Pinnacol recently interviewed Tony Baker, relationship manager with Aviation & Occupational Medicine. This clinic has a five-star rating in our Clinic Provider Initiative (CPI). Here are Baker's thoughts on CPI and how other clinics can be successful.
What was your initial opinion of the CPI?
We were somewhat daunted at first, as many of the performance metrics focused more on the administrative functions of a "well run business" than they did on simply "providing good medicine." It's fairly universally agreed that doctors aren't great businessmen, so coming to terms with the specific requirements of the administrative piece was a challenge for us.
Ultimately, it required a meeting with our provider relations team for us to truly understand how "good paperwork" from our office gave the claims management team better tools for success in doing their jobs timely and accurately. Or, put another way, what we learned was how "bad paperwork" from our office created additional work and delays for the claims team and ultimately, additional work for our staff as Pinnacol had to contact us frequently for additional information or clarification. It did require a re-working of some of our internal work-flow processes, but it has now become our standard operating procedure. All of these changes have resulted in a much better partnership with Pinnacol.
What was your opinion of CPI after the first data publication?
We worked very hard and constantly monitored the quality of our CPI performance, both online and internally from the program's inception – so the initial data publication was not a great surprise to us. We also took the time to appeal the data and had the benefit of reviewing the documents that did not meet the criteria for quality. That information was used to further critique and improve our internal processes, resulting in fewer failed documents in the next reporting period. The data appeal process was very simple, though somewhat time consuming, as we literally reviewed every single document that failed. We felt that the outcome of the appeal was fair and appropriate.
What do you think now?
Certainly the monetary performance bonus offered by Pinnacol is a great incentive, but equally important is the ability to compare (in a tangible way) our clinic's performance against that of our peers. This has been a great motivator for our staff and physicians, and they take great pride in knowing that their extra efforts are being noticed. We have also seen an increase in designations by policyholders, and most recently we're hearing from the policyholders that our five-star rating was one of the primary factors in choosing to work with our clinic. Overall, we believe that participating in the CPI has been very beneficial to our clinic.