Facility and Provider Scorecard


Additional Resources:


Key Terms:


  • Effective Period: Select the time period for the patients you want to view; e.g., the active patients during that period.
  • Date Start/Date End: Select the year of data you want to view; e.g., the data during that period
  • Hierarchy Levels
    • Client Configured
    • Organization/Company. Sometimes an organization has subsidiaries, sister companies, or companies they may merge with in the future with ACO and commercial lines. For whatever reason, they want the company accounts separate. This option allows the assignment of company access
    • Division. A division is a group of facilities.
    • Facility. A facility is single TIN with access to all provider data under the TIN.
    • Subgroup (Facility Locations). A TIN may have 2,000 patients and 5 locations. Provider NPIs that are part of the subgroup are setup.
  • Select Division – View divisional level data that groups facilities.
  • Select NPI – View individual providers designed in the National Provider Identifier (NPI) database.
  • Select TIN – View individual facilities designed by Tax Identification Number (TIN).
  • Select Subgroup – View groups of NPIs setup in a group.
  • Scorecard: NPI or TIN financial and quality performance scorecard.
  • Number of patients with active claims: Number of patients that are "actively" assigned.
  • NPI Number: National Provider Identifier issued by CMS (10 digits).
  • HCC Benchmark: Financial spend benchmark for TIN, Subgroup or NPI based on the Average HCC Score of assigned patients.
  • Year to date average per patient spend: Average year to date per patient spend attributed to TIN, Subgroup or NPI.
  • Average per patient spend VS HCC Benchmark: Percentage of financial spend benchmark used year to date. What you spent vs what you have left.
  • Year to Date Benchmark:Average year to date per patient spend attributed to TIN, SubGroup or NPI.
  • Year to Date Benchmark vs Average Per Patient Spend:Percentage difference from average per patient spend to the year to date benchmark.
  • Quality Measures Detail "Completed Patients":QM Performance Scores calculated based on completed measures only. Scores only measures in which data entered.
  • Quality Measures Detail "Full Population Score":QM Performance Scores calculated based on ALL patients. This is the actual score as incomplete patients are included in the Denominator, but not the numerator.
  • Per 1000 Rate:A normalized rate to compare Organizations, Facilities, or Providers equally. Note that CMS ACO Averages and Fee Service Averages are all calculated at a per 1000 rate.
  • Ed Visits Per 1000 Beneficiaries:Number of Emergency Room visits per 1000 beneficiaries attributed.
  • Discharge Per 1000 Beneficiares:Numer of Inpatient Discharges per 1000 beneficiaries.
  • CT Scans Per 1000 Beneficiaries:Number of CT Scans per 1000 beneficiaries.
  • MRI Events Per 1000 Beneficiaries:Number of MRI Scans per 1000 beneficiaries.
  • 30–Day post Discharge Provider Visits Per 1000 Beneficiaries:Number of post discharge provider visits within 30 days of discharge per 1000 beneficiaries. Note that this is a number that should be higher than the FFS or ACO averages.
  • Hospital Admissions with Stays Between 1 and 3 Days Per 1000 Beneficiaries: Number of Hospital Admissions with a length of stay between 1 and 3 days per 1000 beneficiaries.
  • SNF Admissions Per 1000 Beneficiaries: Number of Skilled Nursing Admissions per 1000 beneficiaries.
  • Average SNF Length of Stay: The average length of stay for Skilled Nursing admissions.
  • Number of Patients with Claims:Patients attributed to a Provider, Practice, Division or Organization based on your selection that have not opted out of data sharing and have claims.
  • Average Chronic Conditions:The average number of chronic conditions for patients attributed.
  • Count of Costly Patients:Patients costly today or trending to be costly in the future. Risk score in top 30% this year or previous year, 1 or more hospitalizations in last 12 months, 3 or more emergency department visits in the last 24 months and 3 or more chronic conditions.
  • Top Chronic Condition:Top occurence of chronic condition for attributed beneficiaries.
  • Average Age:The average age of attributed beneficiaries.
  • Count of Frequent ED:The number of attributed beneficiaries with 3 or more ED Visits.
  • Average HCC Score:Average patient risk score calculated for TIN, Subgroup or NPI. An average below 1.5 is moderately sick population. Above 2.0 is a very sick population.
  • Count of Top 20% Spender:The number of attributed beneficiaries in the top 20th percentile of spend for the organization.

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