Clinicians use a
wide variety of tests and tools to measure the health of their
patients—stethoscope, blood tests, scales and many more. These are very common and clinicians are very
comfortable using them. Can the same be
said of clinicians and administrators in regard to using tools and tests to
measure the health of their provider site?
How can you
measure the health of a site? There are
many variables that can be measured to gauge the health at any site. For instance, if your site has a strategic
plan or vision statement, then you should be measuring how well the plan is
being implemented with key indicator variables (KIV’s). Financial health is key to the health of a
site. Of course you need to measure if
income exceeds expenses on an annual basis; monthly tracking of this variable
is more advisable so that adjustments can be made to reduce expenses or
increase income as needed. Another
variable that you may want to track for financial health is what percent of
insurance reimbursements are paid on the first submission. Variables can also focus on the health of
patients in general, at the population level—the percentage of diabetics with good
A1C levels for instance.
I believe that
having a strategic plan and vision statement is key to the success of any
business enterprise including healthcare.
Having a strategic plan that is updated annually sets goals that focus
on its service to its patients or clients. These goals may be short-term, as
achieved in one year, or long-term, as completed in three to five years. The
primary goal in my opinion is continuously improving care and service that is
patient-centered. To see if you are
meeting your goals, you will need to define variables or data sources that
track the advancement of your site towards your goals. For instance, you may want to track how
accessible providers are to your patients after clinical hours. You can survey a random selection of clients
who have sought care after clinical hours and find out whether they were able
to get care and, if so, how easy was it to get.
After you have
defined the KIV’s for your goals, you will want to continuously collect data on
the variables and have a team review and analyze the data to see if the site is
advancing towards meeting its goals. If
not, care processes and office processes will need to be modified in order to
reach the goals. An executive team
should review the progress made in achieving the goals at least annually. This team can modify goals as needed, perhaps
setting higher standards to reach.
Besides
collecting data on achieving a site’s goals as determined by its strategic plan
there are many other variables that need to be tracked for the health of a site. Variables based upon the quality of care are
becoming more important now and will continue to do so. Payers are negotiating contracts with
providers that are basing some portion of the reimbursement on quality
measures. Providers at primary care
sites that are seeking to enhance revenue by becoming designated as NCQA patient-centered
medical homes need to meet or exceed many different care standards. Among these are asking those with chronic
conditions to complete pre-visit worksheets and have lab tests done before the
visit so that the care team can review the results before the patient visit and
be ready to discuss the results with the patient. The goal for this requirement is 75%
completion.
Along with
measures that check progress in meeting the goals of a strategic plan or
meeting the quality of care measures of payers or outside agencies, providers
need to track the financial health of its site.
This is usually done by administrators but may also involve clinicians. For instance, the implementation of IDC-10
for diagnostic coding is vitally important to providers and should include
clinicians. Failure to meet the deadline
will result in loss of reimbursement for services. A measurement that should be undertaken to
address this transition, as in any other transition that impacts finances, is
an assessment of the current state of the practice in terms of readiness to
make the transition. Once this
assessment is completed then a timeline and implementation program can be
designed to make an orderly transition to ICD-10 or other regulatory
environment affecting the bottom line.
Besides deciding
what to collect one must understand the tools and sources that are available
for data collection. One common tool is
a survey. Professionally designed ones
usually work best. Another source of
data is the Electronic Health Record if your site uses them. If a registry is part of the EHR then data is
readily available at the population level of health. Managers of the financial department and of
the billing department will be good sources of data for financial variables as
well as the practice management software.
The collection
of unbiased data is very important to the success of providing the best care at
lower cost for healthcare providers.
Just as important as understanding the collection is knowing what data
to collect and then making use of it. As
I stated at the beginning of this article, there are many things than can be
measured at a care site. Not all of the
data may be important. A team of
managers, clinicians and staff can help narrow the field of what needs to be
collected. After collection of the
identified variables, someone with expert knowledge of data analysis can help
the site understand the data and how to put it to best use. Without this last step, the collection of
data is useless.
In conclusion, let
me offer the advice of the Gartner Group (ICD-10 Implementation Toolkit, p.116,
MGMA): “The key to thriving in a
competitive marketplace is staying ahead of the competition. Making sound business decisions based on
accurate and current information takes more than intuition. Data analysis, reporting and query tools can
help business users wade through a sea of data to synthesize valuable
information from it”—today these tools collectively fall into a category call Business Intelligence.