Quality Data Matters

Quality, OPPE, ICD Codes, ICD-10There must have been a sigh of relief for many healthcare providers, payors, clearing houses and billing services when the Center for Medicaid & Medicare services (CMS) announced the delay of the ICD 10, again. The new date of October 1, 2015, is exactly one year from the previous deadline.

You may be wondering why such a long delay? Well, going from 18,000 codes to more than 140,000 codes requires a lot of planning, communication, testing and comprehensive training. The implementation, and results, are all about quality.

The success of healthcare providers isn’t just measured by patient satisfaction of quality of care and experience, it’s also based on maintaining positive provider relations. Fostering the success of these relationships requires actionable and equitable quality data and an MEC (medical executive committee) with the ability to analyze data effectively.

Quality Data Matters

Two providers have largely different readmission rates on the same surgical procedure. After careful review of their data, they discover that one surgeon prescribed a different post-op antibiotic compared to the other provider hence a significantly high readmission rate. Problem solved.

That is an example of the benefits of quality data. Quality data not only provides insights into what providers are doing but it also improves disease management and patient safety.

Quality data also helps in fraud detection and reduction by eliminating gray areas.

Technology and Data

Technology equips four basic items required to deliver actionable data and actualize significant improvements in patient safety, satisfaction and a hospital’s bottom line:

  • Clinical data should be integrated with privileging, credentialing, and peer review data to establish provider benchmarks and produce OPPE (Ongoing Professional Practice Evaluations) Reports

  • Clinical data should be integrated with privileging, credentialing, and peer review data to establish provider benchmarks and produce OPPE (Ongoing Professional Practice Evaluations) Reports

  • Apply a case-mix index with the ability to adjust for patient severity

  • Organizational and provider buy-in. This requires cooperation from management and the entire medical staff. By-Laws must state and providers must be assured that outcome data is not going to be utilized only as a disciplinary tool but a means by which the entire organization raises the bar on delivering the best care possible to patients

Every person on the MEC and provider relations team play critical roles in demonstrating organizational goals are to improve patient outcomes, identify best practices and foster a team environment. Understanding quality begins with the success of providers is pivotal to the future success of every healthcare organization.

Provider Credentialing


Jim Leonard

About the Author
Jim Leonard

Jim serves symplr as the business development leader of Provider Management and Payor Enrollment. He brings more than 20 years of highly successful sales, marketing and consulting leadership to symplr. His team’s focus is to aid clients with the identification and resolution of gaps in current credentialing, privileging, peer review, quality, and event reporting programs. Jim’s insight into utilizing technology to create transparency and improve operational efficiency promotes overall improvement in provider and hospital performance; further aiding clients in meeting or exceeding compliance with governing body requirements such as CMS, JC, DNV, and CIHQ.

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