Care Transformation Center Blog

3 steps to cutting down on 100s of pages of paperwork

by Veena Lanka and Anna Johnston

While many of us typically mark our calendars to remind us of birthdays and wedding anniversaries, there's another milestone anniversary happening this year that most of us probably didn't celebrate: the 10th anniversary of Ongoing Professional Practice Evaluation, or OPPE.

The Joint Commission introduced OPPE in 2007 as a way to monitor the performance of individual physicians more often than it could through biennial re-credentialing. It was also intended to raise physician awareness of their professional performance and engage them in performance improvement.

Despite having a very worthy goal, OPPE's burdensome annual reporting requirements have yielded a very different outcome. Most providers have found the administrative burden it places on clinical staff to be at best, frustrating, and at worst, unbearable.

One organization Advisory Board worked with spent 92 days a year manually creating, screening, reviewing, and filing OPPE reviews, which amounts to 920 days total across the last decade. That number might sound shocking, but in our experience it's pretty close to average for organizations that struggle with a manual review process. And after spending such a large amount of time creating and filing reviews, it's hard to find additional time to work with physicians individually on performance improvement—which misses the original intention of OPPE.

So how do providers avoid becoming mired in paperwork and stalled on tedious administrative tasks? In our observations over the past 10 years, we've found the following three-step process works best when trying to streamline and improve OPPE reporting:

Step 1: Choose hospital-wide and specialty-specific metrics

When it comes to selecting metrics, many organizations find this step particularly frustrating. It's important to pick measures that are truly indicative of overall provider performance. But caught somewhere between using obscure clinical measures that need to be tracked and pulled manually, or drowning in a sea of hundreds of measure choices, most organizations don't know where to begin.

Using claims data as a starting place to find common, relevant measures by specialty helps simplify the process. These data points are readily available, and they allow medical staff to go to physicians with options, rather than choosing measures from a blank slate.

Step 2: Develop a clear, concrete review process

When it comes to having a clearly defined review process, this is the step that many organizations find the most time-consuming. A best-practice OPPE review process should not only streamline administrative tasks but also make it easy for physicians to participate in the process and have access to timely, accurate performance data. A well-defined process can also help support standardized decision-making. If the Joint Commission were to ask your clinical staff today how they process physician outliers, would they all give the same answer?

Case in point: OSF HealthCare, an eight-hospital system where each hospital used to have its own methods for fulfilling OPPPE requirements, with no standardization across the system. They invested in an OPPE analytics tool and developed new step-by-step guidelines to standardize report generation, reviews, and sign-off, and rolled it out across the entire system. Not only did the system see a drastic 500-hour reduction in time spent on the OPPE process per cycle, but consistency between hospitals increased and they saw improved engagement and cooperation between quality staff and physicians.

Your OPPE questions, answered

Step 3: Share data on an ongoing basis

This last step is, in our opinion, the most important one, and the one most often omitted by time and resource-constrained organizations. The harsh reality is that even if an organization is able to free up some time on OPPE reporting, that extra time would be spent putting out the next fire, or staffing against other priorities.

Knowing how difficult it is to set aside time for performance conversations, our advice is to keep it simple. Share data with physicians on a regular, ongoing basis so that small issues can be tackled in the moment, rather than letting them build up across the year. And make it easy for physicians to access their own data on their own time. Physicians are life-long learners; if you provide them with the tools to monitor and engage with their data, they can catch issues as they arise and proactively bring them to the fore for resolution.

Looking back

Looking back over the last 10 years since OPPE launched, we see that it's been a bumpy ride. Nonetheless, some organizations have been able to take the bitter lemons of mandatory performance reporting and make lemonade.

Rather than simply view OPPE as another box to check, these organizations embrace the spirit of OPPE and use it as an opportunity to help providers improve their performance on an ongoing basis. It's not an easy road, but getting it right results in better physician engagement, improved organizational alignment around cost and quality goals, and better overall care for the patients.

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