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The MedMetrics blog provides comments and insights regarding the world of Workers’ Compensation, principally, issues that are medically-related. The blog offers viewpoints regarding issues affecting the industry written by persons who have long experience in the industry. Our intent is to offer additional fabric, perspective, and hopefully, inspiration to our readers.

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Thursday, July 19, 2018

If You Don't Know Where You're Going, You Might Land Somewhere Else

by Karen Wolfe

If you don’t know where you’re going, you might land somewhere else. It may at first seem like a senseless phrase, but research, planning, and goal-setting are important directional steps in both our personal lives and in business. The alternative is to react impulsively as events occur and conditions change following no particular plan or strategy. That sort of seat-of-the-pants approach insures landing off course.

Past is prologue
Even more importantly, without analysis of past performance, organizations will miss opportunities for designed excellence. If you don’t know where you’ve been, you could land somewhere else. Actions might be habit-based and detrimental in this fast-paced world.

Decisions and actions will be miscalculated when they are based on mere recollection of the past. Analyzing and understanding the past using technology tools is the way to gain insights that lead to knowledgeable actions going forward. That means analyzing the past to identify pivotal conditions and develop competitive or profitable responses.
Analytics of past performance will notify organizational leaders of conditions that should lead to strategic actions. Alerts are sent to the right persons at the right time regarding current situations with pre-planned initiatives.

However, simply studying the past is not enough. Too many organizations stop at the data analysis stage, missing the opportunity to maximize efficiency, accuracy, and profitability gained through applying analytics-informed insights. The insights gained through analysis should be conveyed to those making daily decisions for the organization. Still, there is a prerequisite to successfully leveraging analytics to inspire intelligent action.

Spoiler alert
The spoiler for analyzing history to design the future is the organization’s data. Data must be accurate and complete to be reliable and worthy of logical planning based on it. For years the Workers’ Comp industry has focused on and relied upon billing and payment data. Most of it is accurate enough to pay bills, however, in this new age of analytics, gaps in data are obvious and sometimes crippling.
For instance, incomplete medical provider data in payer systems can be explained by the fact that in the past only an address and tax ID were necessary to pay a bill. But now analysts are asked to determine which providers are best, particularly for treating and appropriately managing injured workers. Such decisions cannot be made based on an address and tax identifier and making judgements based on inaccurate and incomplete data is perilous. In particular, medical provider data is often too lacking in quality and accuracy to be used in assessing medical quality.

Missing and misleading data

Provider name and address remain critical to performance analysis. However, the address on the bill should be the treatment rendering address rather than a PO Box. Granted, medical providers often list the PO Box because it is the location of accounts receivable, but it is no longer acceptable as the only address submitted with the bill. The rendering address is important to convenience for injured workers and employers, but it also is important in distinguishing individual providers and their practice patterns.

CMS (Centers for Medicare and Medicaid Services) requires the physician NPI (National Provider Identification) on all bills, as do all general health payers. The Workers’ Comp industry has not followed suit but now it must require NPI numbers. The NPI is essential for recognizing individual providers in all their rendering locations found in the data and distinguishing individual providers in group or facility settings.

The NPI is also crucial for assigning medical specialties when that significant data element is missing as it often is. Fortunately, the specialty can be ascertained from the CMS NPI. By insuring the organization’s data includes these few critical data elements, identifying the best medical providers and establishing outcome-based networks can be a straightforward and reliable process.

Understanding the past is essential to intelligent development and consistent execution of organizational planning. Analytics relies on accurate and complete data to inform the best business strategies. Moreover, accurate and complete data is the tipping point because without it, the organization will land somewhere else.

Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation, predictive analytics-informed medical loss management and technical services company. MedMetrics offers intelligent medical management systems that link analytics to operations, thereby making insights actionable and the results measurable. karenwolfe@medmetrics.org