Where in the world are the ambulatory benchmarking data?
Where in the world are the ambulatory benchmarking data?
Information is not easy to find, but it's out there
If you haven't yet been forced to take a hard look at your ambulatory care, get ready. Pressure from payers and patients is driving many health care facilities to hone in on ambulatory services for cost-saving measures and quality improvement. Payers don't want patients in the hospital if there's a less expensive alternative, and patients themselves are more than happy to oblige as long as they're still getting quality care. That makes sense, and it also makes more work for you.
"The ambulatory arena is so dynamic right now; it's where everybody is focusing. The push is on to get patients out of the hospital and to find less expensive ways to care for them," says Sharon Lau, a consultant in the Los Angeles office of Bainbridge Island, WA-based Medical Management Planning. "The problem is that it can be a challenge to find the data."
Lau is not exaggerating when she says it can be a challenge to find data that will help you benchmark your ambulatory efforts. Healthcare Benchmarks would love to point you to a one-stop shop for ambulatory benchmarks. We'd love to tell you tons of free data are at your fingertips. But after making dozens of phone calls to state and federal agencies, consultants, collaborative projects, and professional associations, the best we can do is offer you some places that might help you get started.
"There has not been a lot of information gathering on ambulatory care," Lau says. "Everyone has an emergency department waiting time. Everybody has an admission process waiting time. Those have been around for years. But it's tough to find anything beyond that, especially on the clinic side."
Lau is the consultant for the 27-member BENCHmarking Effort for Networking Children's Hospitals, which has started collecting ambulatory data in response to the growing need. "We need that data. We don't know what a good waiting time is in an ambulatory setting, so we're collecting it ourselves." Lau recommends that hospitals looking for ambulatory data do just that: start collecting it internally. She says you need to measure cost (productivity, worked hours per patient visit), quality (patient satisfaction, unplanned returns within 24 hours) and speed (waiting times).
You certainly need internal benchmarks, but once you've got them, where do you go for outside comparisons? Here's a list of places to start looking for ambulatory data:
1. State sources.
If you want your data for free, the state health department or hospital association is probably your best bet, maybe your only bet. But don't get your hopes up too high: We checked with several states and found that some not only didn't have ambulatory information, but they also didn't know what ambulatory meant. If you can find ambulatory numbers, they'll likely be several years old and it might feel like it's taking that long to get the information sent to you. (For a complete list of state sources of hospital benchmarking data, see Healthcare Benchmarks, May 1997, pp. 67-74.)
California: If you can wait until 2001, you'll be able to get data from the state, but only if a bill pending in the California legislature passes. The bill would require hospitals to report data on ambulatory surgery, emergency services, and other outpatient care. The data would not be available for reporting before 2001.
New York: Go on-line and check out the New York State Department of Health's Web site at www.health.state.ny.us. Look for the Statewide Planning and Research Cooperative System (SPARCS) section, and if you've got the Adobe Acrobat Reader, you can download the outpatient data dictionary to get an idea of what's available in the area of ambulatory surgery records. Or, you can fax a request for information to the department at (518) 486-9144. They probably won't tell you over the phone what's available, and the faxed request probably won't be answered as quickly as you'd like. Contact the department's records access office at Nelson Rockefeller Empire State Plaza, Albany, NY 12237. Telephone: (518) 474-8734.
Minnesota: The Minnesota Hospital and Healthcare Partnership in St. Paul is in its second year of collecting claims data on hospital-based outpatient services including emergency department, freestanding centers, home health, radiology, and laboratory. Ninety-five hospitals are voluntarily submitting these data, but they are not yet available for reporting. When they are, you'll be able to get answers to specific questions, such as the average charge for a certain procedure, a hospital's outpatient market share, and where patients from a certain ZIP code go for a particular set of surgical procedures. Contact the MHHP at 2550 University Ave. W, Suite 350 South, St. Paul, MI 55114-1900. Telephone: (800) 462-5393 or (612) 641-1121.
2. Federal sources.
Centers for Disease Control and Prevention, National Center for Health Statistics: Visit the CDC's Web site at www.cdc.gov for probably the largest collection of ambulatory statistics you'll find in one place. Keep in mind that the data are several years old, but they're free and you'll be hard-pressed to find this information anywhere else. Look under Fastats, and you'll find a section on ambulatory care (doctor visits) and ambulatory surgery (outpatient). You'll find some general numbers that may or may not be helpful, such as total number of office visits and most common diagnosis, but you can also download some reports that may prove valuable, such as Ambulatory Surgery in the United States (1994). You can contact the National Center for Health Statistics at 6525 Belcrest Road, Hyattsville, MD 20782. Telephone: (301) 436-8500.
Agency for Health Care Policy and Research: Expenditure data from the 1996 Medical Expenditure Panel Survey (MEPS) is slated to be released this fall. The data can be used to estimate expenditures for 16 service categories, including physician office visits, medical equipment, and supplies. Information about MEPS is available on-line at www.ahcpr.gov. Some files will be available for downloading from the Internet; you can also get them on CD-ROM or diskette. Contact AHCPR at 2101 E. Jefferson St., Rockville, MD 20852. Telephone: (301) 594-6662.
3. Consultants, software firms.
If you decide the free stuff isn't going to cut it, you can always turn to a consultant or proprietary software firm. If you're willing to pay for it, they've probably got exactly what you're looking for. Here are a couple of examples of what's available:
Iameter, a software firm based in San Mateo, CA, deals exclusively in severity-adjusted clinical data that track patients across the continuum, says Andrew Larkowich, chief operating officer. (That's another benefit of the proprietary data: it's adjusted and crunched to fit your criteria, such as hospital size or region). The data are adjusted to take into account complicating conditions patients might have so you can truly compare apples to apples. Iameter can profile how a physician treats a specific illness to identify where he provided the most efficient care and what his treatment pattern has been historically. The company can create estimates of what a specific treatment should cost and can do automated telephone surveys to assess patient satisfaction. Iameter doesn't sell the data separately from participation in its system. Contact Iameter at 901 Mariner's Island Blvd., Suite 565, San Mateo, CA 94404. Telephone: (650) 349-9100.
Mecon, a benchmarking firm in San Ramon, CA, offers operational data at the clinic and physician level as well as consulting services to help you make changes based on the information, says Eleanor Anderson-Miles, director of corporate communications. You can buy participation in the database, which includes up to 36,000 data points for each of 600 to 700 participating institutions, without the consulting services. The data remain current; anything older than 12 months is flagged off for use in trending. A long list of data arenas includes emergency departments, urgent care centers, air transport, general medicine, gynecology, oncology, orthopedics, and women's health. Examples of benchmarks you can look at are patient exam spaces, staff hours worked, average wait time for initial visits, or dollars spent on clinical support. For more information, contact Mecon at 200 Porter Drive, Suite 100, San Ramon, CA 94583. Telephone: (510) 838-1700.
Evanston, IL-based Sachs Group offers ambulatory benchmarks related to physician staffing and procedures. Sachs can estimate your current and future need for physician staff and provide national benchmarks on staffing ratios. The company can also give you current and forecasted numbers of ambulatory procedures performed for specific populations in specific geographic regions. (See chart on p. 136 for sample numbers comparing Chicago to the rest of the United States.) Those numbers take into account local variation and insurance mix. Contact Sachs at 1800 Sherman Ave., Evanston, IL 60201. Telephone: (847) 475-7526. Web site: www.sachs.com.
4. Associations, collaborative projects.
The Quality Indicator Project of the Maryland Hospital Association offers benchmarking among more than 1,000 hospitals around the country. Hospitals may submit data for five ambulatory indicators: unscheduled returns to the emergency department (ED), registered patient time in the emergency department, ED cases where discrepancy between initial and final X-ray reports required an adjustment in patient management, registered patients who leave the ED prior to completion of treatment, and cancellation of ambulatory procedure on the day of procedure. Reports are customized so hospitals can compare themselves to a narrowly defined peer group, says Nell Wood, director of marketing and communications. Hospitals must pay a membership fee to access the specific data and support that comes with it, but some aggregate data are available on the MHA Web site at www.qiproject.org. Contact the QI Project at 1301 York Road, Suite 800, Lutherville, MD 21093-6087. Telephone: (410) 321-6200.
The American Hospital Association offers a publication called Hospital Statistics, which includes information about outpatient visits. You can order it on-line at www.aha.org or contact the AHA at 1 North Franklin St., Chicago, IL 60606. Telephone: (312) 422-2162.
The Institute for Healthcare Improvement did one of its collaborative breakthrough series projects on reducing delays and wait times in physician offices. Contact IHI at 135 Francis St., Boston, MA 02215. Telephone: (617) 754-4800.
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