This table is designed to show the impact of underutilizing hospice care. For the chosen physician, you can compare metrics for longer and shorter hospice stays as well as compare lengths of stay with patients who did not receive hospice care. The table provides average numbers of visits during the last 30 days of life for four different hospital visit types.
The goal of these two tables is to show the cost benefits of utilizing hospice overall and the necessity of keeping hospice patients out of the hospital.
On the Physician Detail page, two tables work together to tell our story. In order to understand the Last 30 Days of Life, we want to compare the physician's number of mortalities, the count of hospice patients, and the timing of when those patients entered hospice care. We also want to identify the average number of visits to the hospital these deceased patients had in the last 30 days of life in order to show the value of hospice care.
Our chosen physician saw 255 patients during the last six months or their lives, which is the number in the blue box. The physician submitted claims for these distinct patients during the one-year reporting period. Of those 255 patients, 157 received hospice care for some period of time (orange box). The second table breaks out three counts; those who received hospice care for more than 30 days (green), those who received hospice care for 30 days or less (yellow), and those who did not receive any hospice care (red).
The "Utilization for This Physician" is the percentage of patients who received hospice care. From our graphic above, Hospice Decedents / # of deaths X 100% or 157/255 X 100% = 62%.
Understanding the Metrics
Hospital Visit Types
We provide averages for four different types of hospital stays as listed in the bulleted list below. ALL of these are visits that occurred in the last 30 days of life.
- Inpatient Visits - average number of visits admitted to an inpatient stay, but not through the emergency room.
- ER-to-Inpatient - average number of visits admitted to an inpatient stay through the emergency room
- ER Outpatient Visits - average number of visits to the emergency room but who were sent home
- Observation Visits - average number of overnight observation visits per patient.
We break out the hospice patients for the selected physician into three categories to show the benefits of hospice care.
HOS Care Start > 30 days Prior to Death (Early Hospice)
|Counts and averages in this row are tied to patients who were admitted for hospice care more than 30 days before the date of their deaths. This could include any number of days on hospice care greater than 30 days.|
Hospice Care Start ≤ 30 days Prior to Death (Late Hospice)
|In contrast, the metrics in this row reflect patients who were admitted for hospice care with 30 days or less before the date of their deaths. That is, the patients in this row received hospice care for 30 days or less.|
|No Hospice care received||These metrics are for patients treated by the selected physician who did not receive hospice care.|
What does this Table Show?
Broadly, this tables shows the advantage of proactively identifying hospice-appropriate patients and starting their hospice care early. Moreover, we can get a sense for the cost savings that hospice care can provide for connected hospitals if the selected physician were to refer patients to hospice more often and earlier. Using these metrics, you can create a convincing story for the physician to encourage a closer partnership that moves patients to hospice care.
We will use one column, ER-to-Inpatient Visits, from the following table to show how you can use these metrics. You could do this analysis for each of the other three hospitalization types.
Keep it simple - These averages represent patient visits to a hospital. Smaller is better. Even with just a quick glance, we can see that patients with shorter hospice stays and those with no hospice care are substantially more likely to result in a hospital visit - 6 to 7 times more likely. You can show a physician how these averages compare. You can also use these metrics to compare two physicians to (since the metrics are averages rather than actual counts). Finally, you can compare a physician to the state average. All of these metrics are convincing proof that getting patients into hospice care earlier will cut down on the number of hospital visits.
Let's talk Savings
The following table shows a way to look at the metrics from the Average Hospital Visits - Last 30 days of Life table in far deeper detail. The math involved and the numbers generated are highly idealized to show the maximum potential.
|Care Received||Number of patients who received the care in this row||Average number of visits per 100 patients||Projected count of patients who were hospitalized in their last 30 days of life||But what if the physician's patients were in hospice earlier? I.E. what if they were ALL hospitalized at the best rate (12 out of 100)?|
|HOS Care Start > 30 days Prior to Death||59 patients||12 out of 100 would have an ER-to-Inpatient Visit||
7 patients hospitalized
59 X .12=7
|No change - this is the best hospitalization rate.|
|Hospice Care Start ≤ 30 days Prior to Death||213 patients||75 out of 100 would have an ER-to-Inpatient Visit||
160 patients hospitalized
213 X .75=160
Patients Hospitalized (best rate):
213 X .12=26 patients
160-26=134 fewer hospital visits
|No Hospice care received||349 patients||85 out of 100 would have an ER-to-Inpatient Visit||
297 patients hospitalized
349 X .85=297
Patients Hospitalized (best rate):
349 X .12=42 patients
297-42=255 fewer hospital visits
Understanding the Averages
If you look at the average for ER-to-Inpatient Visits - This Physician, in the first row, we can see that the number there is "0.12". It is difficult to visualize every patient as having "point one twoth" of a visit. A better way to look at these metrics is to ignore the decimal, so 0.12 becomes 12 (twelve). Then you can define the metric as "out of 100 expired patients you could have expected 12 visits." This makes it easier to compare the metrics in each column. For example, 12 visits out of 100 expired Hospice patients with a stay > 30 days were admitted to an Inpatient stay through the emergency room. But if we look at those patients who had an hospice stay 30 days or less (second row) we see that, on average, for 100 expired patients, there were 75 visits admitted to an Inpatient stay through the emergency room during the same period. This shows the enormous value of hospice care in general and the advantage of identifying hospice appropriate patients and getting them admitted to hospice earlier.
Important math moment:
- The "Patient Count" column is the count of actual, distinct patients treated by the physician within three months of hospice admission in each of the categories in the row.
- The average visits are a "per 100 hospice mortalities" number.
- So, we need to ask, IF those 59 patients (first row) were 100 hospice patients who died, how many visits per hundred would we expect for that column.
- We can't multiply the average back against the actual number of patients to get a count of patients who were hospitalized.
- Keep in mind that if only 2 of the 59 patients each had 6 hospital visits during their last 30 days of life, that would generate the 12 visits. The averages are truly about visits, not patients.