Check at hospitals for gold mine of outcomes data
Many provide MD profiles, external benchmarks
Suppose you could find an existing database with information on cost, length of stay, and clinical outcomes for your own congestive heart failure (CHF) patients. You could get trend data by physician and compare them with other medical groups. Even better, what if that information was free?
It sounds too good to be true — but it is true. Hospitals have a wealth of information to share with physicians just for the asking. In fact, many hospitals are anxious to work with physicians on quality improvement and performance assessment projects that ultimately will affect their accreditation status.
Doctors don’t know what’s available
"Hospitals have a lot of data, particularly internal clinical and financial information," says Susan Bellile, MA, MBA, president of Q3, a consulting firm based in Westchester, IL, that specializes in helping physician groups gather and analyze outcomes data. "Think about what they have to keep track of just to generate a bill for the patient’s stay."
Unfortunately, physicians are often unaware that they can tap into this resource as a way to bolster their own quality improvement and negotiating position with managed care organizations, Bellile notes. "I’ve been surprised at how little the majority of physicians seem to know about it," she says.
Using hospital data is a good way for physician groups to begin their own outcomes programs, Bellile says.
"They’re accumulating the information. It’s almost like you have a responsibility to know [what it is]," adds Phyllis Brown, administrator of Arkansas Cardiology in Little Rock. At the same time, Brown stresses, you’ll want to gather your own data to set up a complete and effective outcomes management program. "The information that the hospital can give you is a very small piece of the puzzle that you need to develop your own compliance program," she says.
Baptist Medical Center, also in Little Rock, began using data for physician profiling in 1992, reviewing measures that include cost and charges, length of stay, complications, readmissions, infection rates, and mortality.
But for quality improvement projects, the hospital can go much deeper into the data. "Because we have every single thing that was charged to a patient from the billing system, we can tell a physician how many X-rays or lab tests or different types of antibiotics were used," says Alice Comer, RN, MNSc, the hospital’s resource management coordinator.
The hospital began reaching out to physicians by mailing them quarterly profiling reports based on the data. But it took time for physicians to appreciate the value of the information. "When we first started doing profiles, probably three-quarters of all reports were thrown in the trash," Comer says.
The hospital wanted to reduce variations in care and ultimately save money. The physicians were more interested in clinical issues but less concerned about the hospital’s cost concerns, says Jim Novak, clinical systems development coordinator. So the hospital focused on clinical as well as cost data and offered to work with physicians on their own projects.
"We want to be collaborative with them," says Novak. "There’s something in it for them, too. We’re providing a service to our medical staff that they can use in negotiations with managed care."
In fact, some of the physicians who had thrown away their profiling reports sheepishly came back and asked for another copy. They gradually learned the value of the comparative data, Novak says.
"They’re all competitive people, and they all believe they do very good work. They want to be able to show that report card," he says.
Because much of a CHF patient’s care and recovery occurs after discharge from the hospital, Baptist Medical Center increasingly wanted to learn more about outcomes from the outpatient record. But Comer and Novak discovered that most physician offices don’t have sophisticated information systems with a clinical database.
So again, the hospital stepped in. The hospital implemented a disease management program for congestive heart failure and hired a computer programmer to develop a database for the physicians.
Medical groups enter the data on patients and then e-mail the data to the hospital system, using an information network that had been set up previously to exchange lab and radiology reports as well as other information.
"The ultimate goal is to have an information link between the cardiologists, the primary care physicians, and us at the hospital," says Comer.
Other physicians also have approached the hospital for customized profile reports.
Hospitals often have access to outside benchmarks, too. For example, they may belong to a database project such as the University Hospital Consortium or the Quality Indicator Project based in Lutherville, MD. "It’s been common since the `80s for hospitals to compare data," says Bellile. "They almost always have access to some kind of comparative outside benchmark data."
Physicians began to realize the value of the data at Baptist Medical Center when a local health plan did its own physician profiling and tied reimbursement to the results. While the managed care company stopped tying its payments to the profiling, the experience sent a wake-up call to physicians. "That sensitized them," says Comer. "They realized they needed to understand this and use it to their advantage."