Measuring Up: Integrating Performance Benchmarks Into the Practice

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Within the past 10 years, the topic of physician-performance benchmarking has progressed from contentious to being one on which entire meetings in the radiology community are based. Some industry analysts say that this evolution has occurred because measuring physician performance has become a necessity, in today’s health-care environment, due to the many challenges (including financial difficulties) that health care is facing.

Given reductions in reimbursement, practices need to find ways to be more productive, according to David Haws, CFO, Pueblo Radiology Medical Group, Santa Barbara, California. “Productivity benchmarking is one of several tools you have to look at to determine if your practice is becoming more efficient, standing still, or moving backward,” he says.

When Pueblo Radiology Medical Group first implemented its benchmarking program three years ago, it experienced an immediate 10% increase in physician productivity, Haws reports. That number has since leveled off, but the program still serves as a tool to assess the skills and capabilities of each radiologist. Haws says, “I don’t know how a group can survive without understanding its level of productivity. It has to be measured to ensure that each physician is benefiting the group.”

Even though leaders at Pueblo Radiology Medical Group don’t stress clinical productivity as what Haws calls the end-all, be-all element of their work, he says that it is important that the radiologists know how they compare with their peers, how they can improve, and where they are succeeding (compared with other group members). The medical profession is enduring considerable change, and as government becomes more involved in health care, advancing and adapting are critical to success.

“A progressive program is about being willing to change and to find better ways to do what you’ve done in the past. It’s the only way to get ahead and stay ahead,” Haws says. Benchmarking is one of Pueblo Radiology Medical Group’s methods for increasing efficiency and improving performance; in addition, the practice uses a fully integrated PACS, report templates, voice recognition, and peer-review participation.

Lawrence Harter, MD, FACR, practice president, notes that the group’s quarterly and annual benchmarking results, which measure only work RVUs, allow partners to make educated decisions about internal and external staffing. In addition, the quarterly performance reports measure the productivity of individual radiologists.

This helps them align themselves better with their peers, but it also allows the group to assess its performance relative to both national and regional numbers. All the measurements present findings that allow the board to assess the group’s overall performance, including which improvements need to be made (and by whom).

Haws says, “Benchmarking is about self-motivation and self-development. It is a way for physicians not only to set goals, but to reach them.” The numbers also provide important information that can be leveraged for marketing purposes.

Pueblo Radiology Medical Group’s benchmarking reports don’t account for time spent building the practice, Harter says. Everyone in the group, however, is aware of who is performing that activity, and the time that it requires is taken into account if that individual’s numbers fall below the productivity threshold. Harter adds, though, “Most of our practice builders tend not to have productivity issues.”

To ensure that quality isn’t suffering in the pursuit of productivity, there is a formal peer-review process that occurs annually for everyone except partners (who undergo peer review every other year), Harter says. In addition, a quality committee was created to oversee a review process for sentinel events. These involve either follow-up action by the quality committee or an individual meeting between a senior physician and the physician involved in the incident.

Unintended Consequences

In academic settings, performance benchmarking provides some of the same advantages seen in group practice, but it also provides an avenue for radiologists to measure overall contributions, including academic endeavors. In addition, it helps physicians understand the different components involved in the team environment, Paul Nagy, PhD, explains.

Nagy is director of quality and informatics research and associate professor of radiology at the University of Maryland School of Medicine in Baltimore. He also is the