Family Practice's Performance 20% Better than Reported

Tracking clinical data helps practices get more from quality reporting.

"One day our administrator informed me that, according to our Cielo Clinic records, our performance is at least 20% better than insurance companies report," Dr. Trembath explains. "We had been reporting some procedures using the wrong billing codes. Because of the accuracy of Cielo Clinic tracking, our medical group administrator was able to negotiate a pilot with a major insurance network to accept our clinical data [rather than billing data] for our performance ratings."

Dr. Trembath's experience is by no means unique. Pay-for-performance programs, while intended to be an accurate measure of clinical quality, often miss the mark when calculating performance. The reason is simple: insurance companies try to extract meaningful quality measurements from billing data, which is not intended for that use. Information collected and submitted for billing purposes is tailored to meet specific criteria. As such, billing codes may not accurately represent the actual services performed, creating a gap between a clinic's actual and reported performance.

"The way the system works today, it's easy to get dinged for using the wrong code," says Dr. Trembath, "Once insurance companies start accepting clinical quality data, practices who use a CQMS like Cielo Clinic will see an instant increase in their performance scores."

Physicians also choose to incorporate a CQMS into their daily practice to increase the quality of care they provide. As Dr. Trembath notes, "The product we use, Cielo Clinic, is a tool to reach the Holy Grail for a primary care physician: proactive preventative care. I can go to one source to find all of my patients with a particular condition, rather than counting by hand, or going in and out of many different insurance databases." But like many other physicians, Dr. Trembath is realizing the financial benefits as well. "There's intense pressure in the healthcare world to manage in a financially prudent manner; here, for example, we're now being held accountable for managing our own residency practice's financial performance. Historically, we've received only about one-tenth of what's available from pay-for-performance programs - but now, with quality data in hand, we'll be able to capture those funds we've been leaving on the table."

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Family Practice's Performance is 20% Better than Reported

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Volume 1 Issue 1 - April 2008     In this issue: "Q is for Quality" Volume 1 Issue 2 - June 2008 In this issue: "Family Practice's Performance 20% Better than Reported"

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