Leveraging Neural Networks to Profile Health Care Providers with Application to Medicare Claims

Encompassing numerous nationwide, statewide, and institutional initiatives in the United States, provider profiling has evolved into a major health care undertaking with ubiquitous applications, profound implications, and high-stakes consequences. In line with such a significant profile, the literature has accumulated an enormous collection of articles dedicated to enhancing the statistical paradigm of provider profiling. Tackling wide-ranging profiling issues, these methods typically adjust for risk factors using linear predictors. While this simple approach generally leads to reasonable assessments, it can be too restrictive to characterize complex and dynamic factor-outcome associations in certain contexts. One such example arises from evaluating dialysis facilities treating Medicare beneficiaries having end-stage renal disease based on 30-day unplanned readmissions in 2020. In this context, the impact of in-hospital COVID-19 on the risk of readmission varied dramatically across pandemic phases. To efficiently capture the variation while profiling facilities, we develop a generalized partially linear model (GPLM) that incorporates a feedforward neural network. Considering provider-level clustering, we implement the GPLM as a stratified sampling-based stochastic optimization algorithm that features accelerated convergence. Furthermore, an exact test is designed to identify under and over-performing facilities, with an accompanying funnel plot visualizing profiling results. The advantages of the proposed methods are demonstrated through simulation experiments and the profiling of dialysis facilities using 2020 Medicare claims sourced from the United States Renal Data System.