Who's Accessing Your Providers' Performance Data?
Providers' performance data is used across an increasing number of areas by CMS, regulators and accreditation bodies, payers, and healthcare facilities themselves for initiatives like:
- Shared savings programs
- Merit-based incentives
- Peer review and external peer review
- Inclusion on government and commercial or private insurance panels
In the age of data breaches, it's important for medical credentialing and privileging professionals to understand where the confidentiality lines are drawn.
Performance data tracking
The enhanced efforts we experience today to track all kinds of practitioner performance data are rooted in public demand for transparency of healthcare services and in outcomes improvement measures. Both equip payers and consumers to make better-informed quality decisions.
To monitor compliance efforts and educate practitioners about how their practices measure up to identified standards, healthcare organizations have adopted off the shelf software solutions and other tracking methods that generate individualized and aggregate practitioner profiling data. For example, some programs look at major diagnoses (e.g., heart failure) or events and then evaluate a practitioner’s performance. They might examine factors such as length of stay, average cost, mortality, readmissions, or drugs used.
Individual results are compared with those of peers to determine whether the practitioner is performing on par with the peer group or is an outlier in one or more categories. The goal of the profiling exercise, especially as applied to outliers, is to improve outcomes and modify practices where warranted. In the case of payers, it helps inform of under-performers.
To view the full blog post, click here.
Editor's note: the blog post originally appeared on Symplr's website.