Overview

There are numerous tables in the Trella Platform that include data calculated using mortality counts and rates. Understanding mortality counts and rates is critical because high numbers suggest higher acuity patients that are appropriate for more critical care. When facilities or physicians have a patient population with high rates of mortalities, this indicates a more difficult patient population and thus a greater need for post-acute care.

Mortalities metrics are especially useful for hospice agencies, because high mortality counts are a sign of higher need for hospice services. 

In this article

• Sources of Data - How does Trella Health compile beneficiary date of death to include in Trella Analytics
• Usage - Summary of the value of mortalities data
• FAQs

Sources of Data

In order to analyze and create mortality counts or mortality rates, we compile dates of death from a few different sources.

A beneficiary's date of death is available in the Master Beneficiary Summary File and the Vital Status File. For beneficiaries that die during an inpatient or skilled nursing facility stay, date of death is also available from the MedPAR file.

CMS receives death information from a number of sources. The main sources CMS uses to develop its death information are: 

• Medicare claims data from the Medicare Common Working File (CWF)
• Online date of death edits submitted by family members benefit information used to administer the Medicare program collected from the Railroad Retirement Board (RRB) and the Social Security Administration (SSA)
• Because of the variation in sources of information sometimes only the month and year of death are reported to the enrollment data and the exact day of death is not known. In these cases, the death day is set to the last day of month.

The Master Beneficiary Summary File (MBSF) is an annual dataset maintained by the Centers for Medicare & Medicaid Services that includes data on all Medicare beneficiaries enrolled in or entitled to Medicare within a given calendar year.

Usage

FAQs

Mortalities (FFS & MA) comes from enrollment data (which can include SSA, among other sources).

 - Hospice Mortalities (FFS Only)- the date of death comes from enrollment data but the beneficiary must also have a hospice claim present. In this table, it does not look like the discharge status code on the hospice claim is used to verify that the patient died in hospice, just that the date of death falls during one time period and the patient had a hospice claim.

Understanding the Data: 

Usage

Physicians page

Physicians with a high Mortality count and low number of Physician Hospice Patients could be excellent sources of Hospice referrals.

Example:

• Navigate to the Physicians Page using the Top Navigation Menu.
• Filter out Radiology, Pathology, and Anesthesiology from Specialties. (See Article: “Using Filters” for more information.)
• Click “Mortalities to bring the largest Mortality counts to the top.
• Compare the counts between two columns, “Mortalities,” and, “Physician Hospice Patients.”
• For Physicians with a large difference, examining their detail page will help with full evaluation.

In this example, the physician treated 788 patients who died within the one-year reporting period. Only 251 of this physician's patients received Hospice Care during the same period. The difference is 537 patients, but remember that this is a minimum, some portion of the 251 Hospice patients could be those who are still receiving care at the close of the reporting period. It is likely that there are more than 537 patients who died without receiving Hospice Care.

 For Physicians who present a large difference between these two columns, (with Mortalities higher) this signifies that the physician has many patients who die without receiving Hospice Care. Although these physicians warrant further investigation, some possibilities for collaboration seem evident:

• The physician is unfamiliar with Hospice care or the value of Hospice care and needs to be educated.
• The physician is uncomfortable with the painful discussion with patients and family members regarding Hospice care and needs to be encouraged
• The physician is not practiced at identifying Hospice appropriate patients and could use the assistance of hospice professionals
• Physicians, especially in some specialties, may tend to want to continue curative measures beyond the time that a cure is possible. This desperation is often felt by family members as well. Although this is a challenging situation, intervention by a hospice professional could help to close the gap and encourage appropriate care.

In the end, using this table to identify these gaps in care is a good starting point for targeting physician sources of hospice patients and helping more patients to receive the care they need.