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.

Better Patient Reported Outcomes Lead to Better Outcomes

Barbara Mullarky

Barbara Mullarky

Director, Product Management at SRS Health
Barbara has had a successful career in the healthcare industry, working for both vendors and healthcare provider organizations. She has held roles in sales, marketing, product management and professional services, working with EMR and department-focused solutions for the laboratory and imaging.

Prior to becoming the Director of Product Management at SRS, Barbara was with GE Healthcare (now GE Digital), where she held the positions of Senior Product Marketing Manager for Centricity imaging products, Product Marketing Manager and Customer Collaboration Leader for what is now Caradigm, and Upstream Marketing Manager for Centricity Laboratory. Barbara also worked at the University of Arizona Medical Center, where she managed a team that was responsible for implementing and maintaining 27 departmental IT solutions, the ambulatory EMR and the patient safety initiatives.

Originally from New Jersey, Barbara now lives with her husband in Tucson, AZ. She is a graduate of the West Virginia University College of Medicine and is a registered Medical Technologist. When not at work, she loves traveling, taking photographs, watching football and spending time with her two Brittanys.
Barbara Mullarky

Outcomes is a hot topic in the healthcare industry. It is one of the criteria being used to define value-based reimbursement strategies and, more importantly, to drive better care for patients.

For some time now, payers and government agencies have been using traditional measures to evaluate outcomes, assessing the number of patients who were readmitted within 30 days, or how many post-surgical infections occurred. For the most part, this data was retrospectively analyzed; it was used to put process improvements into place, but it seldom took into account patients’ own opinions on how they were doing. Ultimately, how can we claim a successful outcome if the patient doesn’t subjectively experience an improvement in health and well-being?

outcomes-blog-v2Many EHRs provide some level of clinical decision support—reminding doctors of how long it has been since an osteoporosis patient’s last bone scan, or when it’s time to review an arthritis patient’s therapy and order blood tests for his or her medications. Some might put this in the category of outcomes, but to me, they are really alerts. Can they affect outcomes—of course! But do they really tell us how the patient is doing?

To change this paradigm, practices are moving toward collecting and measuring patient reported outcomes (PROs). The National Quality Forum defines PROs as, “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” PROs provide data on what patients are able to do and how they feel by asking questions. They not only cover the clinical aspects of pain, swelling, and range of motion, they assess the patient’s reported status for physical, mental, and social well-being.

In orthopaedics, standardized surveys such as PROMIS, HOOS, and KOOS have been designed to collect patient-reported information before and after surgical procedures. This allows physicians to prospectively and retrospectively evaluate data provided by their patients.

Prospectively, the surveys can be used to determine the factors that will drive a better outcome for the patient. Using best practices standards, physicians can make a determination prior to taking action as to how successful the outcome will be. By discussing potential outcomes, lifestyle factors, and behavioral changes with the patient before surgery is scheduled, doctors can better predict the outcome and recommend the best path—all while controlling costs. For example, if a patient does not have reliable transportation to get to follow-up appointments and physical therapy, physicians might provide information on local transportation services or decide on inpatient versus outpatient rehab.

Retrospectively, if a patient reports unsatisfactory results, doctors can gauge the patient’s feedback against the original expectations of the treatment plan. It might be that the patient is meeting, or even surpassing, the predicted outcome. That little piece of information might change the patient’s outlook and get him or her back on the path to success. Alternately, doctors can determine what could have been done to either reach a better outcome, or develop a more accurate prediction. These learnings can be implemented as best practice to drive better outcomes for future patients.

PROs can also be used as a benchmarking tool, as a way to gauge success against others in the same practice or the same market.

Today, only 35% of orthopaedic practices are collecting outcomes data. Part of this is due to the complexity of managing the process—of collecting, analyzing, and making the data relevant. The most critical step is of course getting the patient to respond to surveys, but equally important is presenting that data in a way that orthopaedists can review it and share it with the patient at the point of care, during the appointment. This allows them to intervene quickly when a negative outcome is reported. Imagine a future when a patient reporting a pain level of 9, a knee that is red and swollen, and an inability to stand without assistance automatically triggers a message to your office to call and intervene. Not only can this save the patient an unnecessary trip to the emergency room, but it can potentially save the practice money if it is doing bundled payments.

At SRS, we believe that the process of collecting and acting on patient reported outcomes should be as automated as possible, and should all take place in the same system you work in, day in and day out—your EHR. That is why we have made this vision a reality with our integrated Outcomes solution.

The More Things Change, The More They Stay The Same

Lester Parada

Lester Parada

Vice President of Operations at SRS Health
As the Vice President of Operations, Lester brings over 10 years of increased management experience in operations and product management to the team having held roles in Product Management, Business Development, and Project Management. Lester often visits clients to ensure their SRS Health experience is positive and that they are optimizing their solutions to meet the needs of their practice. Lester frequently attends conferences and tradeshows where he shares his vast product and industry knowledge to educate, while learning from clients and attendees as well.

Lester earned a BS Finance and Management from Montclair State University and an MBA in Marketing Management from Rutgers. In addition, he is a certified PMP (Project Management Professional), CSM (Certified Scrum Master) and CSPO (Certified Scrum Product Owner).
Lester Parada

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Earlier this month, SRS Health attended the 2018 American Academy of Orthopaedic Surgeons (AAOS) Meeting. For us, it is an opportunity to spend time with our clients, make new connections and most importantly keep our finger on the pulse of the industry. Each year, we come back home with a list of hot topics or trends and ensure that we are addressing them. This year however, I felt a sense of déjà vu. So, I went back to the 2017 post-AAOS blog and found that the high level topics were almost identical to what I would have written myself.

  • prescription safety
  • data mining/outcomes;
  • cost reduction/operational efficiencies; and
  • MACRA/ MIPS readiness.

Does this mean there has been no progress in the 12 months since the last conference? Not at all.

Prescription Safety – in 2017 really translated to Electronic Prescription of Controlled Substances (EPCS). In 2018, we find that although 91.9% of pharmacies now support this technology nationwide, only 22.9% of providers are EPCS-enabled. More importantly, in 2018, new complexities have been added as many states now also do or will require checking Prescription Drug Monitoring Programs (PDMPs) before prescribing certain medications.

Outcomes in 2017, outside of hospital and research settings, was limited to the basic assessment for the purposes of meeting some requirement like a quality measure, CJR or BPCI. In 2018, adoption by larger groups is starting to gain momentum. Rather than just focusing on the minimum government requirements, practices are beginning to see the value in being able to improve the quality and efficacy of care through evidence and solid data.

Cost Reduction/Operational Efficiencies in 2017 meant actual hard cost-cutting or expanding business lines to bring more of the continuum of care under the practice’s control. In 2018, not only do we see a continuation of those two strategies but more and more practices are looking to justify spending. They are looking at the value of each technology, each partner, and deciding what they can change, combine or cancel.

MACRA/MIPS in 2017 was a transition year and HCIT vendors warned providers not to be complacent. We warned that you should be ready to jump into the program in 2018 and beyond. Well, in 2018 Congress enacted the Bipartisan Budget Act of 2018. This act pushes out the full implementation, effectively making 2019, 2020, and 2021 three more transition years.

Although change management, especially in healthcare, is often slow, having the right technology to address the challenges and opportunities we face—at the right time—is key to optimizing patient care, practice performance, and population health.

At SRS Health, we’ve developed and delivered a specialized end-to-end solution that addresses the topics above, so that we are ready when you are!

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.