Physicians and their interactions with patients stand out in the world of medical data because each interaction generates a claim that we are able to use to create insights into the physician's practice. There are several physician/patient metrics that you will find in numerous locations throughout Marketscape. You will find a list of these metrics with their locations and how to interpret each in the article below.
These metrics often provide an instant insight into the value of the physician as a potential referral source. There are two simple differentiators that always stand out:
- Patient Volume: A physician with a large count of patients is more likely to be a potential source of referrals. This is also especially true for physicians who have large numbers of specifically home health patients. In sum, larger counts are better.
- Claim type: Followed Patients, Patients 3 months prior, and Last Claimed Patients - Each of these claim types provide insights into the referral potential for the physician. Each of these claim types reveal a "proximity" between the physician and an admission to a Home Health Agency.
In some Marketscape locations, the three listed claim types are shortened to Followed, 3 Months Prior, and Last Claimed.
Understanding the Metrics
The Patient Volume Table (screenshot above) will be found on the Analyze page for any physician under the Patient Population tab. In this table, the most recent four quarters will not add up to the number in the Total (Distinct Patients) column. This number is not a total; it is best to look at this as an annual count to be compared with the quarterly counts found in the dated columns.
All Medicare Patients
All Medicare Patients is the count of distinct patients for which the selected physician filed a Part B claim during the most recent one year reporting period.
This metric represents the volume of patients seen by the physician. The trend over the quarters indicates whether the Medicare portion of the physician's practice is growing or shrinking. 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.
Home Health Patients
This is the number of the named physician’s distinct patients who received home health services during the reporting period. It is limited to patients who were counted under the three claim types, Patients Followed, Patients 3 Months, Prior, and Last Claimed Patients. As such, it is a union of these three claim types, not a total, because a patient could be counted under more than one claim type.
This is a significant number to examine in comparison to the total medicare patients treated by the physician. The Home Health Patients metric is a count of admissions for a physician who treated the patient within three months to establish a sense of connection between the physician and post-acute care.
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.
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.
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.
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.
- 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.
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.
- 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.