SC starts on-line physician comparison data system
This is managed care a physician could love
South Carolina physicians will soon have a new tool in their black bags: a comparative data system they can access through the Internet that will tell them how they’re doing on a wide range of measures compared with their peers across the state.
The South Carolina Budget and Control Board Office of Research and Statistics and the South Carolina Medical Association, both based in Columbia, have teamed up to start a comprehensive, secure data system they say is like no other.
When the system is up and running in the next few months, physicians will be able to log on through the Internet and see their personal top 10 severity-adjusted reasons for hospitalization and compare those with all other physicians across the state. They’ll be able to see where they fit in the 25th, 50th, and 75th percentiles, but no one else will. The information will not be identifiable by name, and the system will require a physician number and personal password for access.
But that’s not all. In addition, physicians will be able to see data on these factors:
length of stay, with details on pre- and post-surgery, intensive care unit stays, and observation days — in short, any way you can compare LOS;complications based on the UB-92 form;
estimated costs based on Medicare cost reports;
outcomes, such as in-hospital mortality, mortality within 30 to 60 days, readmission rates within 30 days, and visits to the emergency department within seven days.
"This is managed care, managed where it should be — at the physician level," says Pete Bailey, chief of the South Carolina office of health and demographics and leader of the project. "We can sidestep in a lot of ways that kind of managed care where people come in from out of state, skim the cream off the top, take the money, and leave. Other people have taken this type of data and used it all the time, but physicians have never had their own data system. They’ve never known this information about themselves. This is letting physicians manage care, which is the only way to do it."
Tracking data across the continuum
Bailey says the project will begin with inpatient data but will soon expand so physicians will be able to track their data across the continuum of care. Plans are in the works to plug in health data from the 350,000 state employees to make available information on office visits, lab services, radiology, and pharmacy comparisons.
Medicaid data may eventually be incorporated as well so that a physician could look at an outpatient surgery, for example, and the outpatient visits that led up to it. Bailey also plans to group episodic situations vs. disease states, in which one- to two-year treatment patterns would be helpful.
"This is what physicians do every day, but they’ve never had the data to back it up," Bailey says. "That’s how practice is anyway — they think back to past cases, think about what they’ve heard or read, and make a decision. Now we can give them tremendous capability to make decisions based on objective data. Physicians are scientists, so this is right down their line."
Bill Mahon, CEO of the South Carolina Medical Association, says his organization agrees that physicians need access to this type of data. The association is paying $75,000 to fund the project this year.
"We firmly believe the electronic age is here, and it’s going to be a significant factor in health data of the future. With the Internet, the access is there," he says. "We felt that if we made it available to physicians, they could use objective data for self-assessment and performance evaluation. Other people are making this type of information available, and doctors should have access to it so they can evaluate it and make sure there are no glaring errors."
The association also is directing the content of the data system so that it will be most useful to doctors. South Carolina has collected detailed physician-level data for years, and physicians could request a paper printout in the past. "But when physicians request data on paper, they probably have something in mind that they think they need to look at," Mahon says. "Now they can surf and look at all kinds of things at a speed beyond belief. You can leaf through the top 20 procedures you might do and have a profile flash up. It takes the guesswork out."
Bailey says previous research has shown that this type of benchmarking can dramatically improve care.
"Several years ago, we did some work on prostatectomy where we saw differences in length of stay," he says. "We pulled samples and did research to see why. The research showed a couple of differences between the low-length-of-stay physicians and the high-length-of-stay physicians based on when they did surgery and when they took the catheter out. This was presented to the urological specialty society, and we gave every physician his or her comparison data. After just that one presentation, the length of stay changed dramatically."
It’s not enough just to report the data if change is to be made, Bailey says, and that’s why the other players in the project are South Carolina’s two medical schools, the Medical University of South Carolina (MUSC) in Charleston and the University of South Carolina in Columbia. The medical schools plan to use the comparative data to plan their continuing medical education programs.
"You’re going to be able to see where there are issues with length of stay, issues with complications, issues with re-admissions," Bailey says. "Those will dictate the kinds of continuing medical education programs. In the past, CME programs haven’t had a solid way of deciding what to offer."
Jan Temple, director of professional development in the office of continuing medical education at MUSC, says this effort should have a long-term impact on health care in South Carolina.
"We’ll be able to design our CME programs for physicians in a more formalized way to target those areas where improvement is needed," she says. "By comparing state data to national standards, we can focus program content on quality indicators related to the process of care that have been linked to improved outcomes. Then we’ll be able to re-run the state data to see if there has been any change in outcomes."
Temple says they will also be able to look at health priorities in the state, such as diabetes, heart disease, and cancer, to see what specific issues need addressing. "The beauty of this initiative is that it’s unique and focused," she says.
Bailey says when physicians notice areas they need to address, they’ll easily find links to the appropriate continuing medical education information. And when the project directors notice a widespread problem, they’ll encourage research at the medical schools to find out what’s going on. In the future, the state plans to provide the same type of data for hospitals.
"It’s a wonderful coming together of people who are honestly trying to figure out how to educate physicians and figure out ways to solve problems that come up," Bailey says. "I think it’s going to make a substantial difference."
[For more information, contact:
Pete Bailey, Chief, Office of Health and Demographics, South Carolina State Budget and Control Board Office of Research and Statistics, Rembert C. Dennis Building, Room 425, 1000 Assembly St., Columbia, SC 29201-3117. Telephone: (803) 734-4022. Internet address: www.orss.state.sc.us
Bill Mahon, CEO, South Carolina Medical Association, P.O. Box 11188, Columbia, SC 29211. Telephone: (803) 798-6207, ext. 224.
Jan Temple, Director of Professional Development, Office of Continuing Medical Education, MUSC, 261 Calhoun St., Suite 301, P.O. Box 250189, Charleston, SC 29425. Telephone: (843) 876-1925.]
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