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.

Are You PDMP Ready?

According to the United States Centers for Disease Control and Prevention, opioid addiction claims 115 lives and sends more than 1,000 people to emergency rooms every day, and has killed 64,000 people in 2016. It is the leading cause of death for Americans under 50 years old.

Prescription opioids are a main factor in the crisis. Although there has not been an overall change in the amount of pain reported by Americans, opioid prescriptions have quadrupled since 1999.

What’s being done to help?  Prescription Drug Monitoring Programs (PDMPs) are state-run drug-monitoring programs that collect and track controlled-substance prescriptions in a searchable database. They provide physicians with intelligence about prescribing and patient behavior that can help them make appropriate prescribing decisions. Learn how you can get PDMP ready:infographic-srs-pdmp

May your holidays and new year be filled with peace and prosperity!

Happy Holidays

Now is the perfect time to reflect upon the past year and those who have helped to shape our business. You!

We are truly inspired by physicians and healthcare professionals who are dedicated to providing the best care for their patients, and delighted to help them do so now and in the future.

May your new year be filled with good health, happiness, and success!

Happy Holidays,
Your SRS Health Team

Like Holiday Gifts, “Patient-centric Care” is about Quality, Not Quantity

The end of the December is a time for reflection on the closing year, and for making plans for the new one. It’s a time for top-ten lists and New Year’s resolutions. But for now, let’s focus on one of the top buzzwords of the year in healthcare: Patient-centric care. 

It’s actually been several years now that patient-centric care has been gaining buzz-worthy status, and like most trendy new concepts, it has often been used without a clear consensus on what it actually means. Most recently, for instance, it has become a catchall term for any care that offers a more comprehensive focus on the patient. And that should make us pause and think—how in the world did medicine ever lose its comprehensive focus on the patient? There have been many factors, to be sure, but the primary driver seems to have been physicians’ and practices’ need to align themselves with payment models that rewarded the volume of visits over the value of care.

This has permeated all levels of healthcare for many years. Whether it was the development of healthcare IT strategies, the crafting of EHR systems, the HIMSS stages of adoption and utilization, or the use of performance scorecards and data warehouses and analytics—all the focus was on maintaining high volumes of patient care, while a comprehensive approach to the patient often got lost in the flood of individual symptoms, tests, and treatments.

That is, until the recent sea change in the industry that shifted payment models from rewarding for quantity to rewarding for quality. This was a necessary correction, but the resulting increase in focus on value-based contracts puts healthcare providers at risk for the total cost and quality of care provided.  It has also highlighted significant holes in IT and data strategies that need to be addressed if an organization is successful in this new payment paradigm. At the top of that list of necessary improvements is patient engagement.

How to Engage? 

Patient engagement isn’t something that takes place at one point on the healthcare continuum—it’s a way of reorganizing the care continuum so that patient input and feedback are integral parts of the process at every step. Proper patient engagement aims to:

  • Involve patients in their own healthcare, leading to better outcomes and increased patient satisfaction;
  • Meet patient expectations for better ways to access and engage with their healthcare information and data;
  • Automate patient intake and other processes, helping to secure ROI;
  • Leverage patients to enter data, freeing practice staff to focus on patient care;
  • Improve communication between patients and caregivers;
  • Improve compliance with government regulations; and
  • Provide a global platform for patient access that spans multiple facets of the practice, i.e. physical therapy, urgent care, and other office locations.

This means that, when it comes to IT issues, practices need to choose the right vendor if they want to make patient engagement a reality. They need a vendor who does more than just sell a one-size-fits-all solution; they need a partner in the process of restructuring established workflows for greater efficiency, reduced costs, and better patient engagement. Achieving this is a big enough task on its own, so it’s important to minimize any potential challenges to adoption. The solution has to be:

  • Easy-to-use for both patients and practice staff;
  • Vendor neutral (not limited to the products of a specific manufacturer);
  • Data standardized, so the data can be accurately exchanged between different systems, increasing confidence of both doctors and patients; and
  • Able to connect and communicate with EHRs, HIEs, and ACOs.

As we move from volume- to value-based reimbursement, it is critical to understand how to best utilize the available tools and solutions to get patients actively engaged in their healthcare. Achieving this goal won’t be easy, but we will be creating better outcomes for both patients and for the practices that care for them. Is this at the top of your list for the New Year?

Achieving Outcomes Success

How do you improve outcomes? By collecting and reviewing quality and clinical data, comparing it to practice-wide and national benchmarks, identifying the most effective protocols and their impact on revenue, then standardizing best practices across the organization. These simple steps can greatly improve not only clinical objective outcomes, but patient reported outcomes as well—resulting in an improved reputation, an increase in patient referrals, and a stronger bottom line.

See how utilizing the right data can improve patient care, and standardize success: Achieving Outcomes Blog Image

Check out, Managing Outcomes and the Transition to The Value- Based Care World  to learn more on how proving outcomes for your patients, improves income for your practice.

Power of the Patient Interface

patient-powerHealthcare providers have long known that engaging patients leads to improved health outcomes; in a value-based payment world, engaged patients also provide a stronger framework for increased revenues. For this to happen, however, practices need the right patient engagement platform—one that not only empowers patients to become partners in their own healthcare, but that also documents that engagement.

A reliable, cutting-edge patient portal, for example, can enlist patients to provide extensive personal health data outside of the actual healthcare encounter, freeing up caregivers to spend more time with patients. Further, as population health becomes of increasing concern, practices whose patient engagement platform offers the ability to aggregate and analyze these individual health histories will have a head start. Patient engagement is where relevant data on population health begins.

It is equally important that the patient portal supports compliance with MIPS (Merit-based Incentive Payment Systems), enabling practices to comply with government requirements under Meaningful Use and MACRA (Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act) regulations—this will increase Medicare payments and minimize takebacks.

Finally, the patient portal needs to integrate seamlessly with the organization’s electronic health record, health information exchange, and accountable care organization, if any. The right solution will be flexible enough to adapt to the healthcare facility’s IT system, not the other way around.

ACOs and Triple Aim’s interest in patient engagement

Patient engagement was not initially a concern of accountable care organizations (ACOs), which were born of healthcare reform as a way to redefine the shared responsibility of doctors and hospital staff for coordinating care, improving quality, and lowering costs. That changed when the Affordable Care Act officially codified them into law, and recognized that ACOs could not succeed without patient engagement.

Patient engagement has also been deemed essential for the success of the Triple Aim, a framework developed by the Institute for Healthcare Improvement for optimizing health system performance by:

  • improving the patient experience (including quality and satisfaction);
  • improving population health; and
  • reducing the per capita cost of healthcare.

According to the IHI, “quality” is defined from the perspective of an individual member of a given population which leads logically to a focus on patient-centric care and patient engagement.

The ideal patient portal should be easy-to-use, responsive, and allow your patients to communicate with your practice on their terms. Practices need to communicate and connect with their patients to improve healthcare.

Do you have the right platform to engage your patients?