Putting Physician Practices Into Context

Brian Klepper 

Posted 12/11/12 on Medscape Connect’s Care & Cost Blog 

An organization’s ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage. 

Jack Welch

Physicians and medical societies in all specialties would do well to take a look at this article, published in the November issue of The Journal of Oncology Practice. Authored by Elaine Towle, Thomas Barr and James Senese of Oncology Metrics (a subsidiary of the oncology electronic health record firm Altos Solutions), this year’s National Oncology Practice Benchmark Report aggregates and analyzes data on a wide variety of clinical, operational and financial business metrics. There are 89 charts in categories – work units, patient visits, revenue, practice expense, pharmacy operations, clinical trials, and staffing/productivity – from oncology practices around the country. The focus here is on the practice. The report does not delve into relative patient quality or cost.

The authors have deep experience with oncology practice, and they note that the cornerstone of their firm’s approach is “to promote the discovery and adoption of best practices.” Towle and Barr previously ran oncology practices in New Hampshire and Ft. Worth. This is their 7th annual report, meaning they have had the benefit of years of immersing in and refining their work product.

In other words, this is about helping oncologists identify performance – areas of strength and weakness – and understanding how their practices compare with others around the country so they can undertake efforts to improve. Without this kind of information, practices exist in isolation and assume that others’ experience and performance must be like theirs. Without context, there is little impetus to get better.

The team received survey responses from 103 practices, representing just under 800 hematology/oncology (HemOnc) physicians, or about 16 percent of the US oncology community. There were also 136 non-HemOnc specialists in 36 of these practices, making a total of 913 physicians in the survey population. While the authors believe this is the largest existing oncology practice data set, they acknowledge the criticism that the interpretive value of their report may be limited by its sample sizes. For some measures – e.g., full time equivalent (FTE) imaging staff per FTE physician (n=23 practices) – the available sample size  is small. That said, while the results should be considered cautiously, they are a window into practice nationally that was unavailable before this report began, and remains unavailable for most physician practice.

American physicians are caught within intensifying transformational pressures that are associated with competition, reimbursement and market consolidation. It is no longer enough to simply practice and bill. Success is, more than ever, tied to one’s ability to run a measurably efficient, financially viable and demonstrably high quality practice.

Despite the mythology, it is increasingly possible for purchasers – health plans, employers and patients – to make credible judgments about a physician’s relative quality, cost and value. The teams in my primary care clinics want to know, within each specialty and for each major condition, which physicians to refer to and, equally important, which ones to steer away from. We have committed to facilitate higher value care for the employees and families of our clients. The art of medicine is not so ethereal that there are no measurable bases for understanding whether physicians provide good quality care within a specialty with reasonable resource consumption. The business measures explored in the Oncology Metrics survey are a reflection – though not an exhaustive one – of an approach to practice.

Even so, knowing how your practice performs compared to peers is the right place to begin. In a competitive environment, physicians who have these data and can act on it have an advantage. Those who don’t have it work at a disadvantage.

The team at Oncology Metrics has a vision and has developed a big head start. They will undoubtedly expand into other areas of analysis. But their approach is certainly important for every medical organization. It will become more critical as the market moves away from fee-for-service and toward risk/value.

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