Frequently Asked Questions

Modus is comprehensive, independent and strives for full transparency for all our users. If you can’t find your answer here, don’t hesitate to reach out to our team.

Modus is a privately held healthcare company that takes a completely fresh approach to healthcare, leading to Better Care for Less. Our intelligence analytics model and clinical insights rate MSK doctors to ensure patients are guided only to who have shown consistently better quality.

We use our patented machine learning technology to leverage publicly available claims data, for 183 million patients published by Medicare (CMS, LDS, and Data.). The average analysis is 5,400 billing codes per doctor. NPI verified claims that we updated monthly. The data is then compared to that of the doctor’s peers within the same specialty and state before being displayed to users.

Our ART, SUBJECTIVE OPINION, that we form based on the metrics extracted from subjective data and using our clinical lense.

NO. Why

  1. Since we track harmful care that occurs due to ELECTIVE surgeries and procedures, it is the doctors’ duty and responsibility to judge the benefits vs risk of harm to patients before performing any elective care. Surgeons and Interventionist doctors have a clear choice in treating patients with ELECTIVE interventions, compared to primary care doctors who should have risk adjustment because they have limited choices in the type of patients they care for.
  2. Some Providers (doctors and hospitals) as well as insurers (Medicare Advantage) historically had fraudulently Upcoded to make their patients look sicker than they really are, to make more money.

We then deliver our Clinical Intelligence directly to your team at the right moment of the user flow using one of the different options we have available:

  1. API integrations: For teams that currently use and like specific claims management or patient navigation software, we can directly integrate with that software and send information in real-time using APIs.
  2. Web-based portal: Our sophisticated web-based portal allows teams to search for specific locations and care specialties to produce a list of rated doctors.

Sadly, no. And this philosophy practiced by too many doctors makes absolutely no sense. It’s the equivalent of hiring an arsonist to burn down your house for pest extermination, leaving you homeless, and with a bigger problem than you originally had. applying something as a last resort implies that it is beneficial – and a lot of times, it’s not. The right philosophy should be doctors treating patients because our judgment and experience indicate the benefit outweigh the risk and the harm that comes out of the treatment.

NO, cost by itself does not tell the whole picture. It needs to be part of a big picture where multiple metrics create a profile of what type of practice a doctor is doing.

Yes, if other factors are included.

A. Are there patients better or worse off after surgery?
B. Are they holding a hammer so everything they see is a nail?
C. Are they only focused on doing what they know (i.e. surgery) and ignore safer, less invasive, and less expensive treatment options?

A doctor’s practice pattern determines the objective data points, collected by Medicare and used by Modus. Changing your practice pattern will influence the data that Medicare collects which will in turn influence a doctor’s Modus rating.

By following the Modus perceived error data process. You can complete a simple form to raise your concerns and indicate the data that you believe to be incorrect. Modus will then review, investigate, and provide feedback on its findings to you.

If there is an error that Modus can verify, Modus will correct any score found to be incorrectly referenced against the data provided by Medicare. If a Modus score is correctly referenced with the data provided by Medicare, Modus will not be able to change your score.

  1. We focus on doctors’ practice patterns and generally doctors’ behaviors are consistent across payers
  2. Almost always (some states exceptions), fee schedules are set for all codes, so when doctors try to increase their fees they perform more units (to make up for the discounted unit rate)
  3. Medicare data is more accurate because its NPI verified for each doctor, compared to WC data that often identify doctors only by their tax ID, which leads to confusion when multiple doctors are in the same practice
  4. Medicare covers everything, just like workers’ compensation does, in contrast to commercial plans with coverage mandated by their payers
  5. According to the Bureau of Labor Statistics, workers older than 60 years old are the fastest-growing population in the WC, so WC population increasingly looking like Medicare’s