What if you were able to segment your physician data in such a way that you could learn which of your top performing physicians were splitting their business with other hospitals; or which of your most loyal physicians were serious outliers in say, high length of stay, poor patient satisfaction or clinical quality? Then when physicians wanted to join your accountable care organization, you could evaluate their performance and cost efficiency before you made a decision.
That's the idea at Hackensack University Medical Center, a 7,700-plus employee health system in New Jersey with just 2 percent voluntary employee turnover.
First, medical center administrators scored their physicians according to data in three domains: efficiency (e.g., length of stay, cost per case), effectiveness (e.g., readmission rates, mortality rates, core measures), and patient perception of care (e.g., patient satisfaction survey scores, HCAHP scores). They can categorize the doctor by domain or by an overall composite score. Based on the rankings, doctors are grouped in a matrix according to best performers, middle performers and lower performers.
By definition, of course, one-third of doctors always will show up in the lower third of the performance matrix, even as overall performance improves. It doesn't mean the physician is a poor performer, just that two-thirds of his colleagues currently outperform him.
More recently, the medical center has overlaid that data onto an Advisory Board Company database for physician performance, which includes information on volumes. The goals are to express appreciation to high-performing doctors loyal to HUMC with a handwritten, personalized thank-you note; recruit more business from high-performing doctors who split their business by learning what else they need; and to dig deeper with lower-performing doctors on staff.
"The numbers can be a smoke detector," says Louis Teichholz, M.D., division chief of cardiology and director of cardiac services at HUMC. "Smoke detectors go off when there's a fire—and sometimes when you're making pizza—so the data should be the beginning of a dialogue."
The Advisory Board software makes it easy for doctors and leaders to drill down in a particular patient case to see what the confounding factors are.
The data is also transparent. Division chiefs and their physicians can log on and see how their performance stacks up on a dashboard.
What do the doctors think? "It's sort of like Kubler-Ross' five stages of grief," says Jay Goldstein, administrative director of HUMC's department of medical administrative affairs. "Some go through denial, anger, bargaining and depression on the way to acceptance. But nobody wants to be an outlier."
HUMC has a long tradition of proactively engaging with physicians and giving them the tools they need to succeed. High-performing physicians are committed to doing more of what works and less of what doesn't work to deliver more quality and value for patients.
