Health Care Practice Strategies – Summer 2013 - Data Mining: There’s Gold in Your Practice Data

August 06, 2013

With the move to robust practice management software and Electronic Medical Records (EMR), practices now have access to a treasure trove of data that can drive real improvements in performance and clinical quality.

Consider these examples of how savvy providers are mining their data to better manage their practice:

  • No-shows – Data mining does not have to be complex. It may be something as simple as using an Excel spreadsheet to identify common trends. If, for example, your data uncovers that no-shows spike for appointments booked 28 days prior, you can begin looking into why this is happening and adjust accordingly.
  • Billed charges – The same goes for analyzing your most commonly billed procedures, reimbursement rates, payer mix and productivity. Looking at this data can reveal important information, such as your most important payer-mix codes; as well as unearth problems, such as frequent denials from a payer on certain procedures.
  • Cost of care – Combining practice management and clinical data, you can determine the cost of care — and, more important, the cost of quality care — for different patient demographics. In this era of accountable care, you will be ahead of the game if you can show a payer or potential care-model partner (e.g., Accountable Care Organization) that you provide quality care at a competitive cost.
  • Revenue opportunities – Mining your EMR data, you can see how many patients are receiving preventive care and then follow up with those who could benefit from flu shots, mammograms, screenings and the like. Likewise, reviewing your Medicare population, you might discover eligible patients who have not yet taken advantage of the Initial Preventive Physical exam and the Annual Wellness Visit (AWV).
  • Quality reporting – The data in your EMR and practice management system can be extracted into reports that meet key healthcare reform initiatives, such as Meaningful Use, UDS Reporting, Clinical Quality Measures and Patient-Centered Medical Home.

As patient records are increasingly digitized, huge amounts of data are being amassed at the practice level. The challenge is how to manage and analyze it all. Options include:

  • Outside providers – Companies such as Microsoft, SAS Institute Inc., IBM and Oracle all have data-mining technologies that can help practices detect patterns and improve care.
  • IT consultant – A contractor specializing in business analytics can help translate the results of data mining into actionable business information. The right consultant can develop customizable reports and at-a-glance dashboards to help you put all of that data into productive use.
  • CPA/practice advisor – Your accounting firm may be able to provide valuable guidance on not only extracting data but analyzing it in meaningful ways.
  • PMS/EMR vendor – If you haven’t already, ask your EMR and practice management software vendor to show you how to aggregate operational, clinical and/or financial information in a single report, as well as perform data mining in real time from your live database. Increasingly, vendors are building in ad-hoc data mining tools that allow users to extract valuable data without any knowledge of database language or structure.
  • A staffer – If you have an IT-savvy staffer, consider investing in some training (online or offsite) and keep your efforts in-house.

In general, federal law prohibits medical providers from disclosing certain health information without patient consent, but there is an exemption for activities that fall under “quality improvement,” according to the U.S. Department of Health and Human Services. You can also protect yourself by ensuring that you obtain a Business Associate Agreement if your business associates — claims processors or third-party billers, for example — will have access to private patient data.

Health Care Practice Strategies – Summer 2013 Issue 

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