Take Charge of Your Data
Sometimes do you get the feeling that insurers, third-party payers and other entities know more about your practice data than you do? Are they using your data to tell you how to practice medicine? You need to know and understand your own practice data to maximize the quality and efficiency of your practice and to ensure that these reporting entities are not using your data irresponsibly.
Because virtually every reporting entity gives differing levels of performance data to physicians and reports the data in their own format, the AMA created a Standardized Physician Data Report that drills down to patient-level detail in a uniform format. This Standardized Report was used as the basis for creating Take charge of your data: a physician guide to reviewing and using claims data to improve your profile, practice and payment. This guidebook references the fictionalized data in the Standardized Report as an example to teach physicians how they can mine and use their own real data reports provided by the reporting entities. This guidebook was compiled by Howard Beckman, MD, an expert in using physician data to find practice variations and practice improvement opportunities, in conjunction with staff in AMA's Private Sector Advocacy unit. View a webinar recorded by Dr. Beckman and AMA staff to learn more about the concepts outlined in the physician guidebook.
You may also wish to review the AMA's Guidelines for Reporting Physician Data, which were created to encourage health care payers and other reporting bodies to standardize the format used for physician data reports and provide physicians with patient-specific data.
Preface: Before you use this guide
This guidebook shows you how to mine and use your data so that it works for you, your patients and your practice. It will help you understand and verify the accuracy of the data reports that payers use to construct your rating profile for public reporting, pay-for-performance, physician tiering and/or narrow network programs, as well as help you use that data for practice improvement opportunities. Start here for some important background information about this guide and physician performance data.
- Why you need this guide
- Getting started
Part I: General data report features
This section outlines how to use the general report features of the typical physician data report, using AMA's Standardized Physician Data Report as the model.
- Report access
- Physician characteristics
- Physician data report methodology
- Physician data report glossary
- Physician data report structure diagram
Part II: Overall performance summary
This section provides you with information about your overall quality and cost of care performance results.
- Quality & cost of care summary report
Part III: Quality reporting
This section provides you with more detailed information about how closely your practice data align with the reporting entity's quality measures and compares that to your peers' benchmark data results.
- Quality summary report
- Quality detail report by condition
- Quality detail report by patient
- Reconsideration report
- Adjustment report
Part IV: Cost of care reporting
This section provides you with more detailed accounting of your cost of care data and how that compares with the reporting entity's target costs and your peers' benchmark data results.
- Cost summary report
- Cost detail report by diagnostic group
- Cost detail report by patient