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.

Congress Authorizes Changes to MIPS

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

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mips-blogHow many times have you heard the expression, “It would take an act of Congress.”? Well, Congress has acted! Had this blog been posted just 2 weeks ago, the message would have been slightly different and a little more ominous in tone. I would have said—and you may have read articles elsewhere where I did—that the MIPS transition period is coming to an end, and providers should begin to prepare in earnest for 2019, when by law, the MIPS threshold would be much higher and the cost category would account for 30% of the MIPS score. These provisions in MACRA were not subject to CMS’ discretion; but apparently, Congress has been persuaded to extend CMS increased flexibility. As part of the Bipartisan Budget Act of 2018, Congress has pushed out the full implementation of MIPS from 2019 to 2022, effectively making 2019, 2020, and 2021 three additional transition years.

This means that:

  • There will still be winners and losers since budget neutrality remains a requirement; however, CMS is now not obligated to set the MIPS threshold at the mean (or median) of prior performance until 2022. Instead, the threshold will be gradually increased to that level over the intervening years, the good news being that it will not be as challenging to avoid a downward adjustment for a few more years. The consequence of this, however, is that the amount of money available to winners will continue to be less than the maximum provided for in the law, (i.e., 5% related to the 2018 performance year, 7% for 2019, and 9% from then on.)
  • The Cost category does not jump to 30% of the MIPS score in 2019. CMS can hold off on the increase until as late as 2022, with the flexibility to set the rate at between 10% and 30% each year until then and to make it 30% only when the Secretary is confident that the resource use, (i.e., cost), measures are ready for adoption. In addition, the bonus points for year-over-year improvement in this category have been eliminated.

Through these changes, Congress has relieved some of the immediate pressure for providers. However, this does not change the fact that it will become progressively harder to score well as providers gain experience, making MIPS increasingly competitive in the coming years:

  • The Quality and Cost categories will remain distinguishing factors among providers.
    • It will become progressively harder to score well in the Quality category. Benchmarks will be more aggressive as providers build experience. The 2018 benchmarks have been posted on the QPP website, and you can already see differences from the 2017 deciles for some measures.
    • Improving your comparative Cost position is not something you can do overnight; it takes time. So, it’s not too early to address this area more vigorously.
  • MIPS performance has implications beyond Medicare payment adjustments. Your reputation could be impacted as CMS makes more and more performance data publicly available on its Physician Compare website. Consider what you want patients, referring physicians, and payers to see about you when they are researching your practice.

So, don’t let down your guard. Take advantage of the additional transition years to secure your future success.

Getting Down to Business

Khal Rai

Khal Rai

CEO at SRS Health
Khal Rai brings over 20 years of leadership experience to his role as President and CEO at SRS. He possesses a breadth of knowledge and expertise in the healthcare and technology sectors earned through a career that has spanned the globe. His passion for collaboration, strategic development, and delivering healthcare IT solutions that make it easier for medical professionals to deliver care while navigating the ever-changing healthcare industry, inspires and motivates his team, while positioning SRS Health clients for current and future success. Khal has a B.S. degree in Computer Engineering from the University of Cincinnati, and an M.S. degree in Electrical Engineering from Purdue University.
Khal Rai

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“Be part of something greater than myself”—that’s what inspired my career in healthcare technology more than 20 years ago, and it’s what still drives me as I take the helm as CEO of SRS Health. As we close out the first month of the new year, I’m happy to say that the SRS team is devoted to the same goal: we are continuing to develop the solutions, services, and support that our clients need to succeed in today’s and tomorrow’s healthcare landscape.

Outcomes. Value Based Care. MACRA/MIPS. Yes, the healthcare world is changing at a rapid pace, and part of our mandate is to keep clients up tokhal-blog date on changes in technology as well as in regulations. But our larger concern is to preserve the one thing that has not changed—the passion that inspires individuals to enter medicine in the first place. We cannot allow technology and government requirements to diminish that passion, or to degrade the experience of physicians, clinicians, or patients. The SRS EHR was originally developed as an alternative to point-and-click technology that interfered with the doctor-patient relationship, and SRS promises to continue to protect our doctors’ ability to do what they do best.

How? First, by knowing our clients’ patient-care and practice goals, and then by collaborating with them and our partners to create intelligent, innovative solutions with the flexibility to fit both those blazing new trails in value-based care, and those that are just starting out. The challenge is to succeed not just at the practice of medicine, but also at the increasingly complicated business of medicine. At SRS, we believe your healthcare technology should help you do both. It should be simple, practical, and easy to use—it should take care of business so that you can take care of patients.

My experience in healthcare and frequent conversations with clients have helped me understand the challenges facing physicians and practices today. Rest assured that I will sustain SRS’ commitment to ensuring that our clients are well-informed and well-prepared to face today’s and tomorrow’s marketplace challenges: we will continue to develop core and partner solutions, services, and support that ensure that doctors can focus on what matters most.

I look forward to my new role at SRS, to further discussions about the challenges facing healthcare today, and to meeting you at an upcoming industry event!

Why an EHR Solution Is a Must-Have for 2018

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

Looking back at 2017 as we head into 2018, the resounding theme in healthcare has been the push to bring down costs and drive up quality by increasing efficiency and improving care coordination. As the healthcare landscape shifts and evolves with groundbreaking alliances such as the proposed CVS Health/Aetna partnership, it is interesting to note that the percentage of office-based physicians using an EMR/EHR solution is a significant 86.9%, with only a small percentage of medical practices still using traditional paper charts. (Health IT Dashboard)

Reasons cited by physicians for remaining on paper include failed implementations, fear of a loss in productivity, and security concerns. While these are valid concerns, practicing medicine using traditional paper charts is becoming increasingly difficult as the industry moves to a value-based payment model, with more emphasis placed on patient engagement, interoperability, and shared patient data.

Typically, physicians spend 30–40 hours per week interacting with their patients. In a paper-based office, each patient visit results in approximately 10–13 pieces of paperwork, detracting from the time spent on patient care. (Benefits of Modern EMR vs. Paper Medical Records) Even if the physicians themselves do not handle the paper, their staff must, and a paper-driven staff results in an unproductive office. Since paper charts can only be in one location, clinical and administrative staff spend valuable time locating and providing charts. When there are multiple office locations, the additional chart transport compounds the problem and the practice becomes even more unproductive. Most practice administrators estimate the cost of a chart pull at $5.00 in lost productivity. Multiplied across hundreds and thousands of active charts, the numbers become staggering.

To remain competitive in the ever-changing healthcare environment and to attract patients and physician recruits, an EHR solution is a must-have for 2018 and beyond. As the penalties increase and reimbursements decline year by year, EHRs play a critical role in helping to preserve and drive revenue and reduce costs. Significant benefits of adopting an EHR include:

  • Reduced Administrative Burden An EHR can eliminate redundancies in documentation, provide fast and accurate record transmission, and drive efficiencies throughout the clinic, inclusive of patient intake. This can be accomplished while mimicking the traditional paper chart, which allows for an easy transition from paper to an electronic system.
  • Heightened Cost Efficiencies – An EHR can drive productivity, saving physicians and clinical staff valuable time and reducing the need and/or cost of transcription services, chart rooms, and record clerks. Regulatory resources through a reputable HCIT partner can assist the practice in penalty avoidance and meeting the requirements for MACRA/MIPS.
  • Patient Referrals/Community Presence – A 2006 Harris Interactive Poll reported 55% of adults believed that the use of EHRs would reduce the number of medical errors, and 60% believed the use of EHRs would lower their healthcare costs. (Benefits of Modern EMR vs. Paper Medical Records). Since that time, patients have come to expect electronic access and communication with their providers through the use of a patient portal. In addition to medical records access, secured messaging, and appointment and refill requests, an integrated patient portal embedded in the EHR allows patient-entered information and demographics to automatically populate the chart and the note, saving critical time and expense.
  • Patient Safety – EHRs improve patient safety by providing an organized, all-inclusive electronic chart that houses reminders, messages, and alerts in addition to exam notes, diagnostic images, and medical, medication, and allergy history. Each chart is readily accessible from any office location as well as remotely so providers have the complete information when responding to messages from inside or outside the office.

So why do some practices continue to hold out? The most common reason cited for not making the transition is the inability to obtain a physician consensus—there are differing opinions as to the best EHR, and even as to the best approach, including how much or little interaction they want with the solution, and the degree of elimination of paper from the practice.

Successful adoption of a solution, therefore, can be ensured by working with a vendor who can tailor the implementation to the needs of the practice and its providers, addressing individual physician workflow preferences and providing flexibility and ease of use. Further, practices can ensure that the solution will support their preferred clinical workflows by choosing an established and recognized EHR partner with proven experience in their medical specialty. The right partner will also be able to provide testimonials and client references documenting its ability to implement, train, and transition practices from paper charts without any impact on either patient volume or productivity. Is your practice still on paper and if so, what’s holding you back?

Enterprise Growth in the Ambulatory Space – The Benefits & Challenges

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

“Leadership is the challenge to be something more than average.” Jim Rohn

trees-growth-39281207_sEnterprise growth is an emerging trend in the ambulatory specialty space. The shift to a value-based market with an emphasis on quality rather than volume, together with associated pressures in the healthcare landscape, has fueled the consolidation of individual practices into super groups.

This trend was a predictive model and growth strategy for hospital systems as the shift to value-based care loomed on the horizon. Hospitals understood the need to grow by becoming better—leveraging cost, quality, and service advantages to attract key decision-makers as opposed to pursuing prior, price-extractive growth strategies that were driven purely by increasing size through acquisitions and expanded market share. (Advisory Board: Health System Growth Strategy for the Value-Based Market)

A similar shift is occurring with ambulatory specialty practices, which face challenges from declining reimbursement, increased costs, changes in government regulatory requirements with the advent of MACRA/MIPs, hospital system pressure and competition, and the shift from a fee-for-service model to value-based care. Physicians have realized that, in order to remain independent and profitable, they need to come together and create regional—and in some cases statewide—groups united under a common brand name and/or the formation of clinically integrated networks (CINs).

Enterprise growth empowers physicians to practice independently and compete with area hospitals and health systems. Enterprise specialty groups are a strong sustainable alternative to hospital employment and they support ancillary growth opportunities like ambulatory surgery centers (ASCs), urgent care, imaging, and physical therapy locations. They provide a platform from which to negotiate local/state/national contracts inclusive of malpractice premiums, and to direct employer opportunities. This bargaining power allows for a reduction in overhead together with an improved revenue stream. Enterprise groups also have the advantage of scale to tackle infrastructure and HCIT investments, improvements, customizations, and maintenance.

In any industry, growth through acquisition and consolidation brings challenges. It’s not easy to merge management, staff, locations, and office cultures—it requires strong leadership and governance. A unified community-facing brand, a shared growth strategy /approach, and the development of KPIs are key determinants of success. Performance metrics may include market share, geographic reach, patient growth vs. physician density, annual revenue by specialty, total cost of care, and outcomes quality. Other important considerations are developing an integrated approach for human resources, employment contracts, health and malpractice plans, purchasing/procurement, and Bundled Payments for Care Improvements (BPCI).

The emerging organization must keep the community it serves as its top priority as it transitions and the pieces come together. The main driver of enterprise growth—the need to demonstrate quality outcomes and low-cost episodic care—also serves as the attraction for referral sources within the surrounding medical community and their consumers, the patients.

Done well, the demonstration of quality outcomes will support a strong brand reputation, providing the necessary bargaining power needed with payers and employers. To accomplish this, many groups seek a common HCIT platform for patient engagement, regulatory compliance, and outcomes reporting. While this represents yet another change during a time of transition, the right HCIT partner is an integral part of the success of the organization. Other key considerations are the ability to integrate these solutions to drive a seamless experience for both the clinician and the patient. Equally important is that the HCIT solution participates in a collaborative dialogue regarding ongoing needs, and supports each individual specialist’s clinical workflow preferences and patient volume while providing reliable, dedicated, hands-on support.

The Top 5 Challenges for Orthopaedists

In a recent article featured on Becker’s Healthcare, 19,200 physicians representing over 27 unique specialties were surveyed on what the most challenging parts of their careers were.

Here are the top 5 challenges for orthopaedists:

The Top 6 Challenges for Orthopaedists

It is also interesting to note that “Despite challenges, 79 percent of orthopedists would choose a medical career again, and 95 percent would choose orthopedics again.”

Would you?

What Are Specialists Faced With Today? Uncertainty and Change!

Ryan Newsome

Ryan Newsome

Vice President of Product Development at SRS Health
Ryan Newsome is the Vice President of Product Development. In this role he is responsible for the Product Development, Engineering, Quality, Development Operations, and Program Management teams.

Ryan began his career as a Software Engineer for Pitney Bowes/Map Info building early location-aware web services and solutions. Since joining the SRS Health team in 2005, Ryan has held multiple engineering, architecture and management roles in the Product Development organization. Over his 12-year tenure with SRS, Ryan has helped lead the Development organization through a number of growth cycles and evolutions, most recently being the organization’s transition to Agile development. He is passionate about building strategies and solutions that have a big impact on the lives of the specialists we serve, as well as their patients, and believes this is achieved through a commitment to collaboration among clients, strategic partners, and the SRS team. He regularly attends industry trade shows, conferences, and commercial engagements where he represents the company’s product vision and strategy. Ryan received a Bachelor of Science in Computer Sciences from Sienna College.
Ryan Newsome

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Changes AheadRecent Nobel-recipient Bob Dylan wrote “The Times They Are A-Changin’” in 1963—a time of growing social upheaval reflected in the song’s lyrics, which called for listeners to acknowledge and embrace the transformations taking place around them. As I listened to this song over the past weekend, I couldn’t help but draw a correlation to the radical transformations we are currently experiencing in our industry. The past several years have epitomized the term “change” as the nation has taken big steps to transform the delivery of healthcare.

The American Recovery and Reinvestment Act, signed in 2009 by President Barack Obama, was one of the catalysts for this transformation by requiring the “meaningful use” of digital systems in healthcare. Since then, change has been the only constant that we have been able to count on. Government regulations, payment models, and product innovations have continued to evolve in disruptive ways—both good and bad. As soon as we become comfortable with one wave of change, another wave is already threatening to drench us to the bone (for us, the next big one is MACRA & MIPS).

So, coming off nearly a decade of constant uncertainty, what’s next? Well, you guessed it—more change! Starting in 2017 we will have new policy leaders in place who have promised to significantly restructure the incumbent’s healthcare programs. President-elect Donald Trump’s appointment of Tom Price as the head of HHS may be indicative of the changes on the horizon. Price, a 6-term congressman from the Atlanta, Georgia, area, was formerly an orthopedic surgeon. Will a specialist at the helm help make government programs, that have typically been focused on primary and in-patient care, more meaningful for specialists?

Time will tell, but the one thing that is certain is that, as the song says, the wheel is still in spin. In other words, the times they are still a-changin’.