Getting More Value Out of Physician Quality Review

Bending the trend on cost continues to be a big challenge for Healthcare CMOs, Medical Chairs and Staff, and Quality organizations. One process that is often a prime opportunity for cost outtake is Physician Quality Review. While the process is often tedious and time-consuming, it’s necessary for a health organization’s survival. Medical staff leaders must perform Quality Reviews on all providers on a frequent basis in order to keep their hospital privileges, and to continue to accept Medicare/Medicaid as a payer. However, these review activities sometimes come with a hidden price tag.

Weighing the costs of Physician Quality Review

The Quality Review process is mission critical, but it takes time, resources (financial and human) and focus. However with the right approach, those resources can all be maximized. Here are three important areas to consider when evaluating the effectiveness and efficiency of your Quality Review process.

1) The time it takes

Medical Staff Chiefs and Chairs are expected to be “on” for long periods of time, not only caring for their own patients, but also mentoring providers and completing their administrative work in a standard work week.

The AMA estimates that about 62% of physicians work between 40-60 hours per week, another 18% work between 61-80 hours per week, and 5% work over 80 hours per week. A 2020 Medscape study estimates that the hours spent on administrative work equates to about 16% of a physician’s time. That’s about 1/6 of a physician’s overall productive time spent doing paperwork and other administrative tasks.

Source: American Medical Association


A recent study by Conduent dives deeper into the overall time spent by Medical Staff chiefs and chairs, who are often the highest paid physician resources in a medical staff organization. The study analyzed 10 high-profile specialties across Conduent clients who use out Statit Provider Scorecards, and the data shows that the average cost for each specialty to perform regulatory Physician Quality Reviews twice per year is just under $300K for peer groups of between 20-100 providers.

2) The impact on productivity and cost

Multiple studies have shown that provider satisfaction, and therefore provider productivity, is directly affected by the type of work being done. The American Medical Association and RAND Corporation published a study that providers are in their element when they are delivering high-quality care. Regulations and Electronic Health Record implementations were cited as primary contributors to physician dissatisfaction. It stands to reason that performing administrative Quality Reviews, while important, doesn’t always likely fall into the category of “delivering high-quality care” in the minds of most physicians.

Additional barriers to quality patient care affecting physician productivity are evidenced in the measurement of productivity itself. Measures are implemented frequently by federal, state, and local regulatory organizations and require specific performance thresholds be met in order for providers to be paid for their services. The value-based physician payment system for patient care puts added pressure on providers to do more with less, elevating quality of care and making it a condition of payment. Hospitals rely on data provided by medical staff and quality organizations to analyze and address negative trends and turn them around.

3) The effect on patient satisfaction and patient care

What does the administrative burden of Quality Reviews mean for patient care? The reality is that providers are spending more and more time away from patient care in order to drive improvements in care delivery through performance improvement, documentation, and other administrative tasks. An AMA study shows that an alarming 38% of physicians spent 10-19 hours per week on paperwork and administration in 2018, about 13% higher than the same survey conducted in 2017.

Patients get their voices heard in the larger healthcare space through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Study, which provides patients the opportunity to give feedback on their hospital experiences. HCAHPS is nothing new, but the survey goals and questions have progressed over time to provide key indicators of quality in patient care.  The Communication with Doctors component of the HCAHPS survey still hovers around ~80% across the board nationally. This still leaves enormous opportunity for physicians to improve their quality of patient care — but that’s much more challenging to do when you’re mired in daily admin work.

How improved workflow can change the game

By adopting solutions and driving outcomes focused on improving overall workflow, providers and quality leaders will have tools to save time and money — and enhance their productivity as well.

Healthcare organizations are often quick to move to a business intelligence tool that provides flashy charts and the ability to slice and dice data in various ways. Those are nice, but the key to a successful and streamlined Physician Quality Review process is more about the workflows you employ to get the job done. Since providers only log in a few times per year to perform these Quality Reviews, standardization and repeatability are key to lessening the time leaders spend on performing these important tasks.

By implementing a standardized workflow tool that is both flexible and customizable, health organizations can manage the lion’s share of their administrative tasks through a single interface including things like:

  • Provider Quality Reviews
  • Maintaining accreditation standards
  • Credentialing
  • Focused reviews
  • Contract services

The bottom line

Every healthcare organization wants providers spending more time on care, higher patient satisfaction scores and more revenue. But there’s no simple path to get there. Time savings and overall reduction in costs through workflow-specific tools and software is a great start — and an avenue for healthcare organizations to make incremental progress on achieving their long-term goals.

How Conduent Statit Provider Scorecards can help
Statit’s Provider Scorecards offer standardized workflow tools that are specific enough to easily manage provider Quality Reviews and meet accreditation standards, yet are still flexible enough to be used for alternate reporting needs, like credentialing, focused reviews, and contract services. Our client partners utilize Statit Provider Scorecards to review over 150K providers annually. Batch reviews help to automate reviewer workflow, resulting in time and cost savings of up to 80%. Based on Conduent cost studies, our partners can save on average $235K on semi-annual provider Quality Reviews. For more information, visit us online at Conduent Statit Scorecards.

About the Author

Dustin Richardson

Dustin Richardson joined the Conduent Midas team in 2012 working across multiple disciplines. He is currently a Product Manager for Conduent Midas Health Analytics Solutions. Dustin is also an Agile Certified Product Manager and Product Owner (ACPMPO) and a co-author of "Data-Driven Healthcare Improvement: A Recipe for Provider Excellence," a step-by-step resource for organizations who need a framework from which to understand and master the Provider Quality Review process.

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