For patients treated by the selected physician who died, we break that population into the following three categories:
- Early Hospice - Patients who were admitted to hospice care prior to their last thirty days of life.
- Late Hospice - Patients admitted to hospice during the last 30 days of their life.
- No Hospice - Patients who were not admitted to hospice.
For each of the timing categories the table shows patient counts and counts of visits (per 100) to four different hospital levels of care.
Patients included in the counts for either Early Hospice or Late Hospice could have potentially revoked hospice care, and also been re-admitted to hospice or not. The variety of possible hospitalization scenarios are used to calculate the metrics in the table, but those events do not impact the categorization of Early vs. Late. We only count hospice stays that are the last admission prior to the patient's death.
This table provides four insights into hospice patient care for the selected physician's patients. The metrics are based on patients treated by the physician who died during the one year reporting period and reflect care provided by all hospices.
The value of hospice
In light of the cost savings and benefits to patients and families that hospice care provide over hospitals for patients near the end of life, this table verifies the value of Hospice care. For each type of hospital visit, the table shows that early admission into hospice care is better than later admission, and that any hospice care is better than no hospice care at all. We will look at the numbers below.
This table makes it almost too easy to prove that getting hospice appropriate patients admitted to hospice care early is preferable. If you want to use these metrics in this way, most of the time you can prove this point using either the physician's metrics or the state averages. For the math, see below.
State metrics for comparison
In addition to metrics specific to the selected physician, the table provides state averages for all physicians with the same specialty. The comparative nature of these metrics allows you to see how your selected physician performs against his peers. If your selected physician underperforms or overperforms against his/her peers, you will want to do some careful evaluation of the demographics of the patient population to find out why.
You will want to be careful relaying these metrics to a physician. Although for a high performer you could communicate, "Hey, you're doing great!" it is important to dig in on why the physician's metrics are so good. If the metrics show poor performance against the state averages, you would want to only provide these insights in a context of trust and with a persuasive message of how you can help.
Keep in mind that these metrics also reflect on the care provided by all hospices that treated the physician's patients.
Patient mix between categories
The patient counts are a breakdown of the selected physician's patients who died during the reporting period.
The sample image of a physician's metrics (above) demonstrates the need. This physician's patients break down thus:
- 52 - early hospice (11 % of the total)
- 153 - late hospice (34% of the total)
- 247 - no hospice (55% of the total)
Considering the value of hospice care, these numbers are upside down. The message is clear. This physician needs help to identify hospice appropriate patients and get them admitted to hospice earlier.
There are four hospital events that we track for hospice patients in this table.
- Inpatient Visit - A patient is admitted to a hospital for inpatient care.
- ER-to-Inpatient Visit - a patient is admitted to inpatient care through the emergency room.
- ER Outpatient Visit - a patient is taken to the emergency room, but not admitted for other additional care.
- Observation Visit - a patient stays overnight for observation but is not admitted to inpatient care.
The metrics in this table are based on visit counts, not patient counts. That is, a single patient could be counted multiple times for any level of hospital care, and counted for more than one type of hospital care.
Understanding the Metrics
Who is being counted?
The patient population on which the metrics are calculated is the set of distinct patients 1) who died within the one year reporting period and 2) who were treated by the selected physician within 6 months of their death.
Since an individual patient could be seen by more than one physician within 6 months of passing on, these metrics will overlap with any other physician who treats the same patient.
This population of patients is then broken down into the metrics in the Patient Count column into Early Hospice, Late Hospice or No hospice.
What are all these tiny numbers?
Even though this table shows the value of hospice care, the actual number of visits per patient is so small that these numbers are small.
The numbers in this table (Except the patient counts) are the average number of visits per patient.
Take the following example:
If the Early Hospice count represented 100 patients, and each patient was admitted to one inpatient stay, the average would be 100 patients divided by 100 hundred visits or an average of one visit per patient.
(This would be like batting 1.000 in baseball - which would be amazing for baseball, but it is a terrible average for hospice care.)
Now imagine that out of that 100 patients, 50 patients were admitted to inpatient care. Our calculation is 100 patients divided by 50 visits, or 1/2 visit per patient, or .5 visits. (Still amazing for baseball and not so good for hospice.)
And if only one patient has one visit, the average is .01 visits per patient.
The problem is that our minds have trouble thinking of patients having an average of a part of a visit. A patient can't have a part of a visit. A group of patients can have an average number of visits that is less than one.
If it helps, you can move the decimal two places to the right to change the perspective. If the average per patient is .12 visits per patient, that means that 12 patients out of 100 had a visit. Same thing.
Enough Math! What does it mean?
Let's take a look at one set of numbers:
|My Selected Physician||State Average|
|Early Hospice||.13 - or 13 per hundred||.05 - or 5 per hundred|
|Late Hospice||.52 - or 52 per hundred||.54 - or 54 per hundred|
|No Hospice||.77 - or 77 per hundred||.58 - or 58 per hundred|
You can look at the column left-to-right or top-to-bottom.
Comparing our physician to the state averages, we notice is that our selected physician is not doing well against the state averages for ER-to-Inpatient Visits. The metrics are better in all other columns.
When we compare Early Hospice to Late Hospice, we discover that a patient is four times more likely to be admitted to inpatient care after an emergency room visit if they entered hospice in the last 30 days of life instead of earlier. (13 X 4 = 52) Clearly early admission to hospice is far better. A patient is even more likely to be admitted to a hospital after an ER visit if they are not under hospice care. (Almost 6 times.)