Archive for the ‘Practice Management’ Category

The Use of Analytics In the Business of Medicine

Monday, April 27th, 2015

William R. Pupkis, CMPE, Healthcare Consultant
Fee-for-service has been the typical business model for medicine since the beginning of time. This is especially true for orthopaedic medical care in most markets across the country. However, with the passage of the Affordable Care Act, that is slated to change.

A major component of this law is the development of a national quality improvement strategy that includes priorities to improve the delivery of healthcare services via patient health outcomes. There will be initiatives to create processes for the development of quality measures involving input from multiple sources to be used in reporting to, and payment under, federal health programs. The law also requires the development of plans to implement value-based purchasing programs for ambulatory surgical centers, many owned by orthopaedic surgeons.

These measures can push the payment system away from fee-for-service, which is volume-based care, to a value-based care system. No longer will health care be about how many patients you see, how many procedures or tests you order, or how much you charge for these things. Instead, it will be about costs and patient outcomes: quicker recoveries, fewer readmissions, and lower infection rates, to name a few. It will be about value.

If that is to be the future, then medical practices will need to answer questions that until now have not been asked such as, how one’s practice has better patients’ outcomes compared to other practices in the community. Where would you find that information? There is no shortage of data within the practice management and electronic medical records in use today for most practices that will give you the answers.

Analytics is the systematic use of data and related business insights developed through applied analytical disciplines, i.e., statistics that drive fact-based decision making for planning, management, measurement, and learning. Analytics allows you to sort through the volume of data currently available to answer outcome-related questions, i.e., what is your infection rate, how many readmissions did you have, etc.

Analytics may be descriptive, predictive, or prescriptive. Descriptive analytics look at past performance by mining historical data, and finds the reasons behind past successes or failures. Most management reporting, such as finance, uses this type of post-mortem analysis. Predictive analytics is used to help answer questions of what will happen. And, prescriptive analytics goes beyond predicting future outcomes by suggesting actions and showing the implications of each decision option.

Practices have been using baseline transaction monitoring, utilizing basic reporting tools, spreadsheets, and application reporting modules, for years. With the movement to value-based care models, insurance companies and patients will now want additional information about treatment plans and outcomes.

Analytics can be used to manage small details to large processes, which can lead to improved service delivery and operations, by providing a means for measuring and evaluating critical organizational data. Analytics in medicine is a move toward a model that can be used to drive clinical improvements to meet future challenges, such as reducing variation in clinical practice, utilization rates, and helping to eliminate unpleasant surprises.

Forty percent of the medical care data provided in the United States may not add value, based on reports from the Dartmouth Institute for Health Policy and Clinical Practice. A study released by the American Academy of Orthopedic Surgeons (AAOS) in February 2012 found that 96 percent of orthopedic surgeons practice defensive medicine. Findings show that 24 percent of tests being ordered were for defensive reasons and without significant benefit to patients, and 35 percent of specialist referrals by these surgeons were also motivated by defensive medicine. In order for health care to move towards value-based, rather than volume-based, models, physicians need to work together to remove unnecessary steps in the care process.

There is no shortage of data in a medical practice and the sheer volume of data that needs to be analyzed can inhibit the development of meaningful insights. There is a real need to use analytics, integrated from multiple sources, and standardized to better ensure consistent definitions throughout the practice. This should allow practices to modify and manage relationships, as well as motivate and modify behaviors. Practices can set up value-based care teams to review both internal and external benchmark data, thus eliminating unnecessary practice variations by developing evidence-based care paths to improve care coordination for moving patients more easily through the system.

Many medical practices use reporting tools descriptively to understand what has happened in the past, and to categorize historical, structured data. Some organizations focus on data warehousing to create financial and operational dashboards, and clinical data repositories. As these are typically real time databases, data is consolidated from a variety of sources to present a unified view of a single patient. The goal is to allow clinicians to retrieve data for a single patient rather than identify a population of patients with common characteristics, or to facilitate the management of a specific clinical department. This explosion in the amount of structured and unstructured clinical data makes data warehousing essential for turning the stored data into actionable information.

In order to begin establishing your value-based practice model, you must first start with questions, not data. Gain valuable insight into the various problems that need to be solved by asking questions that you would like answered. For example, if a department requests another FTE, bring all the staff involved in that aspect of the practice together and determine each person’s role within that department. This should lead to a better understanding of the organizational information needed to help resolve the problem and the data that can be used to generate that information. A method that I have found most helpful is to use post-it notes, writing down every step in the process, putting all the post-it notes on a wall, then stepping back to determine which steps are absolutely necessary, consolidating where possible to make sure that each step is adding value.

Analytics leaders foster appropriate information sharing through better data management and new approaches. They keep existing capabilities while adding new ones, trying to create analytics initiatives that are scalable and flexible, while not growing too complex or costly. They understand that it all starts with defining issues and desired outcomes. Asking the right questions will illuminate the data that matters, and will bring objectives and targets into better focus.

Terms and Conditions

Statements and opinions expressed in the Newsletter, Preferred Talk, are those of the author(s) and do not necessarily reflect those of DT Preferred Group, LLC. DT Preferred Group, LLC makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. In publishing this Newsletter, neither the authors nor DT Preferred Group, LLC are engaged in rendering medical or other professional service. If medical advice or other expert assistance is required, the services of a competent professional should be sought. DT Preferred Group, LLC will not be liable for any losses, injuries, or damages from the display or use of this information. This policy is subject to change at anytime.

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PQRS Reporting in 2014 is Critical for Orthopaedic Practices

Wednesday, December 10th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

The Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). PQRS in 2014 is critical for Orthopaedic practices. Non-participation in 2014 will result in a 2016 penalty or payment adjustment decrease of 2.0% on ALL claims.

Consider this, if your practice has revenue of $20 million per year and you report successfully on three claims, you’ll receive a $100,000 bonus. However, if you do nothing and do not report on at least one PQRS quality measure on a Medicare claim in 2014, your reduction in reimbursement (2.0% penalty) will be $400,000. The difference from doing nothing to qualifying via “self-nominating” could be as much as a half a million dollars ($500,000).

Orthopaedic practices can elect the penalty avoidance option if the goal is simply to avoid the 2.0% penalty, or a reduction in reimbursement in 2016. This method requires you to submit at least half, (50%) of your eligible Medicare patients visits for at least three (3) measures.

The Registration System can be accessed at https://portal.cms.gov using a valid “Individuals Authorized Access” (IACS) to the CMS Computer Services User ID and Password.

A “group practice” is defined as a single Medicare billing Taxpayer Identification Number (TIN) with 2 or more individual EPs (as identified by their individual National Provider Identifier (NPI) who have reassigned their billing rights to the TIN.

IMPORTANT: filing using the Group Practice Reporting Option (GPRO) requires self-nomination by September 30, 2014. PQRS reporting in 2014 is critical for Orthopaedics practices; non-participation in 2014 will result in a "payment adjustment" (penalty) of -2% in 2016.

If your goal is the incentive payment option, to meet the reporting requirement, enter data from 20 unique patient visits, a majority of which – at least 11 – must be Medicare Part B Fee-For-Service (FFS) patients. Submitting for the incentive payment successfully avoids the -2% Payment Adjustment in 2016.

Note that measures with a 0% Performance Rate will not count – you must meet the quality action when able at least once for the selected measures or measures group to be incentive eligible.

There are different ways for a practice to report these measures: through a claim, a registry, GPRO, or through an EHR. Ask your EHR vendor to see if your practice can submit through an EHR and how to file for PQRS incentives.

CMS has established different reporting requirements for various sizes of practices. CMS finalized its proposal for 2013 to change the definition of “group practice” from 25 or more eligible professionals (EPs) to only two [2] or more to allow groups of smaller sizes to participate as a group. When considering numbers of EPs within your practice, it’s important to note that Physical Therapists, Nurse Practitioners and Physician Assistants are included in PQRS’s definition of EPs.

CMS has defined a numerator and a denominator that permit the calculation of the percentage of patient visits that achieve appropriate reporting of quality measures. According to CMS: “Quality measures consist of a unique denominator (eligible case) and numerator (clinical action) that permit calculating the percentage of a defined patient population receiving a particular process of care or achieving a particular outcome.” In order to be eligible for the PQRS bonus for registry submissions, the threshold is 80% for at least 3 measures. For claims submissions, the threshold is 50% for 3 measures.

If fewer than nine measures apply, the EP can meet the satisfactory reporting requirement by reporting those that do apply—as few as one or as many as eight measures. This is similar to the exception to the current requirement, if fewer than three measures apply. CMS will continue to use the Measure Applicability Validation (MAV) process to test whether the EP should have reported additional measures.

For more information you can use the link below to get to CMS self-nomination/registration through the PV-PQRS registration system:

www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
PhysicianFeedbackProgram/Self-Nomination-Registration.html

Terms and Conditions

Statements and opinions expressed in the Newsletter, Preferred Talk, are those of the author(s) and do not necessarily reflect those of DT Preferred Group, LLC. DT Preferred Group, LLC makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. In publishing this Newsletter, neither the authors nor DT Preferred Group, LLC are engaged in rendering medical or other professional service. If medical advice or other expert assistance is required, the services of a competent professional should be sought. DT Preferred Group, LLC will not be liable for any losses, injuries, or damages from the display or use of this information. This policy is subject to change at anytime.

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Fostering Patient Compliance

Wednesday, July 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

Patient-ComplianceThere are as many reasons why patients don’t follow your instructions as there are patients.  Your role is to provide a trusting, cooperative atmosphere that encourages patients to become partners in their treatment process.  Some of the most difficult instructions for patients to follow are those that involve changes in their lifestyle or habits.  (more…)

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Setting Performance-Based Pay Increases and Handling Raise Requests

Wednesday, July 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

Employee-ReviewIn order to retain valuable staff, you need to set a range for salaries and wages that is competitive, yet flexible enough to allow for raises.  Several resources are available to help you compare your pay levels to similar practices in your area.  You can participate in state or local medical management organization surveys and receive blinded results.  (more…)

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Physician Departure

Wednesday, July 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

Physician-DepartureWhether a physician leaves a practice due to retirement, a new position, or termination, steps must be taken to guarantee a smooth transition.  Different situations will require different steps. The departure of a retiring solo practitioner will be more involved than that of a relocating member of a group practice.  Whatever the circumstances, patient care must be assured and legal obligations must be fulfilled. (more…)

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Mobile Device Use

Monday, June 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

As patients and clinicians increasingly use mobile devices to communicate with each other, concerns about the security of protected health information (PHI) should be raised.  There are strict HIPAA compliance standards regarding the security of mobile devices whenever PHI is created, stored, accessed, sent, or received. (more…)

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Electronic Health Records and Meaningful Use

Monday, June 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

ElRecAn electronic health record (EHR) is a systematic collection of a patient’s health information. This information can be shared across different health care settings, such as labs, hospitals, and pharmacies. While implementing an EHR system involves a significant investment of time and finances, the benefits of the program are numerous.

(more…)

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Certified Athletic Trainers in the Orthopaedic Office

Monday, June 30th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

Certified athletic trainers (ATCs) are a valuable resource in an orthopaedic practice setting, able to offer many support services. Working under the direction of physicians, ATCs are highly educated health care professionals who specialize in the prevention, assessment, and rehabilitation of musculoskeletal injuries and illnesses. (more…)

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HIPAA Risk Analysis

Wednesday, May 28th, 2014

William R. Pupkis, CMPE, Healthcare Consultant
HIPAAThe Health Information Portability and Accountability Act (HIPAA) privacy and security enforcement has grown this year. Combined with the recent very high fines for non-compliance, your practice can’t let its guard down where protected health information is concerned. Under the New HIPAA Security Rule’s Meaningful Use measures and the Health Information Technology for Economic and Clinical Health (HITECH) Act, your practice is required to perform a risk analysis to identify possible security breach areas. If your practice does not, it could incur a $10,000 minimum penalty for “willful neglect” of compliance. (more…)

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OCR and HIPAA Compliance

Wednesday, May 28th, 2014

William R. Pupkis, CMPE, Healthcare Consultant

In response to advances in electronic technology that could potentially compromise the privacy of health information, Congress incorporated Federal privacy protections into the provisions of the Health Information Portability and Accountability Act of 1996 (HIPAA). The Privacy Rule set national standards to protect individually identifiable health information, while the Security Rule established national standards to protect electronic health information. Compliance with the Privacy and Security Rules is enforced by the Office of Civil Rights (OCR). (more…)

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