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Jim Cox

By: Jim Cox on March 7th, 2013

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Quality Data's Role in Provider Relations Strategy

Quality | OPPE | ICD Codes | ICD-10 | FPPE | Provider Relations | CPT Codes | Healthcare Provider Credentialing

Quality, OPPE, ICD Codes, ICD-10, FPPE, Provider Relations, CPT CodesIn healthcare, the success of an organization relies on the accomplishments of its providers. Successful providers impact a patient’s satisfaction, experience, and overall quality of care. Overlooking the patient’s experience as well as the importance a provider’s role plays can be detrimental to the organizations bottom line. Unfortunately, many hospitals are without a clear understanding of how their greatest assets-- their providers, perform.

Increase Provider Value

Today, many organizations that track provider performance wield results like a weapon, the equivalent to abandoning real estate because it’s not increasing in value as quickly as other properties. Instead, wouldn’t it benefit both parties to learn what could be done to raise its value and resolve problems? Maintaining positive provider relations is crucial to success and fostering that success requires access to actionable and equitable quality data and an MEC (medical executive committee) with the ability to analyze data effectively.

The Benefits of Acquiring Quality Data

Many healthcare organizations believe the most important data to drive success is financial, but simply reviewing costs of procedures doesn’t give an accurate history. When reviewing readmissions related to post-op infections, scrutinizing the costs of readmissions will only illuminate a problem, but won’t provide a correlation to understand why infections and readmissions are occurring.

If you had the ability to review quality metrics like individual provider outcomes and discovered one of three surgeons had a higher infection/ readmission rate, what would you do? With the ability to review similar cases, you could determine the outlier simply prescribed a different post-op antibiotic than the other two; resulting in prompt identification and a quick solution to the problem. Overall, your surgeon is better, the hospital saves money, and most importantly-- patient safety and satisfaction are improved while the hospital avoids certain risk.

Acquiring Actionable, Quality Data

Technology drives the ability to harness the four basic items required to deliver actionable data and actualize significant improvements in patient safety, satisfaction and a hospital’s bottom line.

  • The delineation of each provider’s granted privileges tied to the appropriate ICD/CPT codes.

  • Your 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 isn’t 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.

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About 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.