Patient-reported Data is your Magic Asset
Your practice has many assets. One of them you may have forgotten about or undervalued is your data – to be clear, the data you have gathered from and about your patients. This asset will likely not appear on your balance sheet but it is one of the most valuable in creating sustainable growth for, and equity in, your practice. This is what the pros at TCO had to say about their data collection program:
Twin Cities Orthopedics is currently a large independent specialty practice of 39 clinics and 115 physicians across the Twin Cities metro area and western Wisconsin. Like many of you, we face increased consolidation and competition from other orthopedic practices and healthcare systems. We also experience downward price pressure from payers, and payers using their definitions of value, based on claims data to rate our physicians in tiers that were not representative of the quality and value our physicians and our practice staff deliver.
Still, we are fortunate to have a very successful practice, attributable to many people and great efforts. One of our most significant success factors has been our culture and practice of collecting useful data and using it to drive our endeavors. In this brief article we hope to outline our strategy and outcomes from considering and deploying patient-reported data as an asset to reach practice goals.
Begin with the End in Mind
Steven Covey, the author of “The Seven Habits of Highly Successful People1” preached that to be successful you must “Begin with the end in mind.”, that is, envision what you want in the future so you can work and plan towards it. We began our odyssey of patient-reported data collection and usage with the following ends in mind:
- Improve the value of our practice by growing it in effective and sustainable ways
- Receive more consideration for what we provide
- Prepare to be successful in value-based care situations
- Be the leader in our market
Define Value as it Should be Used and Collect Data that Supports it
Michael Porter from Harvard Business School defined Value in a landmark article2 about healthcare as being the quotient of relevant outcomes divided by cost. We took that definition to heart and developed our version of practical value for the services we provide as:
VALUE = PATIENT OUTCOMES (EXPERIENCE AND FUNCTIONALITY)
This definition provided us with guideposts to follow as we considered various types of data to collect. Our mantra was, “If we can’t use it, don’t collect it!”, meaning of course that if a data element would not serve to get us to our end goals in a clear way, we would not invest in collecting or reporting it. We asked ourselves questions like, “Does it allow us to improve our value?”, “Does it allow us to change one of our physician’s practice behavior?”, “Will it allow us to have a better relationship with a local healthcare system?”. If the data we were considering would answer these and other, similar questions related to our end goals then we would collect and use it.
So, Where do You Start
To be honest, our initial approach was a bit scattered. Were we to do this again, we would definitely move a bit more slowly. Our first step was, and would be, to engage and empower physician champions in as many specialties as possible. But there is a bit of a Catch-22 with this because you need some credible data and results to enlist and support your champions. We began by gathering and reporting basic patient-reported data that we could use, and benefit from, immediately and shared the results with our early champions to gain their advocacy.
Our initial focus was on data that would help us understand our performance against our aforementioned value definition for our patients and partners. We started by collecting patient experience data and some basic outcomes metrics – adverse events and selected standardized functional patient-reported outcomes for our major procedures. We used that data to assess and compare performance by physician and for the organization overall. We asked ourselves, “How are our patients doing?”, “How is each physician doing?”, and “How are we doing as an organization?” We have subsequently expanded the range and detail of these questions into many sub-segments such as performance by procedure type and hospital partner, but our start was with a limited set so we could use it and quickly evaluate the results therefrom.
The other strategy we adopted early was to share our data with all of our constituencies. And in doing so, we try to present the information in contexts relevant to our relationship with them and in metrics they could easily understand and interpret. For example, in our patient discussions pre-treatment, we outline expectations for the patient with real data relevant to their procedure. Similarly, post-treatment, we show how a patient’s self-reported functionality, pain and quality of life compare with others having the same procedure. This helps patients understand how much better they are compared to their situation pre-treatment and gives them more to share with their family and friends.
To provide broader transparency we share our performance publicly for our more frequent procedures. For total hip arthroplasty as an example, we convey the percent of our patients’ having no to mild difficulty sitting, or rising from sitting to standing, at appropriate intervals post-surgery. These are metrics the public understands, as opposed to an overall HOOS score. And, we show a comparison of our results with regional and national norms where available.
With our health system partners we share our outcomes scores along with adverse events and compare this metric with other systems we work with across our market. With our payers, we share performance data from standardized outcomes instruments and connect it to our cost data (which they already have) to illustrate our delivered value using our definition of value. The important efforts here are understanding each constituency’s goals and articulating how we are helping them reach those goals.
So, How Has This Asset Performed?
Collecting and using our patient-created data has been a very worthwhile enterprise for us. While there is always more we can accomplish, we have made substantial progress toward our end goals. As examples, we have seen our new patient visits, on a per-physician basis, increase about 14% over the last three years. We have increased the number of our direct employer relationships from none to six in the same time period. They are now guiding their patients needing orthopedic services to our practice. With commercial payers we have seen substantial growth in our participation in bundles, to the point that last year we provided them with more than 1,300 bundles. We have also been more successful with our co-management agreements in that we can demonstrate quantitatively the value we bring and can be on the offense more in these discussions. The collection and use of patient-reported data has positioned us as a leader in our market in part because others do not have this data and therefore cannot articulate their performance or assist partners in making better decisions as we can.
Finally, and perhaps most importantly, we can continue to build and sustain a culture of clinical and service performance delivery and improvement based on data transparency and sharing. We believe that to define a culture you have to report performance back to your team and match it against individual, group and overall goals. By way of example, we have defined our patient experience goal as expecting that a minimum of 98% of our patients will recommend us to family and friends. We report individual results to each physician on this (and other) metric(s) so they, and we, can see how they are performing and have the appropriate discussions as necessary.
In summary, your patient-reported data is an asset and should be recognized and managed accordingly. We believe that many markets are starved for delivered-value data, presented in the context of various player’s goals and in terms they understand. Further, value-based care models of payment are not likely to go away. We believe they may even extend to the point where it will be necessary to create internal networks of providers for various procedures. These will certainly be difficult discussions if they are not informed by credible delivered-value data.
You should carefully consider your end goals and collect and report data that helps you understand and make progress toward those goals. Use the data to create a data-driven culture to motivate, and where necessary change, behaviors toward personal and organizational accountability to deliver value as you define it. This is not a lighthearted nor inexpensive endeavor. It takes thoughtful planning, constant and consistent attention, and a lot of listening. But, it is worth it!
1 Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change, Simon and Schuster, 2003
2 Michael E. Porter, PhD, N ENGL J MED 363;26 Nejm.Org December 23, 2010