What's new Physician Explore now shows how many of a physician's referred hospice patients were admitted in their first benefit period — no prior hospice claim on record. We call this BP1. |
What is BP1?
BP1 stands for Benefit Period 1. A patient falls into this category when they're brand new to hospice care, meaning there's no earlier hospice claim anywhere on their Medicare record.
Think of it as a flag that answers one question: is this physician sending patients to hospice early in their end-of-life journey, or later?
A physician whose referrals are mostly BP1 is consistently getting patients into hospice sooner, while there's still meaningful time for your team to build a relationship with the patient and family, manage symptoms, and provide the kind of support hospice is built for.
Where to find it
Head to Physician Explore and look at the Hospice Patients Overall metric for any physician. You'll now see a breakdown showing how many of that physician's total referrals were BP1 admissions.
Why this is worth your attention
Referrals aren't all the same, even when the total volume looks identical on paper. Here's what BP1 helps you do:
Spot your early referrers. Some physicians consistently send patients right when hospice becomes appropriate. Others tend to wait. BP1 makes that pattern visible at a glance instead of something you only notice anecdotally.
Focus your outreach where it counts. Instead of spreading relationship-building time evenly across every referral source, you can prioritize the physicians who are already sending patients the way you want more of and figure out what's holding back the ones who aren't.
Get ahead of your aggregate cap. Medicare sets a per-patient payment limit for hospices each year (the “aggregate cap”), and if you go over it, you have to repay the difference. Your mix of BP1 vs. later-stage admissions plays directly into that average, more early admissions help balance it out. Watching this throughout the year gives you a running view, instead of finding out where you stand only at year-end reconciliation.
A quick example
Say one physician refers 48 patients to you, and most of them show up as BP1, that's a strong signal they're sending patients early, while there's still time for your team to make a real difference. Another physician might refer 19 patients with only a few landings in BP1. That doesn't mean it's a “bad” referral relationship, it just points to an opportunity conversation about bringing patients to hospice sooner could help those patients, their families, and your organization.
FAQ
Does a low BP1 count mean a physician is a “bad” referral source?
Not necessarily. It just means their patients are typically further along when they reach hospice. That's useful context, not a judgment, and often a good opening for a conversation about earlier referral timing.
How does this affect my cap?
More BP1 admissions generally mean a healthier mix against your aggregate cap average, since these patients are entering earlier and diluting the impact of longer, higher-cost stays. Insights surfaces this pattern continuously so you're not managing it reactively.
Where does the “no prior hospice claim” data come from?
We look back across our full historical claims’ dataset (roughly four years) rather than a shorter window. We tested shorter lookback periods but landed on the full history because it gives much more confidence that an admission really is a patient's first-ever hospice election, not just their first in the last year or two.
How are physicians matched to patients for this metric?
BP1 uses the same attribution approach already powering the “Hospice Patients Overall” metric on Physician Explore, same 1-year cohort, same rules. That's intentional: it means you can compare BP1 counts directly against the totals you already know and trust, with no new methodology to learn. As with that existing metric, a patient can be attributed to more than one physician (for example, if care was shared), but each patient is only counted once per physician, so you won't see inflated counts from a single patient being tallied twice under the same doctor.
Could a claim correction or void cause a patient to be miscounted?
No we account for this. Corrected or voided claims are only used as a fallback in the rare case (under 3% of claims nationally) where the original claim's admission date doesn't line up with the patient's documented election date. This is specifically to prevent the same admission from being counted twice.
Methodology
If you want the precise technical definition behind this metric:
- Attribution: BP1 uses the same 1-year cohort and physician attribution methodology as the existing “Hospice Patients Overall” metric, so the two numbers are directly comparable.
- BP1 classification: A patient is classified as BP1 when a hospice claim with Type of Bill (TOB) 811 or 812 is present, and the patient has no prior hospice claims anywhere in our global claim tables (an approximately 4-year lookback).
- Corrections: Void (TOB 818) and replacement (TOB 817) claims are used only as a fallback, and only when the claim's admit date doesn't match the Occurrence Code 27 date, a mismatch that occurs in fewer than roughly 3% of claims nationally. This prevents the same election from being double counted while still correctly accounting for claim corrections.
Have questions about what you're seeing on Physician Explore? Reach out to your Dedicated CSM or support at support@trellahealth.com— we're happy to walk through it with you.