• Specialties and subspecialties
• Individual procedure rankings
• Quality and cost performance
• Year-over-year trends
• Adverse event patterns
• Patient demographics and risk profiles
This eliminates guesswork, bias, and incomplete assessments.
6. Seamless Integration via API
PRS is designed for:
• Automated workflows
• Care navigation platforms
• Insurer integration
• Self-insured employer analytics
• Medical tourism decision-making frameworks
All without complex installations or infrastructure upgrades.
Why This Matters for Medical Tourism and Global Care Navigation
1. Cross-Border Patients Require Absolute Precision
When patients travel internationally, the margin for error is small:
• No second chances
• No easy follow-up
• No tolerance for complication-driven delays
• No room for specialty-level assumptions
Procedure-level precision is essential.
2. Employers and Insurers Demand Value Alignment
Global organizations want:
• Lower costs
• Better outcomes
• Optimized referral pathways
• Reduced variation in care
Procedure-based intelligence delivers measurable improvements across all four categories.
3. Destination Hospitals Compete on Expertise, Not Marketing
Medical tourism thrives when:
• Quality is measurable
• Expertise is transparent
• Outcomes are objectively validated
Procedure-level ranking empowers facilitators to create accurate, trustworthy patient pathways.
The Future of Provider Quality Starts With Precision
Specialty-level ratings worked for a simpler time, when data was scarce, outcomes were opaque, and expertise was assumed rather than measured.But modern healthcare demands more.
Patients deserve to know:
• Not just who is a good provider
• But who is the right provider for their specific procedure
Employers, insurers, and medical tourism agencies require tools grounded in evidence, not reviews, reputation, or generalized labels.
Denniston Data’s methodology represents a new frontier of provider evaluation: transparent, comprehensive, and procedure-driven.
In a world where incomplete data creates costly misalignment, precision is not a luxury; it is a necessity.And procedure-level intelligence is the only path forward.
The Medical Tourism Magazine recommends Denniston Data for anyone who islooking for high quality healthcare data analytics. Launched in 2020, DDI is aninnovator in healthcare data analytics, delivering price transparency andprovider quality solutions known as PRS (Provider Ranking System), HPG(Healthcare Pricing Guide), and Smart Scoring combining quality and price. Theyhelp payers, hospitals, networks, TPAs/MCOs, member apps, self-insuredemployers, and foreign governments identify the best doctors at the best pricesby procedure or specialty at the national, state, or local level, and by payeror NPI/TIN code.
Join an intro to PRS Webinar:
https://zoom.us/webinar/regist0065r/7117646163323/WN_2ELqNeDSS2W-fMPb4lOsRA
Or schedule a discovery call with Denniston Data:
