Physician Performance: Five Opportunities to Leverage Your Own Data

omniMD-twitterBy OmniMD
Twitter: @omnimd

Measuring physician performance for public reporting is required; however, many practices are missing out on the value of private reporting and benchmarking.

Insights driven from clear, concise quality, operational, financial and business data can be used to enhance, not only, quality of care and compliance, but also the practice’s performance in five areas:

1.  Health Plan Contracting – Arm Yourself to Negotiate More Effectively
Even back as far as 2008, 89% of HMO health plans were using pay-for-performance programs. And, one-third of those were measuring and rewarding quality at the individual physician level.

Add to that coalitions of private insurers and provider organizations, like the Health Care Transformation Task Force, say that 75% of their contracts are moving into alternative payment models by 2020. Quality, accurate and accessible data is key to ensuring that improvements are tracked and rewarded appropriately.

By the end of 2016, it is said that 30% of CMS fee-for-service payments would become quality-based. Lastly, with the passing of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and the establishment of the Quality Payment Program (QPP), existing Medicare programs like Meaningful Use, Physician Quality Reporting System and Value-Based Modifier Program will be combined with new measurements to become two programs — the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

These highlight, once again, the importance of benchmarking data to reveal trends and best practices relevant to health plan contracts.

2.  Manage Your Reputation On Social Media
The launch of the Medicare’s Physician Compare website, mandated by the Affordable Care Act (ACA), gives patients sorely desired data on physician quality. While many view the site as disorganized and insufficiently audited, it is out there and a growing number of patients are using it. Additionally, as patients have become consumers, “find a doc” sites like Health Grades, Vitals, Zocdoc and even Yelp offer physician public perception and ratings.

However, physicians and practices have an opportunity to defend their reputation. They can supplement and arm their prospective patients and current patients with their own data, mined from their own EHR or practice management software.

Armed with their own performance and benchmarking data, physicians have an opportunity to make information more accessible and tout their quality of care.

3.  Big Data Can Improve Clinical and Business Outcomes
Physicians are leaders in many ways, but now more than ever, they need to be equipped with useful information and trending in order to make strategic decisions for their practices. The average practice generate millions of data points a year.Beyond compliance and clinical performance and outcome-related decisions, physicians can leverage big data to make operational, financial, technology, and service-oriented decisions that affect their profitability, cash flow and business model.

Additionally, time-honored productivity measurements, like work relative value units (wRVUs), can be supplemented to include more team-based and value-based productivity, including practice revenue, visits, patient contact hours, panel size and contributions by advanced practitioners.

Benchmarking clinical and finanancial data across the practice as well as processing big data from third-party sources can reveal best practices and inform better clinical and business outcomes. However, EHR systems need to be in place that capture and analyze this input.

4.  Determine Evidenced based Guidelines
Whether physicians follow evidence-based clinical pathways developed by their professional specialty organization, develop their own in cooperation with colleagues or provided from health plans, data is key to improving clinical guidelines, building new pathways or tracking outcomes to applied pathways.

Also, key to benchmarking and tracking is identifying when going off-pathway is merited and when the occurrence is a trend to address.

Lastly process measurement is, many times, just as critical in clinical performance improvement as outcomes measurement. Data on both outcomes and process can lead to better insights that drive better quality and evidence-based care guidelines.

5.  Improve Utilization and Reduce Cost
There are numerous sources physicians and practice leaders have at their disposal as part of their quality improvement activities, but, also when making strategic operational and business decisions.

Sources like the CMS-provided Medicare Provider Utilization and Payment Data,, ProPublica Data Store, Agency for Healthcare Research and Quality (AHRQ), and the Health Care Cost Institute (HCCI) provide a host of cost and utilization data. CMS, also, provides confidential feedback reports — Quality and Resource Use Reports (QRURs) — containing cost and utilization information that are disseminated privately to individual practitioners as well as group practices.

Using comparative, specific, physician group data can help identify resource and cost optimization opportunities by highlighting variances in productivity, cost and utilization.

In the final analysis, many physicians take issue with how performance measures are chosen, tracked and reported. While some of these standards can only be influenced at the professional or national level, physicians do have an occasion to home in on the data that is most relevant to them and their patients and practice. Thereby, giving substantiation or contrast to publicly reported data, as well as uncover intelligence to drive financial and operational decisions within the practice.

This article was originally published on OmniMD and is republished here with permission.