Overview
The Sales Spotlight and the Sales Spotlight email have two sections of metrics:
Click on the Metric name to immediately navigate to the details for that metric.
- Top Physician Metrics - there are 7 different metrics that can appear in this section. (See below.)
- Patient Volume - two metrics - The count of distinct patients treated by physician and the count of physician's patient who were admitted to home health
- Total Followed Patients - 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 - 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 Facility - 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.
- Our Agency Relationship - There are only three metrics included. However, these metrics could be shown for different Diagnostic Groupings.
- Six Month Risk Adjusted Total Cost of Care following Home Health - The average cost of care for your agency for patients discharged from home care for the six 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 it in Marketscape, but most importantly, meaning and usage.
Some of these metrics include trend information and county or state benchmarks.
Section 1 - Top Physician Metrics
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.
What is in here?
The Physician Top Metrics in the Sales Spotlight tab on a Physician Analyze page and the content of the Sales Spotlight email are slightly different. The table below shows the metrics and identifies which metric can be found in each location.
| Sales Spotlight on Analyze page | Sales Spotlight email | |
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Click on image to expand it
Each header below is a link to the details for that metric in the article below. |
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| Patient Volume | Appears when you click on the Conversation Starters toggle. |  |
| Total Followed Patients | |
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| Home Health Utilization | - named HHA Utilization - 3 Months Prior |
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| Top HHA Destinations | |
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| Patient Risk Score | |
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| Highest Affiliation Facility | |
Understanding the Metrics
Usage note
When you click on the Conversation Starters toggle, three things can happen:
- Any Top Physician Metrics not included in the Sales Spotlight email are removed from view.
- Some metrics that are additional in the email will be displayed.
- Some metrics will be displayed in the format of the Sales Spotlight email.
Patient Volume
| Sales Spotlight on Analyze page | Sales Spotlight email |
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Usage
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.
Actions
- Look at the Home Health Destinations table under the destinations tab for the physician to see if the 82 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 small 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?
Definition
Home Health patients - This is the count of distinct Medicare FFS Patients treated by the listed physician who received home health services during the one-year reporting period (from Followed, Three Months Prior and Last Claimed patient counts)
Medicare 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).
Metrics Calculation
These are both unique counts, although the Home Health patients is also a union of three other counts, Followed Patients, Patients 3 Months Prior, and Last Claimed Patients.
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:
- On the Explore page. In that table, the metrics are called Physician HHA Patients, and Annual Patient Count (FFS).
- On the Analyze page, under the Patient Population tab in the Patient Volume table under the names Medicare FFS Patients, and Home Health Patients (Overall).
- The Home Health Patients count can be found under the Destinations tab as the "Distinct Patient Total, at the bottom of the Home Health Destinations table.
Total Followed Patients
| Sales Spotlight on Analyze page | Sales Spotlight email |
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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. |
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Usage
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.
Actions
- 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
Total Followed Patients - 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.
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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. |
Although the word "Total" is included in this metric name, this is a unique count from the claims, not a sum of other metrics.
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 these metrics:
- 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.
HHA Utilization - 3 Months Prior/Home Health Utilization
| Sales Spotlight on Analyze page | Sales Spotlight email |
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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. |
In the Sales Spotlight email, this metric is presented in comparison with the state average for all physicians in the same specialty, showing the selected physician's. The difference between the selected physician's metric and the state is included. |
Usage
Home Health Utilization is a measure of the physician's commitment to home health care. The higher the percentage, the higher the commitment.
Actions
This metric stands alone and doesn't require further evaluation or investigation. It is a performance metric 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.
- Use this metric to engage a physician. On the one hand, if they are 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.
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.
Top HHA Destinations
| Sales Spotlight on Analyze page | Sales Spotlight email |
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Usage
This table shows you up to the top four home health destinations for your selected physician. At a glance you can see if your agency is in the top four agencies receiving patients treated by the selected physician.
Where can I find this metric?
The complete table of all home health agencies who 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 |
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Not included |
Usage
In general, Risk Scores provide insight into the amount of care that can be expected for a patient population, and it helps calibrate a provider’s performance relative to its peers. The Risk score is an index number used for comparison. Based on the score for each provider, we assign a risk category, which is included under the number.
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.
Where can I find this metric?
In addition to the Sales Spotlight email, you can find these metrics:
- On the Explore page in the row for your selected physician.
For more detail on Risk Scores, click here.
Highest Affiliation Facility
| Sales Spotlight on Analyze page | Sales Spotlight email |
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Not included |
Definition
This is 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. The highest affiliated facility is named and the patient percentage is included below the name.
Calculation
This metric is the percent of the selected physician's distinct Medicare patients
Where can I find this metric?
In addition to the Sales Spotlight email, you can find these metrics:
- On the Explore page in the row for your selected physician.
Section 2 - Our Agency Relationship
Overview
To orient you to the content in this section of the Sales Spotlight tab there are four critical features you must know. After we present these four, we will analyze the metrics.
Diagnoses - The metrics in this section are based on 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, Injury and Poisoning.
All diagnoses will be included for every physician, other diagnoses will be included if that diagnosis represents greater than 15% of the physician's patients
For more information on the Trella Health Diagnostic Groupings, click here.
Metrics - There are three metrics included for each diagnosis set: (Green boxes from image below.)
- 6-month Risk Adjusted Total Cost of Care following Home Health
- Readmission Rate
- Hospitalization Rate within 30 Days from Start of Care
All three metrics are displayed for
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.
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| At a glance metrics | Comparisons turned into a sentence |
Comparisons - All comparisons are made between the top three agencies for the selected physician. If there is not a favorable comparison for My Agency, a comparison will be made with the state/county benchmarks.
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.
6-month Risk Adjusted Total Cost of Care following Home Health
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Definitions
This metric is an average cost of care for medical expenses for patients after discharge from my chosen agency. The three 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 average.
- For "All Diagnoses" Allegheny has costs 4.98 percent lower that the listed competitor, Weirton Medical. For circulatory patients, Allegheny's costs are 2.99 percent lower than the competitor. These advantageous metrics are indicated with a green arrow, pointing down.
- "Injury and Poisoning" patients treated at Allegheny incurred costs, post discharge, 9.0 percent higher than the state average. This unfavorable metric is indicated by a red 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 6 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 Cost of Care table in the Reports section of Marketscape 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
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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; includes transfers.
To the left of the metric is an arrow that indicates my agencies performance against the county average. In this case, all of the performance metrics are unfavorable and are indicated by a red arrow and the percentage difference from the county average.
Allegheny is not performing well against readmission rates. Here is an example of a successful metric from another agency, with the green arrow and the competitor comparison
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 of Readmission Rate metrics in Marketscape, click here.
Hospitalization Rate within 30-days from Start of Care
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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 all three diagnoses 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.
