Feature Story |
 |
|
|
Apples to apples to oranges—comparing lab practices June 2003 The College’s PathFocus program, now in its second year, can help
In a nutshell, PathFocus participants complete two data-collection forms, and the program gives them a comparative analysis of how their practice is performing in relation to similarly configured practices. “The peer group analysis allows the practice to see how other practices have addressed the same balance of responsibilities,” says Tom Sodeman, MD, chairman of laboratory medicine for North Shore Long Island Jewish Health System Laboratories, Lake Success, NY. Pathology and Laboratory Management Associates, Ann Arbor, Mich., credits its PathFocus analysis with saving the practice money on negotiating a Part A contract with a large hospital system. Using a combination of readily available compensation benchmarks, the group had already reached agreement with hospital administration about fair market reimbursement for a pathologist full-time equivalent devoted to medical director and administrative services, says Paul Valenstein, MD, president of the group. The more difficult task was determining how many full-time pathologists the hospital’s laboratory needed to perform the Part A services. PathFocus provided the answer in objective, quantifiable terms. Dr. Valenstein and his colleagues are currently using PathFocus to help set staffing levels. “Right now we are involved in hiring a pathologist. We made the decision to hire a pathologist by looking at our workload and where our workload is going,” Dr. Valenstein says. “And we have used PathFocus to help us determine how well our group’s productivity compares to similarly configured operations.” The PathFocus survey and analysis also helped St. Louis Pathology Associates negotiate with its hospital. “Hospital administrators, to some extent, know what the pathologist is supposed to do under CLIA requirements, but few have identified the amount of time required for a CLIA medical directorship,” says the group’s president, Scott Martin, MD. The hospital administrators shared the practice’s PathFocus time study data with the lab’s section supervisors and learned that they wanted the pathologists to spend more time, not less, in certain areas of the lab. “So we used that feedback—not to hire more staff but to reallocate work to free up certain pathologists so they could spend more time on the specified clinical laboratory management activities,” Dr. Martin says. The PathFocus
analysis forced the Topeka (Kan.) Pathology Group to scrutinize
its billing and other data, reports Mark Synovec, MD, president
of the group. As a result, the practice was able to correct missed
opportunities for coding services. PathFocus translates the data submitted by a practice into a unique snapshot, or “fingerprint,” of that practice based on the presence and absence of characteristics that have been determined statistically to have the greatest influence on staffing. The computerized program then creates fingerprint clusters of 10 pathology groups that resemble each other. The program, therefore, is able to provide an apples-to-apples comparison—or, more precisely, it compares a McIntosh red to a McIntosh red, a Jonathan to a Jonathan, and so on. Starting this
year, practices can also choose a customized peer group for comparison
by selecting up to five characteristics from a master list to measure
the practice’s performance. In this way, practices with unique
components can make sure they are compared with similar groups.
The group practice activity report compares a group practice’s activity and volume data to its peer group and practice-defined group. It also displays the data for the best and second-best matches. The peer group
characteristics report provides a graphical and numerical overview
of the extent, expressed in percentages, to which an individual
practice matches its peer group and its two closest matches on what
the program calls short-term and long-term manageable characteristics.
“It’s simply meant to provide a general measure for
how well the group practice matches its peer group,” says
Rhona Souers, CAP biostatistician.
The short-term manageable characteristics, which like the long-term manageable characteristics apply to much of the analysis, “are those things that have the potential to be modified in terms of what is going on in the practice’s environment now,” Dr. Synovec explains. Examples are the number of specimens the practice sends out or whether it agrees to accept certain types of specimens. Some, but not all, of the long-term characteristics might be altered, such as the practice’s mission or the hospital’s service mix, but it would take time and negotiation. Other long-term care characteristics are practically written in stone. Once the practice
understands its short- and long-term management issues, it can better
manage staff for those functions and negotiate more effectively
with a hospital or managed care organization for contracts. In addition,
says Stephen Ruby, MD, MBA, president of Palos Pathology Associates,
Palos Heights, Ill., “When you compare groups that are The practice
complexity form takes about two hours to complete, and “Some pathology practices say they don’t know the frequency distribution of CPT codes of the services provided in their practice,” Dr. Martin says. “But I can guarantee them that someone in a cubbyhole somewhere in the fiscal section of the parent organization does know.” There’s also a synergy that can be developed when practices use the PathFocus tool and the Medicare-required time study, says David Mongillo, CAP director of professional and regulatory affairs. The time study that pathologists complete for hospitals helps Medicare determine Part A or B reimbursement for the hospital and is used also for the wage index calculation, according to an official from the Centers for Medicare and Medicaid Services. Dr. Ruby’s
practice, in fact, has decided that the one-week PathFocus Dr. Synovec agrees. “When we [the program’s developers] first went into this, we wanted something that was easy to look at and say, yes, we should hire or fire someone,” he says. But they soon realized it wasn’t that simple. “In other words, PathFocus is not intended to be a dummy’s guide to practice management,” he says. “The individual practice has to really analyze the data unless the practice is so glaringly outside the standard that it slaps them in the face.” “This analysis,” he adds, “may show that one practice, when compared to peer groups with similar surgical pathology volume and complexity, takes 50 percent more time to provide similar services. The practice can use these data as a quality improvement opportunity to see where their time is less efficiently expended—say, for example, in report sign-out procedures.” Members of the practice, says Dr. Martin, can look at benchmarks from the College’s Q-Tracks and Q-Probes or from other organizations to ensure that their turnaround time for reporting results of surgical pathology specimens meets the benchmarks. For example, the most recent PathFocus summary report for Dr. Valenstein’s practice shows that the practice’s 11 pathologists are performing work that would typically require 14 pathologists (based on a standardized 40-hour week). In placing that information into context, however, the group identified similar groups that were equally productive. When the practice looked at its short-term manageable characteristics, it seemed that the group’s pathologists were very efficient in handling professional (Part B) work. So, as a next step, the members of the practice asked themselves whether they felt pressure to complete their work too quickly. They concluded that was not the case. “We believe that our extensive use of synoptic and standardized reporting allows us to operate more efficiently,” Dr. Valenstein explains. On the other
hand, PathFocus suggested that the practice might be able to reduce
the time it devoted to administrative work. “Like all groups,
our practice has some unique characteristics, and we had concerns
that these characteristics were not fully represented in the peer
groups to which we were compared,” Dr. Valenstein says. Nevertheless,
the practice has been able to re-engineer its workday in the past
few years to spend less time on administrative work. “And
we have trained technologists to perform some of the activities
we [pathologists] used to perform and have eliminated some pathologist
work entirely,” he says. “This has enabled us to maintain
reasonably high overall productivity.” The practice
also has an active transfusion medicine service with special blood
product services. “So we have two labor-intensive services
that contribute to an explanation of the staffing requirements for
our group relative to others in our cluster,” Dr. Martin says. “Say a pathology practice in a teaching hospital, with built-in inefficiencies due to resident teaching and other factors, wanted to improve its efficiency in performing surgical pathology work to bring it more in line with a nonteaching hospital in performing surgical pathology work,” Dr. Ruby suggests. “If so, the practice could use that key characteristic to compare itself to nonteaching hospitals based on the CPT coding volume for surgical pathology services.” Of course, the practice would have to realize this is not a fair comparison. “It would be like comparing your family sedan to a sports car,” Dr. Ruby says. “You use the sports car as an external benchmark or goal, even though you know you may not be able to achieve its performance. Yet it would give you a tangible goal to work toward.” A practice could also plan for the future by participating in the program anew and creating a future scenario that might change the complexity format of its practice environment. That way the group could see if the projected change might require an additional pathologist. Dr. Ruby believes
the PathFocus program may have even more creative uses, which is
why it’s important, he says, for practices to share feedback
on how they are using it. And while some
practices have questioned whether the current database is sufficient
to give them a valid result, PathFocus developers and proponents
say the program is ready for prime time. “The PathFocus program
developed slowly and went through a series of alpha and beta tests
to build the initial database so it would provide a valid comparison
when it started last year,” Dr. Sodeman says. “That’s
why CAP fellows need to participate in the program, to help build
the database so that it can provide increasingly “The ideal is for everyone to participate,” Dr. Ruby adds. “Then a practice can compare itself to the whole population.” As PathFocus
continues to grow, it can provide a broader perspective on what’s
happening in pathology. As chair of the CAP Economic Affairs Committee,
Dr. Synovec views PathFocus as another tool that the But that’s “frosting on the cake,” he adds. The real value of the program is to the individual practice. “The program has a lot of power,” he says. “Even the data collection itself is powerful because it makes pathologists think and manage their practice more intentionally.” Karen Lusky is a writer in Brentwood, Tenn. |
|||
|
