Compelling Clinic Metrics 111711 Linked In

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Compelling Clinic

Metrics

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Compelling Clinic Metrics

• David Manning, CPA,

CMPE

• Manager in Health Care

Consulting, Eide Bailly,

LLP

• Former manager of

several clinics, both

hospital-owned and

private practice

• T. 701-476-8334

• [email protected]



Why did I choose “Compelling”

Compelling means:

• Forceful

• Powerful

• Convincing

• Persuasive

• Demanding Attention



The underlying idea:

“There is no substitute for knowledge.”

and

“You can expect what you inspect.”

- Edward Deming



Questions:

So, what do we measure?

How do we in turn that information into

knowledge?

How do we use the knowledge in managing

a clinic?



Would you board a commercial flight without

RADAR?

Or a merchant ship?





Without regular reporting and benchmarking,

you’re flying blind.




Granted, instruments and data do not fly the

plane – a good pilot is necessary for that.

But a good pilot

would never take

off without working

instruments.



What makes a good metric?

Possible Criteria:

• Objective (vs. Subjective)

• Transparent (Verifiable)

• Independent

• Discrete

• Cyclical

• Stable

• Comparable (Common denominator)



Pros & Cons Analysis:

Pros:

• Ease of collection

• Immediacy to behavior

Cons:

• Expense to collect

• Multiple causes

• Elements beyond control of employees

• Difficult linkage to behavior



Efficiency and Efficacy• Efficiency is defined as maximizing profit for the

given disposable resources.

• Efficacy is defined as the power or capacity to

produce a desired result (i.e., effectiveness).

• It is possible to be effective while being inefficient,

to be efficient while being ineffective, to be both,

and (unfortunately) to be neither.



Efficiency and Efficacy of Clinic Metrics

Lower Effective Higher

Higher(Low cost)

Efficient

Lower(High cost)



Efficiency and Efficacy of Clinic Metrics

Lower Effective Higher

Higher(Low cost)

Efficient

Lower(High cost)

Measure #2

Measure #1

Measure #3



Common Types of Measures:1. Measures of Productivity

2. Measures of Contribution

3. Measures of Quality

4. Measures of Business Operations



1. Measures of Productivity

• Productive Efficiency

(Ratio of what is produced to what is

required to produce it)

• Productive Capacity

(Ratio of used to installed productive

capacity)




(Defined as the part played by a person or

thing in bringing about a result or helping

something advance)


(Transcendental view, Product-based view,

User-based view, Manufacturing-based

view, Value-based view, etc.)

Garmin, “Managing Quality”



4. Measures of Business Operations

(Defined as the business performance of

the clinic or organization unit inclusive of

providers and other support staff)

Garmin, “Managing Quality”




Productive Efficiency:1. Gross Revenue per provider

2. Contractual adjustments per provider

3. Net Revenue per provider

4. CPT procedure code volumes per provider

5. Work Relative Value Units per provider

6. Ambulatory encounters per provider

Grading




Productive Efficiency:7. Gross Revenue per provider FTE

8. Gross Revenue per staffed & available patient

schedule hour

9. Work Relative Value Units per provider FTE

10. Work Relative Value Units per schedule hour




Productive Efficiency:11. Ambulatory encounters per provider FTE

12. Staff Hours per provider FTE

13. Staff Hours per provider WRVU

14. Staff Hours per schedule hour




Productivity Capacity:1. Provider Full Time Equivalent (FTE = hours

worked per week/normal number of weekly hours

for full time employee)

2. Provider clinic days per week/month

3. Schedule hours (staffed & available) per

week/month (e.g. appointments, slots, etc.)

4. Patient appointments per day (per week,

average/day, etc.)




Productivity Capacity:5. Ratio of filled to available scheduled

appointments (staffed & available)

6. Wait time to next available scheduled

appointment

7. Walk-in appointments per day/week

8. Ratio of filled to available walk-in appointments




Helping to advance a goal or bring

about a result:1. Participation in medical staff activities

2. Staff supervision or mentoring (mid-levels,

residents, etc.)

3. Timely completion of charting activities (hospital

& clinic)

4. Uncompensated administrative duties

(directorships, committees, education, etc.)




Helping to advance a goal or bring

about a result:5. Uncompensated care activities (outside of

organization)

6. Community involvement

7. Marketing and networking activities

8. Public support of organizational mission &

objectives



3. Measures of QualityNever an easy subject – many different views:

• Transcendental - cannot describe, but you know it

when you see it

• Product-based – quantifiable and measurable

characteristics used to define quality (PQRS/PQRI)

• User-based – that which best satisfies the consumer

defines quality

• Manufacturing-based – products best conforming to

design and delivery standards define quality

• Value-based – defined by consumer in terms of service

experience and price



3. Measures of Quality• PQRS (formerly PQRI) measures – Examples:

Diabetes Melitus: Lipid Profile within last

18 months

Asthma: Tobacco Exposure Screening

Queried within last 12 months

Asthma: Tobacco Use Screening Queried

within last 12 months

Hypertension: Plan of Care documented

within last 12 months



3. Measures of Quality• PQRS (formerly PQRI) measures

• E&M Code Distribution by provider

• Patient satisfaction survey

• No-show appointments

• Patient willingness to see next available provider

• Trend monthly referrals by referring provider

• New patient appointments



4. Measures of Business Operations1. Total Accounts Receivable (A/R) by aging

category

2. Days in A/R

3. Active A/R (versus A/R in outside collections)

4. Total Staff Hours

5. Total Staff Hours per ambulatory encounter

6. Total Staff Hours per patient schedule hour



4. Measures of Business Operations7. Business & Clinical staff hour splits (above

metrics)

8. Average days to file clean claim

9. Days from payment receipt to posting in system

10. Adjustment codes for past timely filing

11. Financial performance to budgeted performance

12. Referral source trend analysis



What can you do with Compelling Clinic

Metrics?Whatever metrics you use, they must be:

- Understood by providers

- Objective (not subjective by data gatherers)

- Reliable (stable)

- Re-calculable (transparent)

- Linked to behaviors under the control of

providers and/or clinic staff



What can you do with Compelling Clinic

Metrics?Whatever metrics you use, they must be:

- Reported regularly & consistently

- Presented with prior periods

- Visual presentation (graph), if possible

- Focused (suggestion of 6-10 metrics)



What can you do with Compelling Clinic Metrics?

Benchmarking (using external comparisons)

• Useful for assessing current performance and

setting future performance goals

• Useful for gaining consensus among providers

and clinic staff

• Sources:

1. MGMA

2. AMGA

3. State associations

4. Applicable specialty associations or organizations




Benchmarking (using internal benchmarks)

• Useful over time for monitoring change and

progress toward goals

• Useful for comparing performance between

providers within the organization

• Wide range of metrics are available without

regard for external benchmark parameters




Planning Daily Clinic Schedules

• Establish annual/monthly/weekly/daily production

goals

• Use these goals to build a clinic schedule from

the bottom up




Setting Productivity Goals

MGMA Median

Specialty Annual WRVU's

Family Practice without OB 4,819

Weeks per year 52 weeks

Less: CME -2 weeks

Less: PTO -4 weeks

Less: 5 Holidays -1 weeks

Net clinic work weeks 45 weeks

Total WRVUs per week 107.1 WRVU's

Clinic days per week 4 days

Total WRVUs per day 26.8 WRVU's

Non-clinic WRVUs 25%

Clinic WRVUs per day 20.1 WRVU's




Sample Family Practice Production - 6 month period

6-Month 2011 CMS 6-Month Percent of Estimated

CPT Description Count WRVUs Tot WRVUs Tot WRVUs Daily Count

17000 Destruct premalg lesion 5 0.65 3.25 2% 1

17003 Destruct premalg les 2-14 3 0.07 0.21 0% 1

17110 Destruct b9 lesion 1-14 4 0.70 2.8 2% 1

99202 Office/outpatient visit new 2 0.93 1.86 1% 1



99211 Office/outpatient visit est 1 0.18 0.18 0% 1



99214 Office/outpatient visit est 16 1.50 24 16% 4


147.47 28




Planning Daily Clinic Schedules

• Go ahead, assemble your day…



Back to Basics

with LEGO Building BlocksExample of 20.1 WRVU's - Daily WRVU Target

Existing Patient New Pt Other

E&M's E&M's Proc

1 1 1

1

1

110 11 12 13 14

1 2 3 4

4 5 6 7 8 9

1 2

1 2 3

1

1



Back to Basics

with LEGO Building Blocks

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Back to Basics


2 Room Option

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We used many metrics in assembling the

schedule:

• CPT Procedures

• WRVUs

• Benchmarks

• Schedule hours (appointments, slots, etc.)

• Staff hours



Recap1. Measures of Productivity



4. Measures of Business

Operations

“You can expect what you inspect.”



And finally, remember:

If you link compensation to performance…

Physicians become very interested in metrics and

reporting.

• Who

• When

• Where

• How

• Why


Physician Clinic Profitability

• David Manning, CPA,

CMPE

• Manager in Health Care

Consulting, Eide Bailly, LLP

• T. 701-476-8334

• [email protected]

Thank you for your kind attention.


Physician Clinic Profitability

Who Has the First

Question?

Compelling Clinic Metrics 111711 Linked In

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