The Patient Metrics table provides statistics on the patient population for a physician so you can assess the physician’s potential for having patient interactions that influence the decision to elect hospice. The Total (Distinct Patients) column contains the same data as the Physicians Page Main Table and Physician Referral Sources table on the Hospices page. The Patient Metrics table adds a breakdown of the statistics by quarter for the past four quarters so you can see trends in the physician’s practice.
The quarterly numbers will not add up to the Total (Distinct Patients). The counts in each column are distinct counts, so a specific patient could be counted in multiple columns but will only be counted once in the Total column.
Patient Metric Details
The following metrics are used throughout the Hospice Solution in many tables. In general, the definitions below are accurate with respect to the same data throughout the Solution. Where these metrics are nuanced in other tables, clarifying notes are included in the Solution and additional description will be added to the knowledge-base articles for the specific tables where the data is different.
All Medicare Patients
This is a count of distinct patients who had at least one Medicare claim submitted by the physician on this page during the reporting period (last four quarters).
This metric represents the overall volume of Medicare patients seen by the physician and is a good baseline for comparing all subsequent metrics. The trend over the quarters indicates whether the Medicare portion of the physician's practice is growing or shrinking.
This is the count of patients who died during the reporting period (last four quarters) who had been treated by the physician during the six month reference period prior to their death.
Mortalities is an excellent indicator of the number of potential hospice patients in the physician's patient population. The Medicare Hospice benefit is for patients who have a prognosis of less than six months if their terminal disease takes its normal course. Since Mortalities looks at the last six months of a patient's life, it shows you the number of patients who expired and may have been eligible for Hospice. A physician with a high mortality count should also have a commensurate number of hospice patients.
This metric is a count of distinct patients where the physician on this page was listed as the attending physician, or medical director if an attending is not provided, on the Hospice Admission claim during the reporting period (last four quarters).
They have the most significant role in the determination and delivery of the patient’s care while they are on Hospice. Physicians with high numbers of Total Attended are typically seeing patients with a high potential for hospice. They very well may be a medical director with your agency or a competitor’s, and thus not a likely target. A full time medical director will likely have high attending counts but little or no 3 months prior or last claim counts, indicating no past relationship to the patient. Their commitment to a specific hospice makes them an unlikely candidate for hospice patients. One the other hand, physicians that do have a high number of attended patients, and are not a medical director, are prime targets for hospice services. This also suggests they are comfortable with the philosophy of hospice and willing to follow their patients while on hospice. Many physicians don’t act as attending physicians because it isn’t in keeping with their reasons for practicing, i.e. curative care.
Total 3 Months Prior
This count represents the number of patients who entered Home Health within the reporting period (last four quarters) for whom the physician submitted a claim within the three month reference period prior to the Hospice admission.
These patients are potential referrals by the physician since the physician interacted with the patient in the time period shortly before their selection of a hospice provider. Even if the physician isn't likely to make referrals, they may still influence the patient's perception of hospice as an appropriate choice given their prognosis.
Total Last Claim
This data enumerates the count of distinct patients who were admitted to hospice care during the reporting period (last four quarters) where the selected physician submitted the last claim prior to hospice admission.
Physicians that are the last doctor to interact with the patient before they start hospice may have had a direct influence on which provider the patient chooses.
Patient Metrics Example - Rudy
Rudy was an 85 year old male diagnosed with CHF. During his final year of life, he had numerous Emergency room visits and several visits to his Primary Care Physician. Eventually he was diagnosed with severe heart failure and entered hospice. He passed away after a 44 day long stay in Hospice.
The timeline below depicts the Medicare claims and other important events in Rudy’s history. Notice how the different claims impact the Patient Metrics for his Primary Care Physician (PCP), Emergency Room MD, and Hospice Medical Director.
- The Medical Director receives a single count as the Attending physician for being listed on the admission claim as the attending physician.
3 Months Prior
- The PCP and Emergency Room MD both receive a count for 3 Months Prior because they each submitted a claim during the three month reference period before admission to Hospice (Date of Election).
- The Medical Director did not receive a 3 Months Prior count for this patient. As a medical director this physician would not file professional claims for this patient.
- The Emergency Room MD receives a single count in Last Claimed for submitting the claim in July. This was the most recent claim submitted prior to admission to Hospice.
- All physicians receive a single count in Mortalities for submitting a claim within 6 months of the date of death.