Gaps in data analytics and other technologies historically have prevented providers from getting a truly accurate portrayal of what is working and what isn’t working in their healthcare organizations, especially when it comes to surgeons. Analytics have been used for some time, but all they have mostly looked at volume-based measures – procedure lengths, turnover ratesor gross revenues. A few have included light shades of complication rates, but that’s about it.
Now imagine you are a surgeon in a hospital and it is discovered your complication rates are 70 percent higher than your peers’. That’s really not actionable information, because you can’t tell what is causing the higher complication rates so you can’t change your behavior.
Additionally, your peers’ complication rates may not even be comparable. Often hospital and health systems are working with outdated data that has to be compiled from disparate sources at different hospitals on various surgeons, meaning comparison data is often delayed and not always relevant.
The interesting paradox is clinicians love to have as much data as they can to improve the quality of care and, ultimately, outcomes for their patients – something that is crucial in today’s pay-for-performance healthcare business model. They actively seek out information they can learn from to develop best practices and establish evidence-based guidelines to help them to diagnose and better treat the patient.
New analytics focused on quality can evaluate factors such as postoperative complications and mortality; procedure metrics, including specific complications, reoperations, readmissions and compliance with best practice protocols; and efficiency rates, such as length of stay, surgical “cut-to-close” time, days in the intensive care unit and hospital direct costs. They can also examine productivity, including RVUs, procedures, visits and consults; and financial factors, including net revenue, net income, total costs and contribution margin.
This data, presented in a timely fashion and in terms physicians can readily understand, provides the opportunity for surgeons to identify where their performance is in relation to their peers. But that’s not all: not only will they have a barometer of their performance, but they will also be able to learn from their colleagues and improve their skills so they can achieve better outcomes for their patients.
A good example is in the evolving use of video analysis to complement other measures of outcomes and efficiency. John D. Birkmeyer, MD, chief scientific officer of ArborMetrix and a leading authority on outcomes and healthcare policy, points out that surgeon skill is a powerful predictor of patient outcomes. In his 2013 study “Surgery Skill and Complication Rates after Bariatric Surgery” published in the New England Journal of Medicine, surgeons with low technical skill —as judged empirically by peer ratings — had significantly higher complication rates than high-skill surgeons (14 percent vs. 5 percent). They also had higher mortality, more reoperations and more readmissions.
Video analysis provides an obvious opportunity for improvement. For example, general surgeons and urologists from over 30 Michigan hospitals are uploading their videos into ArborMetrix’s registry platform. Those videos are analyzed empirically in various domains of technical skill and linked to surgeons’ outcomes, giving them insights into where they can improve. In some cases, surgeons are using this tool to provide peer-to-peer “digital coaching.”
Justin Dimick, MD, MPH, chief of the Division of Minimally Invasive Surgery at the University of Michigan Health Systems in Ann Arbor, says the new surgeon skill analytics his organization is using provides excellent feedback to surgeons about their performance. “Perhaps more importantly, this cool new technology is helping surgeons learn from their peers, as well as from their outcomes,” he says.
With such a more comprehensive, action-oriented view of the performance of surgical groups and other specialty practices, providers – especially those with acute care specialists on staff – can glean accurate, relevant and timely information that can be used by physician executives, practice managers, surgeons and specialists to improve the performance of their organizations.
And in today’s “pay-for-performance” world, that is going to go a long way toward determining the winners and losers among health systems, healthcare collaboratives and medical societies.
Brett Furst is CEO of ArborMetrix, which provides healthcare’s leading performance analytics platform for acute and specialty-based care.
