1. Review and analyze clinical outcomes

Review the physician's case mix/stratification compared to like specialties within the same jurisdiction. Drill down into tertiary specialties (tight groupings of similar practices based on what the physician is actually doing). For example, whether their primary certification is orthopedics or neurology, if the claims data shows a high volume of spine surgery procedure codes, that's the group to which they will be compared. Define inclusion in these groups by actual treatment codes in claims and bills.

Look at statistical measures of claim and paid data. Review claim duration. Claims have a beginning, a middle treatment period, an observation period, and an ending. An inability to close claims can be tied to multiple stakeholders: the injured worker, the claims team, and the doctors. However, a doctor that has a high association with claims that don't close timely could be an indicator of a challenge with patient engagement. It's important to have a claim duration that's reasonable and to have that claim closed after appropriate treatment. Analyze the incurred total expense, as there is far more to the total cost of a claim than just the price of one or more procedures. TTD (Temporary Total Disability) days are equally as important as getting someone back to work, and increasing activities will shorten treatment and yield better results. Note the litigation rate of that physician to find outliers. Review the recidivism rate, that is, the reopening of the claim after it's closed.

Special Reports /

Quality doctors matter: How physician scorecarding improves Workers’ Comp outcomes