How to Sell a Patient-Reported Outcomes Program to Your CFO
A Note from CODE: Welcome to Professor’s Corner, a series brought to you by Steve Wood, Ph.D.
So, you know you need to collect and report patient-reported outcomes (PROs), and your surgeons agree. But, your CFO doesn’t know a PRO from an MRI. How do you convince her that an efficient PRO collection and reporting program is important to the organization?
The answer is WHIFT… or, “What’s in it for them?”
What is your CFO looking for in a new program? Basically, no cost and lots of revenue and profit. Tough – right, but 2 out of 3 isn’t bad, and if you are playing major league baseball with that average you are headed for the Hall of Fame.
You need to make the case of value in terms your CFO and senior administrators understand, in formats they accept, and in processes and time frames they follow. So, let’s break this down into five steps.
Step 1. Define a PRO program in simple terms
On shows like Shark Tank, they call this the elevator pitch. In the simplest terms:
A PRO program collects patient-reported outcome measures from our surgical patients using validated survey measures. Patient-reported outcomes are trendy in orthopedics because of the CMS program CJR, but other service lines are starting to collect PROs too.
Step 2. Say how your organization would use and benefit from PROs
- We would use PROs to benchmark surgeon, clinic, and administrative performance, and identify best practices, surgeons, and processes that could be improved.
- We would have performance metrics to include in bundled payment opportunities and data to submit to commercial and governmental registries that are increasingly requiring that we do so. This can result in substantial new revenue for our organization.
- If you are a CJR hospital, it might be required to participate in the CMS CJR program, we are currently not submitting PRO data; by doing so we can improve our score by at least 20% and increase our payments for total joint procedures.
- By being able to benchmark the performance of our providers, we will be able to determine better which are delivering more value to us and our patients.
- We will be able to identify best practices from these providers to share with other surgeons.
- We will also be able to engage in data-driven conversations with lower-performing providers to develop ways to improve their outcomes.
- Benchmarking with external registries can also help us understand how we are doing with the entire patient engagement process, including our activities and partners in post-surgery care. This will help us improve the efficiency of our operations.
Step 3. Present the options
You have two basic options for this program: In house collection – or outsourcing to a vendor.
If you choose to collect using an in-house team, likely you will need to add personnel and develop a process for collecting, scoring, and reporting the data. Likely this will require support from both administrative and clinical team members.
If you go the vendor route there are many options to choose from. Some require effort from your staff to run the day-to-day, others require in-clinic collection via iPads or a combination of in-clinic collection and paper forms and emails. Another vendor – (cough, cough .. CODE Technology) provides patient-reported outcomes collection, scoring, and reporting as a complete service – not requiring any staff time and causing no distraction. (We liken it to being your cleaning service, not just a vacuum.)
Step 4. Provide a recommendation and show them the money
We’re biased, but we recommend the full-service solution as it is no more costly than the partially outsourced approach and demands no effort on your team’s part to have this important data available for a variety of purposes.
Let’s work through a simple example that outlines the cost (and savings!) of a PRO initiative focusing on total joints:
Assume you have an average of 42 new patients per month for either THA or TKA procedures and have 5 surgeons you wish to include in your PRO initiative. With 42 new patients per month you will actually have to manage about 840 survey sets in the first year (assuming one pre-op and one post-op survey set) and about 2310 survey sets over a two-year period. This would likely require the part-time involvement of a nurse, two administrative personnel, and a data analyst (assume at 10, 15, 15, and 10 hours/week at a minimum). Using their fully burdened hourly rate this would accumulate to about $145,000 over a two-year period. Using a vendor, it’s possible to outsource this activity for about $37,000 to $45,000 over two years. This shows your CFO that you have thought through the approaches and have a way to accomplish your goals with a minimum of $100,000 savings over two years.
Now for the affiliate benefits that come with a high-performing outcomes program.
There is so much value in the intelligence you get from benchmarking and other aspects of the data you obtain. As mentioned previously you will be able to identify best performing physicians and transfer that knowledge to other providers. Let’s say that you are able to reduce complications requiring readmission from a TJA procedure by only 1/year. This alone will likely pay for an outsourced approach to this program.
If you are a CJR hospital, the mere submission of PRO data in the required format will earn you an additional 2 points on your Composite Quality Score. More specifically, and as outlined in a previous article in this series, Winning the CJR game with PRO data, assume your hospital is in the 45th percentile of complications (Quality) and 25th percentile for HCAHPS. This would put you in the “Acceptable” category with a Composite Quality Score (CQS) of 6.25. If your hospital successfully submitted PRO data, you would earn another 2 points putting you at a CQS score of 8.25 and at the “Good” grade level. Assuming your average historical episode price was $32,000, your hospital would improve its financial position for these procedures with CMS by over $330,000 during the CJR program.
You can be sure this will get your CFO’s attention.
Step 5. Know when and how to present your proposal
If you don’t already know, check with your CFO to understand your organization’s budget cycles and when a proposal should be submitted for the next opportunity to be considered. As a PRO collection program is not greatly expensive compared to many items and activities in a service line budget, it may be that a proposal for additional funds for this purpose can be submitted at any time. Ask also for the format to submit your request. Many hospitals have structured forms to complete for budget increases and new initiatives; ask for one and complete it fully with a discussion of the benefits and rationale as outlined above.
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