Identifying and measuring key performance indicators is the first step a practice manager needs to do in order to implement data-driven management in their healthcare organization.
Nate Moore, CPA, MBA, FACMPE, president and chief executive officer of Moore Solutions Inc., looks at medical practice data from an analytical perspective to show practices how to improve operations and profitability.
“It’s all about using your data in ways that can change the way your practice sees your business … the way it sees your physician operations,” Moore says.
As I’ve written for MGMA Connection magazine in the past, a financially successful practice is not always the one that slashes costs. In recent years, a closer look at successful practices has shown a pattern of higher productivity, more revenue and somewhat higher operating costs yields the best bottom line.
Moore notes that cutting expenses is easy, but that revenue is a bigger driver of a practice’s financial health, and by being focused on making physicians and other providers more effective and efficient is the key to building revenue. “There are a lot of things we can control that can leverage physician productivity without just saying, ‘Hey, the doc’s got to work harder,’” Moore notes.
There are trade-offs, however, in optimizing provider schedules to maximize patient access and the number of visits and billable claims. That may entail taking more control over scheduling away from physicians to fill the schedule — but first you need the data that backs up schedule changes.
“If you can see your appointment data, you can see the future,” Moore says. If you can point to no-shows occurring more often on certain days and other patterns, it frees the practice to double book. Similarly, blocking off too much time for unsold appointments will cap patient volume. As I mention in Benchmarking Success: The Essential Guide for Group Practices, measurement and benchmarking are essential for the descriptive, comparative and contextual work that leads to improvement in practice management.
As Moore mentions, a February 2018 MGMA Stat poll reports that only 38% of practices use a system-generated report to track past open appointments and another 12% use a custom report. “About half of them don’t have visibility to unsold appointments,” Moore says. “It’s as if a plane has taken off with empty seats and you don’t know it, and if you’re not measuring it, you can’t manage it.”
It starts with the data
Whether part of an existing EHR or practice management system or something you require additional IT support to procure, Moore says that the investment in accessing your existing appointment data has the greatest benefit in guiding a COO in leading practice operation improvements.
Moore recommends storing open appointment data over time to allow for tracking by date, time, provider, location and appointment type, and then capturing information on why the appointment was open: Was the slot never filled, canceled on short notice or simply a no-show? These data points then allow for trending to identify days of the week with the most open slots, as well as whether your unsold appointments are increasing or decreasing.
Building culture
Obtaining the data and beginning analysis is important for an executive to guide not only decision-making, but to enable the organization to have a cultural shift around those decisions. Moore suggests that dashboards, once they reflect the KPIs that are most important to the organization and its mission, be widely shared whenever possible.
“Sometimes we’re a little to protective of the information,” Moore says, especially as it relates to provider productivity. “I think folks are naturally competitive, if we can only get them the right information” on where they rank among their peers in terms of productivity.
Practice leaders on the administrative side also are served by taking a micro-level view of staffing to understand the issues affecting physician productivity, especially when support staff levels have been diminished.
Recalling a conversation with an annual conference attendee, Moore noted that listening to providers explain where their hurdles are — waiting for x-rays to come back, for example — gives your practice’s administrators more credibility by demonstrating they are listening to issues and addressing pain points to get the most from a physician.
“We go back and say, ‘Hey, you should have worked harder,’ and blame the doctor, when in reality we didn’t give the doctor the resources they needed,” Moore said regarding nonphysician provider and support staffing issues, which includes the vital role played by front-office staff.
The right numbers
Time to third next available appointment is regarded as a key metric for understanding patient access. Moore suggests that beyond measuring this metric, practice leaders also look at days to schedule: the difference between the day an appointment is created and the date of the appointment. “That’ll tell you how hard it is to get in to see a provider,” Moore says, which is all the more vital in a world of growing patient consumerism.
“If you are a primary care practice and your patients can’t get in … they’ll go elsewhere,” Moore says. “And if you’re a specialty practice, the same thing occurs and you may not even know it,” if there is no referral or request for records.
Assessing the wait for a patient to be seen extends to the micro-level, as well: Numerous practices now have some sort of wait time displayed for specific providers in their front office, akin to airport flight departure tables. “Most practices I show that to are like, ‘Man, you’re crazy.’ … But your patients aren’t stupid. They know they’ve been waiting for 30 minutes,” Moore contends. Providing that knowledge is better than a patient “sitting there, flying blind,” and helps show your patients that you are focused on them despite a wait.
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