Overview

The purpose of this article is to help you understand the metrics in Sales Spotlight and know how to use them effectively.

Navigation to specific metrics in this article -

 

Brief Orientation

Sales Spotlight comes in five flavors and the differences between the flavors is where you will find each version and the metrics available in each. 

• Sales Spotlight In Marketscape Insights - - on Physician or Facility Analyze pages, Sales Spotlight is the content in the first tab.
• Sales Spotlight Email - - In Marketscape Insights only, on Physician or Facility Analyze pages, under the Sales Spotlight tab, you can send yourself the Sales Spotlight email. Look for this button 
• Sales Spotlight In Marketscape CRM - - click on Market Spotlight, then for any physician or facility, when you click on the provider's name, Sales Spotlight will open.
• Conversation Starters - In the case of both Sales Spotlight in Marketscape Insights and Sales Spotlight in Marketscape CRM, there is a "view" of the content called Conversation Starters. The metrics in Conversation Starters are different in that they are presented in a sentence that compares two metrics. The metrics in the Sales Spotlight email are all presented in this sentence format.

For more information about all of the pieces of the Marketscape Platform, see Welcome to the Marketscape Platform.

 

Signposts

So that you can quickly determine which metric is in which version of Sales Spotlight, as each metric is described below, we will display the following icons:

    - For metrics included in Sales Spotlight in Marketscape Insights (MARINS)

- For metrics included in the Sales Spotlight email (SSEmail)

- For metrics found in Sales Spotlight in Marketscape CRM (MARCRM)

Details about Conversation Starters will be included under each metric in which they appear.

 

 

 In this article

Content summary

This article contains how to understand and use the content found on each metric tile in Sales Spotlight. You can certainly browse the entire article, or, you can use the following list of metrics in order to find a specific metric of interest and navigate to that section of the article using the link. The metric names are links to the detailed content.

 

Sales Spotlight has two sections - Get to Know this Physician  and How do I stand out?

Click on the metric name to immediately navigate to the details for that metric.

Get to Know this Physician

• Patient Volume - two metrics - Annual Patient Count (FFS) and HHA Patients: Followed - The count of distinct patients treated by the selected physician and the count of physician's patient who were admitted to home health. 
• HHA Patients: Followed - The count of home health patients where the selected physician is identified as the certifying physician for the home health course of care
• Home Health Utilization - 3 Months Prior - The percentage of the physician's patients who were admitted to home health care.
• Top HHA Destinations - The three home health agencies who admitted the largest number of the selected physician's patients.
• Patient Risk Score - The HCC risk scores are used to adjust cost relative to other NPIs of the same provider type.
• Highest Affiliation Hospital - The facility where the highest percent of the selected physician's patients were treated by the physician in an inpatient or outpatient setting during the one year reporting period.
• CMS Payer Mix - 20XX - (MARINS4HHA only) - This tile has the most recent possible comparison metrics for patient counts for the selected provider in the same year for Medicare Fee for Service, Medicare Advantage, and Medicaid. Since MA metrics are not released by CMS for about two years, this comparison is generally two years old.
• Annual Patient Count (FFS) - the count of distinct Medicare FFS patients treated by the selected physician during the one year reporting period. These counts come from professional claims only.
• Patient Locations - This table includes counts and percentage of patients for the top five counties where patients lived who were treated by the selected physician.
• Chronic Conditions - This table includes the top five chronic conditions diagnosed for patients treated by the selected physician.
• Patient Diagnostic Mix - This table includes the top five diagnoses for patients treated by the selected physician.
• Total Patient Count - This table includes counts of distinct home health patients by claim type.
• Place of Service - distinct patient counts and percentages for the locations where the selected physician treated patients.

How Do I Stand Out? - There are only three metrics included. However, these metrics could be shown for different Diagnostic Groupings.

• Total Patient Cost Following HHA (12-month Risk-Adjusted) - The average cost of care for your agency for patients discharged from home care for the twelve months after discharge.
• Readmission Rate - The readmission rate for your agency.
• Hospitalization Rate within 30-days from Start of Care - The percent of patients admitted to your agency who were admitted to a hospital within 30 days of home health start of care.

In this article we take a deep dive into each metric; definition, calculation, and where to find the metric in Marketscape Insights or Marketscape CRM.

 

 

Section 1 - Get to Know this Physician

Evaluate

As the name implies, the metrics in this section of the Sales Spotlight or the Sales Spotlight email you will find some of the most helpful and insightful metrics to help you evaluate the selected Physician as a referral source.

 

Understanding and Using the Metrics

 

Patient Volume

This Conversation Starter is called "Patient Volume" in the Sales Spotlight email and in both versions of Sales Spotlight under Conversation Starters. (See image)

 

Using this Metric

Evaluate - Simply, a physician who treats more patients has a greater potential as a source of new and ongoing referrals. As an advocate for home health care in general and a partner with your agency in particular, a physician with more patients has higher potential.

Connections

• Look at the Home Health Destinations table under the Destinations tab for the physician to see if the 357 home health patients are being admitted to a small number of home health agencies or to a larger spread of agencies. A small number of agencies might be indicative that the physician is referring those patients, which shows a commitment to home care. A large number may also mean that the physician is already locked in with another agency. A spread could mean that a partnership with this physician could inspire referrals to your agency.
• Next steps? Examine the patient demographics for the physician. Are the patients in locations you serve? Are the primary diagnoses of the physician's patients aligned with your initiatives and areas of strength?

Understanding the Metric

Definition

Home Health patients - This is the count of distinct Medicare FFS Patients treated by the selected physician within 3 months of home health admission. This metric is called "HHA Patients: 3 Months Prior" throughout Marketscape.

Medicare FFS Patients - Count of distinct Medicare FFS patients treated by the physician during the one-year reporting period (where the physician was listed as the performing physician on a professional claim).

The count of Medicare patients is included in both versions of Sales Spotlight in the tile "Annual Patient Count (FFS)."

 

Metrics Calculation

These are both unique counts based on the claims.

Reporting Period - Both of these counts are from a one-year reporting period.

 

Where can I find this metric?

In addition to the Sales Spotlight email, you can find these metrics:

• In MARINS, on the Explore page. In that table, the metrics are called HHA Patients: 3 Months Prior, and Annual Patient Count (FFS).
• In MARINS, on the Analyze page for the selected physician, under the Patient Population tab in the Patient Volume table in the rows for Medicare FFS Patients, and HHA Patients: 3 Months Prior.
• In Marketscape CRM, under the Marketscape Spotlight tab, this metric is called Home Health Patients (Overall) and HHA Patients: 3 Months Prior for the selected physician.
• In both versions of Sales Spotlight the count of Medicare FFS patients can be found on the tile for "Annual Patient Count (FFS)"

 

HHA Patients: Followed

 

Sales Spotlight -

Sales Spotlight email

To the left of the main metric, you will find an arrow pointing up or down that indicates whether this metric has increased or decreased for the selected physician since the prior year count. The number in the top row indicates the change.  The image above is from Marketscape Insights for Home Health. The tile in Market Spotlight in Marketscape CRM is identical apart from the image used for the arrow.

This metric is not included in the Sales Spotlight email.

 

Using this metric

Evaluate - 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.

Connections

Similar to the general patient counts above, you will want to look at the Home Health Destinations table under the destinations tab for the physician to see if these followed patients are being admitted to a small number of home health agencies or to a larger spread of agencies.

 

Definition

HHA Patients: Followed - This is the count of distinct Medicare Part A patients who received home health services during the one year reporting period with the physician listed as the certifying physician on the home health final claim.

Details

To the left of the main metric, you will find an arrow pointing up or down that indicates whether this metric has increased or decreased for the selected physician since the prior year count. The number in the top row indicates the change.

 

 

Calculation

This metric is a count drawn directly from the claims.

Reporting Period - This metric is calculated from a one-year reporting period.

 

Where can I find this metric?

In addition to the Sales Spotlight email, you can find this metric:

• On the Explore page, in the row for the selected physician, although the metric is called Physician HHA Patients.
• On the Analyze page, under the Patient Population tab in the Patient Volume table under the name HHA Patients: Followed.
• Under Market Spotlight in Marketscape CRM, in the main table. 

On the Marketscape Insights Explore page, and in Market Spotlight, you can use this metric (sort) to find physicians who have followed a larger number of physicians.

 

 

Home Health Utilization - 3 Months Prior

 

Sales Spotlight on Analyze page	Sales Spotlight email and Conversation Starters
To the left of the main metric, you will find an arrow pointing up or down that indicates whether this metric has increased or decreased for the selected physician since the prior year percentage. The number in the top row indicates the percent change. To the right of the main metric you will find the state home health utilization percent average for all physician in the same state with the same specialty. The image above is from Marketscape Insights for Home Health. The tile in Market Spotlight in Marketscape CRM is identical apart from the image used for the arrow.	In the Sales Spotlight email and in Conversation Starters, this metric is presented in comparison with the state average for all physicians in the same specialty. The difference between the selected physician's metric and the state is included.

 

Using this metric

Evaluate - Home Health Utilization is a measure of the physician's commitment to home health care. The higher the percentage, the higher the commitment. 

Connections

This metric is a performance indicator that shows you something about the selected physician and his or her desirability as a partner or potential as a reference source.

Use this metric to compare physicians. (You can compare physicians using this metric on the Marketscape Insights Explore page, or in Market Spotlight in Marketscape CRM)

 

Create your story

Use this metric to engage a physician. On the one hand, if the physician is beating the state average, it is a powerful conversation starter to point out a physician's excellence. On the other hand, you might use this metric in a discussion with an underperformer to offer your assistance to help the physician increase their connection to home care.

 

Definition

This metric is the percent of the selected physician's patients who received home health services during the one year reporting period and were treated by this physician within 3 months of admission to home health.

 

Calculation

Numerator - Count of home health patients who were treated by the physician within 30 days of home health admission.

Denominator -  Count of Medicare patients treated by the physician.

 

 

Reporting Period - This metric is calculated from a two-year reporting period. Since this is a calculation based on counts from two year reporting periods, neither the numerator nor the denominator appear anywhere in Marketscape.

 

 Details

With Conversations Starters off

• In the center is the core metric. This is the metric for the selected physicians calculated from the most recent two years of claims.
• On the left is a trend indicator. The  indicates that the selected physician's home health utilization is down 3.92% from the previous metric from a year ago. The arrow is red to indicate that a decrease year over year is an undesirable trend. If the trend had been up, the percentage increase would have been indicated by a green arrow, pointing up.
• On the right is the state average of home health utilization for all physicians in the same state and in the same specialty as the selected physician. The comparison shows that our selected physician, despite dropping since last year, is still performing well against his peers.

 

Sales Spotlight Email or with Conversation Starters on

• The selected physician's utilization metric is compared to the state average for all physicians with the same specialty in the same state. The difference is calculated.

 

Where can I find this metric?

In addition to the Sales Spotlight email, you can find this metric:

• On the Explore page, in the row for the selected physician, the metric has the same name, HHA Utilization 3 Months Prior.
• This metric can be viewed as a quarterly trended metric under the Utilization tab on the Analyze page for the selected physician.
• In Marketscape CRM, under the Market Spotlight tab, in the column "Home Health Utilization."

 

 

Top HHA Destinations

Sales Spotlight on Analyze page	Sales Spotlight email	Sales Spotlight in Marketscape CRM

 

Using this metric

This table shows you the top three home health destinations for your selected physician's patients. At a glance you can see if your agency is in the top agencies receiving patients treated by the selected physician.

If you are not showing up in this small table, see "Where can I find this metric" below.

 

Evaluate  and Compare

Obviously, the goal is to be a top destination for a physician's patients. This table (along with the complete table on the Destinations tab, or in the Market Spotlight table) will allow you to evaluate your rank and compare your patient counts against you competitors.

 

Where can I find this metric?

The complete table of all home health agencies that admitted patients treated by the selected physician can be found under the Destinations tab on the Analyze page for the selected physician.

 

Patient Risk Score

Sales Spotlight on Analyze page	Sales Spotlight email and Conversation Starters
	Not included

 

Using this metric

Evaluate & Compare

Risk Scores provide insight into the level of care required for a provider's patient population, and the score provides a frame of reference to evaluate a provider’s performance relative to its peers. Based on the score for each provider, we assign a risk category, which is included under the number. 

Example: when we compare two similar providers using performance metrics, like patient costs or length of stay, we expect a provider with a higher risk score to have higher costs or longer lengths of stay. For your messaging, therefore, you want to account for the level of care required for a provider's patients, and the Risk Score provides this insight.

 

Definition

The HCC risk scores are used to adjust cost relative to other NPIs of the same provider type. Adjusted costs allow for better comparison across NPIs with different risk scores because it accounts for the increased cost of patients with chronic conditions.

 

Calculation

Trella Health uses CMS’s Hierarchical Condition Category (HCC) model to calculate Risk Scores.

 

Connections

When you compare two providers and notice a higher risk score for one over the other, it is helpful to investigate further to see the details that explain why one provider has a higher score. For example, on the Analyze page for a provider, you can click on the "Patient Population" tab to investigate patient diagnoses and chronic conditions to see more about the provider's patients.

 

Where can I find this metric?

In addition to Sales Spotlight, you can find this metric:

•  On the Explore page in the row for your selected physician.

 

For more information, see Risk Scores and HCC.

 

Highest Affiliation Hospital

Sales Spotlight	Sales Spotlight email and Conversation Starters
	Not included

 

Using this metric

Understand - This is a metric for use in strategic planning. It identifies where the physician spends their time. This helps to identify possible connections to a health system or a joint venture system. At the most basic level, it might just help the right rep to know where to make contact.

 

Definition

This is the facility that treated the highest percentage of the selected physician's patients in an inpatient or outpatient setting during the one year reporting period. The highest affiliated facility is named and the patient percentage is included below the name.

 

Calculation

This metric is the percentage of the selected physician's distinct Medicare patients who were treated at the listed Facility.

 

Where can I find this metric?

In addition to the Sales Spotlight email, you can find this metric:

•  On the Explore page in the row for your selected physician.

 

CMS Payer Mix - 20XX

Using this metric

Evaluate - As a user, this table allows you to view the payer mix for a physician or hospital at-a-glance in Sales Spotlight so you can identify whether the provider is a good fit for your organization. For example, if you want to target FFS patients, you can qualify a referral source by viewing their payer mix here.

The table includes counts of distinct patients treated by the selected provider during the one-year reporting period for three different payers:

• FFS - Medicare Fee for Service
• MA - Medicare Advantage
• Medicaid

In order to provide a meaningful comparison between the three different payers, we display counts from the most recent year for which all three payers have complete counts available. Since Medicare Advantage data is delayed by two years, we use two year old data to make counts of FFS and Medicaid patients.

This means that the Medicare FFS counts will not match any other metrics in Marketscape Insights.

 

 

Annual Patient Count (FFS)

Using this metric

Evaluate - Use this metric to assess whether the physician is a good prospect to cultivate for increased referrals. In general, a physician with a larger numbers of distinct patients has a higher potential for referring patients.

 

Questions - It is important to consider what the patient count represents. What does it mean when a physician has a patient count over 50,000 patients? What about 10,000? 5,000? How many patients can a doctor reasonably treat in a year? If a physician submits claims for 9,000 patients, how many of those claims represent patients with whom the physician discussed additional care? Is the office submitting all claims under the same physician's NPI? The largest number of patients associated to a physician's NPI might not mean an excellent referral source.

 

Connections

In Marketscape CRM, it is helpful to check out the remaining Sales Spotlight metrics which provide patient demographics, chronic conditions and diagnoses. In short, investigate the demographics of the physician's patients to see if there is a good alignment with your agency.

In Marketscape Insights, these metrics are found on the physician's Analyze page under the "Patient Population" tab.

 

  Where can I find this metric?

• In Marketscape CRM, this metric can be found under the Market Spotlight tab in the column named "Annual Patient Count," in the row for the selected physician.
• In Marketscape Insights, the metric is visible:
  • On the Physician Explore page in the row for the selected physician.
  • On the physician's Analyze page, under the "Patient Population" tab in the "Patient Volume" table in the column, "Annual Patient Count," in the row for "Medicare FFS Patients."

 

Patient Locations

 

Using this metric

Evaluate

This table reveals location demographics for the selected physician's patients. At a glance you can see if the physician is treating patients in an area that your agency serves.

 

Understanding the Metric

 Definition 

This table contains the top five counties where the most patients live who were treated by the selected physician during the one year reporting period.

Counties with less than eleven (<11) patients residing therein are aggregated together into a count and reported as "Other" in the table. When this category is displayed in the table, what you are really seeing is the top four counties for patients of the listed physician. There is no way to display the breakdown of the counties with <11 patients because of the privacy suppression requirements.

 

 Calculation

From the physician's professional claims, we count the number of distinct patients who reside in each county listed.

 Details

This table includes three columns:

• County - The county where the patients live.
• State - The state where the patients reside. In cases where a physician lives near a state border, you will sometimes see counties from multiple state displayed in this table.
• Percentage - The percentage of the physician's total distinct patients that live in each county listed.

It is possible that not all counties show up in this table. If that is the case, the percentages will not add up to 100%.

 

  Where can I find this metric?

• In Marketscape CRM, there are no additional metrics of this type available.
• The complete table of all patient location demographics can be found in Marketscape Insights, under the "Patient Population" tab in the "Patient Locations - County" table

 

Chronic Conditions

 

Using this metric

Evaluate

This table displays the top five chronic conditions for patients treated by the selected physician during the one year reporting period. The value of this table is that it allows you to identify areas of care where your agency's expertise aligns with the patients of the selected physician. In addition, the counts of patients with chronic conditions will also help you to evaluate the level of care required for the physician's patients.

 

Understanding the Metrics

 Definition 

The table has three columns:

• Chronic Condition - the patients counted in the row were treated for the listed diagnosis.
• Annual Patient Count -  this is the count of distinct patients treated by the selected physician during the one-year reporting period who met the criteria for the listed chronic condition.
• Percentage of patients - the percentage of the selected physician's patients who met the criteria for the listed condition.

 Calculation

In short, we count the number of patients who met the criteria for the listed chronic condition.

What is the criteria?

We follow the CCW chronic condition algorithm that searches the CMS administrative claims data for the specific diagnosis codes, MS-DRG codes, or procedure codes for each chronic condition. For each patient that matches one of the specific criteria, we count that patient for the identified chronic condition.

For those of you who want all of the details, see Lotsa Chronic Conditions Details. This is the source we use for aligning patients to chronic conditions.

About the percentages

• These percentages will probably never add up to 100%. Patients with multiple chronic conditions in their diagnoses will be counted when calculating the percentages in each row. That is, lots of patients impact multiple rows.
• If you are interested, this is one of the metrics that you can see how we calculated the percentage. One of our previous metrics, Annual Patient Count (FFS) shows that our selected physician treated 1,845 patients. If we look at the count in the first row of the Chronic Conditions table, we see that 1,524 patients were diagnosed with hypertension. 1524/1845 = .826 or 82.6% which we round up to 83%, as the table shows.

  Where can I find this metric?

• In Marketscape CRM, there are no additional metrics of this type available.
• The complete table of chronic conditions for all patients can be found in Marketscape Insights, under the "Patient Population" tab in the "Chronic Conditions" table

 

Patient Diagnostic Mix

 

Using this metric

Evaluate

This table displays the top five Trella Health diagnostic groups  for patients treated by the selected physician during the one year reporting period. The value of this table is that it allows you to identify areas of care where your agency's expertise aligns with the patients of the selected physician. 

For more details, see Trella Health Diagnostic Groupings.

 

Understanding the Metrics

 Definition 

  The table includes three columns:

• Trella (Health) Diagnostic Group - the patients counted in this row have a primary diagnosis that is included in the Trella Health diagnostic group listed in the row
• Top Diagnoses - this column contains the top three diagnoses (based on the primary ICD-10 diagnosis codes) for patients treated by the selected physician that fall within the listed Trella Health diagnostic group
• Annual Patient Count - the count of distinct patients treated by the physician with a primary diagnosis code included in the listed Trella Health diagnostic group

 

 Calculation

The connection between diagnosis codes and the Trella Health diagnostic groupings is described in detail in the article: Trella Health Diagnostic Groupings. We identify the primary diagnosis for each patient treated by the selected physician and count the number of distinct patients that align with each diagnostic group. The diagnostic groups with the highest counts are included in the table.

 

  Where can I find this metric?

• In Marketscape CRM, there are no additional metrics of this type available.
• The complete table of metrics for the Trella Health Diagnostic Groupings for all patients can be found on the Marketscape Insights Analyze page for the selected physician, under the "Patient Population" tab in the "Patient Diagnostic Mix" table.

 

 

Total Patient Count - CRM only

 

Sales Spotlight on Analyze Page	Sales Spotlight Email	Sales Spotlight in Marketscape CRM
Although this content is not available in Sales Spotlight, the complete table can be can be viewed in Marketscape Insights for Hospice on the Analyze page for the selected physician under the Patient Population tab, in the table, Patient Volume.	This content is not available in the Sales Spotlight email.

 

For a complete introduction to the metrics in this table, see Patient Counts and Claim Types.

Understanding the Metrics - 3-months, Last Claimed, Followed

 Definitions 

These three metrics are probably the most important metrics in Marketscape for identifying referral potential for a prospective physician. It is not too much to say that you should probably start your assessment of any physician by looking at this table.

Medicare claims do not contain any referral information. However, we can infer "referral potential" by looking at details and connections between claims. Trella Health uses three categories of claims to identify a physician's potential as a referral source.

• 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.
• 3 Month Prior - This is the count of all patients treated by the selected physician during the one year reporting period who were admitted to home health care within 3 months of being treated by the selected physician. Since we are looking for referral potential, a physician who treats patients shortly prior to admission to home care are more likely to have the opportunity to identify the need for home care and advise the patient. A physician with a high number of 3 month prior patients is worth closer evaluation as a referral source.
• Last Claimed - This is the count of patients for whom the selected physician submitted the most recent claim prior to home care admission. This is an even more focused connection between the physician and patient with regard to home care admission. Imagine a physician who treats 100 patients right before home care admission. That physician either advised the patient to seek out home care, or should have advised the patient to do so. We know that since the patient was admitted to home care. Either way, that physician is a prime referral contact.

 Calculation

For Followed patient counts we simply count the number of distinct patients for which the selected physician is named as the certifying physician from the home health claim (institutional claim.)

For 3 Months Prior and Last Claimed patient counts, we look for a (home health) claim identifying a patient admission to home care. We then look back to identify every physician who treated that patient within the previous 3 months and the one physician who submitted the most recent claim prior to admission. We then add up the counts from all patients - for all applicable physicians - including the selected physician. In short, each of these counts require a connection between two claims.

 

Using these metrics

Evaluate

 Use these metrics to evaluate the selected physician to determine the referral potential before talking to the physician. As described immediately below, counts for each of the claim types is already indicative of referral potential. These metrics are also insightful when viewed in connection to each other. 

Questions

• What does it mean when a physician has a high number of Followed patients, but very low 3 Months Prior, and Last Claimed? This suggests that the selected physician is closely connected to a home health agency but does not see patients prior to their admission. We can conclude that the selected physician is committed to home health care, but is not a likely source of referrals.
• What about a physician who has a lot of 3 Months Prior patients, but no Followed? Or who has a lot of Last Claimed, but no Followed? Metrics like this are indicative of a physician with good referral potential. This physician is in a place to identify conditions requiring home health care in the immediate future along with advising the patient to seek home care.
• And what about a physician with high patient counts in all three? Clearly that physician is involved and committed to home care. The next step is to dig deeper.

 

Connections

As always, identifying potential is one step in the process. Once you identify a physician as having high referral potential, the next step is to view their Analyze page to investigate patient demographics under the Patient Population tab, or home health destinations under the Destinations tab. As it turns out, many of the other metrics in Sales Spotlight already assist with getting this additional helpful information once you have identified the physician as a good referral source for home health patients.

 

 

 

Place of Service

 

Using this metric

Evaluate

This table shows us where the selected physician is having visits with patients. By looking at the different venues, it is easy to see, for example, the relative number of home health patients seen by the physician in the private practice office, or in the hospital.

 

Understanding the Metric

 Definition 

There are five different locations that we identify for each physician:

• Hospital- This could include both inpatient or outpatient claims.
• Office- Reflects patient visits in the physician's office.
• SNF- Visits by the Physician in a Skilled Nursing Facility
• Other - These could include patient's homes, nursing homes, clinics, etc.
• Telehealth - The location where health services and health related services are provided or received, through telecommunication technology. 

 Calculation

On all professional claims submitted by the selected physician, we identify the place of service and count how many of each visit occurs in each location.

 

 Details

• This table only includes professional claims, not institutional claims. 
• If a claim includes multiple settings, we include the count for that claim in the top option in this order of priority: Hospital, Office, SNF.

Place of Service Codes

All of the Place of Service metrics are taken from the Part B (Professional) claims submitted under the Physician's NPI. The place of service code is entered into box 24b of form 1500. The existing codes are 01 through 99, (not all used). This table generates metrics based on the following codes:

• Hospital - code 21 or 22
• SNF - 31
• Office - code 11
• Telehealth - code 02 and 10 (02 is used when the patient is not at home, 10 is used when the patient is in their home.)
• Other - any other code. This is why there may be a large count of visits linked to this category

  Where can I find this metric?

• In Marketscape CRM, there are no additional metrics of this type available.
• The identical table can be found on the selected physician's Analyze page, under the "Practice Details" tab in the "Place of Service" table.

 

Section 2 - How Do I Stand Out

Overview

Compare and Create -  The purpose of this section of Sales Spotlight is to help you create a winning story about your agency. To that end, the metrics in this section are specifically about your agency in comparison to the top agencies (competitors) and state and county benchmarks.

To orient you to the content in this section of the Sales Spotlight tab there are five critical features of which you must be aware. After we present these five items, we will analyze the metrics.

 

My  Agency - In order to provide the most meaningful metrics, you will need to select your "My Agency" from the dropdown selector at the top of Sales Spotlight.

In Marketscape CRM, the dropdown selector is down in the second section, directly above the metrics impacted by the selection.

 

Diagnoses - The metrics in this section are calculated for different patient populations distinguished by diagnoses. In the image below, the blue boxes surround the metrics related to these different populations. The top box contains metrics for patients with all diagnoses, that is, all patients. The middle box contains metrics only for Circulatory System Patients. The bottom box, patients with diagnoses under Injury and Poisoning.

The "All Diagnoses" category will be included in Sales Spotlight for every physician, other diagnoses will be included if that diagnosis represents greater than 15% of the physician's patients. Only the top three diagnoses that meet this 15% criteria will be displayed in the "How Do I Stand Out?" section of Sales Spotlight.

For more information, see Trella Health Diagnostic Groupings.

 

Metrics - There are three metrics included for each diagnosis set: (Green boxes from image below.)

• Total Patient Cost Following HHA (12-month Risk-Adjusted)
• Readmission Rate - 
• Hospitalization Rate within 30 Days from Start of Care

 

All three metrics are displayed for each diagnosis displayed.

 

Conversation Starter Toggle - There are two modes for presenting the included metrics. In sum, with the Conversation Starters toggle off, you can see the featured metric with trends and comparisons. With the Conversation Starters toggle on, the comparison is stated in a sentence.

 

Conversation Starters Off	Conversations Starters On
At a glance metrics	Comparisons turned into a sentence

 

Compare to: By default, we show metrics that tell the best story about your agency. To this end, we present comparison for your agency in the following order:

• Against the top competing agency - we show when your agency performs better against one of the top three recipients of patients treated by the selected physician. (As seen in the Top HHA Destinations table.)
• Against the state or county benchmark - If your agency doesn't outperform against a competitor, the comparison is made against the state or county benchmark.
• If your agency doesn't outperform the state or county benchmark, we will still show how your agency stacks up against the state average.

Using the "Compare to:" dropdown, you can choose to compare your agency to the top three home health destination agencies, or against the state or county benchmarks. If you choose an option from this dropdown, all comparisons in the section will be shown against your selection.

 

Understanding the Metrics

Although the array of content looks intimidating at first, there are only three metrics, broken out by diagnoses, and two views of each.

 

Total Patient Cost Following HHA (12-month Risk-Adjusted)

In the images below, we show the metric tiles for All Diagnoses, and for Circulatory System. This is only to show a full example of the kind of content you will see.

Conversation Starters Off	Conversations Starters On

 

Definitions

This metric is an average cost of care for medical expenses for patients after discharge from the chosen "My Agency". The different diagnostic groups showcase the following:

• Each different diagnosis set has its own metric for a total cost of care.
• Trends - to the left of each cost is a colored arrow that shows the percentage of cost difference against the listed competitor or state benchmark. 
  • For "All Diagnoses" Allegheny has costs 6.88 percent higher than the state average. The arrow is pointing up to indicate that the metric for "My Agency" is higher by the state average.
  • If "My Agency" had a better metric, (see image below) the arrow would point down, and the agency that didn't perform as well is identified. The percentage of my agency's advantage is next to the arrow.

• Conversation Starters - With the toggle on, these comparisons are presented in a sentence format.

 

Calculation

The following details will help clarify how we calculate the metrics in this column:

• We calculate the total cost of care for all patients who were discharged from "My Agency" who were treated by the selected physician within the three months prior to home health admission. We then create an average for this body of patients.
• The discharge must occur during the one year reporting period. This reporting period is pushed back one year prior to the current data set in order to allow time from the discharge to calculate subsequent expenses.
• The total cost for each patient is drawn from all claims submitted in the 12 month period subsequent to home health discharge. The included costs are included in the image below under Where can I find this metric?
• We use Risk adjusted metrics to make the comparisons meaningful.

 

Where can I find this metric?

The Total Patient Costs Report table in the Reports page of Marketscape Insights will allow you to compare post home health care costs agency by agency. That table allows you to slice the metrics in numerous ways.

 

Readmission Rate

In the images below, we show the metric tiles for All Diagnoses, and for Circulatory System. This is only to show a full example of the kind of content you will see.

Conversation Starters Off	Conversations Starters On

 

Definition

This metric is the rate at which My Agency's patients were discharged from an inpatient setting, were newly admitted to My Agency, and were subsequently readmitted to any hospital within 30 days of the first inpatient discharge; this includes transfers.

To the left of the metric is an arrow, pointing down, that identifies that "My Agency's" metric is lower that the listed competitor, UPMC.

 

Calculation

This is the percentage of all patients discharged from an Inpatient stay and admitted to home health within 30 days who were admitted back to inpatient care within 30 days of the initial discharge.

Numerator - count of patients discharged from inpatient care who entered the chosen home health agency and who were re-admitted to inpatient care within 30 days of initial discharge

Denominator - count of patients discharged from inpatient care who entered the chosen home health agency within 30 days

 

Where can I find this metric?

In addition to the Sales Spotlight email, you can find this metric:

• On the Explore page, in the row for My Agency, under the header Readmission Rate: 30-days.
• On the Analyze page for My Agency, under the Insights tab.
• On the Analyze page for My Agency, under the Operational tab in the table, Home Health Agency's Summary. The metric is Readmission Rate: 30-days
• On the Analyze page for My Agency, under the Quality tab in the table, Readmission Rate table in the All row at the bottom under All Acuities - This HHA.

For a comprehensive view, see Readmission Rates.

 

Hospitalization Rate within 30-days from Start of Care

In the images below, we show the metric tiles for All Diagnoses, and for Circulatory System. This is only to show a full example of the kind of content you will see.

Conversation Starters Off	Conversations Starters On

 

Definitions

This metric is the percentage of patients admitted to inpatient care within 30 days of admission to Home Health Care.

To the left of the metric is an arrow that indicates my agencies performance against a competitor. In this example, My Agency's metrics are better than my competitor for the diagnoses shown and this is indicated by the green arrow and the number that shows the percent difference showing my agency's advantage.

 

Calculation

To calculate this metric we use the following:

Numerator - count of patients admitted to the home health agency who were admitted to a hospital within 30 days of start of care.

Denominator - count of patients admitted to the home health agency

 

For a LOT more information about Hospitalization, click here.

 

Where can I find this metric

In addition to the Sales Spotlight tab, this metric can be found:

• On the Explore page in the row for My Agency in the column Hospitalization Rate: SOC to 30 days.
• On the Analyze page for My Agency, under the Insights tab.
• On the Analyze page for My Agency, under the Quality tab in the table, Hospitalization Rates within 30 Days from Start of Care by Acuity table in the All row at the bottom under All Acuities - This HHA.

 

For a LOT more information about Hospitalization, click here.