Overview
Marketscape Insights for HME/Infusion includes metrics for both claim counts and patient counts. Since one patient can have multiple claims, knowing both of these counts gives you a more detailed view of a physician's volume of patients and the products and services that a customer provides.
The tables with these metrics can be found in more than one place. The counts are broken up for each physician or organization into rows by code set. In this way, you can focus on counts of patients or counts of claims for a specific code set. See images below.
The Claim Counts metrics in this article are counts of service lines on the claim. For example, if a patient received a CGM, vial, and pump on the same claim, those three items count as three in the count in the Claim Count column, even though there is just one claim. If you want, you can see a "60" in one of the "Claims Count" columns as sixty service lines counted from the applicable claims.
In this article
- Understanding the Metrics
- Location in Marketscape Insights for HME/Inf
Understanding the Metrics
Physicians
Some quick observations
- In the image above, we moved the columns around to bring the counts together - what you see on your page will not match, unless you have moved the columns.
- There are two counts of claims - an all claim count and a count specific to Medicare FFS claims. (In the top left box)
- We include 5 different distinct patient counts. (Top right box)
- Each row includes counts of claims specific to the listed code set. These are shown in each row. A single claim, just like a patient, could be counted in more than one row if the claim includes more than one code set.
| Metric Name | Metric Definition |
| Physician All Claim Count | Sum of estimated claims filed with the listed physician NPI for all claims billed during the most recent 18 months for the listed code set. The purpose is to quantify the claim volume for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithms. |
| Physician Medicare FFS Claim Count | Count of estimated claims filed with the listed physician NPI for claims billed through Traditional Medicare FFS during the most recent 18 months for the listed code set. The purpose is to quantify the Traditional Medicare FFS claim volume for the chosen code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. |
| Physician Medicare FFS Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed physician NPI for claims billed through Traditional Medicare FFS during the most recent 18 months for the listed code set. The purpose is to quantify the Traditional Medicare FFS distinct patient count for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. |
| Physician MA Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed physician NPI for claims billed through Medicare Advantage during the most recent 18 months for the listed code set. The purpose is to quantify the Medicare Advantage distinct patient count for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. |
| Physician Medicaid Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed physician NPI for claims billed through Medicaid during the most recent 18 months for the listed code set. The purpose is to quantify the Medicaid distinct patient count for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. |
| Physician Commercial Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed physician NPI for claims billed through a Commercial plan during the most recent 18 months for the listed code set. The purpose is to quantify the Commercial plan distinct patient count for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. |
| Physician Other Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed physician NPI for claims billed through an insurer other than Traditional Medicare FFS, Medicare Advantage, Medicaid or a Commercial plan during the most recent 18 months for the listed code set. The purpose is to quantify the Other distinct patient count for the listed code set where the listed physician was either the referring physician or likely influenced the referral based on Trella's algorithm. Other patients will typically consist of VA, Tricare, Workers Comp or Unknown payers. |
Organizations
Some quick observations
- In the image above, we moved the columns around to bring the counts together - what you see on your page will not match, unless you have moved the columns.
- There are two counts of claims - an all claim count and a count specific to Medicare FFS claims. (In the top left box)
- We include 5 different distinct patient counts. (Top right box)
- Each row includes counts of claims specific to the listed code set. These are shown in each row. A single claim, just like a patient, could be counted in more than one row if the claim includes more than one code set.
| Metric Name | Metric Definition |
| Organization All Claim Count | Sum of estimated claims filed with the listed organization NPI for all claims billed during the most recent 18 months for the listed code set. The purpose is to quantify the claim volume for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization Medicare FFS Claim Count | Count of estimated claims filed with the listed organization NPI for claims billed through Traditional Medicare FFS during the most recent 18 months for the listed code set. The purpose is to quantify the Traditional Medicare FFS claim volume for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization Medicare FFS Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed organization NPI for claims billed through Traditional Medicare FFS during the most recent 18 months for the listed code set. The purpose is to quantify the Traditional Medicare FFS distinct patient count for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization MA Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed organization NPI for claims billed through Medicare Advantage during the most recent 18 months for the listed code set. The purpose is to quantify the Medicare Advantage distinct patient count for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization Medicaid Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed organization NPI for claims billed through Medicaid during the most recent 18 months for the listed code set. The purpose is to quantify the Medicaid distinct patient count for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization Commercial Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed organization NPI for claims billed through a Commercial plan during the most recent 18 months for the listed code set. The purpose is to quantify the Commercial plan distinct patient count for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. |
| Organization Other Distinct Patient Count | Estimated count of distinct patients who had a claim filed with the listed organization NPI for claims billed through an insurer other than Traditional Medicare FFS, Medicare Advantage, Medicaid or a Commercial plan during the most recent 18 months for the listed code set. The purpose is to quantify the Other distinct patient count for the listed code set where the listed organization was either the billing organization or likely influenced the supply based on Trella's algorithm. Other patients will typically consist of VA, Tricare, Workers Comp or Unknown payers. |
Counting Claims - How does Trella Health attribute a claim to a physician?
If you read the definitions for the claim counts, you will notice that we refer to the "Trella algorithm" that we use in order to count a claim for a physician. This attribution is an extensive process that has taken us years to develop. Some claims name specific physicians, which makes attribution simple, but sometimes we need to dig into the data deeply in order to establish a connection that makes sense. What do we do if the claim doesn't name a physician? In those cases, we look at other claims that provide a level of proximity close enough to infer an association. Previous physician/patient connections or claims on the same date or at the same organization provide a compelling reason to connect a physician to a claim for our estimates.
Location of Claim Counts
This section is pretty simple. The purpose is to show you where the columns with the metrics featured in this article can be found. We will also mention some tips for working with each table
Physician Explore
| Navigate to the Explore page by clicking the "Explore" button in the left navigation. The Physicians tab is the default |
The image below shows the Physician Explore page. To bring some larger numbers to the top, we sorted the table by the Physician MA Distinct Patient Count.
Using the filters and sorting will focus the entries in the table:
- Set the Location filter to a region that makes sense based on the territory you want to evaluate.
- Choose a Code Set of interest (you can choose more than one)
- Click on a header to sort the listed physicians to bring the largest numbers to the top for that metric.
Physician Analyze
- Clicking on the name of any physician listed on the Explore page will open the Analyze page for the selected physician.
- Click on the Utilization tab (arrow below)
Observations
- The metrics shown in this table for the same physician and code set will match the content of the Explore page.
- If you used a filter on the Explore page, you will notice that the code sets displayed here are automatically saved from your Explore selections. If this NPI is missing any of those selections, they do not have any data available for those code sets.
Organization Explore
| Navigate to the Explore page by clicking the "Explore" button in the left navigation. Then, click on "Organizations" at the top to open the Organizations tab. |
Using the filters and sorting will focus the entries in the table:
- Set the Location filter to a region that makes sense based on the territory you want to evaluate.
- Choose a Code Set of interest (you can choose more than one)
- Click on a header to sort the listed organizations to bring the largest numbers to the top for that metric.
Organization Analyze (Physicians)
- Click on the name of any organization to navigate to the Organization Analyze page.
- Then, click on the Order Share tab.
- The table shown, "Orders Share by Physicians" will display the metrics.
Observations
- The breakdown for the metrics is by physicians and code set.
- The code sets displayed here are automatically saved from your Explore selections. If this NPI is missing any of those selections, they do not have any data available for those code sets.
Service Count here is talking about the service lines on the claim. It's relevant because if they've defined their code set with a variety of related codes (e.g., a CGM, an insulin pump, insulin vials, etc), the counts will include each individual service line per claim. If a patient received a CGM, vial, and pump on the same claim, that's counted 3x (even though it's just one claim).Loran did point out we never say "distinct" claims, so maybe it's not quite as bad as I thought, eh.
