This article is sponsored by SOIX.Surgical Outcomes Information Exchange has been doing procedure-level benchmarking since 1999. All clinical benchmarking results are reported based on the CPT code of the primary procedure. For example, a multispecialty center that uses SOIX to benchmark may receive reports specific to their knee arthroscopies, cataracts and colonoscopies.
A specialty center such as orthopedics may receive benchmarking results specific to their knee arthroscopies, ACL reconstructions, and diagnostic or therapeutic shoulder arthroscopies just to name a few.
"One of the things that I think makes us unique is our effort to ensure that the data we receive from our members is of the highest integrity," says Jennifer Green, RHIT, Vice President of Network Development at SOIX. "We take great efforts to train members on what data they will be reporting and exactly how that data will be used to measure outcomes that will be benchmarked with national averages. We make sure they understand that their data is used in calculating the benchmarks, so the quality of their reporting can impact everyone. Finally, we offer all of our members a one-on-one review of their initial benchmarking reports, with follow-up consultations thereafter. We want to make sure that they are able to interpret their results and know how to use the information so that they get a full return on their investment. The work they do in submitting the data should pay off, and we make every effort to see that that happens."
Maximizing productivity
Benchmarking allows surgery center leaders to determine where there is room for improvement. When an aspect of performance is not meeting a benchmark — such as recovery time taking longer than the national average — ASC leaders can investigate their processes and pinpoint issues for quality improvement.
"A surgery center that benchmarks is one that is continually looking for ways to improve," says Ms. Green. "By making report consultation an ongoing part of their membership package, SOIX helps the centers translate 'data' into 'information.' It's all about informed decision-making, and if you don't have the right information you may not be able to make the best, most informed decision."
Most benchmarking is based on statistics, but some ASC administrators and DONs were never schooled on percentages and rates so they have a hard time understanding the impact on the center operations. You really need to understand the basis of the statistic in order to understand the impact. For example, if you don't know that your OR utilization percent is based on hours used out of hours available, how will you know that a low percentage may mean you need to change the way you schedule or staff your OR..
If you don't know that your rate of discharge delays is based on recovery time, how will you know what it means to have a rate that is 10 percent higher than the benchmark average?
SOIX can work with ASCs to conduct a "mini-analysis" in specific areas. This is particularly helpful when the administrator or office staff don't have time to fully engage with the statistics and understand where to begin quality improvement projects on their own.
Physician buy-in
Physician owners are an essential element to process improvement. Administrators and staff can benchmark and develop process improvement programs, but without a committed effort from the surgeons change is unlikely. SOIX was able to work with a specialty center in the northeast to increase case volume by cutting down unnecessary recovery time, but it was a challenge to bring the physicians onboard.
"Their average recovery time for their top procedure was three hours," says Ms. Green. "The national benchmark average was one-and-a-half hours. Their surgeons were still doing things 'the way they'd always done them' and keeping the patients in recovery for a designated period of time. All patients undergoing this particular procedure stayed for three hours regardless of how well they were doing post-op."
It took about a year to convince the surgeons to change their recovery time protocol, but when they saw the benchmark remained unchanged for several quarters and the high volume of data in the benchmark average, recovery time gradually started to fall.
"When I talked to the center several years later, they told me how many more procedures they were able to do because they'd cut their recovery time in half," says Ms. Green. "So, whoever said 'time is money,' this example certainly proves the theory."
Interpreting financial benchmarks
Financial benchmarks are difficult for many administrators to grasp, but when they understand how the benchmark is calculated and where the data comes from, financial benchmarks are easier to interpret.
"We try to help our members focus on the key financial indicators, like days in accounts receivable," says Ms. Green. "Regardless of where your center is located or what kinds of procedures are performed, or the size of the center, the benchmark for A/R days is something everyone can relate to."
Last year's SOIX Cost Benchmark study showed an average for total days in A/R days of 40. Centers falling above that benchmark needed to seek ways to improve.
"Even if the center was within the benchmark for overall profit margin or net income per case, they could still improve their bottom line if they reduced the number of days in A/R," says Ms. Green. "But the key is understanding that this means getting bills and claims paid faster. How are they handling past due accounts? How often are they evaluated? Are there trends? Does one payer consistently pay later than others and if so, why? Sometimes it's about improving even when you meet the benchmark."
Benchmarking beyond accreditation
Benchmarking is important for achieving accreditation and meeting regulatory requirements, but with pay-for-performance becoming more important in the healthcare field, centers are benchmarking beyond just those requirements.
"The reality is that pay-for-performance is becoming more and more important and facilities that only benchmark to meet a requirement for accreditation, or state or federal regulation, may suffer the consequences of pay-for-performance," says Ms. Green. "It's really very simple; if we don't perform well, we can't expect our business to grow and prosper, and once a center closes it no longer matters whether or not they received accreditation."
Going forward, Ms. Green sees centers expanding their current benchmarking methods to improve the quality of their data. Experts recommend comparing "apples-to-apples" when benchmarking, and this can be difficult because there are a lot of differences across surgery centers. How can a surgery center that does only ENT compare their rate of return to surgery with a center that does only ophthalmology? How can an orthopedic center compare their incidence of post-op pain to a GI endoscopy center?
"I think one key to improving data quality is by sharing benchmarking results with the staff that was involved in collecting the data," says Ms. Green. "For example, if you benchmark your rate of post-op pain following discharge but don’t share those findings with the staff that are entering this data in the computer, how can they truly appreciate the importance of their data accuracy?"
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