Compelling Clinic Metrics 111711 Linked In

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Compelling Clinic
Metrics

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
• dmanning@eidebailly.com

www. e ideba i l l y.c om


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

Higher
(Low cost)

Efficient

Lower
(High cost)

Lower Effective Higher



Efficiency and Efficacy of Clinic Metrics

Higher
(Low cost) Measure #1

Efficient
Measure #3

Lower Measure #2
(High cost)

Lower Effective Higher



Common Types of Measures:
1. Measures of Productivity

2. Measures of Contribution

3. Measures of Quality

4. Measures of Business Operations



• 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”


(Defined as the business performance of
the clinic or organization unit inclusive of
providers and other support staff)

Garmin, “Managing Quality”


Grading
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



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



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



Never 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



• 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



• 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



1. 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



7. 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 Blocks
Example of 20.1 WRVU's - Daily WRVU Target

Existing Patient New Pt Other
E&M's E&M's Proc

1 1 1

1 2 1
1

1
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1

1 2 3 4

1


Back to Basics

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

14:30

15:00

15:30

16:00

16:30
8:00

8:30

9:00

9:30

Room 1 LUNCH

Room 2 LUNCH



Back to Basics

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

14:30

15:00

15:30

16:00

16:30
8:00

8:30

9:00

Room 1 1 2 3 9:304 5 6 7 8 LUNCH 1 9 10 11 12 13 14

2 Room Option

1 2 1 1 1 1
1 1
Room 2 1 LUNCH 1 2 3 4



Back to Basics

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

14:30

15:00

15:30

16:00

16:30
8:00

8:30

9:00

9:30
1 1
Room 1 1 1 4 7 LUNCH 1 9 11 13

1 1
3 Room Option 1 1
Room 2 3 6 LUNCH 1 10 4

2 1
Room 3 2 5 8 LUNCH 2 3 12 14


We used many metrics in assembling the
schedule:
• CPT Procedures
• WRVUs
• Benchmarks
• Schedule hours (appointments, slots, etc.)
• Staff hours



Recap
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
• dmanning@eidebailly.com

Thank you for your kind attention.


Physician Clinic Profitability

Who Has the First
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Compelling Clinic Metrics 111711 Linked In

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