F E AT U R E S C O LO R A D O R E T I N A A S S O C I AT E S : C O N T
We analyzed our basic practice metrics: From 2012 to 2017 we had experienced a 27 percent growth in clinic visits and a 37 percent growth in new patient visits but we had not addressed the need for more robust staffing, revenue cycle management, IT and clinical infrastructure to meet administrative burden. What gets measured gets managed; what gets measured, managed and rewarded gets repeated. We needed a major overhaul with better oversight and performance metrics.
prescribing lower cost, off-label pharmaceuticals for first-line therapy. CRA physicians perform 64 percent of their major surgeries in ambulatory surgery centers whenever medically appropriate. CRA also saves payers by providing same-day access with their physicians on call 24/7 including nights, weekends and holidays, thereby avoiding emergency room visits. In early 2018, CRA transitioned to a cloudbased EHR that allows on-call doctors access to patients’ charts and images for higher quality triage.
C R A commi t te d to our cul ture of patient-centered care built on a foundation of continuous quality improvement. We constantly challenge ourselves to be a high-performer clinically, providing excellent care to patients and holding surgical rounds to shorten the post-fellowship learning curve. CRA was an early adopter of the AAO IRIS Registry (Intelligent Research in Sight), which aids in quality tracking, and our practice is in the second year of deploying Lean Six Sigma to drive continuous process improvement using metrics, benchmarks and internal feedback loops, resulting in care well above peer practices, while demonstrating improvement over baseline.
The next projects we are working on are, as specialists, attempting to integrate with primary care in the larger medical neighborhood to improve communication and patient referrals from and back to primary care, and to begin to leverage our data and outcomes to generate a performance story that makes the business case for quality and cost-effective delivery of care to payers, changing the discussion from arguing for another few dollars on a given code to reworking how value-based care would look for both the provider and payer. For instance, with data demonstrating “exemplar practice” status, how can a practice get relief from the inefficiencies of prior authorization and the revenue cycle? Showing payers how we have implemented data-driven care redesign, beating benchmarking of peers to demonstrate high-value care with high quality, and that we are aligned with their interests will hopefully translate into better contract terms.
My experience with Lean Six Sigma has been overwhelmingly positive: Our subject matter experts guided us through a remarkable process of self-discovery unique to our organization. Innovation bubbles up from the front-line workers rather than command-and-control directives pushed from above. Lean is a fundamental reordering of how the work is done. The efficiencies created are more respectful of patient time, allowing more patient interaction to discover their values and preferences to guide care. Another clear benefit is a reduction in stress of staff and physicians, in turn positively feeding back upon patient care. It has been an eye-opening, transformative experience. In addition to data to support excellent clinical outcomes, CRA contributed $20.3 million in cost savings in 2017 to the health care system, with a projected $23.5 million in cost savings for 2018, by
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I believe that physicians in all practice settings do not have to choose between taking care of your business and doing the right thing for the health care system. You can do both by studying your own clinical and business operations to wring out the waste. ■
COST SAVINGS MEASURES
AT A GLANCE PRESCRIBING
LOWER COST PHARMACEUTICALS
2017
20.3
MILLION
2018
(PROJECTED)
23.5
MILLION
SURGERIES PERFORMED IN AMBULATORY SURGERY CENTERS
64%
24/7
ON CALL
AVOIDS EMERGENCY ROOM VISITS