Why isn’t [physician or facility] in the market data?
There are many reasons why a record isn’t in the market data:
- Market data is based on Medicare claim. If that physician or facility accepts other payors such as Medicaid or private insurance - or like many assisted living facilities, do not bill through Medicare - those claims are not included.
- In addition, there may be the way that the physician or facility submits their claims. The most common are:
- Claims data is collected at the NPI level and based on the address for billing, which is not always the same as the treatment office location(s). For example: a facility may have been around for years, but the facility use an off-site billing office (and a different NPI) for their claims, rather than the NPI on the registry.
- Not every physician has a hospital or SNF affiliation. The way the claims are processed, their name and the facility name must be on the same claim form otherwise the market data analysis can't make the association.
- Not every practitioner has a NPI. Physician's Assistants (PAs) and Nurse Practitioners (NPs) often bill under a supervising MD. It’s possible that the MD listed as the attending physician on the claim vs the PA/NP.
- Lastly, was the physician or facility in business during that time - check the latest claims update for current reporting periods.
Do clients only receive Market Data for counties purchased?
Clients can only view counties that they purchased at the top-level tabs. However, with sub-reports, a client would see all associated data for the line that they’ve drilled into.
Example: A PlayMaker client has only purchased data for Davidson County, TN. When viewing the physician sub-report or drop-down lists on a hospital in the county, physicians outside of Davidson County could be visible as long as they were affiliated to that hospital.
Clients can only view Profiles for agencies or physicians within the counties that they have purchased. However, within the report, a client would see all the associated physicians or agencies for the report as a whole.
Example: A PlayMaker client has only purchased data for Davidson County, TN. When viewing the Physicians report for Davidson County all physicians applicable within the selected dataset will be visible, though only physicians within the purchased data will have a blue hyperlinked Physician Profile.
What is the “claim” – an actual claim on patients, an ADC, or is it billing?
Adjudicated claims (claims that were finalized).
How is agency location determined in Market Data?
We use the Primary Agency Address listed in the NPI Registry to determine an agency location.
My agency name doesn't look correct in Market Data. Where is this name coming from?
We use the DBA associated to the NPI as listed in the NPI Registry to determine an agency name.
What is "Workload Roundup" or Workload %?
Column labels and definitions will vary within the reports, sub-reports and presentations of data throughout Market Insights and TargetWatch, but broadly: workload roundup is a measurement of a physicians’ referral volume at a selected facility.
For example: if a physician displays as 100% Workload Roundup on the sub report, all of their hospital claims are at that hospital and they will not display on the Physician sub report for other hospitals. A physician that shows 75% would have the bulk of their hospital claims at that hospital, but may also show up on other Physician sub reports for different hospitals with varying claims percentages.
In the apps:
- The Physician's sub-report of a SNF (TargetWatch), shows Workload RNDUP as a measurement of the physicians’ referral volume at the selected SNF.
- The Hospital Workload sub-report (TargetWatch) outlines a physician's hospital workload regarding referrals associated to a physician’s name as part of a hospital claim.
- Workload % (Market Insights) indicates the percentage of that physician's overall claims associated to that hospital - it can be viewed as a proxy for the time spent at that facility.
What’s the difference in Market Share and Hospice Share Percentages?
- Market Share = Where are patients going that the provider is signing orders for
- Hospice Share = Where are patients going that the provider is coming in contact with
What's the difference between the Hospital LTAC Readmit Rate and Agency LTAC Readmit Rate in the LTAC Hospital Crosswalk?
- Hospital LTAC Readmit Rate = the percentage of patients that were readmitted to the hospital after being discharged to LTAC
- Agency LTAC Readmit Rate = the percent of patients that are readmitted after being sent to Home Health from the LTAC
Now that count data is incorporated into the reporting, what are the nuances that we need to be aware of in terms of how data is being displayed?
Keep in mind that the analytics provided are based off adjudicated claims counts, though the numeric values provided in the “counts” columns are of Patient Count, not claim count.
What is the difference between Total Patient Count and Total Home Health Count?
- Total Patient Count is the total number of Medicare-eligible patients that a referral source interacted with over a 12 month period.
- Total Home Health Count is the total number of patients that the referral source referred for HH service over the period.
What is the Other Agency line on the SMA sub reports?
In the SMA report, Other is used to identify agencies that have <11 admits in a particular county or state, to maintain anonymity in compliance with privacy regulations. For each county, agencies will either be listed by name or as Other, where they are aggregated with any other agency holding fewer than 11 admits. Please note that Other will be different for every county/state, and that counts are based on the patient address, not agency location.
How are physicians on the Group Practice tab grouped together in TargetWatch?
The group practice tab looks for common addresses in the NPI registry/database and creates the organizational groupings and then associates the physicians with similar addresses.
What is the exact time frame of the Market Data claims? This article says that the current year is a rolling year, which sounds like it includes duplicate information for previous years.
Yes, there is some overlap in the current year data. We receive updates for any historical claims that are adjudicated since our last data refresh along with any new claims within the date range we receive from our data partner. Data sets that we’ve received full years on (2016, for example) do not “roll” – they just update as new adjudications are added. Until a current year is fully provisioned we backfill the year with the rolling calendar data to provide a 1:1 comparison with other annual data sets.
Example: A current rolling 12-month period is being compared to the last completed calendar year. Once a calendar year is completed, it simply shows the trend over the prior year.
How do I locate Washington, DC [or other non-standard location listing] in TargetWatch?
TargetWatch follows the State>>County >> City format in order to maintain consistency within the Heat Map. This does, from time to time, require some non-standard locations listings. Here are some of the most common, to help you target more effectively:
- DC Area: State = DC >> County = The District >> City = Washington
- Louisiana Parishes are listed as counties
- New York City has a City listing, as do each of the five boroughs: Bronx, Brooklyn, Manhattan, Queens, Staten Island
Though not visible on the Heat Map, market data is also available to purchases for the following:
- American Samoa (AS)
- Guam (GU)
- Northern Mariana Islands (MP)
- Puerto Rico (PR)
- Virgin Islands (VI)
What criteria does a claim have to meet to be included in the Referral Source annual admit number?
- Review the claim and if there is a "referring NPI" give credit to that physician/facility
- Look for any claims for the patient in the prior 15 days and give credit to the most recent facility
- Default back to attending physician on the claim as referral source