“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
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.
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.
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.”
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.