Overview

The Utilization and Quality Section on the Hospitals and Agencies Analyze page contains tables with metrics that focus on two areas: operational performance for the selected hospital or agency and insights into post-acute care provided to patients discharged from the selected hospital or agency. All data under this tab is calculated using claims for patients treated by the selected provider.

 

 There is a LOT of data under this tab. It helps to categorize the tables and group some to help navigating. Each of the tables will be described in more detail below.

Operational - Three tables about the selected facility

• Skilled Nursing Utilization - summary below.
• Trended Readmission Rate - summary below.
• Patient Diagnostic Mix - summary below - details here.

Discharged patients' Post-acute experience

• Discharge Events by Setting - summary below - details here.       
  • Inpatient
  • Outpatient
  • SNF
• Outcomes by Setting: Inpatient - summary below - details here.
• Adherence by Setting: Inpatient (Only in graph view.) - summary below.
• Patients Discharged with SNF Instructions (Inpatient Only) - summary below - details here.

 These tables can be viewed as either a table or a chart. Use the selector to turn charts on or off. 

These tables will be found under the Utilization and Quality tab of the Analyze page for a facility.

 

Understanding the Metrics - Operational Tables

SNF Utilization

The metrics in this table are a trended percentage, by quarter, of the selected hospital's patients who were admitted to SNF services during the one year reporting period and who were discharged from the selected hospital within 30 days prior of admission to skilled nursing. The table includes county and state benchmarks for comparison.

   

 

 

Trended Readmit Rates

A readmission is a multi claim event where a patient is discharged from an inpatient stay at a short term acute care hospital and is readmitted to inpatient care again within 30 days. This readmission scenario could include a post-acute stay, or multiple post-acute stays during that 30 day period. The goal of a readmit rate is to evaluate each organization's success at keeping patients out of the hospital.

This table includes a trend of readmission rates over the most recent four quarters. The state and county comparison metrics cover all similar facilities in the stated area for the same period.

The Trended Readmission Rates are calculated using a one year reporting period the end of which aligns with the end of the listed quarter. In other words, from the image above, the 15.99% rate under 2018 Q2  will be based on claims from 2018 Q2 and the previous 3 quarters to create a one year reporting period. Some find it easier to describe this as a rolling one year metric ending in the listed quarter.

Because this metric is calculated for a one year period, this metric will not match other readmit rates listed under the last reported quarter in other locations in Marketscape. In addition, because of the shortened reporting period, you will notice a higher number of Readmit rates that are not reported to comply with privacy suppression.

For more information, see Readmission Rates.

 

Patient Diagnostic Mix

This table breaks out several key metrics by the Trella Health Diagnostic Categories. This will allow you to zoom in on areas of strength based on more narrow patient populations.

   

 

Metric Summary

The following list includes summaries of each section. Please go to the full article for more details and links. 

 All state and county benchmarks are calculated from claims submitted by similar facilities in the same state or county as the selected facility.

• Diagnostic Category - This column identifies the diagnostic category for the metrics in each row. 
• Percent per Category - This metric is the percent of the selected facility's Medicare patients who had a primary diagnosis code included in the diagnostic category in each row. 
• Total Medicare Patients -  This is the count of the selected facility's Medicare patients who had a primary diagnosis code included in the listed diagnostic category in each row during the one-year reporting period. The quarterly metrics are calculated from the quarter listed as the reporting period.
  •  - It is better to think of this metric as Annual Medicare Patients - this metric is a unique calculation and is not a total of other metrics that were added together.
• Skilled Nursing Facility Patient Count -  This count is a subset of Total Medicare Patients. It is the count of the selected facility's Medicare patients who had a primary diagnosis code included in the listed diagnostic category in each row and who were admitted to home health within 30 days of discharge. 
• Skilled Nursing Facility Utilization % - This metric is the percentage of the selected hospital's "Total" Medicare patients who had a primary diagnosis code included in the listed diagnostic category and were admitted to home health within 30 days of discharge.
• Average Length of Stay -  This metric is the average length of stay (in days) in home health care for patients who had a primary diagnosis code included in the listed diagnostic category and who were admitted to home health care within 30 days of discharge from the selected facility.
• Readmission Rate -  This is the percentage of patients who had a primary diagnosis code included in the listed diagnostic category who were readmitted to a hospital within 30 days of the initial discharge from the selected hospital. 
  •  Remember: For inpatient facilities a patient who is readmitted multiple times during the reporting period will be included in this metric.
• 30 Day Mortality -  This metric is the rate at which patients discharged from the selected facility expire within 30 days of discharge. 

 For the full article on this table, see Patient Diagnostic Mix

Aggregated INS

There is an entry titled, “Aggregated INS” which represents the combined percentage for all diagnostic groupings that are too small to be presented on their own. In any case where the total number of patients in a specific diagnostic grouping drops below 11 patients, we can't show that number for privacy reasons. We roll all diagnostic groupings that represent counts <11 into this one category and present that count with this header. In sum, this row includes all diagnostic groupings that have insufficient counts aggregated into a single metric.

 

 

 

Inpatient DRG Breakout

This table contains a breakdown of patients discharged from the selected facility by Diagnostic Related Group (DRG). For each DRG we have included patient metrics, length of stay metrics, and readmission rates.

  This highly detailed view of patient diagnoses provides insights into areas of specialization where you might be able to develop a partnership with a specific hospital. Start by knowing which DRGs represent diagnoses for which your care is excellent. Then evaluate a selected hospital of interest to see if that DRG represents an area of need, like a high readmission rate.

The Average Length of Stay metrics are for the inpatient stay. For any DRG where you excel, look for an ALOS longer than the state average. Building a trust relationship with a hospital in that situation may allow you to help by getting patients into post-acute care faster if they know you will provide excellent care for their patients. This will help the hospital to lower their inpatient ALOS.

Understanding the Metrics

Metric		Description
Diagnostic Related Group (DRG)		This is the Diagnosis Related Group (DRG) listed on the inpatient claim.
DRG Description		This is the description of the DRG listed on the inpatient claim.
Distinct Patient Count		The count of distinct patients discharged with the DRG listed on an inpatient claim during the two-year reporting period.
Percentage of Patients		The percentage of patients with the listed DRG on an inpatient claim during the two-year reporting period.
Discharge Count		The count of stays discharged with the DRG listed on an inpatient claim during the two-year reporting period.
Average Length of Stay	This Hospital	The average length of stay (in days) spent in this hospital for patients that had the DRG listed on an inpatient claim during the one-year reporting period.
	County	For the selected hospital's county, this metric is the average length of stay (in days) for patients who had the DRG listed on an inpatient claim during the one-year reporting period.
	State	For the selected hospital's state: The average length of stay (in days) for patients who had the DRG listed on an inpatient claim during the one-year reporting period.
Readmission Rate	This Hospital	The percentage of patients who had the DRG listed on an inpatient claim during the two-year reporting period and were readmitted to a hospital within 30 days of discharge from this facility.
	County	For the selected hospital's county: The percentage of patients who had the DRG listed on an inpatient claim during the two-year reporting period and were readmitted to a hospital within 30 days of the initial hospital discharge.
	State	For the selected hospital's state: This metric is the percentage of patients who had a DRG on an inpatient claim during the two-year reporting period and were readmitted to a hospital within 30 days of the initial hospital discharge.

DRG's with less than 11 patients (or DRG's that represent less than 1% of total inpatient stays) are excluded from this table.

 

 

Understanding the Metrics - Post-acute Tables

The tables included in this "section" provide an in depth look at the character of post-acute care for patients discharged from the selected facility.

 For many of you familiar with the Original Trella Health solution, many of the new tables and charts in this section are offshoots from the Post-Acute Destinations (PAD) table. The PAD table was broken up into other table and also new metrics have been introduced. 

 

Discharge Events by Setting

Imagine that a patient is about to be discharged from a hospital. The discharge planning team evaluates the patient and determines that the patient should continue some level of care from a subsequent post-acute agency. They record this "status" on the discharge claim. This table shows the collection of those discharge events and the outcomes for those patients as they moved on to additional care.

 Notice that the table is titled, Discharge Events. The reason is that the counts in this table are not counts of patients. If a single patient had multiple discharges during the reporting period, each discharge would be counted in this table.

However, If you think of an individual patient, for a moment, this will make the table more clear. There are a few possible outcomes from the perspective of home health providers:

• The patient had a status for home health care at discharge, and the patient was admitted to home health care. We call this adherence. (In the table, this is the column, Adhered.)
• The patient had any other status than home health at discharge, and the patient was admitted to home health care. (This column would be Entered without Instructions, that is, the patient entered home health care even though not instructed to seek home health care.)
• The patient had a status for home health care at discharge, but the patient either didn't receive any post-acute care, or the patient was admitted to another form of post-acute care. (Patients who follow this path are counted in the column, Instructed, Not Adhered.)

 For more information on how Trella Health determines status at discharge, click here.

   

Metric Summaries

• Inpatients - Think of this as Patient Pathway. In this column we identify which post-acute destination the inpatient discharges were admitted to. Example: INP to HHA indicates that the metrics in this row pertain to patients who were discharged from INP and were admitted to HHA
• Instructed - This is the count of discharge events that were coded with the status that aligns with the listed post-acute care. 
• Adhered - This is the count of discharges who were admitted to the post-acute type listed in each row. Adhered is the union of Instructed and Entered, to be in the adhered column, a "patient" must both be discharged with the correct status and be admitted to the matching post-acute setting.
• Entered - This is a count of all discharges from the selected facility who were admitted to the listed post-acute care setting. This count includes those who received any status at discharge.
• Instructed, Not Adhered - Opportunity # 1! - This is the count of discharges who were coded for a specific post-acute setting but who were not admitted to that type of care within 30 days of discharge.
• Entered without Instructions - Opportunity #2! - This is the count of the discharges who were admitted to the listed type of care within 30 days of discharge, but the initial status coding at discharge was not aligned to the patient's post-acute destination.
• Adherence Rate - This is the percentage of discharges who adhered to the coding status at discharge. (Calculation: Adhered/Instructed * 100%)

 It is possible that a patient could be admitted to more than one post-acute setting within the 30 days after discharge. Each pair of discharge and admission events within 30 days will be counted in the appropriate column. Example: A patient is discharged with a status for SNF, and is admitted to a SNF, but is then admitted to hospice, all within 30 days. The following would receives "counts" in this scenario

Inpatients	Instructed	Adhered	Entered	Instructed, not adhered	Entered without Instructions
INP to HOS			X		X
INP to SNF	X	X	X

 Just because we use the word, "instructed" should not be taken as an indication that any patient instruction of any kind was provided. The claims indicate the chosen status at discharge but do not contain any other insights into what took place at discharge

 The content on this table is intended to be introductory - for usage information and more detail, see Discharge Events by Setting.

 For more information on the category, "other," see Facilities Analyze page - What is "Other?"

 

Outcomes by Setting

This table is the flip side of the table Discharge Event by Setting . That table answers the question, "After Discharge, where'd everybody go?" This table answers the question, "What happened when they got there."

This action-packed table provides several insights into the post-acute care provided to patients discharged from the selected facility. Readmit rates and mortality rates are calculated for several different post-acute destinations with county and state averages available as benchmarks for comparison.

 The Outcomes by Setting table will only have an Inpatient version for selected hospitals and a SNF version for selected Skilled Nursing Facilities. The image below is for a hospital. For a selected SNF, the table will be identified by "SNF," instead of "Inpatient," or "INP."

 For those of you familiar with the original Trella Health product, this content was found in the second half of the Post Acute Destinations table (PAD).

   

Metric Summaries

• Inpatient - Think of this as Patient Pathway. In this column we identify which post-acute destination the inpatient discharges were admitted to. Example: INP to HHA indicates that the metrics in this row pertain to patients who were discharged from INP and were admitted to HHA
• Readmit Rate - This is the percentage of discharges from the selected facility who were admitted to the type of post-acute care listed that were readmitted to a hospital within 30 days of the initial discharge. Another way of looking at this is that this is the readmit rate for the selected facility calculated from the subset of patients who entered the listed post-acute care setting. 
  •  For more information on Readmission rates, see Readmission Rates.
  • State and County benchmarks are included for comparison.
• Mortality Rate - This is the rate at which patients expired within 30 days of discharge from this facility following admission to the type of post-acute care listed.

 For more information on the category, "other," see Facilities Analyze page - What is "Other?"

 The content on this table is intended to be introductory - for usage information and more detail, see Outcomes by Setting.

 

Adherence by Setting: Inpatient (Only in graph view.)

In the Trella Health products, Adherence is a measure of the rate at which patients discharged from a hospital are admitted to the intended post-acute setting. This chart compares adherence performance between the three primary types of post-acute care providers for discharges from the selected facility.

 

 

State and County Comparison 

 For each post-acute type, the county and state averages are indicated in each chart. The county average is marked with a triangle,  - the state is marked with a circle, .

 If you hover over any of the blue bars, the metrics will be displayed for the post-acute provider type, state, and county. See image above.

 There is no parallel table if you turn off chart view . These metrics are the right-most column of the table: Discharge Events by Setting.

 

 

Patients Discharged with Home Health Instructions (Inpatient Only)

This table shows the impact of home health care on the patients discharged from the selected facility. For all patients discharged who were coded for home health, we compare metrics for three possible outcomes:

• Patients admitted to home health as a new stay
• Patients admitted to home health as a resumption of care
• Patients who were not admitted to home care - this could mean they were admitted to another post-acute setting or just went home.

For each outcome we calculate a patient count and performance metrics specific to the patients for whom the listed outcome applies. The performance metrics have county and state benchmarks for comparison.

Metric Summaries

• Total - This is the count of patients who were coded for Home Health at discharge from the selected facility relative to the outcome in the row header.
• Percentage of all Inpatient Discharges - This metric is the percentage of all inpatient discharges for whom the outcome in the row applies. (You would find the count of all patient discharges above on the same page in the "Total" row of the Discharge Events by Setting: Inpatient.)
• Percent of all Patients who Received Instructions - The percentage of patients who were coded for home health at discharge from the selected facility for the outcome in each row.
• % Readmitted: 30 Days - the percentage of each listed outcome who were readmitted.