Dr. Philip Kregor, a graduate of VUSM, has been recruited as the new Director of Orthopaedic Trauma in the Department of Orthopaedics and Rehabilitation. (photo by Dana Johnson)
Web-based reports boost Medicine productivity
New Web-based monthly reports are allowing physicians in the department of medicine to examine their clinical practice in detail and track their clinical productivity in comparison with their practice group, their prior-year productivity and any current year productivity targets.
“Getting our clinical practitioners a frequently updated snapshot of their practice habits provides a serviceable tool that allows each clinician to make unprompted adjustments to their activity,” said Dr. Eric G. Neilson, Hugh Jackson Morgan Professor and Chair of Medicine. “It has long been my observation that people work more effectively when they have direct access to good information about themselves.”
Originally developed by the division of general internal medicine, the report has been used there since April, and has been available in other divisions since November. In all, there are 13 divisions and 234 physician faculty members (out of some 360 total faculty) in the department of Medicine.
The report prototype was instigated and developed by Dr. Jim Jirjis, assistant professor of Medicine and director of the Adult Primary Care Center. Senior Financial Analyst Allen Kilpatrick did the programming. The duo began by setting a few guidelines: all the information would be graphic, “Because that’s what connects,” Jirjis said; and methods for comparing individual productivity with that of the group would be fair and accurate, warranting everyone’s confidence.
“Doctors wanted to know how much they were producing and what the division’s expectations were,” Jirjis said. “Doctors everywhere need to balance service with considerations of cost and revenue, and striking the optimum balance requires information. Having the right data can empower a division. It can stir the interest and commitment of faculty. People who are working hard get recognized, and those who aren’t are no longer enabled by a group information deficit.”
Jirjis gave doctors in the division an early draft of the report and spent a few months gathering their feedback. The report grew to include patient demographics and various data that help to interpret and refine apparent differences in productivity.
“Proper use of the report requires a champion who knows the factors that determine productivity in the division and is prepared to fine-tune numerators and denominators to assemble an accurate, useful representation,” Jirjis said.
Varied teaching, research and administrative obligations leave doctors with varied amounts of time for clinical productivity; any productivity comparison must factor in these differences. All of Vanderbilt Medical Group uses an electronic patient scheduling system called Epic; each physician has a certain number of weekly templated hours in this system. Because many adult primary care center doctors routinely use additional time not incorporated in their Epic template to see last-minute add-on patients, Jirjis’ group early determined that skewed reports would result from using templated hours in Epic as a basis for productivity measurement. Jirjis checked with each doctor to learn how much time he or she routinely devoted to seeing patients; the productivity report in the adult primary care center is based on half days per week devoted to seeing patients, and templated hours in Epic are ignored.
Each doctor in the adult primary care center is budgeted to conduct a certain number of patient visits per year, and this individualized goal features prominently in the report; doctors are told their average visits per week and average visits needed in the year’s remaining weeks to meet budget. Since the report has gone into use some of the doctors in Jirjis’ area have become more productive.
Two important effects of the report were unforeseen. “The report is having a tremendous effect on how we allocate staff resources,” Jirjis said, “and we see now that the report will open new areas for faculty publication.”
As the original report began to take shape, Jirjis recognized that the productivity information, if combined with patient demographics and staff utilization data, could provide new insight into how best to predict staff utilization and apportion staff resources. “It’s demoralizing to have a system that isn’t empowered with information to help you make fair decisions about resources,” he said. In the division, for the first time, decisions on how to apportion resources are being backed up with careful examination of each faculty member’s clinical load and the staff work required to support that load. While older patients and female patients are generally known to require more resources, the center’s detailed data on phone use (duration of calls, wait times, missed calls, etc.) viewed against the backdrop of demographic variances is beginning to provide new accuracy in predictions of staffing requirements, and this data will be used by Jirjis and others for practice management studies.
The reports also have helped doctors in the center recognize they were too often documenting care in ways that led to inadvertent under reporting of the intensity of clinical services, which can result in lost reimbursement and inaccurate reviews of clinical quality by outside groups.