The Proof Is in the Data Collecting and analyzing client data can document your value and provide leverage with payers. In Private Practice
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In Private Practice  |   April 01, 2017
The Proof Is in the Data
Author Notes
  • Shannon Butkus, MS, CCC-SLP, is executive director of Butkus & Associates, Inc., which provides pediatric speech and language services in and around Houston. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. shannon.butkus@butkusandassociates.com
    Shannon Butkus, MS, CCC-SLP, is executive director of Butkus & Associates, Inc., which provides pediatric speech and language services in and around Houston. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. shannon.butkus@butkusandassociates.com×
Article Information
Practice Management / In Private Practice
In Private Practice   |   April 01, 2017
The Proof Is in the Data
The ASHA Leader, April 2017, Vol. 22, 42-43. doi:10.1044/leader.IPP.22042017.42
The ASHA Leader, April 2017, Vol. 22, 42-43. doi:10.1044/leader.IPP.22042017.42
As a private practitioner, you may think collecting data on your clients and services is a luxury that you just don’t have time for. Think again, because data collection gives you the tools to help your bottom line.
I have used my practice data to successfully postpone a rate decrease with a private insurer, negotiate a higher rate with another, and also earn a pay-for-quality incentive.
But let’s start at the beginning. When I started my private practice 10 years ago, I aimed to establish a career and maybe hire one or two speech-language pathologists along the way. I never expected that I’d ultimately hire a staff of 10 SLPs and that, over time, I’d morph into an administrator rather than a practitioner. Yet here I am.
I’ve known all along that running a business isn’t easy. I took a few elective economics courses as an undergrad and clearly remember my professors saying that being an entrepreneur isn’t for the faint of heart. Starting a business takes a tremendous amount of work, and it’s even harder to adapt to change. But change is inevitable, and failing to think beyond the present is undoubtedly a danger to long-term viability.
One of my greatest challenges has been the need to change as a result of health care reform. In the beginning, I didn’t really know how reform would affect my practice. But I knew the talk of a paradigm shift in service-delivery models involving outcomes, value-based purchasing and alternative payment models would mean my practice might have to evolve.
One of the first decisions we made was to keep data about our practice patterns. The data were pretty rudimentary at first: We kept track of our patients by insurer, the diagnosis and procedure codes we billed for all patients, and the length of time from admission to discharge for each patient. At that time, we didn’t use any fancy statistical software—we simply kept an Excel spreadsheet.

I knew the talk of a paradigm shift in service-delivery models involving outcomes, value-based purchasing and alternative payment models would mean my practice might have to evolve.

Successful appeal
That was the best decision we could have ever made. About six months after we starting keeping consistent data, an insurer sent us a notice of a reimbursement rate reduction. The insurer had warned us it was coming, but we didn’t expect it so soon because we are a relatively small practice. I called the insurer to ask why we were one of the first companies to receive the notice, and the response was quite simple. According to their data, my practice had “atypical” billing patterns.
I was shocked. I’d spent years building a business I could be proud of and those were the last words I ever expected to hear. I dug deeper until I identified the rubric the insurer used to analyze providers. As it turns out, the insurer considered only the number of visits billed per patient, with no regard to patient diagnosis codes. I knew right away I had the information I needed—my patient data—to defend my billing patterns.
At that time, more than 80 percent of our clients had an organic speech and language delay, most with autism, cerebral palsy or Down syndrome. I knew that the law prevented insurers from discriminating against providers who treat patients with more advanced needs. Using that information, I successfully argued that unless the insurer could demonstrate that it had compared my billing practices to other practices whose clients had similar needs, it was discriminatory to have used that particular metric. The health plan conceded it had not compared my practice to like practices and agreed to delay the implementation of the rate reduction for several months.
I learned a lot from this experience. Although the rate cut was inevitable—it was a network-wide reduction—I successfully used data about my practice patterns to delay the rate adjustment. By using my data to defend my practice patterns, I gained confidence that the decision to keep data had been prudent.

We can tell you our per-session practice expense, as well as the total amount we’ve been reimbursed by an insurer for any given patient.

Reimbursement and quality success
Since that time, we’ve become more savvy data-keepers. I enrolled in a PhD program in health-services research to learn more about statistics and economic analysis. We now use more complex statistical software and keep additional data: referral sources, reason for admission and discharge, total number of treatment sessions, attendance patterns, patient case mix and a host of other information, including cost to provide care—that is, we can tell you our per-session practice expense, as well as the total amount we’ve been reimbursed by an insurer for any given patient. We’ve used this information repeatedly to demonstrate our value as a member of the patient care team to insurers, and we recently negotiated an increase in our reimbursement rates—across all diagnosis and billing codes—with an insurer.
We’ve also used our data to earn a pay-for-quality (P4Q) incentive (a Medicaid pilot program in Texas). P4Q programs reward providers based on their performance on certain quality measures, which are usually quite rigorous and focus on process improvement. We used the baseline assessment from the P4Q program to identify our areas of weakness, prioritize areas for process improvement, set goals to accomplish our targets, and chart our progress toward achieving the goals. By the program’s second reporting period, we had successfully met each of the required quality measures, earning us an increase in payment rates for all our patients.
Although it was a tremendous amount of work to implement, I’m glad we took the initiative to evolve as a practice. To each of you who owns a private practice or is thinking about starting one, I’d challenge you to capture data so that your practice thrives well into the future.
Hands-On Data Collection at Private Practice Connect

Shannon Butkus will present on collecting patient and practice-pattern data at ASHA’s Private Practice Connect, to be held July 7–9 in New Orleans.

A new feature of the conference is combination lecture-lab sessions. In her combined session, “The Importance of Data: Tracking Your Patient and Practice Patterns,” Butkus will address the need for health care analytics that demonstrate the value of speech-language pathology services to payers.

Following the presentation, Butkus will lead a hands-on learning lab, in which participants will learn how to create and use a spreadsheet to track patient and provider practice patterns.

Butkus will also present “How to Thrive in the New Reimbursement World,” a session that explores alternative payment models, their financial impact on private practices, and the need to consider alternative practice patterns.

Private Practice Connect, co-located with Schools Connect and Health Care Connect, is designed specifically for private practice owners. Attendees may attend sessions at any of the three conferences.

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April 2017
Volume 22, Issue 4