Mining data to gauge practice performance


Mining data to gauge practice performancePhoto used with permission from Shuttershock.com

Today’s healthcare market demands that technology provide a physician practice with an on-demand snapshot of its performance, and enable it to benchmark that performance against itself and against similar practices to establish targets.

Practice management technology and analytical reporting software ideally offers physician groups three levels of data: (1) dashboards, (2) benchmarking and (3) drill-down access.

Transparent windows give way to benchmarking
Dashboards give physician groups a transparent window into the billing operation and provide topical, day-to-day key performance indicators. They can reveal whether a physician is only running charges on the last week of every month, or errors in claims due to coding. While dashboards should not serve as a micro-management tool for practice partners, they can offer peace of mind that the group is on track at any given point in time.

Dashboards, then, lend extensive data for benchmarking purposes. Data points to benchmark include but are not limited to:

  • Productivity levels
  • Volume
  • Procedure counts
  • Charges
  • Reimbursements
  • Relative Value Units (RVUs)

With these metrics, practices can compare against their own performance in prior years.  Traditionally, best practices have suggested that it is most effective to benchmark against other groups, but it is more important for a practice to benchmark against itself. No other practice has the exact challenges, payer mix, modality mix or hospital systems. Quickly benchmarking current practice status against where it was last year will lend great insight into how the practice is faring from a business and operational standpoint.

It should be noted that physicians are also increasingly seeking to benchmark themselves against their fellow physicians in the practice. This can become political and the information can be contentious; therefore, a group should have the ability to blind the data. For example, looking at procedure volume may make one physician appear more productive than a colleague, while the RVUs may reveal another story. 

Each group has to decide for itself how revealing it wants to be about physician performance, and how it can achieve transparency within the practice. When groups are using this data for compensation, it becomes especially important to offer quick access to the data so physicians know where they stand.

Benchmarking against other practices can be useful as well, but is made more difficult by the scarcity of data. Nationwide billing providers have access to the data of an array of practices, which can be anonymized and matched against the characteristics of a given group to yield useful information. 

Local benchmarking is a smarter approach for practices because it shows the same payers and similar volume in a given region. Reimbursement should be compared against the practice’s own figures, against other local practices and against national benchmarks.

National benchmarks allow practices to see that their struggle with bundling, decreased reimbursement and costs are not singular, but are instead industry-wide. For example, a radiology group may have taken a 3 percent hit for CT bundling, but looking across the country that average could be closer 6 percent for most groups. National benchmarking is more of an exercise in perspective, and can be useful when trying to either get ahead (or fall below) the averages.

Drilling down for fragmented information
Third in the “levels of data” is technology that offers on-demand access to information with drill-down capabilities.This becomes increasingly critical especially when highly granular information can be broken down by physician, location, modality and/or CPT code. At this level, groups can get highly specific and put a microscope on several areas.

With access to this level of data, physicians can be more confident in their decision-making, but only if the information is accessed expediently, when the need arises. Getting information in a timely manner in order to make a correct decision is key to the value of the information.

Based on the need for quick information, mobile access through web-based portals is also emerging, and data should also be formatted in such a way that it is immediately comprehensible. For instance, an Excel spreadsheet with 150,000 CPT codes on it will not be easily readable (if at all), so the data has to be in a concise format that is usable in order for doctors to make clear decisions.

Rapid decision-making is important to physicians on both a personal and a professional level, and the speed of access is a big part of what has changed with regard to this data. Physicians now want to know if they stand to make $20,000 less next year if Medicare changes the RVU weighting in their reimbursement equation. This information is invaluable to making decisions, not just on the practice health side, but also on the side of personal life.

For these reasons, IT software must be carefully evaluated to ensure it meets the vast scope of the practice’s needs.

Neal Peterson is a director of client development with Medical Management Professionals, Inc. (MMP).

Photo used with permission from Shuttershock.com.