When looking at metrics for a selected physician, it is helpful to know how Trella Health creates those metrics. It is important to remember that Medicare claims don't contain any referral information, so it is impossible to get counts of referrals or create metrics about physician referral patterns from the claims. However, by looking at connections between claims, we can infer referral potential between a physician and different levels of post-acute care.
Not all of the metrics listed below will be visible in Marketscape CRM. Nevertheless, the descriptions of the metrics behind the metrics you see will be helpful.
You will see HHA Patients: Followed in Sales Spotlight for a selected physician (click on their name.)
But you will not see HHA Patients - a patient count. This metric is a union of three different metrics that are not visible in Marketscape CRM: (these are also listed below)
- HHA Patients: Followed - A count of patients where the selected physician is the certifying physician
- HHA Patients: 3 Months prior - A count of patients who were admitted to home health care who were treated by the listed physician within 3 months of admission. That is, the physician submitted a professional claim and within 3 months the patient was admitted to home care.
- HHA Patients: Last Claimed - the count of patients where the professional claim submitted by the physician was the last one submitted prior to the patient being admitted to home care.
You can see that for a specific physician-patient pair, the claims could generate a "count" in one, two or all three categories. A patient for whom the physician submitted that last claim prior to home health admission would most likely be also within three months, and the physician could also be the following physician. However, that one patient would be only counted once in the umbrella metric "HHA Patients."
Each of the metrics above tell a story about the referral potential of a selected physician.
Understanding the Metrics
Some of the following metrics are used throughout Marketscape CRM in the main table or in Sales Spotlight. Others are listed so you can understand them when they are described in reference to other metrics. Where these metrics are nuanced, clarifying notes are included and additional description will be added to the Help Center articles for the specific tables where the data is different.
Medicare FFS Patients
These metrics are the count of distinct patients for which the selected physician filed a professional claim during the most recent one-year reporting period.
This metric represents the volume of patients seen by the physician. Evaluating this metric is critical. Clearly a physician with a very small count will not be a fruitful source of Medicare patient referrals. Some physicians (Radiologists for example) have enormous counts but don't necessarily have actual patient contact that can be turned into referrals. Many times identifying the physician's specialty will help to evaluate patient counts.
This is the count of patients who died during the one-year reporting period who had been treated by the physician during the six month reference period prior to their date of death.
Home Health Patients (Overall)
This is a union of the next three metrics, Home health Patients: Followed, Home health patients: 3 Months Prior, and Home health Patients: Last Claimed. As the name of the metric implies, this is an overall metric that provides a measure of the home health appropriate patients treated by the physician. Specifically, this is a number of physician's patients who were admitted to home health care.
You can't add the three following metrics to get the overall number. As mentioned above, a single patient could be counted in one, two, or three of the other metrics, but would only be counted once in the overall metric.
This is a significant number to examine in comparison to the count for Medicare FFS Patients treated by the physician.
HHA Patients: Followed
This is the count of distinct patients who were admitted to home health services during the reporting period where the named physician is identified as the certifying physician on the home health claim.
The following physician certifies that the patient needs home care services and determines the course of care. A physician who follows a larger number of patients is clearly committed to home care and is a prime candidate to cultivate as a partner. Look for physicians whose patients are spread over a number of home health agencies and discuss with that physician areas of strength that you have shown with shared patients.
HHA Patients: Three Months Prior
Three Months Prior is the count of distinct patients where the named physician treated the patient in the 3 months prior to the patient's home health admission.
A physician with a high number of 3 Months Prior patients is involved with those patients during a critical time in the continuum of care. These physicians are poised to engage patients on the course of care and even the selection of a home care facility. It is always valuable to evaluate the Home Health destinations for a physician with numerous 3 Months Prior patients to see how your facility is being utilized.
HHA Patients: Last Claimed
This metric is the number of distinct patients for whom the named physician submitted the last professional claim prior to the patient's home health admission.
A physician who has a large number of last claimed patients has the highest likelihood of being the physician who recommended the subsequent post-acute care. This number does not indicate an actual referral, only the logical inference that the physician could have influenced the care choice.
Patient Metrics Example - Ruth
Ruth was an 85 year old female diagnosed with COPD and CHF. She recently suffered a fall at home and went to the emergency room for treatment. The emergency room referred her to an Orthopedic MD for a broken wrist. After treatment, Ruth was referred to Home Health care for OT, PT and nursing. The total stay for the course of treatment included one initial episode and 1 re-certification - July 3 to October 7 - 96 days of care. During that period Ruth received an average of 8 visits per episode from nursing and 14 visits per episode for all types of therapy.
HHA Patients: Followed
- The Orthopedic MD receives a single count as the following physician, identified on the RAP (Request for Advanced Payment) at the time of admission for Home Care.
HHA Patients: 3 Months Prior
- The Primary Care Physician and the Orthopedic MD both receive a count for 3 Months Prior because they each submitted a claim in the three month reference period before admission to Home Care.
- The PCP only receives a single count despite submitting multiple claims during the three month reference period. The counts in these columns are unduplicated counts, that we call distinct patients.
HHA Patients: Last Claimed
- The Orthopedic MD receives a single count for Last Claimed for the claim submitted in June. This was the most recent claim submitted prior to admission to Home Care.
- The average visits for Nurses and Therapists provides an insight into the amount of care provided by each of the specialties. The nursing average includes visits by both RNs and LPNs. Therapist visits includes Physical Therapy, Occupational Therapy, Speech-Language Pathologists, Physical Therapy Assistants, and Occupational Therapy Assistants.