Numbers help a practice measure up to its potential
Numbers help a practice measure up to its potential
Clinical, operational benchmarking prove worth
As part of the billion-dollar integrated health delivery system Clarian Health Partners, Methodist Medical Group (MMG) of Indianapolis has to make a case for every dollar the 100-physician practice spends. "We are a deficit for our system," explains Kyle Allen, RPh, MBA, chief operating officer at the practice. "Primary care groups usually are. That means that we have to prove to them that our costs are reasonable." A benchmarking program seemed the natural way to make the case for continued financial support.
What Allen didn’t anticipate was the kind of impact the program — which includes both clinical and operational benchmarking — would have on the practice. The group saved $3 million from the operational side of the program, and was able to improve preventive care through its clinical benchmarking.
Operational goals are largely based on data from the Medical Group Management Associa tion (MGMA) of Englewood, CO. Allen says targets and variances from targets are reviewed monthly and a report is sent to the board. (See story on what a report contains, p. 36.) Annually, a more in-depth look helps Allen with budgeting. "We see where we are, where the MGMA says we should be, and the variance. We look at what is controllable and what is not."
Control what you can
Being pragmatic about what can be controlled has been key to the operational benchmarking program’s success, Allen adds. "Our chief financial officer has a lot of experience, and with the management team discussed what measures were appropriate for us to focus on." For example, rent may show a big variance, but it isn’t controllable. "But we can control physician compensation."
The program has been extremely successful. From its start in 1996, it has saved more than $3 million in operational expenses. Those savings came from several areas, including reducing benefits expenses, cutting transcription costs by half, and consolidating or closing 12 clinic sites. For example, one practice had four internists working full-time in an office. But they were only seeing about 30 patients a day among them. "We asked ourselves: Why are they there? We closed the practice. And savings like that occur because we were looking. Every single practice is judged against data. So is every staff member we replace. We always ask: Do we have to replace that person?"
Allen says the best way to get your physicians and staff on board for the operational benchmarking — which she admits is a harder sell to those who aren’t familiar with or interested in the business side of medicine — is to show them local examples where benchmarking has worked. "Find some place down the street," advises Allen. "That was our advantage. We told them, Call this doctor and ask them how it works.’ And you should always focus on the long term. Tell them that you can’t sustain this level of loss, and if you want a job in three years, this is how you have to get there."
Administrators and support staff, who have more and more work foisted on them, also may need convincing. It helps, says Allen, if you are large enough that a finance department does the reports for you. But even if you aren’t, you can ease the burden by meeting and talking about your benchmarking needs regularly. "We don’t just say, See you in a year when your budget is due.’"
There is help for practices, too, adds Allen. Along with the MGMA, the Group Practice Improvement Network based at Henry Ford Health System in Detroit has material that can show your practice what others are doing in a particular area. The network can be reached at (313) 874-4746.
Clinical program
The clinical benchmarking started when a staff-model HMO was absorbed into MMG in 1994, Allen says. "We wanted NCQA [the National Committee for Quality Assurance in Washington, DC] accreditation, and so we started the clinical benchmarking on the whole organization."
First, MMG did peer audits of patient charts, says Allen. What the practice found was that although some physicians used a preventive service sheet that noted what preventive care was given and when, some did not. Those who did use the sheet were more likely to ensure that women got timely mammograms and that children were appropriately immunized. "It is an intermediate outcomes measure," says Allen. "You improve preventive care, and it’s just intuitive that that improves overall outcomes."
When Allen looked at HEDIS data as a clinical benchmark, she says she was surprised at how well MMG was doing. "On preventive care measures of the networks that participate with our HMO, we are best in 10 of the 15 measures. That’s significant."
The target was to reach 90% to 95% compliance in preventive care, she says. After three years, MMG continually meets or exceeds those targets. And because clinical benchmarking related to the health and well-being of patients, Allen says convincing the physicians to use the benchmarking program was easy. "They were actually excited about it."
The latest part of the clinical side of the program included the 1996 launch of seven different clinical guidelines — for adult asthma, depression, diabetes, COPD, early identification of pregnancy, hypertension, and tobacco use. The MMG team that developed the pathways used national standards as a template. The goals, Allen says, were to minimize variance in patient care, improve quality of care, and find places where performance could be improved.
Interim results have shown that the guidelines have made care more consistent. More physicians are using the pathways — for instance, they are more likely to document tobacco status of patients, and if they are users, to advise them on the health consequences and help them to quit.
The results are reviewed monthly, Allen says, although not every target is looked at every month. So far, the physician enthusiasm has continued.
There is always resistance to adding work, says Allen. "But if you have a vision to sell them on how this will make their practice better over the long run, that some work will be eliminated, then you can do it. For instance, if they use the preventive care sheet, then they don’t have to thumb through every page of a chart to see what’s needed."
Source
• Kyle Allen, RPh, MBA, chief operating officer, integrated practices, Methodist Medical Group, Indianapolis. Telephone: (317) 929-2411.
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