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The senior management team of Efficient Network HMO is evaluating the year-end data related to emergency room (ER) expenses. One physician group within the network had ER expenses that were three times the rate of any other group within the network. Senior management has studied group operations and theorizes that three factors are influencing the high rate of expense. The group does not utilize triage nurses, does not have after-hours urgent care services, and has limited office hours from 8:30 to 11:30 a.m. and 1:30 to 5:00 p.m. An answering service, not staffed by nurses, relays calls during the remainder of the hours.
The physician group is willing to work on the problem but is asking for detailed, comparative information from the HMO’s senior management team before it implements any changes. How would you, as the clinical data specialist for the HMO, answer the following questions:
What information would be useful to the senior management of the HMO and the physician practice in evaluating the ER expenses?
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