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Healthcare Administrators Grapple with Using Data to Improve Quality

By Becky Cook, Executive Consultant

Today’s healthcare organizations must measure key performance metrics and push revenue cycle operations to a higher priority level than at any point in history. Recent value-based changes in healthcare have intensified this demand. Yet, no matter how much the focus changes in healthcare, one thing will always hold true: revenue cycle effectiveness will remain the primary responsibility of the practice administrator and CFO.

Our physicians and patients expect outstanding quality and service despite operating at a time when payers are turning our world upside down and demanding more data. Payer contracts with fixed fee schedules are disappearing. Claims are being paid at a percentage of Medicare fees. And new contracts contain provisions for quality standards, incentive payments, risk measurement, patient engagement/access scores and cost savings metrics. If you participate in certain contracts such as MSSP, Medicare Advantage, Managed Medicaid, Patient Centered Medical Home or Accountable Care Organizations (ACOs), you have most likely already been engaged in identifying, tracking and reporting this data.

The common denominator in all these measurement systems is the physician. Although we do not like to think of ourselves as a statistic or have our life’s work defined by a numeric score, we must acknowledge – even if we don’t care much for the system – that the physicians in our groups are being measured by Medicare, Medicaid, payers and physician ranking services that offer ratings to the public.

In my work with multiple ACOs, I’ve encountered many of the measures that payers, both government and private, are using to gauge our groups’ and physicians’ performance. These metrics – including productivity, patient access and quality benchmarks – are critical to your success. As you might expect, the challenge is data that comes from multiple sources, including payers, the Medicare Stars program, required patient satisfaction scores and clinical programs. And none of it fits neatly into a data mart with the billing data we normally work with.

This new data must be managed to blend meaningful pieces into a comprehensive, balanced document that carefully describes to a physician how others view his or her practice and highlights excellence or opportunities for improvement. To create such a report requires the use of new tools and techniques, such as data blending, the use of web-based analytics that can be rapidly built and updated, and delivery to mobile devices – technology still in its infancy in the healthcare environment. And this technology must be easy to use while maintaining the highest levels of privacy and security for our patients’ data.

We are beginning a new journey down a pathway with new payment models, evidence-based care protocols, patient engagement and community involvement. As with other clinic processes where administrators and financial managers have had to implement changes, this is an area where being proactive and making “front-end” improvements can provide significant benefits for better-quality contracting, revenue enhancement and patient retention. Obtaining the best payer rates, outstanding patient loyalty and bonus payments requires the practice to understand and manage both the perception and the reality of clinical quality and patient satisfaction. Measuring outcomes for the “Triple Aim” of improving quality, reducing cost and improving patient access will become the prevailing standard over the next few years. In a challenging healthcare environment where hitting revenue goals is not enough, organizations must be proactive – planning and implementing new strategies with an eye toward future practice improvements. As the New Year continues to bring new changes, successful healthcare practices will be the ones that lead the way.

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