Mining EMR/PM Data Can Help the Bottom Line

Seven initiatives to reduce overhead, boost income.

BY PATRICK BEESLEY AND DAVID GALLE

The success or failure of a practice rests in that narrow margin between "revenue" and "expense." To open up that expanse, savvy practices are constantly on the lookout for strategies to increase income while holding the line on — or reducing — overhead.

It seems like a difficult undertaking for most ophthalmology practice managers. In fact, the adage of getting blood from a turnip seems to best describe the situation. They may believe there simply are no more corners to cut or revenue opportunities to seize.

But that's not necessarily the case. The challenge is to identify areas ripe for improvement and outreach. Fortunately, most ophthalmology practices have all the information they need to uncover openings right at their fingertips — in their electronic medical record (EMR) and practice management (PM) systems. By learning how to optimize these tools and understand the data they contain, a wealth of opportunities unfolds.

The Sabates Eye Centers in Kansas City implemented a PM in 2004 and added the EMR component in 2006. Relying on a shared database and generating a broad spectrum of reports, the technology is supplying practice leadership with the business intelligence it needs to enhance growth, productivity and profitability.

This article will explain seven of these initiatives while offering a basic template for other practices to emulate.

1. Benefiting From PQRI Bonus Program

While most practices see the value of programs like Medicare's Physician Quality Reporting Initiative (PQRI), many struggle with the additional data collection required to qualify for bonus payments. The EMR that Sabates uses has been customized to identify patients for whom PQRI reporting is appropriate. Screens prompt the ophthalmologist to perform necessary tests. When complete, the physician need only click the appropriate check box, and all coding and report generation is completed automatically. The system similarly will ease Sabates' transition to electronic prescribing, which Medicare will require in 2010.

2. Mining Information to Plan Expansion

Ophthalmology practices are in an enviable position: All studies indicate that the need for their services will grow in upcoming years. Therefore, many will be making decisions about if, when, how and where they should expand.

Sabates, with 13 ophthalmologists and two optometrists, has mined information from its EMR/PM systems to determine the zip codes from which it draws most of its patients. Likewise, it tracks referral patterns to determine which ophthalmology colleagues most frequently send patients. Decisions about new office locations — and even where to open an ambulatory surgical center — are made based on recent and anticipated trends. Not only does this approach position Sabates strategically, convenient locations increase both referring physician and patient satisfaction.

3. Staffing to Improve Patient Flow

Few specialties rely on clinical staff as heavily as ophthalmology — and how effectively staff members are utilized can tip the balance sheet towards the good or the bad.

Sabates leadership turned to its PM system to track the flow of patients from check-in to bill payment. Time stamps allowed the practice to capture when patients arrived, how long they sat in the waiting room, when their vision exam was completed and when their eyes were dilated. These data were analyzed to determine which physicians needed additional ophthalmology technicians to speed care delivery — and which might have enough techs, but weren't maximizing their productivity. This allowed Sabates to have the right technician with the right skill set performing the right test at the right time — to minimize delays during diagnostic testing, ensure the patients were ready to be seen by the ophthalmologist and allow the practice to see more patients each day.

4. Building Ties With Referrers

As a subspecialty practice, Sabates depends on referrals from other ophthalmology practices. The EMR and PM systems, both provided by NextGen Healthcare (Horsham, Pa.), allow management to analyze referral patterns by number of patients, variety of diagnoses, types of procedures — and, ultimately, revenue opportunity. With this detail in hand, Sabates can initiate marketing strategies like the development of continuing medical education activities, special events and social opportunities to strengthen the most promising relationships.

5. Customizing Patient Communications

Sabates uses patient demographic data in a similar fashion. The practice produces a quarterly newsletter that can be tailored to specific patient populations. Content for diabetic patients can be different than that aimed at patients within a specific age range who are candidates for refractive surgery, for instance.

Data analysis also supports Sabates' ability to offer patients therapeutic alternatives, as well. The practice can pull data on patients who may benefit from multifocal intraocular lenses. Staff can explain the benefits — as well as the additional out-of-pocket costs — and allow patients to make the decision best suited for them. If they choose the multifocal IOLs, the technology provides on-screen prompts to collect an advance beneficiary notice and documents all conversations related to the procedure.

6. Encouraging Participation in Research Studies

Sabates conducts clinical research in a wide variety of areas such as glaucoma and corneal issues at its Vision Research Center. During an encounter, EMR templates automatically alert ophthalmologists about patients who may benefit from enrollment.

The physician can explain the study, its pros and cons, and outline the level of care the patient would receive — often more advanced than standard treatment but with most costs covered. This opportunity increases the subject pool to enhance the viability of the research, helps generate revenue for the practice and results in optimal care for the patient.

EMR data can help in another way as well. Practice managers can analyze patients who may have a certain condition (or have a loved one with it), or who have a specific interest in research. They can then be diplomatically approached about supporting the research center financially through donations.

7. Looking Ahead for New Opportunities

Leadership at Sabates is continuing to investigate ways to maximize the value of its EMR and PM systems. Early next year, for instance, it plans to analyze expenses on a procedure-by-procedure basis and calculate internal revenue value units (RVUs). Using this approach, the practice will be able to determine its true costs and make appropriate pricing decisions. At the same time, Sabates will be able to identify the most profitable procedures and, where appropriate, develop marketing programs to increase utilization. OM