Are Your Providers Worth a Hill of Beans?

Quality, ICD-10, Provider RelationsWhy do healthcare organizations have difficulty assessing provider value? Because valuing providers isn’t as clear as reviewing a financial statement; it requires understanding the nuances of provider performance which should be every healthcare executive's highest priority!

Dollars Alone Don’t Tell the Tale

Relying solely on financial data to assess provider performance is a mistake. When examining financial data related to re-admission rates you see a negative financial impact from payors and your providers are seeing the same patients again rather than new patients that generate revenue. Utilizing re-admission rates as a tool to help assess a provider's value is important, but it shouldn’t be the only grading instrument.

At the same time, it doesn’t necessarily mean a surgeon with a higher post-op infection rate is less valuable than his/ her peers. Further investigation into the post-op infection could simply reveal the surgeon in question prescribes a different antibiotic. Properly assessing the problem reveals a simple solution - the hospital saves money, the surgeon has better outcomes and most importantly, patient safety is improved while reducing unnecessary risk.

Gathering Meaningful Data

The following data is needed, at a minimum, to adequately measure provider value.

Access to Billing or EMR Data: Having access to actual procedure information is a key data point in evaluating outcomes. Be sure to gather the basic information such as patient type (inpatient versus outpatient), procedure performed, readmission, length of stay, and outcome.

ICD/CPT Codes Tied to Privileges: Tying the procedures performed to privileges granted is an often overlooked, yet an important step. Having a system in place that ties ICD/CPT codes to granted privileges will allow for fast and accurate review. Moreover, these same reports will also shed light into procedures performed outside a provider’s granted privileges as well as counts to maintain privileges.

Case-Mix Adjustment: Reviewing patient information provides crucial detail in provider assessment. For example, if you knew a patient died during a simple Shockwave Lithotripsy - you may have a very negative view of the provider; however, when information is provided that shares the patient was a 96 year old woman in poor health, your perspective changes.

Benchmark Data: Examining provider value without comparison data is nearly useless. Ensure your review includes peer and hospital/organizational benchmarks and use negative outcome information as a tool to help providers improve.

Gathering financial information is easy and may be why many healthcare organizations use it heavily when assessing provider value. However, collecting and analyzing meaningful performance data can also be easy and more effective with the right tools. Remember, measuring outcomes and other key metrics is the best way to validate and display the true value of your biggest assets, your providers.

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Jim Cox

About the Author
Jim Cox

Jim Cox is the CEO of Medkinetics, LLC. and the Co-founder of SEERhealth LLC. Jim is a serial entrepreneur who has been creating software for over 30 years. For the last 12 years, his work has been focused on the healthcare industry through Medkinetics and specifically on developing world class software for credentialing, privileging and performance improvement. Jim is the author of numerous patents and is a graduate of MIT in Aeronautical and Astronautical engineering.

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