This is particularly true for specialty care providers, who routinely incur significant costs as part of their day-to-day management of patient care. As expectations around value-based care grow, specialty practice leaders will need to clearly demonstrate the quality of care they deliver to those responsible for purchasing—patients, payers and employers—to ensure fair reimbursement.
Of equal importance, as margins become smaller, specialty practices will require the ability to assess and quantify the real costs associated with each aspect of patient treatment—from sites of care, to procedures, to devices and drug therapies—so they can minimize waste and inefficiencies that are a drain on their balance sheet.
To create a clear picture of value, practices must be able to quickly and efficiently harness the data they manage on a daily basis—clinical, financial and operational—and organize it in an understandable and actionable way. Increasingly, specialty practices are recognizing the benefit of data analytics software that can translate raw data into powerful business insights and help practice leaders to make more effective decisions.
The power of analytics
Other industries have routinely relied on business intelligence tools to access and query large quantities of data, but physician practices have not experienced the same pressure to digitize their patient records until recently. With the speed of healthcare’s transformation to new payment models that reward providers for value not volume, today’s practice leaders need to not only understand the economics behind the decisions they are making, they need the ability to demonstrate that the care they are delivering is both high quality and affordable.
When deciding whether to make an investment in data analytics, practice leaders should start by defining the information that is most needed by internal and external stakeholders and identifying the questions that are most critical for the practice to answer. Some examples may include:
- Am I capturing all of my drug charges? Analytics can provide clarity on how drugs move through the practice – from purchase to utilization and billing – as well as insights on how to improve charge capture.
- How many outstanding claims and denials do I have? Understanding how and when the practice is being paid is critical. Analytics tools can help identify payers that reimburse quickly and reliably, as well as shed light into what claims are being denied and for what reasons.
- How large is my patient population for a particular diagnosis? Analysis on the practice’s treatment patterns (by diagnosis, visit, types of services and costs) can help enhance clinical decision making and inform business planning.
- How are my drug margins changing compared with Medicare Average Sales Price (ASP) and Average Wholesale Price (AWP)? Whether looking across all procedure or NDC codes, or focusing on a single code, practices can use analytics to determine if they are buying at the lowest-cost available, and if they are being fully compensated.
- How am I getting paid compared to my peers? What are my days to payment? Benchmarking data can help practice leaders to determine whether their compensation is aligned with other specialty practices, and help prepare them to negotiate with payers to maintain or increase reimbursement levels.
- What steps am I taking to reduce audits? Ongoing assessment of E&M codes helps practices to decrease their risk for a Medicare audit by identifying how physicians are coding office visits compared to the nation, their region and their peers.
- What services am I providing to specific patient populations? Monitoring procedures and services to specific patient populations helps to standardize practice patterns and reduce variations that may exist, ensuring that services are in compliance with guidelines of care.