Are you the best in your field? Prove it by joining a national database
But work out cost, staff, technology issues first
Physicians have never had so many opportunities to prove they’re the best or to better themselves. And in a managed care era, bragging numbers translate into more lucrative contracts.
But as national outcomes projects expand exponentially amid a growing demand for data, outcomes experts urge physicians to exercise caution. Consider exactly what you’ll be measuring and the administrative, technological, and cost issues involved.
The benefits of the information will likely outweigh the burdens, but success may well rely on good planning, says John Cockerham, MD, associate professor of pediatrics at Georgetown University Medical Center in Washington, DC, and an outcomes management consultant.
"There are strong advantages to joining a national database," says Cockerham. "[But] it’s going to be a lot more effort than you think. You can’t just say, We’ll do outcomes tomorrow.’ It requires a great deal of thought about what you’re collecting."
A national database can jump-start your outcomes management program, since it generally provides the data collection tools, approved software vendors, regular reports, and trend charts. But can it collect the information you most want to know? How much data are you required to provide? Can you start slowly, perhaps with just one indicator?
"Don’t try to implement a complete and total outcomes management program at once," advises Cockerham. "Do it in small pieces. Limit the scope of the project at the outset to something that’s easily accomplished."
For example, an orthopedic practice that joins the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) project of the American Academy of Orthopaedic Surgeons in Rosemont, IL, may choose to begin by measuring outcomes following treatment for low back pain. The academy has extensive data collection modules for all parts of the body, pediatric patients, and patient satisfaction. (For more information on the experiences of individual practices, see related articles on pp. 27-28 and 30. For a partial list of databases, see chart on p. 29.)
National database projects can benefit those who are experienced in outcomes management, as well. For several years, Mid-Carolina Cardiology in Charlotte, NC, gained a wealth of knowledge from the group’s own home-grown outcomes management surveys. Complication rates and variations among physicians declined in the angioplasty procedures.
But after a while, the cardiologists wanted a bigger yardstick. "They looked pretty good next to each other, but they didn’t have any idea what anyone else was doing," says Joanna Younts, a Dallas-based outcomes consultant who was formerly outcomes director for the cardiology group.
However, Younts and her colleagues needed to convince some physicians who were outside the practice but affiliated with the same hospital to sign onto the project. Physician support is critical to the success of your database project, so you need to actively seek input even from those who are less favorable toward it, advises Younts. "First and foremost, involve the physicians in the decision-making process. [Otherwise, their objections] can derail the whole thing."
Here are some other considerations when deciding whether to join a national database:
1. Determine who is responsible for data completion.
As Mid-Carolina Cardiology considered involvement with the American College of Cardiology database, a task force considered the increased demands for data. Presbyterian Hospital in Charlotte actually maintains the database for the cardiology group, so hospital representatives, as well as Younts and physicians, were involved.
A national database organization expects you to have every data element for every physician at every reporting period, says Younts.
Accurate, complete data essential
Concerns about data collection prompted the task force to make strict rules about who would collect the data and who would be responsible for making sure it was complete. The conclusion individual physicians must ensure that the data is accurate and complete. While the project will have a manager, the buck stops with the doctors.
"The hospital agreed that they would suspend privileges for physicians who did not take responsibility for their data," says Younts.
2. Evaluate your staffing needs and process changes to collect data.
"You have to rewrite people’s job descriptions and make them responsible for the collection and entry," says Cockerham. That may require reassigning other tasks or even hiring another employee.
Depending on the size of the practice and the demands of the database, you may not need a full-time outcomes manager. But if you designate a clerk, nurse, or office manager with responsibilities, you need to make sure to give that person enough time to accomplish them.
In fact, senior management need to provide visible support so staff realize this is a priority, he says. An outcomes management task force should review the practice’s patient care process to determine when is the best time to give patients the questionnaires and who will administer them or assist the patients.
Some outcomes projects may rely heavily on chart review or data you can cull from your practice database, or it may require physicians or techs to log information during a procedure.
Keep in mind, also, that the hospitals your physicians are affiliated with are now required by the Joint Commission on Accreditation of Healthcare Organizations to conduct quality improvement projects. You may need to provide some data, or you may want to link your outcomes management to theirs, notes Cockerham.
In fact, you may save time and money by working with an affiliated hospital on an outcomes project, such as reducing cesareans. The hospital may provide staff support and patient education and you will still get outcomes data that you can tout with managed care organizations.
3. Consider the technology demands and additional costs you will incur.
Presbyterian Hospital had just purchased a new advanced computer system when the hospital and Mid-Carolina Cardiology decided to join the American College of Cardiology database. But then a possible problem emerged: The database only works with a select group of approved vendors. The company that produced the hospital’s new system wasn’t on the list.
"We sort of panicked," recalls Younts. But the president of Medical Dynamics, a software firm in Columbia, SC, assured her that the company already had begun the process to become an approved vendor. Younts advises groups to consider such issues when purchasing new computer technology and to look carefully at the technology requirements and costs before committing to join a database.
In conducting a technology assessment, you should determine how you must transfer your data to the database and whether you need interface capabilities with another entity, such as an affiliated hospital that may share data with you, says Cockerham. Will you need to buy new computers? If so, add that into your costs.
After calculating the costs and burdens of implementing an outcomes system such as this, you may feel it’s hardly worth the trouble. But now consider the costs of not doing it. They may ultimately be much higher in loss of managed care contracts and competitive advantage, says Cockerham. Outcomes data can tell you how effectively you are practicing medicine and you can promote your statistics.
Right now, not everyone has jumped on the outcomes bandwagon. So, says Cockerham, "you will achieve market differentiation when you embark on this plan."