Mining EHR and PM Data to Improve Outcomes, Financial Success

Chances are, the data you have at your fingertips can tell you exactly how productive your physicians are, which patients will likely require the most care, and what codes are used most often. And in turn, knowing these things can make you more attractive to partners, improve your practice’s bottom line, and help your physicians provide the highest-quality care to the neediest patients.

But most practices don’t use this data or other data that’s available through EHRs, practice management systems, and other technology to their advantage. And that’s because they don’t know how to “mine” it – analyze it to ultimately help their practice improve and succeed in an increasingly competitive healthcare environment.

During his MGMA12 session, “Getting Your Data Out of a Mine and Singing like a Canary,” healthcare consultant Nate Moore, president of Moore Solutions Inc., highlighted the ways data can help practices. He also spent the session advising practices on how to mine data that might unearth problems (such as frequent denials from a payer on certain procedures).

“It’s hard to do this with just a narrative,” Moore told attendees of his Tuesday session, adding that one of his hobbies is to show practices to use Excel to analyze data. “As we’re moving to EMRS we’re looking to do more of this mining stuff.”

For example, let’s say you’re trying to reduce your “no shows.”

By noting no shows, and using Excel to create a chart such as “days from schedule date to appointment date,” a practice can see when no shows spike, said Moore, who recently did this for a practice he was working with.  So if, for example, a practice saw that, for appointments booked 28 days prior, the number of no shows spiked, it could look into why this is happening. Perhaps physicians said something to the effect of, “If it’s still hurting in four weeks, come and see me,” and this was not relayed to the administrative staff.  

“Some of you will be grateful for no shows, because you get home at 5 p.m., but many of you will need to consider a better system so you don’t have these massive no shows on 28 days,” he added.

Another example: using billed charges (CPT codes and modifiers) to analyze the most common procedures, reimbursement rates, payer mix, and productivity. Looking at this data can reveal important information such as “how many days was my doc in the office?” or “where are my most important payer-mix codes?” Practices may also analyze physician productivity by looking at this data, and even go so far as seeing how many procedures a practice does per hour.

Another example: combining practice management and clinical data to find out the cost of care for different patient demographics. By doing this, you can find out “what does care cost, and what does quality care cost,” said Moore. The result, your practice can go to a payer and say something to the effect of, “I’m so much less expensive for the quality of care I provide.” Payers and potential care-model partners (such as potential ACO partners) will be impressed that you can compare the cost of care with the cost of high-quality care, he said. 

Moore suggested looking at common data fields, such as patient ID or telephone numbers that reside in practice management and EHR systems, to catch trends. A practice could, for example, task an IT-savvy contractor (or someone who knows how to manipulate the back-end technology of a system) to do a search on how often the practice interacts with a payer’s claim denial hotline.

“I might think I have a good relationship with Blue Cross, until I see that I have three times as many calls with Blue Cross for denials,” said Moore. “It’s all about getting a common denominator. Once you have a common piece of information, there’s a bunch of things you can join.”

Moore cautioned providers who are leaning toward adopting (or migrating toward) cloud-based technology to make sure they can access data whenever they want for analysis purposes. Not being able to do so is comparable to being restricted to withdrawing money from a bank only in $7 increments on Thursday afternoons.

“The bottom line is that practice data is your asset,” said Moore. “Leverage it.”