Executive Session: Nate Moore on data in healthcare

MGMA senior fellow David N. Gans, MSHA, FACMPE, sat down with Nate Moore, CPA, MBA, FACMPE, president, Moore Solutions Inc., at MGMA19 | The Operations Conference in Austin, Texas, to discuss the importance of personalized, actionable data in healthcare groups and how data accessibility is critical to driving meaningful change.

Q. What is a key data set that you would like to see in an organization?

A. The most important aspect of data in a medical practice system is customization. What matters to your practice may be different than what matters to someone else’s practice, and healthcare leaders must find the things that are going to drive the needle. Compensation is one of them. To make an impact and drive change is to understand how your physicians are compensated and what’s going to incentivize them to change something. If it’s wRVUs then you need to look at wRVUs in the organization and track it … Rather than tell a physician you need to work harder, [data] can show where they need to be and how their goals can be supported.

People also need actionable information. By moving data into a firm metric, looking at that metric and having that information to make those decisions, practices can drive their marketing plan, open their appointment calendar or do whatever it takes to get that goal.

Communicating that information is crucial. The last thing you want to do is report 2019 activity in March 2020. You need to have a timely reporting system that is going to give you the metrics that are going to move your practice in actionable timeframes.

Q. How do you work with practices to identify the metrics that are going to be important?

A. My approach is to give you data that you have never been able to see before. Canned reports and most practice management systems are limited, and I look at what will drive change in a practice, specific to the needs of administrators and physicians working in that office. If the issue is that patients are waiting too long and it’s costing space, drill down on the data at the practice level and find what you need to see and when to implement changes.

I think it’s also important to find information that’s inherent in your systems, but that you may not be looking at. A great example would be the date stamp function in EHRs.

I spoke with a practice last week that was experiencing issues with payer mix. In their environment, workers’ compensation cases paid well, but some physicians weren’t getting enough work comp cases, or any at all. I suggested the physician(s) build a payer mix into his or her dashboard and compare this against the number of cases in the practice. The date stamp listing the time a new record was entered also lists who entered it. Practice managers can go back into the system and see who scheduled that appointment and who is sending more work comp patients this way and that way. There are a lot of things an organization can do if they examine raw data and identify root causes as opposed to showing the same charges, payments and adjustments every month.

A practice’s information system is a gold mine, but you have to be mining that gold and do something with it or else you lose out on its potential.

In healthcare, you cannot file a claim and throw the rest of the data away. There is a lot of other information buried in that gold mine that you can access, changing the way you see data run your practice.

Q. What other metrics should a practice executive or physician executive look for?

A. I’ve taught pivot tables for years for MGMA, and one of things I love to do is to grab revenue data. If you’re looking at a table of data that has a row for every single collection that the practice made, every payment that came in the door and the columns to describe it, you can examine the data and understand where the change is. If revenues are up 5% or down 10% from last month, this data can help determine why. The ability to drill down data — by location, by provider, by referring physician, by primary insurance — is huge and once you understand what’s causing the variance, you can act on it.

Q. For an administrator or physician executive who’s not a data expert, what can he or she be doing?

A. Retrieve your data out of your practice management system, not in a canned report or PDF, but in a format where you can interact with the information. My preference is pivot tables. Grab your data out of your system and work with your IT department and vendor to get to the raw data, which will enable you to interact with your practice’s data and discover insights that can change the game.

Q. If an organization wants to provide information to each of its physicians on a periodic basis, what would you suggest they look at to help them be more productive, see more patients and most important, provide better healthcare to their patients?

A. When I work with a practice, I start with one page, which could be emailed monthly and ask, what should be on that page that your group’s physicians care about? However, they should be things that physicians can influence. An interesting piece of data such as duration of patient appointments may not be under their control. I did a dashboard for an orthopedic group, and they wanted to see “days worked” on the first line and that’s something they could control. Maybe you’re a specialty group and you want to see top referring physicians by group and how is that changing over time? What your practice needs to see is customized, controllable data shown in ways that your physicians can interact with it. That information is powerful.

Q. When you’re talking to doctors, what questions do you ask to find out what is important to them?

A. The first question I ask is, how are your physicians compensated? That will tell me something about the culture of the organization and also how to motivate physicians in that organization. Then I’m going to ask, where are your struggles? What information can’t you find? The most frustrating part [for practice members] is that it’s in your system somewhere, but how can you grab that data to effect change in your organization?

Q. How often do you find resistance coming from the IT vendor or IT staff in the practice?

A. Their concerns are that they don’t want another report to support or they’re worried things are going to break. If you’re going to get access to your data, the first thing to ask for is read-only access to the data. You don’t want to be able to change the data or break anything, which can add to IT’s burden. Communicate with IT that if they could allow access, one well-designed pivot table can replace dozens of canned reports, and they won’t need to be bothered for running reports or customizing reports. It’s often the same issue for administrators who spend two or three days a month creating dashboard-type reports that take a long time to build and create less time to act on the data. Determine how to automate the process of getting the data, and then you can act on it more efficiently.

Use it as part of the decision process.

Absolutely. Part of it is culture to decide that a practice is going to make decisions based on data. They’re going to find the customized information that matters to their practice, and that is how they’re going to drive decisions.

Q. Among the themes at MGMA19 | The Operations Conference was how does a practice prepare for shifts and payment away from the fee-for-service model to being paid more on a value-based payment system where there is concern on the total cost of care. What shifts are you seeing in the type of information people need to have to manage better in this value-based payment environment?

A. We need to put more information around cost of care into the systems. If a patient was discharged, where were they discharged to? If a patient had to be readmitted, why? That data can be shown to payers. I’ve seen people go to payers with data that shows how fast a patient can be seen in the group. This indicates the practice is seeing patients sooner, therefore addressing problems sooner and keeping them out of more expensive care settings.

Q. How do you convince a practice to spend the money it takes to tap into its systems?

A. The first question I ask is, can you act on the data I’m going to give you? I worked with a group from the Midwest that had significant variation between allowed amounts by payer, and the practice was very honest and communicated that they had other priorities but said they would return to look at that in a couple months. If you have the resources, for example, to appeal claims or identify underpayments, there will be huge return on investment; however, if you can’t act on the data, there is no ROI.

Q. How does an organization take that data and act on it?

A. The first key is visibility. A practice should see data and recognize this is where they are now so that they can come back and mine that data again. … The role of data is to identify opportunities and to keep score. I look at professionals to come back and use this data to decide how to move forward.

What I found is that the best source of this information is oftentimes frontline staff — team members who haven’t been listened to in the past or haven’t had a way to interact or make a difference. Some of the best ideas I’ve received for which reports to run are from [front office staff] who are spending four hours a day on it and it doesn’t make sense.

You’re also acting as a change agent because you come into the practice and you give them ideas and insights that they might have intuitively felt but never saw.

Sometimes you need data to back up those intuitions. If you sense something is off, you can approach a physician with data to show he or she is spending 20% more time in every exam room than his or her peers and competition through comparison is another way to help drive change. The ability to see what your peers are doing can lead a group to look at how to do things differently, optimize workflows and achieve similar results.

Q. Data requires transparency — Is it an open culture? Is it a sharing culture? How do you overcome obstacles with someone who may be more secretive, more concerned with, and less inclined to share information with others in their practice?

A. It’s a culture thing, Dave. One of the dashboards I use lists a physician’s number of new patient appointments last month paired with a number in parenthesis that shows what the rest of the practice did. It doesn’t name each provider but lists what your peers in the practice had and starts to give you a sense of where you are in comparison without naming who.

Therefore, you design the dashboard to meet the culture of the organization.

It’s customization again. You might have to crawl before you walk into a transparent environment, and over time, you can show more information about everybody and among everybody in your practice.

Q. As we wrap up our discussion, what are the top elements an organization should look at?

A. Each individual should have access to his or her own raw data. I don’t want to know what the practice management system thinks is important or what other practices think is important. Your raw data should be available to you.

Then find a tool to interact with that data. … Discover ways to access your data and then find a way to communicate that data effectively throughout your organization. Rather than rely on me to give you the data you need, find and implement tools to run reports on your own.

As last thoughts, what would you like people to know?

A. Start with something. Get access to some data. Maybe you’re not going to get access to all of it at once or maybe it won’t be perfect to start but get access to something and start the ball rolling. Prove the concept: When we can get data, we can make decisions on data.

— Edited by Kelsey Brading, MGMA content production coordinator