Keith L. Martin

While used to change, physicians don’t necessarily embrace it, notes 

, national director of clinical consulting for The Chartis Group, a healthcare consulting firm. 

“Physicians in general don’t tolerate uncertainty very well,” says Werner. “We work in a field accustomed to facts and information and things that are tangible. Now we find ourselves in a period where things are really pretty unclear and our comfort level as a profession with this level of unknown is a bit challenged.”

In a time and profession of everchanging realities, managing your response to the unknown in your professional and personal life is critical.

This slideshow originally appeared in Medical Economics, Physician’s Practice's sister publication, under the headline “

Top tips for physicians to deal with uncertainty

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Medicine, like life, is everchanging. Here’s some strategies for abating stress in your practice.

5 strategies for dealing with uncertainty

At the crossroads of near-universal use of EHRs and quality care initiatives calling for numerous patient data, clinical registries are becoming vital repositories of health care information.

Whether focused on a specific disease state, procedure, or even on the performance of a medical device, there is no shortage of registries for interested practices to submit data to. And with the CMS Quality Payment Program (QPP) and commercial payer programs providing incentives for participation, they are gaining more acceptance.

At the annual Healthcare Information and Management Systems Society (HIMSS) conference, Seth Blumenthal, MBA, director of data and innovation for health outcomes organization, PCPI, will discuss how medical practices can benefit from participation in these registries, despite lingering interoperability issues.

Blumenthal recently spoke to Physicians Practice to preview of his session, “Clinical Data Registries: Solving for Interoperability,” scheduled for Friday, March 9, from 12-1 p.m. Pacific.

Physicians Practice: What are the benefit to medical practices (especially smaller private practices) of clinical registries?

Medical practices of all sizes - but particularly at smaller, private practices - the physicians, clinical leaders, and administrative leaders are under tremendous strain these days because of all the burdens they face. Amid many regulatory burdens, they are just trying to provide the best patient care they can, with an appropriate and efficient use of resources. They have a number of issues, particularly centered around the use of their EHR, but there are a couple of different aspects around the use of clinical data registries that might impact them.

They should participate in a registry, the physicians particularly, because it is a good way for them to participate in a value-based payment program, such as the QPP or perhaps programs from private payers that have negotiated a risk-sharing contract with their group with incentives for registry participation.

There are benefits for participating in a registry, particularly a registry that has achieved the Qualified Clinical Data Registry (QCDR) status - those that have passed a certification process by CMS that allows them to be used for participation in the QPP. QCDRs make available to physicians performance measures that …are approved directly by CMS.

Fundamentally, registries support measures that clinicians and physicians care about and should be relevant to their practice. I know that there has been issues with some specialties having more or less of a selection of measures that are relevant to their practice. [However], the primary benefit is that if the registry is a QCDR, simply by participating on behalf of their patients, physicians can participate in the QPP and hopefully choose measures that are relevant to their practice. They then increase their chance of being successful in terms of their financial performance as per the incentives.

[As a physician], I’m going to get feedback about my performance relative to those like me, perhaps in my own practice or in other practices like mine in my region of the country, perhaps my state and then nationally.

PP: How can these practices access such registries amid current interoperability issues?

So part of [interoperability issues are] due to the design of the EHR and part of it is due to the increased regulatory burden / documentation burdens. What you don’t want to do is participate in a registry in a way that increases that burden. What registry programs are trying to do, as much as possible, is work with EHR vendors so [that the] data they need to populate their registries can be automatically extracted from the EHR and transmitted to the registries. It’s pulling the relevant information, processing it and forming it, and translating it in a way that it will make sense to the registry, given how the registry is storing specific data.

One reason you can use registry data to make comparisons across performance across a wide area is because registries are careful about vetting and quality checks and formatting data that they put into the registry into a form.

One of the interoperability issues we are focusing on at PCPI and other organizations we collaborate with is to try and help the industry increase the percent of data that go into registries where they can be collected automatically.

We are not there yet with automatic transfer of information, so part of my work is to help the industry do that better and many others are doing similar work.

PP: What do you want attendees of your session to walk away with / what advice can you give non-attendees at HIMSS18?

I’d say to all clinicians, those who attend my session and those who don’t, if there is an opportunity to participate in a registry that fits your practice and is in your specialty, it will give you access to not only the kinds of feedback I talked about, but also access to a community.

Registries are national, professional communities of practice. People around the country who are in your specialty, who are passionate about being the best specialty they can be. What I think a lot of clinicians find is participating in a registry results in meeting others like them that are all facing the same kind of burdens, all trying to solve the same kind of problems, focusing on the same kind of issues, and don’t have to solve for those issues alone.

They have the benefit of a national network of friends and colleagues, so there is a social, human element of participation available for the taking.

Clinical registries can assist medical practices with their quality initiatives, but also provide a high-tech community, says one expert.

The Professional and Social Benefits of Clinical Registries

The 2018 Healthcare Information and Management Systems Society (HIMSS) Conference will take place March 5-9 in Las Vegas.With more than 1,300 exhibiting vendors and an expected attendance of over 45,000 attendees from across the globe, the annual tech showcase features a wide array of educational sessions, keynote speakers, and hands-on learning opportunities.There is no way for an attendee to get to everything HIMSS18 has to offer. The Physicians Practice editorial staff has gone through and picked out the top 10 things you should do during your limited time in Las Vegas.

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HIMSS18 has arrived. The Physicians Practice editorial staff has gone through and picked out the top 10 things you should do during your limited time in Las Vegas.

10 Things to See and Do at HIMSS18

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Medical practices have always tracked their "numbers." From the days of tracking patient payments via paper to EHRs to now monitoring performance on quality metrics, physicians and practice staff are keeping a close eyes on the data their office produces.

"It's shifting away from just an accounting and payroll function to becoming more of a strategic thought partner at the practice, providing real insight to support organizational decisions, whether that person is a physician or a practice administrator," says Mandi Clossey, CPA, a principal with Somerset CPAs and Advisors, in Indianapolis.

At this year's Medical Group Management Association Annual Conference in Anaheim, Calif., Clossey will present 

"Building Real-Time Analytics for Practice Improvement."

 Her session, scheduled for Monday, October 9, from 7 to 8 a.m. Pacific, will explain how practices can measure progress toward their goals using key financial indicators.

 recently spoke to Clossey about her session and the importance of data analytics, especially for smaller practices.

: What are the specific benefits for practices in looking at their data analytics?

The benefits of a deeper data analytics person or the ability to do that internally in a practice and benchmarking is pretty amazing. I think benchmarking, as we look at it, is an important tool in data analytics. You utilize it to identify best practices and then areas where improvement may be needed in your practice. So when we think of benchmarking and key performance indicators (KPIs), sometimes [practices] get caught up in a feeling of "I don't know if I want to benchmark as I don't want to see all the areas that need improvement" [and get a little overwhelmed].

[[{"type":"media","view_mode":"media_crop","fid":"63695","attributes":{"alt":"Mandi Clossey, CPA","class":"media-image media-image-right","id":"media_crop_1500211160247","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"8129","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 5px; float: right; height: 200px; width: 200px;","title":"Mandi Clossey, CPA","typeof":"foaf:Image"}}]]But they….can use the KPIs for their core practice metrics, looking internally, and in …broader scope, for performance of ancillary services and [staff] position productivity, for example, especially as more and more practices are utilizing extenders in today's healthcare world.

Data has been around for a long time. The [issue] a lot of practices face, specifically some of the small to medium size ones, is that they've had this data, yet no one has paid much attention to it. Or they take a snapshot view of it and are caught up in day-to-day practice management and don't really utilize the data or react upon it.

So I think the real struggle in many organizations, due to the sheer volume of healthcare information and analytics is: Where do I even begin? The practice with the data that is acting upon it is obviously in a better position, from negotiating with payers to different contracts.

So how do small practices best get a handle on utilizing data?

You need leadership on the management team and physicians need to drive and be engaged in the practice data. If you have one person who is all on-board with gathering data and doing all the analytics and no one is else to support them from the management team or physicians, then it all goes to nil.

You need a culture of data within your practice and to really understand the data. What often happens is a physician will go to a conference and come back and say "Well, the sky is falling because our overhead is 70 percent and someone at the conference told me theirs was 35 percent." Most would understand 35 percent not realistic, but they come back and think they need to cut staff, etc. So we need to understand the data and compare apples to apples when we look at your practice versus others.

 What metrics would you recommend small practices pay the most attention to?

You definitely want to look at your overhead - staff and facilities are the two major buckets at your practice. So you want to look at staffing and expenses and your staff FTEs. You also want to look at your facilities. Your office expenses and marketing are small [low] hanging fruit you can cut and it won't make a dramatic difference.

You need to look at your revenue cycle. What does our [accounts receivable] aging look like? What is our payer mix so we can understand whether we have a high commercial volume or a high Medicare volume? Those are things might affect revenue number.

From a physician / provider standpoint, we need to look at patient volume, number of surgical cases, compensation and relative value units as key indicators. Then you would want to look at your ancillary service line: if you have an allergy or audio department or a pharmacy or an urgent care or MRI. What is the profitability there? That way, if you want to add a new service line, you can build out a service line based on patient volume looks like, revenue projections, patients captured, and other things of that nature.



Do practices need to invest in an advanced dashboard for all their data or is there a simple, low-cost way to follow your advice?

I'd say start with an Excel spreadsheet if you don't have anything else. You don't need to spend hundreds of thousands of dollars on an automated tool that refreshes nightly right out of the gate.  We do a lot of things in Excel, so you can have a provider dashboard that backs up to your financial statements. A very easy Excel manipulation sets something [like that] up.

Now long term, you may want to look at something else as practice grows and there are a variety of tools out there that do automated uploads to look at things, even call center data, on a daily basis.  Focus on key components you should be tracking internally and reporting to management team and what you may want to report to your physicians.

Collecting data to analyze practice operations doesn't need to be intimidating. 'One expert explains why.

The Importance of Data Analytics for Medical Practices

As an industry, healthcare is miles behind its peers in retail, manufacturing, and scores of other sectors when it comes to reaching its core audience and promoting more of an experience than a one-off interaction.

The good news, however, is that the mindset of the patient as a consumer is advancing rapidly and there are plenty of examples for physicians and practices to use as a guide to catch up.

Healthcare Information Management Systems and Society (HIMSS) conference

 in Orlando, Joshua Newman, a family physician and chief medical officer for cloud computing firm Salesforce, discussed the shift in healthcare and health IT to focus on customer relationship management (CRM). By actively engaging patients, Newman said, physicians can create patient loyalty and generate feedback to improve what they do.

And "care is complicated," noted Newman with lots of different players in the patient's life, from a physician and nurse to pharmacist and insurer interacting through various means, from phone calls to texts. "We need to unify around the patient," he said. "It needs to be more experiential for you to understand what the patient goes through. Once you do that, you'll see that it is not easy to navigate … and that gets you thinking about how to organize."

Enhancing CRM software also means physicians and practices need to not only look at the interactions of a patient, but the path of those interactions toward wellness. "Consider the patient on a journey, not someone who gets a service, but for whom up to that moment and after gets the care they need [to be healthy]," said Newman.

To connect the patient journey, Newman focused on three aspects of patient interaction along the path:

• Acquire: Personalize the experience to build trust

• Serve: Provide ongoing services and follow up to improve care

• Engage: Connect the ecosystem to coordinate intelligently

"As a doctor, I realize outcomes are not just practice-based, but it's about what happens at home," Newman said. "No longer is it sufficient to just do surgery or give a medication … part of the job is to take care of the patient once they get home."

To better illustrate this concept, Newman highlighted three systems making strides in the steps he outlined.

For "acquire," Newman pointed to weight-loss firm Weight Watchers, which uses real-time tailored connections across various channels to make the journey relevant, he said. Starting with a mobile app that tracks a consumer's progress, they also send e-mail reminders and text messages encouraging consumers to stick with the plan and connect them with the company's experts to help meet personal goals.

Under "serve," Newman introduced Robert Van Tuyl, chief innovation officer for Easter Seals Bay Area, who discussed his company's work to expand autism and disability services through a relationship management platform. The technology brings together caregivers and patients in a single platform across the continuum of care.

"This was a big cultural changes for us," Van Tuyl said. "But we started at the executive level and got rid of siloed functions … in favor of centering around the customer. Once you put yourself in the customer's shoes [and see how hard things can be], it opens up new discussions."

And for "engage," internist Jitendra Barmecha, MD, chief information officer at New York-based St. Barnabas Health System discussed their care collaboration efforts around more than 386,000 lives through its more than 5,000 providers. The health system also works with the Bronx Partners for Healthy Communities, a coalition of organizations aiming to increase patient access, care quality, and efficiency in care delivery.

Barmecha said that healthcare needs to get past the negative connation of patients as "consumers" and realize that being more patient-focused, "will help us truly connect the dots."

Technology is a useful tool to personalize the patient experience along the care journey while improving well-being and producing better outcomes.