In physician profile data, home-grown is best
When a physician profiling project is launched within your medical office, remember there's a world of difference between a warehouse full of data and a couple of useful measures reflecting the daily effectiveness of the practice. "Data about your own practice is the best starting point for improving it," explains practice management consultant Susan Bellile, president of Westchester, IL-based Q3 Inc. "Besides, if you bring the doctors actual data, it's immediate. It generates more excitement than trying to get them to support something that won't produce figures for six or 12 months."
You can turn to these two sources for numbers on which to build profiles:
1. Hospital data.
Bellile suggests asking your inpatient facility's quality improvement director to lend a hand in obtaining statistics on the physicians in your office. Be aware, however, that some hospitals only release such data to the physicians. So you might need an authorization from one of your doctors.
On the other hand, you might discover that the hospital routinely sends the very information you need and it's just lying on somebody's desk. "Until the doctors get interested in these types of reports, they'll go unread," Bellile observes.
Advantages:
· Most institutions compile reports by DRG categories, comparing physicians by costs and lengths of stay. "Hospitals usually have all the details behind the reports," Bellile says, "like breakdowns by DRG and on lab and drug costs."
· Hospital databases often compare each data set to corresponding numbers from the state or geographic region. They also compare each doctor to hospital and statewide norms.
· Hospital QI programs have an incentive to cooperate with your profiling project, she adds. "After all, if a doctor has high inpatient costs, it's a negative reflection on the hospital."
· As your group compares the treatment costs among the different hospitals they use, obvious cost discrepancies might provoke fruitful discussions.
Limitations:
· Hospitals usually lack accurate and uniform methods of charging pieces of care episodes to the doctor who actually rendered the care. For example, an emergency department (ED) physician admits a patient suffering chest pains. Does the record assign the open heart surgery to that same ED doctor or to the cardiovascular surgeon from your practice who performed the bypass? The point is to find out how cases are assigned to each doctor so you can determine which charges in an episode of care actually belong to the physicians in your office.
· Different hospitals present their data differently, so if your doctors practice at various institutions, you'll need to arrange reports in a consistent fashion before you can use them.
2. Claims data.
These statistics are probably easiest to come by because payers send them regularly. They often determine the size of physician bonuses from respective payers.
Advantages:
· The data will give you a snapshot of your practice from the insurers' perspective. "It's there and you might as well use it," Bellile says. "Other people are looking at it so you should know what they're seeing."
Limitations:
· Claims data are less detailed than hospital data. So if certain charges are abnormally high, you won't see the severity adjustments for comorbidities or complications which help distinguish justified expense from overutilization.
· Claims data only reflect the portion of your patient population covered by that plan.
In spite of hospital and claims data limitations, they're still a great starting point from which to create your own tools, Bellile says."Physician groups will ultimately develop the most comprehensive profiles because they have the overview of what happens to patients across the continuum."
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