Individual provider report cards for emergency medicine groups

Emergency medicine (EM) groups must work to capture every dollar they’re entitled to in the face of ongoing healthcare reimbursement reductions, rising costs and growing competition. At the same time, maintaining strong hospital relations has never been more important for collaborating on patient satisfaction results and reducing the possibility of being replaced by another emergency group.

Measuring and tracking practice-wide operational and financial metrics has long been a key to improving EM performance and demonstrating value to hospitals and payers. Now groups are taking reporting to the next level by developing provider report cards that focus on the activities of individual physicians and physician extenders.

At Optum, we’ve seen a growing number of our emergency department clients embrace reports that show how each clinician performs in specific areas vital to the overall success of the practice. The goal is to help reduce revenue leakage by understanding and improving all aspects of individual and organizational performance.

Provider Report Cards are generated from medical claims data and can be customized to include a wide range of metrics. For example, individual provider reports can show number of patients seen, charges associated with patients treated, total RVUs generated and number of CPT codes assigned.

This information will indicate which clinicians are the most productive and may be used as the basis for performance bonuses. At the same time, practice managers can work with those whose efficiency is lagging to develop new processes or methods for boosting productivity.

Also important is average length of stay for each patient, as well as patient discharge, admission, transfer and “left against medical advice” rates. This data can be critical to hospital administrators, since it will show admission differentials between providers as well as outlier lengths of stay.

One of the most important categories of provider-specific information for practices involves documentation. Documentation deficiencies reflect instances in which incomplete or inaccurate clinical documentation results in a lower evaluation and management (E/M) code being assigned to the patient encounter.

Because a lower code translates into lower charges and collections, understanding which clinicians have chronic problems with documentation is essential. Once identified, additional documentation education can be provided for those physicians or extenders to help strengthen their performance. Ensuring accurate and complete documentation is particularly important today, given the level of detail required to code appropriately with the ICD-10 coding system.

On a similar note, provider report cards impart new insight surrounding completion of the chart process. Since protracted charting can contribute to delayed claims and reduced cash flow, tracking chart lag time is a highly useful metric for EM groups. An effective report card will summarize by provider average length of chart lag time and help managers take appropriate steps to assist those with inordinate delays.

While these areas represent some of the most significant individual metrics that can be tracked through individual Provider Report Cards, no two EM groups are the same. That’s why the best kinds of reports are those that are tailored to the specific needs of the group.

In conclusion, the adoption of transparent performance metrics in emergency medicine not only enhances operational efficiency but also fortifies the quality of care provided. By focusing on clinically relevant and meaningful measures, EM groups can ensure better patient outcomes, foster accountability, and drive continuous improvement. This strategic approach to transparency and customization in reporting is essential for EM groups to navigate the complexities of healthcare delivery, optimize financial performance, and maintain strong hospital relationships in a competitive landscape.