3 Proven Ways to Improve Practice Profitability and Clinical Performance | OBERD

06/05/20

"Why should we collect data?"

"What's the ROI of PROs?"

"How do providers and practices use outcomes data most effectively?"

These are great questions, and we get them all the time. Prospects, clients, and partners constantly look for the most valuable and effective ways to utilize outcomes data.

Our answers and advice typically vary, but we inevitably reply with a question of our own: “What are your goals?”

Clinic goals, quality goals, business goals, marketing goals and others factor into play when utilizing quality data.

This article focuses on the three that, in our opinion, provide the most significant ROI potential for a PRO collection program:

Let's dig in.

1. Payer Negotiation

When preparing for payer negotiations, administrators, QA staff and physicians can gather and utilize outcomes and satisfaction data that highlight the practice’s quality and demonstrate its continuous improvement in outcomes scores.

Armed with outcomes data, physicians and administrators can demonstrate to payers the collective quality of providers and/or service lines by procedure. They can also demonstrate the improvement in score at milestones such as the 1-year post-op mark. Showing patient improvement in outcomes is essential because payers need to know how many of your patients get better, and how much better they get. Ask yourself, can I say with certainty, “85% of our Total Knee Arthroplasty patients experienced an improvement in pain, function and quality of life, at the 12-month post-op time point, that they perceive as meaningful and beneficial?”

Whether they know it or not, this is the information private payers need.

And it’s worth it to payers. If they know a provider has high (and predictable) quality metrics, they know the provider will, more than likely, get it right the first time. They can hedge against adverse events and re-admissions because they have the data that demonstrates low risk.

This is especially useful in markets where competition for the patient population is fierce. Providers and institutions who can demonstrate quality and value, backed by data, are a safer bet for payers.

2. Physician Reviews

Administrators and quality managers may struggle with physician quality reviews if they’re not armed with data-driven quality and satisfaction metrics. PRO data, especially when blended with Satisfaction data, can give an administrator a quantified view of the quality a physician provides.

Practical use cases include identifying why a surgeon’s quality scores are high for a specific surgery (or even a specific patient cohort), and utilizing that data to refine methods for other under-performing providers.

Imagine the following conversation between an administrator and surgeon: "Dr. Smith can no longer perform a total knee for patients with a BMI over 30 because outcomes scores are too low and it makes the practice vulnerable to margin if it affects our payer contracts. Dr. Smith needs to adjust his process, perhaps by adopting Dr. Jones's approach because Dr. Jones’s scores are above average on comparison reports between the two. Or we can change workflow triage that patient cohort (<30 BMI) out of Dr. Smith’s patient schedule."

3. Data-driven Marketing

It seems like every time you hear about an orthopaedic surgeon, you also hear, "he's the best" or “she’s the best.”

Surely not every surgeon is the best, even among their local market or patient population. But practices and providers have benefited from anecdotal reputations like “he’s the best” for years.

In the future, a claim of being “the best” needs to be backed up.

Practices and providers who collect data can also demonstrate quality by leveraging data in data-driven marketing messaging.

Savvy practices have already begun. Instead of advertising PRO scores (because what does a KOOS JR of 72 really mean to a layperson?), consider diggin into outcomes data at the individual question response level. That will enable a provider or group to say something like, “86% of patients who have a Total Knee Arthroplasty at our practice experience no to mild pain climbing stairs 6 months after surgery.”

It’s a simple and succinct way to showcase quality based on data. And it’s done using language related to what patients and referring providers can understand: symptoms.

Data collection is an effective, credible way to market value-based care.