In today’s healthcare environment, using data analysis to improve your bottom line is an issue of survival.
A data-powered revolution is taking place in healthcare, yet few small-practice physicians are capitalizing on this new digital currency.
Practice management and electronic health record (EHR) systems are generating a wealth of reportable data on population health, patient scheduling, and claims processing and billing. However, practices that are extracting only the minimum data required to file claims and meet reporting requirements are not benefiting from the treasure-trove of information at their fingertips.
“Too many practices see the return on their EHR investment as getting the Meaningful Use incentive money,” says business intelligence consultant Nate Moore, CPA, MBA, of Moore Solutions in Salt Lake City, Utah. “The return on investment ought to be information to better run your practice and … to give your patients better care.”
In today’s healthcare environment, using data analysis to improve a practice’s bottom line is an “issue of survival” for most physicians, says Michael McLafferty, CPA, with EisnerAmper in Iselin, New Jersey. “Costs continue to go up in the industry, reimbursement for most people, best case, is flat or somewhat declining,” he says. “You need to understand where there might be some opportunities to grow your business.”
McLafferty says practices often run only a few reports each month, failing to create a big-picture overview of their business. To understand how your practice is functioning, he recommends reporting on revenue cycle (billing charges, collections, adjustments, and reimbursements versus benchmarks), staff productivity (measured in Work Relative Value Units), and quality metrics (Physician Quality Reporting System, Meaningful Use).
“A lot of times physicians don’t look at the data they should be looking at,” McLafferty says. “You can’t make those decisions if you aren’t focused on the data.”
Consultant Elizabeth Woodcock, MBA, of Woodcock and Associates in Atlanta, Georgia, understands that time is at a premium for most small-practice physicians. Rather than wade through pages of reports, she says, physicians should review a one-to-two page dashboard overview each month.
“Spend time deciding what data you want to see…If you are going through [data] reports and millions of data points, it is going to take too many hours in your day,” Woodcock says.
Breaking down the data
Data can provide a practice with a wide range of useful information, from the average amount of time a patient spends in the waiting room and the time of day they wait the longest, to the number of patients visiting emergency departments (EDs) following surgery, says Mona Reimers, FACMPE, director of revenue services for Ortho NorthEast, a 13-clinic orthopedic practice in Fort Wayne, Indiana.
Many practices benchmark themselves using data from the Medical Group Management Association or other professional organizations, she says, comparing their performance with that of a practice in the same specialty. “They want to know: ‘How am I doing compared to my peers?’ Financially, they want to have a broad overview, but they don’t get down to thinking, ‘It takes five minutes for people in my practice to do this. How can I make it four?’”
Moore believes the “low-hanging fruit” for smaller practices seeking to make practical use of their data lies in the financial portion of practice management systems. It is there that practices can determine which providers are most productive or find information on payments, receivables, and adjustments.
“Typically, practice management data is more standardized. Everybody has to send a bill and use CPT codes and ICD-10 codes. When you get to the clinical side, it is harder because there is so much more specialization and the standardization all goes away,” says Moore, coauthor with Reimers of “Better Data, Better Decisions: Using Business Intelligence in the Medical Practice.”
Reimers recommends that physicians start small and focus their attention on two or three areas needing improvement, using data to quantify problems and guide solutions. She suggests also that smaller practices consider their return on investment when deciding where to invest data-mining dollars. Money spent identifying scheduling and patient flow problems, for example, could quickly pay dividends if a new workflow enables a physician to see additional patients each day. “It doesn’t matter if a project costs $1,000, if you make $5,000 more a year” as a result of the information, Reimers says.
When Data uncover problems
What should you do when data indicate problems ahead? When data analysis pinpoints areas needing improvement, Steven Waldren, MD, director of the American Academy of Family Physicians’ Alliance for eHealth Innovation, says practices should follow the steps outlined in a quality improvement exercise to find solutions. “There’s a cycle to that: plan, study, do, act. You’ve already done the measurements, then you need to study and say, ‘Why do we think that is the case?’ ”
For example, when one client’s weekend ED report showed high patient usage, Woodcock says the practice identified frequent ED users and instituted a “tuck in” program each Friday to check on potential medication issues, illnesses, or other problems that could lead to an ED visit.
Woodcock expects data to continue to grow in importance for small-practice physicians. “It is like data is this web that we’re in the middle of in healthcare,” she says. “If we’re not part of it, we’re going to be on the outside looking in,” she says.
McLafferty urges physicians to have a detailed understanding of what their data are saying before implementing changes. “With statistics, you can’t look at any one thing,” he says. “You need to look at a number of data sets and it tells us a story. Once we understand the story it is telling us about where to make improvements, then we can start looking at other pieces of information that verify we’re on the right track.”
Turning data into easy-to-use reports that improve your practice’s bottom line and clinical outcomes, however, may not be as simple as a few clicks on your computer. Woodcock says practices often are frustrated by the built-in reporting templates in their EHR systems because typically they are geared toward responding to mandates. Instead, they turn to add-on analytic tools.
“We’ve been in a little bit of a pickle as an industry, trying to steer the ship to what the government is asking us to do while at the same time creating value for the patient. That is where data needs to go,” Woodcock says.
McLafferty believes the tide is turning. He maintains that most practice management packages today can generate hundreds of different reports and numerous ways to sort data. Often, he finds that physicians do not have the reports they need because they have not upgraded to the latest versions of their software.
As data become increasingly important in healthcare delivery, Woodcock argues that practice managers in small practices must be data analysts as well as personnel managers. “The role of the practice manager is changing and data is a massive part of that,” Woodcock says. “It’s not just looking at charges and receivables. All of the pay-for-performance programs require analytics.”
At a minimum, Moore says practice managers need to know the practice’s EHR and practice management systems “inside and out,” understanding what kind of data goes into the systems and what reports they can generate. The practice manager also must know how to convert raw data into meaningful information for the physicians and staff.
“The practice manager needs to be able to download raw data into a tool like Excel and then be able to manipulate the data and run their own reports.” Moore says. “The reports won’t be fancy, but at least you’ll have data.”
Providing a practice manager with training in basic healthcare data analytics does not require a large budget. Reimers says free tutorials on using Excel, Access, or Crystal Reports to build medical practice reports can be found on YouTube and other online sites, while professional associations offer additional resources. If hands-on training is necessary, a consultant could be called in.
Outsourcing IT help
When a smaller practice needs only one or two customized reports, McLafferty says turning to a vendor may be the most economical option. “Let them create the report for you. They will do a better job than you would by yourself,” McLafferty says. “They’ll put it in your menu, and when they set up the report, they can create it so you can sort it in a couple of different ways.”
When the need for customized data solutions is greater, Reimers says, practices may need in-house IT help to increase revenue, lower overhead, and improve patient satisfaction. She suggests a five-to-six doctor practice may need a multiple-person IT staff. She contends the data-driven efficiencies created should enable a practice to reduce hours worked by front office and other support staff.
“What’s important is to get the data in a visual presentation that you can quickly see and digest and have it e-mailed to you,” she adds. “I have about six reports that I get every morning. It takes me a second to open an e-mail, take a look, make sure we’re on the right trajectory, and move on.”
Reimers says physicians should not be scared off by the prospect of having to add in-house IT help. She and Woodcock both suggest turning to local community colleges and universities for computer programming interns or recent graduates for low-cost or free resources.
Hiring a data-mining vendor or consultant is another option, Reimers says, but outside companies need to provide the responsiveness physician practices demand. A consultant must be able to “tweak a report in a matter of hours or days and build a new report in a matter of a few weeks,” she says.
Practices using cloud-based EHRs face an additional hurdle. Moore says cloud-based systems can be a source of frustration when practices attempt to access their own data because they cannot automatically download information. “You’re at the mercy of the vendor of your EHR or PM system as to what data you can access,” he says. “It is a whole lot easier if you own your data and it’s on your network.”
In addition, Moore points out, the data you download may be restricted to the format the vendor provides, meaning you may have to reformat information and “start from scratch every time you want to run a report.”
Getting staff on-board
Persuading staff members to make the shift to data-driven customized reports may not be automatic. Reimers admits to occasionally having to remove handwritten lists and sticky notes from staffers’ desks to force a transition to data-driven tools. “If you are getting data reported to you regularly without having to dig it out, everybody is happier,” she says.
As an example, Reimers points to a daily report she receives on the next day’s patients that eliminates chart prep. “If a doctor is seeing 30 patients the next day, why have somebody open 30 charts to see if something needs to be done. Have a report prepared for you that says these people are missing labs, these people need medications, these patients need to see the nurse, not the doctor,” she says.
Many smaller practices do not have the money, IT know-how, or staff necessary to “crunch data and ask questions and answer them with data,” says medical practice management consultant Mary Pat Whaley, FACMPE, president of Manage My Practice in Durham, North Carolina.
“I find most small practices are just trying to survive and look at the basics,” she says. “Very few of them realistically are using EHR data for anything except reporting as required by the government.”
As healthcare transitions from a fee-for-service to a value-based reimbursement model, Moore argues physicians cannot afford to ignore the reservoirs of digital information at their disposal. “As the reimbursement model changes, it is going to be key to have better data to understand how to thrive in a new reimbursement model where it is not just see how many procedures you can do,” he says. “If they are going to start paying for outcomes, then dang it, we better understand our outcomes.”
Until providers are reimbursed for proactive care, Woodcock says smaller practices need to find ways to offset the cost of data-mining initiatives. She suggests physicians look for community grants or payer incentive programs for managing specific populations. Woodcock notes that she worked recently with a practice that received a grant from Texas Medicaid to manage a cohort of patients for cardiovascular issues.
Jacob Reider, MD, chief strategy officer at Kyron, a Palo Alto, California, startup focused on advancing personalized medicine, believes healthcare remains a long way from optimizing the information data provides. He cites the example of Tylenol’s dosing recommendations for adults–two tablets every four to six hours–regardless of the patient’s weight or size.
“Even in this very simple instance, we are failing consumers, failing ourselves, and failing as an industry to connect the dots together,” says Reider, the former deputy national coordinator for the Office of the National Coordinator for Health IT. “If we can’t do just this in terms of helping us make the right dosing decisions for a medication probably used a million times every day, we’re a far way off from using much more intricate and sophisticated tools.”
While challenges remain in the quest to use data to improve healthcare, Reimers says smaller practices do hold an advantage over larger physician groups. “They can put their data to work tomorrow. They can have a group meeting with however many people they need and go forth and do it,” she says.