Don’t rely on MCOs for your outcomes measures
Measuring outcomes is critical to health care providers who contract with MCOs. But if you are relying on an MCO to provide you with that data, you may be surrendering a critical negotiating tool.
More physicians and hospitals are setting up their own outcomes measurement systems, rather than accept MCOs’ numbers.
The following tips for practices or hospitals thinking of battling back were developed by John McCally, vice president of managed care services for BSM Consulting Group in Minneapolis, an independent consultant who has helped clients set up outcomes reporting systems.
1. Plan to invest time and money in setting up an appropriate system.
This varies depending on the size of the practice or hospital, as well as the types of specialties offered. A small practice of 20 physicians can expect to spend up to $50,000 for software licensing, installation, training, and assistance in developing a reporting system.
Other factors that will determine reporting system and start up costs include:
size of practice or facility;
percentage of patient base enrolled in a managed care plan;
amount of outcomes information that purchasers in your market want;
whether the network with which you contract can be trusted to invest in a capable system and competent staff to run it.
2. Review outcomes literature pertinent to your specialty.
The American Medical Association, your specialty group’s national board, or consultants can provide journal references. Identify the parameters you need and then work with a consultant to help adapt the system to your practice or hospital.
3. Gather enough meaningful data to compare with benchmarks.
Twelve months’ worth of data collection is a good starting point.
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