Bottom Line Benefit of Evaluating Your Medical Practice

As health care moves toward value-based reimbursement, it will be important for practices to better understand the patients being served as their satisfaction is one component.

The changing health care landscape includes a move toward new reimbursement methodologies. Under those new methodologies, such as value-based, physicians are reimbursed for keeping patients healthy, not how many procedures they perform or how many patients they see in a given day.

As that migration occurs, it will be important for physician practices to have a better understanding of the patients being served within their communities, says Todd Evenson, director, data solutions department, for the Medical Group Management Association-American College of Medical Practice Executives.

“They need to understand where their strengths and weaknesses are as a practice,” Evenson explains. “They’re going to have to be able to find the most at-risk patients, understand the dynamics of patient ages and have a disease registry.”

Fortunately, there are tools to help medical practices achieve those goals. One of them is MGMA-ACMPE’s web-based DataDive: 2012 Procedural Profile Module.

Blending two worlds

The DataDive tool allows medical practices to develop an organizational profile that can be benchmarked against peers using national and credible MGMA data. That data can then be used to better understand patient demand and future workload — two elements that Evenson believes will be critical under value-based reimbursement methodologies.

“It used to be that you performed a procedure and you were reimbursed for that procedure,” says Evenson, adding that he expects patient satisfaction to be one of the components used in determining the delivery of quality care. “It’s not just the clinical outcome that is quality, it’s also the patient experience. Now all of a sudden wait times start to matter. Patient flow matters. The checkout procedure matters. It will be important to have a symbiotic relationship between the business side and the clinical side in order to have an effective organization.”

Evenson adds that a medical practice does not need to be working with an electronic medical or electronic health record to maximize the benefit of the procedural profile tool’s data.

“The data that you could think about collecting really is a function of what would be coming out of your billing system,” he says. “We’re going to ask for a provider; we’ll ask for a CPT code; we’ll ask for the frequency that they’re performing that CPT code and its modifier. So, as a function of that, all of that information is actually extracted directly off of a claim.”

The organizational profile

One of the features of the procedural profile tool is that it examines the coding characteristics of physicians, and categories them by physician specialty. For example, the tool identifies the activities of an orthopedic hand surgeon relative to an orthopedic general surgeon.

“So, when I look towards somebody like a family practitioner, as an example, I might be able to segment specific regions of the country, or I might be able to look at that single specialty as a whole and maybe there’s things I’m uncovering whereby [other physicians are] performing services to their community that I haven’t even thought of,” Evenson explains. “As a function of that you start to understand the types of activities that the medical practice performs as a small business, and how physicians can serve their patients in different ways.”

The tool can also help physicians ensure adequate practice staffing. An examination of coding characteristics reveals how much work is occurring on a per-physician basis, helping to identify and understand the resourcing it takes to perform specific services. Examined under the microscope, that data can be extremely beneficial.

“The natural reaction is to alter staffing, and constrain staffing to become a higher performer,” Evenson says.

The opposite is actually true. Evenson has found that the organizations with more appropriate personnel utilized the right way tend to be the highest performing groups.

Practice impact

Evenson says that access to the procedural data and information collected by DataDive can help a medical practice to define appropriate staffing levels, uncover new opportunities for service lines, and also expose places where a service should be discontinued. In effect, the data can help a practice re-define and refine the services it provides to its patient population.

But it can also have a future effect, with the union of clinical information with non-clinical information, such as patient satisfaction. Ultimately, says Evenson, understanding that non-clinical information — that the medical practice is truly a business working with patients who are customers, and that the business side will be an increasingly important component for success — will enable a medical practice to achieve the most positive results.

“The more that [physicians] can effectively partner with support staff, the administrators, and the physicians can align with one another to focus on the embodiment of that entire piece of care, the more successful they’re going to be.”