How Hospitals Get More Value from Physician Quality Review

Bending the trend on high costs in healthcare continues to be a big challenge for hospital administrators, especially quality directors and physician leaders such as CMOs and department chairs.

At the same time, medical staff leaders must frequently perform quality reviews to enable providers to keep or update their clinical privileges and to participate on Medicare/Medicaid panels.

Unfortunately, quality review activities sometimes come with a hidden price tag, especially if they’re inefficient or outdated. As a result, physician quality review is one process that can present hospitals with a prime opportunity for optimization and cost-cutting. 

Gauging the costs of physician quality review 

While peer review and other performance measurement initiatives—such as focused and ongoing professional practice evaluation (FPPE and OPPE)—are often tedious and time-consuming, they’re necessary for a healthcare organization’s survival. They’re also the best way to help your providers improve and contribute to the achievement of organizational quality goals surrounding value-based care. So how can hospitals facilitate their critical reviews in the most fiscally responsible way? 

 Here are three important areas to consider when evaluating your quality review activities. 

1. The duration of provider quality reviews 

Medical staff chiefs and chairs are expected to be on duty for long periods of time in a “standard” work week, not only caring for their own patients, but also mentoring providers and completing a heavy administrative load. 

The AMA estimates that about 62% of physicians work 40-60 hours per week, another 18% work 61-80 hours per week, and 5% work more than 80 hours per week. An alarming 38% of physicians spent 10-19 hours per week on paperwork and administration, an increase of about 13% compared with data from the year prior. 

Source: American Medical Association 


Our recent study dives deeper into the overall time medical staff leaders—often the highest-paid physician resources in a healthcare organization—spend on administration. The study analyzed ten high-profile specialties that use symplr’s Midas Statit. The data shows that the average cost for each specialty to perform physician quality reviews twice per year, as required by The Joint Commission, is just under $300,000 for peer groups of between 20-100 providers. 

2. The impact on productivity and cost 

Multiple studies have shown that the type of work being done directly affects provider satisfaction, and therefore provider productivity. The American Medical Association and RAND Corporation published a study that shows providers are "in their element” and most satisfied when they are delivering high-quality patient care. Conversely, attending to regulations and learning/using the electronic health record (EHR) was cited as primary contributors to physician dissatisfaction. It stands to reason that performing administrative quality reviews, while important, doesn’t likely fall into the category of delivering high-quality care in the minds of most physicians. 

Additional barriers to quality patient care that affect physician productivity are visible in the measurement of productivity itself. Measures are implemented frequently by federal, state, and local regulatory organizations and require specific performance thresholds be met in order for providers to be paid for their services. The value-based physician payment system for patient care puts added pressure on providers to do more with less by elevating the inherent value of quality and making it a condition of payment. Hospitals rely on data provided by medical staff and quality organizations to analyze and reverse negative trends. 

3. The effect on patient satisfaction and patient care 

What does the administrative burden of quality reviews mean for patient care? The reality is that providers are spending more time away from patient care to drive improvements in care delivery through performance improvement, documentation, and other administrative tasks. 

Patients’ voices are heard through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) study, which provides patients an opportunity to give feedback on their hospital experiences. HCAHPS is not new, but the survey goals and questions have matured over time to provide key indicators of quality in patient care. The Communication with Doctors component of the HCAHPS survey still hovers around 80% across the board nationally. This leaves significant room for physicians to improve the quality of patient care they deliver. However, that goal is much more challenging to achieve when they’re mired in daily administrative work. 

Improved workflows conserve resources 

By adopting solutions and driving outcomes that focus on improving the overall workflow for measuring quality indicators, providers and quality leaders will have tools to save time and money—and enhance their productivity. 

Healthcare organizations have found quick fixes in business intelligence tools that provide flashy charts and the ability to slice and dice data. However, the key to a successful and streamlined physician quality review process is more about the workflows you employ to get the job done. Because providers log in only a few times annually to participate in quality reviews, standardization and repeatability are key to decreasing the time leaders spend on performing these important tasks. 

By implementing a standardized workflow tool that is both flexible and customizable, health organizations can manage the lion’s share of their administrative tasks using a single interface to accomplish tasks like: 

  • Conducting provider quality reviews 
  • Maintaining accreditation standards 
  • Credentialing 
  • Performing focused reviews 
  • Attending to contracts 

The bottom line 

Every healthcare organization wants providers to spend more time on care to ultimately achieve higher patient satisfaction scores and more revenue. But there’s no simple path to get there. Time savings and overall reduction in costs through workflow-specific tools and software is a great start—and an avenue for healthcare organizations to make incremental progress on achieving their long-term goals. 

The quality review process is mission critical, but it takes time, resources (financial and human), and fortitude. However, with the right approach, you can maximize allotted resources.

How Midas Statit can help 

Statit’s Provider Scorecards offer standardized workflow tools that are specific enough to easily manage provider quality reviews and meet accreditation standards, yet are flexible enough to be used for alternate reporting needs (e.g., credentialing, focused reviews, and contract services).

  • symplr’s customers use Statit to review more than 150,000 providers annually
  • Batch reviews help to automate reviewers’ workflows, resulting in time and cost savings of up to 80%.  

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