Medical groups’ futures rely on benchmarking
MGMA conference highlights need for better info
Most medical groups today aren’t benchmarking for quality improvement with such tools as protocols and practice guidelines. But that could change, virtually overnight, as benchmarking becomes a mandate from payers or an economic necessity due to capitation, speakers said at a November benchmarking conference sponsored by the Englewood, CO-based Medical Group Management Association (MGMA)."The world’s changing now," says conference coordinator Thomas R. Prince, PhD, a professor of health services management and accounting and information systems at Northwestern University in Evanston, IL. "If you want to survive, you better get with benchmarking."
A study of 38 medical groups presented by leading health services researcher Stephen M. Shortell, PhD, shows the emergence of benchmarking: 45% reported using practice guidelines, 55% use protocols or pathways, 40% use case management, and 45% use disease state management programs. The data come from an ongoing three-year study of 60 medical groups that will cover issues such as governance and management, internal culture, compensation models, and physician satisfaction.
"The groups in our study are more likely to be leading medical groups in the country," says Shortell. "Others would be quite a bit lower."
MGMA is assisting practices with benchmarking in productivity and efficiency by identifying better practices in its annual cost survey and providing practice comparisons. MGMA’s Center for Research in Ambulatory Health Care Administration is developing benchmarking projects in patient satisfaction and clinical outcomes.
Shortell advises medical groups to seek comparisons that they can learn from — best practices that offer similar and obtainable goals. "Benchmarking is really about improving the processes of care," he says. "It isn’t just about comparing numbers."
In the case of customer service, the search for worthy comparisons could lead you outside of health care to other fields, such as financial services, notes Prince. Some practice administrators have visited American Express or Disney World for pointers.
"There are very few people who are doing a good job in health care in terms of registration and relating to the customer," he says.
Prince also outlines the following steps in benchmarking which you can suggest to physicians and groups with whom you contract:
• Set up a quality improvement team.
It should be headed by a physician but should include a representative from administration, Prince says.
• Make a flowchart of the major patient episodes.
From that chart, pinpoint areas to seek benchmarks, from customer service (phone calls, appointment scheduling) to clinical issues (pathways).
• Focus on high-volume procedures.
By sorting reimbursement codes in the billing system (CPT and ICD-9), discover the top seven to 10 procedures. "You [physicians] focus on 80% of your business," says Prince. "You don’t really try to benchmark the other 20%."
• Identify payer mix and patient types.
Physicians want to know some demographic information about their patients. Are they elderly? Do they have co-morbid conditions? They also want to know what proportion of patients are Medicaid or Medicare vs. commercial. The benchmarks found may differ according to the population they include.
• Compare with themselves.
The most useful benchmarks may be their own. After all, no one has precisely the mix of patients and local market conditions that they have.
They should set criteria for performance based on best practices and compare data with others. But after a year of collecting data, they should compare against their own baseline to determine if performance improvements have occurred.
• Implement an electronic medical record.
As capitation expands, so does the need for immediate information and the ability to analyze trends in treatment and cost, says Prince.
"Once you get to 15% capitation, you’ve got to change your information systems," he says. "You have the opportunity to lose so much money. You cannot economically continue at that level without supporting information."
[Editor’s note: For a copy of the MGMA cost survey report ($200 members, $300 non-members, plus shipping and handling), contact MGMA, 104 Inverness Terrace East, Englewood, CO 80112-5306. Telephone: (888) 608-5602. For information on future educational programs related to benchmarking, contact the Center for Research in Ambulatory Health Care Administration, (303) 397-7879. World Wide Web: http://www.mgma.com.]
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