One need not look far to see evidence that our health care system requires a major overhaul. Physicians are often overwhelmed by large amounts of paperwork that need to be processed. The vast amount of physician paperwork can often seem like a never-ending stream of requests for information from payors, patients, and providers. Physicians, like many of us working in the health care industry, struggle with data management.
Today, expenditures for health care are near 17% of the GNP, and some predict that this may reach almost 20% in the next 10 years.1 Thus, managing data to improve outcomes will play a paramount role in the future of medicine.
Sleep centers, like all health care providers, should consider what role data will play in the future of health care. How will data and its analysis shape your business or change the way you practice sleep medicine? Can this data make your facility more efficient?
WHY WORRY ABOUT DATA?
Data management has always been important in the field of sleep medicine and plays a vital role in the initial diagnosis and treatment of patients. You will need some of this information for accreditation, and it makes sense to know that it is easily available. Also, redundancy and paper records inevitably lead to an inefficient workflow. Over the past few years, sleep centers have placed greater emphasis on follow-up and management of the patient after the therapy setup—largely because the actual tolerance of sleep therapy (compliance) is much lower than sleep professionals consider optimal. Besides the patient impact that a follow-up program delivers, it also provides a valuable opportunity to mine the data to guide you and your staff in improving your sleep business. With data, you can provide valuable input to payors and referral sources regarding patient satisfaction and other metrics associated with the care of a chronic condition. Many people believe that what you cannot measure, you cannot improve.
Clearly, collecting data is not free. Often, health care providers overlook the up-front costs, as well as the cost of collecting and maintaining the data. In addition, poor data is worse than useless. Many practitioners and durable medical equipment companies report unbelievably high rates of compliance with PAP treatment to payors, referral sources, and peers without explaining what metrics they used when gathering the data. Whether one measured the PAP therapy use based on hours per night or number of nights per week or month can make a big difference, as can whether the data was based on subjective patient self-reports or objective information from the PAP system.
Outcome measures also can be subjective. Some articles show improvements in daytime sleepiness when patients use PAP therapy just a few hours per night, and other studies report improvement in daytime symptoms and reduction in blood pressure only when patients use PAP for more than 4 hours per night at least 5 nights per week.
Remember, only collect data that can be handled effectively. Storing data “in case we need it later” or processing bad data is rarely successful. It is imperative that the sleep management team be disciplined and discuss expectations and goals when selecting the process (eg, follow-up plan) and the supporting technology. If your plan is “mission critical,” you should get advice from a statistician before you begin. Also, if there is even the smallest possibility that you will want to publish the results or present them at a meeting, you should discuss that with your research body or investigational review board.
SELECTING A SYSTEM
There are many choices for monitoring and managing SDB patients—and a wide variance in costs as well. The simplest strategy, and arguably the minimal standard, is to follow published standards of practice and rely on a single, easily determined end point, such as success at 1 year. This data may be documented on paper or a simple spreadsheet. For all other levels of sophistication, digital tools are effective. Some key considerations when selecting which system is best for you are:
• What is the scope of your sleep-disordered medicine business, or what would you like it to become? What current business practices could be improved (reduced costs, improved outcomes)? How much data—and what type—will the system need to collect? If the data is neither required by third-party sources (payors, referrals, etc) nor able to provide information that will affect decisions on patient management, resource allocation, current facility operations, or future business plans, then it is likely superfluous and cost prohibitive. You should also avoid questions—such as would cardiovascular outcomes be improved by slight changes in PAP pressure—that would be best answered by a study involving large sample sizes, multiple sites, etc. Generally, you will be looking at questions such as how an independent factor (effort), eg, education time, affects a dependent factor (outcome), eg, compliance. So you will need a system in which these factors can be tracked accurately and easily.
• How many SDB patients are in your database from the past several years, and what is the annual setup rate and plan for growth? These are key questions to determine if the return on investment (ROI) on the patient follow-up system is positive. Also, the numbers drive the difference between personnel and technology requirements, which need to complement each other. Patient follow-up and collection of data for a database of up to about 500 patients are probably within the reach of one FTE employee with sound information technology (IT) support. Specialty programs or software systems are usually required to manage follow-up and collect data for businesses with databases exceeding 500 SDB patients.
• How will the data be used? Is the data marketable? Demonstrating to payors and referral sources that collected data on SDB patients is necessary, and that it can change the decision process in overall patient management, is critical to obtaining reimbursement for services. A professional report displaying documented interaction and the impact on compliance is marketable. It enhances any provider/referral/payor relationship. From a technical point of view, your system will need to easily produce adaptable tables, reports, and graphs.
• What is the status of “data” in your current business practices? How current are your technology/data management systems? A patient follow-up system is only as good as the methodology of data collection, and the investment is handicapped if the data is not “clean.” A very basic question is “Where is the data from SDB patients?” A system with easy export capabilities allows referral sources and payors to electronically exchange or access well-designed and streamlined reports while you still meet HIPAA requirements for data protection.
• Are IT resources available to do the job? An investment in savvy, sophisticated IT personnel to set the data collection and analysis processes in place paves the way for smooth and accurate implementation and interpretation of the results. IT resources should contribute to the selection of a system that uses standard language and access, and maintains security and protection of patient data.
• Have all the sources of revenue and expenses to calculate the ROI on the patient follow-up program or system been estimated? Measurement of the replacement supplies patients use is fairly straightforward. Many insurers set a schedule at which such supplies may be reimbursed, and tracking based on this schedule might simultaneously optimize reimbursements, compliance, and patient satisfaction. Other potential revenue sources are available. They range from generating referrals via objective analysis of the likely outcomes of patients who have entered the program to negotiating higher reimbursement rates from private payors with detailed compliance results. Also, remember the financial value of tracking patient satisfaction, in both the sleep diagnostic and therapy setting. The expense of a follow-up system varies with the scope of the program and the volume of the patient database. ACT or MS databases are less expensive than specialty systems, and may be fine for smaller patient databases. Larger databases require a finely tuned mixture of technology for the routine and personnel for the interaction and problem-solving needed to optimize the benefits of the system.
Careful analysis of these key areas provides direction in choosing the best patient follow-up system to match your plans and capabilities. Any data can be used to calculate a percentage or ratio, and propose a conclusion; however, for the long term, for payor reimbursement of data collection and for optimizing business processes, it is best to “mine” that mountain of data for truly meaningful data.
Ron F. Richard is senior vice president of strategic marketing initiatives for ResMed Corp, Poway, Calif. He can be reached at . Nancy Nunley, MBA, is a founder and managing partner of LGS Enterprises LLC, a project services firm serving the home health care industry. She has received numerous certifications from both the American Marketing Association and the American Management Association in marketing, sales, management, finance, and strategic planning. She can be reached at . Nigel Ball, PhD, DABSM, is clinical director of the Swedish Medical Center in Seattle. Ball can be reached at .
- Poisal JA, Truffer C, Smith S, et al, of the National Health Expenditure Accounts Projections Team. Health spending projections through 2016: modest changes obscure Part D’s impact. Health Affairs. 2007;26(2):w242-w253.