3 Proven Ways to Improve Practice Profitability and Clinical Performance Using Outcomes

outcomes-blog“Why should we collect data?”

“What’s the ROI of PROs?”

“How do providers and practices use outcomes data most effectively?”

These are great questions, and we get them all the time. Prospects, clients, and partners constantly look for the most valuable and effective ways to utilize outcomes data. Our answers and advice typically vary, but we inevitably reply with a question of our own: “What are your goals?” Clinic goals, quality goals, business goals, marketing goals and others factor into play when utilizing quality data.

This article focuses on the three that, in our opinion, provide the most significant ROI potential for a PRO collection program:

  • Negotiating with payers
  • Internal physician quality reviews
  • Marketing

At OBERD, we know our role: we’re the data collection experts. And for good reason: Our clients likely don’t think about data collection nearly as much as they’re thinking about how to improve their practice, how to differentiate their providers, and how to grow margin by negotiating more favorable reimbursements from payers. Outcomes data plays a role in all three. Let’s dig in.

Below, we identify three core initiatives common at most orthopaedic institutions and discuss how quality data plays a key role each.

Payer Negotiation

When preparing for payer negotiations, administrators, QA staff and physicians can gather and utilize outcomes and satisfaction data that highlight the practice’s attention to quality and demonstrate its continuous improvement in outcomes scores.

Armed with quality data relating to patients and procedures, administrators can drill down and have data-driven negotiations with payers to gain more favorable reimbursement rates in contracts.

And it’s worth it to payers. If they know a provider has high (and predictable) quality metrics, they know the provider will, more than likely, get it right the first time. They can hedge against re-admissions and complications because they have the data that demonstrates low risk.

This is especially useful in larger metropolitan areas where competition for the patient population is fierce. Providers and institutions who can demonstrate quality and value, backed by data, are a safer bet for payers.

Physician Reviews

Administrators and quality managers may struggle with physician quality reviews if they’re not armed with data-driven quality and satisfaction metrics. PRO data, especially when blended with Satisfaction data, can give an administrator a quantified view of the quality a physician provides.

Practical use cases include identifying why a surgeon’s quality scores are high for a specific surgery (or even a specific patient cohort), and utilizing that data to refine methods for other under-performing providers.

Imagine the following conversation between an administrator and surgeon: “Dr. Smith, can no longer perform a total knee for patients with a BMI over 20 because outcomes scores are too low and it makes the practice vulnerable to margin if it affects our payer contracts. Dr. Smith needs to adjust your process, perhaps by adopting Dr. Jones’s approach because Dr. Jones’s scores are above average on benchmarking reports. Or we can change workflow triage that patient cohort (<20 BMI) out of Dr. Smith’s patient schedule.”

Data-driven Marketing

It seems like every time we hear about an orthopaedic surgeon, you also hear, “he’s the best” or “she’s the best.”

Surely not every surgeon is the best, even among their local market or patient population. But practices and providers have benefited from anecdotal reputations like, “he’s the best” for years. In the future, a claim of being, “the best” needs to be backed up.

Just like so many other consumer purchasing decisions, prospective patients are first turning to the internet for reviews and fact-finding about a surgeon prior to going for a consult. Practices and providers who collect data can also demonstrate quality by leveraging data in data-driven marketing messaging.

Savvy practices have already begun advertising their data collection initiatives. Advertising shows how providers collect quality data using patient questionnaires in order to tailor care to a unique patient, or make recommendations based on “patients like you.”

That line of advertising instills a sense of ownership in the patient. They intuitively understand that the questionnaires they complete play a role in the care they receive, giving them an onus of control in the process. Therefore, data collection is an effective, credible way to market value-based care.

As seen in OBERD’s Insights Blog.

2.02% Reward for Perfect 2017 MIPS Score

final-score-100The results are in! We now know how providers will be rewarded for their 2017 MIPS efforts. You may be disappointed to see that with a perfect score of 100, the 2019 payment adjustment will max out at just slightly above 2%. And, unless a provider exceeded the exceptional performance threshold, thereby qualifying for a share of the $500 million bonus pool, the reward for successful MIPS performance is no more than an approximately 0.3% positive payment adjustment.

A survey of a few SRS Health customers revealed the following correlations between scores and payment adjustments:

2019-positive-payment-adjustments-v3

To summarize, MIPS Medicare payment adjustments fall into the following categories:

chart3

So what happened to the 4% positive payment adjustment “carrot” that the MACRA legislation appeared to offer (even before the bonus)? It vanished when CMS eased the requirements and reduced the threshold for penalty avoidance. Under the mandate of budget neutrality, with fewer providers receiving negative payment adjustments, there will be less money to share among the many providers who merit positive payment adjustments.

This was not unexpected, and a similar result should be anticipated for the next few years. The 2020 payment year (2018 performance year), offers a carrot of 5%, which will be similarly elusive. And the challenge of how to sufficiently motivate and reward providers will continue over the next few years, now that Congress has extended the transition period and relaxed the previously aggressive timetable for increasing the performance threshold.

 


 

Note:  To find out your individual or group’s 2017 final score and precise payment adjustment, log in to the QPP portal and follow the “QPP Performance” prompt. Your final score will likely be what you expected based on your attestation and/or other submission(s). If there is a difference, it could be due to new information reflected in the Quality component of your score, for example:

  • If, based on sufficient volume, you were subject to the All Cause Hospital Readmission measure, that data would be included in both the numerator and denominator of your Quality score.
  • If one of your CQMs was CAHPS for MIPS, that score will now be reflected.
  • If you reported a CQM for which no historical benchmark had been available at the time of submission, a benchmark may have been created subsequently, based on 2017 performance data.

If you believe that there is an error in CMS’ calculation of your final score—and therefore your payment adjustment—you can request a “Targeted Review” by September 30, 2018.

Are You Preparing for Appropriate Use Criteria Compliance?

auc-blogAppropriate Use Criteria (AUC) is a lesser-known government law that will affect everyone who orders advanced imaging procedures—a staple of orthopaedic practices. AUC is part of the Medicare Physician Fee Schedule regulations.

The law will impact the ordering, performing, and payment for advanced imaging procedures beginning January 1, 2020. The initial year (2020) will be an educational and testing year that will not affect payment.

Included in the advanced imaging procedure category are MRI, CT, PET, and nuclear studies. While certain specialties may not order many PET or nuclear studies, MRI and CT are staples in the diagnostic pathway and help determine care.

How does the law work?

The government is mandating that before any advanced imaging procedure is ordered, the ordering provider must consult an approved Clinical Decision Support Mechanism (CDSM). The CDSM will consider multiple factors on the patient and provide a recommendation as to whether or not the ordered procedure is appropriate or whether an alternative would be better.

At this point, providers have the choice to continue with the original order or to follow the CDSM recommendations. Information provided in the CDSM recommendation must be provided to the furnishing provider (imaging facility). The imaging facility must then include this information on the claim to the payer, and data on the choices made by the ordering provider will be stored in the CDSM for future auditing purposes.

Those who do their own in-house imaging will be impacted on the ordering and furnishing side. Your EHR, Radiology Information System (RIS), and claims management system will all need to be updated with new software to manage this.

We encourage you to speak with your EHR vendor to make the process of remaining compliant and meeting the requirements as seamless and minimally invasive as possible.

Customers or Clients… What’s the Difference?

I have read a lot of books on customer service, including, J. W. Marriott’s The Spirit to Serve and Without Reservations, as well as Hug Your Customers by Jack Mitchell, upscale clothier to the rich and famous. Both describe the service culture, personal attributes, and dedication required to build a trusted brand and to create an exemplary customer experience that keeps customers coming back.

A lot can be learned from these entrepreneurs and the organizations they’ve built. In fact, we at SRS Health have a lot in common with them in striving to create an experience that exceeds expectations. But there is one important difference. While these trusted brands sell a product or service, we are charged with offering our clients ongoing professional guidance and support.

In short, customer service involves a one-time transaction (which may be repeated if there is a good experience) while client service involves an ongoing relationship (which may not go on very long if there is not a good experience).

With the healthcare landscape changing at a rapid pace, a good client experience requires an atmosphere of mutual trust so that medical professionals can rely on their healthcare IT partners to advise them. Just as financial counselors are charged with ensuring their clients are informed and prepared to make sound investments decisions, HCIT partners are charged with ensuring that their clients have the insight to make sound decision regarding their healthcare IT investments.

But that is not all—we are also charged with providing expertise in regard to compliance, operational efficiency, patient engagement, and more. As trusted advisors, we need to know where the industry is headed, and to provide the solutions that prepare our clients to succeed in that future.

At SRS, we like to say that our expertise is helping specialists practice their expertise—we provide solutions that take care of the business side of medicine so that medical professionals can take care of their patients. In practice, this means integrating intelligence within physicians’ workflows—where it can be seen and used to help them make informed patient care decisions efficiently and effectively.

And it doesn’t end there—we also provide the business intelligence within the administrative workflow, so that business leaders can utilize the data to improve operational efficiencies, lower cost, build their practice reputation, and improve their bottom line.

A continued passion for, and commitment to, ensuring that our clients are prepared to achieve their patient care and practice profitability goals—that is how we grow our relationship and earn their trust each and every day.

Does your healthcare IT partner make you feel like a customer or a client?

Hackathon IV: Notes 2.0 and Beyond… A New Evolution Has Begun

Hackathon 1Last month, SRS Health participated in an energizing, collaborative and fun-filled Hackathon IV, a company-wide event designed to stimulate the innovative mind-set and competitive spirit of the organization to explore creative solutions for client needs.

The theme for the 4th Annual Hackathon Event was, Notes 2.0 and Beyond. Technological advancements in the healthcare space has enabled the use of various mobile devices and technologies at the point-of-care. The team was challenged to come up with ideas that revolutionize the process of capturing and documenting patient encounters, while maintaining/improving accuracy, high productivity, and efficiency for the end user.

Scores of ideas were submitted from across the organization and narrowed down to six ideas that our hackathon teams focused on. At the end of the event, the organization held a traditional “science fair” to showcase the incredibly innovative solutions developed over the one-week event.

We are excited that a number of these concepts have the potential to make it into future versions of our products. We look forward to sharing them with our clients in the 2018 User Summit’s Innovation Expo in October in Las Vegas.

At SRS Health, we strive to bring innovative healthcare IT solutions to the marketplace and our hackathon events allow the team to innovate without restraints.

Hackathon 2

Spring at SRS Brings New Growth

ceo-spring-blogThree months have passed since I took over the reins at SRS Health, and what I have enjoyed most over that time is sharing in our clients’ successes, as well as learning about the challenges they face, their experiences, and their visions for the future. So far this year, I have had the pleasure of speaking with many of them on the phone and off traveling around the country to meet others in their practices or at conferences like ADAM, AAOS, AAOE, The OrthoForum, and HIMSS.

One recurring theme that has been a part of every conversation is the need to embrace change—to look forward, to anticipate, and to strive for improvement. Our mission is to help our clients do just that. We are excited to share the innovations SRS has been working on to help our clients excel at the practice and the business of medicine. Here are a few examples:

SRS Health launches the first end-to-end integrated clinical and financial solution suite for high-performance enterprise practices

I am pleased to announce that SRS recently debuted a unique and powerful new addition to our end-to-end software suite that leverages both clinical and financial expertise. What makes this solution unique is the integration that addresses true episodic care. SRS’ roots in the orthopaedic market combined with the new financial management capabilities offers a seamless set of tools for enhancing workflows, adapting to regulatory changes, adopting risk-based models, managing the increase in patient economic responsibility, and expanding programs in the employer market.

The Opioid Crisis and Drug Monitoring

As you know, the opioid crisis has become a top-of-mind political, social, and policy challenge. SRS has committed to joining the fight by being the first specialty EHR to offer PDMP (Prescription Drug Monitoring Program) checking and documentation integrated within the prescribing workflow—delivering a 67% time savings over current methods. More than 40 states already have PDMP mandates and it won’t be long before they all do. This is a great step in keeping our clients ahead of the curve.

Improving Our Clients’ Experience

While working on innovation, we haven’t forgotten about our clients’ day-to-day experience. To ensure their success, we have been formalizing the structure of the SRS Client Success Program. This year we’ve launched the Client Success Training Program and the Features Improvement Team. In addition, we have increased our clients’ ability to integrate with registries, HIEs, and more. These programs ensure that they have the knowledge and skills to fully leverage their HCIT solutions, the facility to share knowledge across their organization, and the connections to exchange information with optimal efficiency.

Medicine continues to put more and more demands on physicians, clinicians, and other healthcare professionals, and we’re excited that our integrated solutions suite optimizes performance and care before, during, and after the patient encounter. Our goal is to help our clients by taking care of the business of medicine, so they can focus on what matters most—their patients.

The Opioid Crisis

It’s not news that America is facing a crisis with opioids and narcotic abuse—public service announcements are running on every network; the president has declared it a health emergency; and an increasing number of Americans have had personal experiences with a family member or friend who has become addicted.

Laws have been put in place or are being considered at every level of the government to help address the problem. One approach to helping doctors continue to care for their legitimate patient requests while identifying drug seekers or “doctor shoppers” is the PDMP, or Prescription Drug Monitoring Program.state-of-market-041718-600px

1 Interstate Data Sharing: http://www.pdmpassist.org/pdf/Interstate_Data_Sharing_20170920.pdf
2 PDMP Hub-to-Hub Interoperability Updates: http://www.pdmpassist.org/pdf/Interstate_Data_Sharing_20170920.pdf
3 PMP Gateway: https://apprisshealth.com/solutions/pmp-gateway/

PDMPs are state-run databases containing patients’ prescription histories. PDMPs now exist in all states, and more than 40 states have laws making it mandatory to check the PDMP before prescribing a narcotic. Some states require documentation that the doctor not only checked the PDMP, but also counseled the patient. And some states are starting to identify doctors who prescribe high numbers of narcotics, and are putting programs in place to counsel those providers. The College of Healthcare Information Management Executives (CHIME), a branch of HIMSS, recently met and recommended that the Center for Medicare and Medicaid Services (CMS) include the use of Electronic Prescribing of Controlled Substances (EPCS) as part of the MIPS portion of the Quality Payment Program (QPP) in 2019. They also recommended that CMS and Office of the National Coordinator (ONC) focus on interoperability and removing the burden for clinicians.

Another method to help control the crisis is the use of EPCS. Unfortunately only 17 percent of physicians in the US are EPCS enabled. [1] While 90 percent of standard prescriptions are processed electronically, only 14 percent of controlled substance prescriptions are electronically delivered. [2]

Does your EHR offer PDMP connectivity? Does it allow for EPCS? The technology to automatically complete PDMP checking and documentation does exist—today—providing physicians with the option of making their prescribing and compliance workflows seamless. Providers who use EPCS with PDMP should automatically be presented with the patient’s prescription history any time they prescribe a narcotic. The system should also automatically connect to the state database, retrieve the history, display it to the physician, and record that the physician checked the PDMP. This can be up to a 67 percent time savings over the current process of logging into the PDMP directly. [3]

SRS has committed to joining the fight by being the first specialty EHR to offer PDMP checking and documentation integrated within the prescribing workflow. This is a great step in keeping our clients ahead of the curve.

What are you doing to address the opioid crisis?