Using the Right Metrics to Improve Physician Practice Management
- 1. Using the Right Metrics to Improve Physician Practice Management Drew Franklin, MBA, FACMPE Director of Business & Revenue Strategies ENT and Allergy Associates® Margaret Hargrove, CPC Director, Revenue Cycle ENT and Allergy Associates LLP Sponsored By: Tuesday, March 22, 2016 (12:00 – 1:00 pm Pacific / 1:00 – 2:00 pm Mountain / 2:00 – 3:00 p.m. Central / 3:00 – 4:00 pm Eastern)
- 2. ENT & Allergy Associates Locations 1999 2005 2012 28 MDs, 10 offices 62 MDs, 24 offices 128 MDs, 36 offices 2
- 3. 2015 and BEYOND! 41 Locations – 160+ Physicians! 3
- 4. Practice Overview Originally formed in 1998 when three practices merged creating 12 partners and 8 locations. ENT and Allergy Associates currently has over 170 physicians and 90+ licensed audiologists practicing in 41 office locations throughout New York and New Jersey. 2015 HFMA MAP Award – Physician Practice 4
- 5. Parameters for Success How are the metrics defined? Are performance goals related to best practice standards for revenue cycle? Do you have a documented process flow? Has this been reviewed by your peer groups? Do you use internal and external benchmarks? Do you have a mechanism to not only measure quantitative and qualitative goals, but also a feedback mechanism? Do you have stakeholder buy-in? Do you have a physician champion? Do you own the front desk inputs? Garbage in, garbage out.
- 6. Analytics, Billing & Collections Processes How are the Metrics Reviewed? Daily: The Revenue Cycle Management Department tracks cash ,charges, collections and ‘unbilled’ claims using our Practice Management (PM) system. We have daily benchmarks that must be met. We have established daily goals for the ‘unbilled’ dollars and closely monitor performance. Claims are tracked and logged through our Clearinghouse using the Clearinghouse Dashboard. Continuous Feedback Loop: Business Development team has monthly and bi-weekly meetings to go over physician productivity metrics and practice analytics. 6
- 7. -$5,000,000 $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 10/13/15 10/14/15 10/15/15 10/13/15 10/14/15 10/15/15 Cash Target by Day $9,020,734 $10,148,326 $11,275,918 Month to Date $8,971,786 $10,729,197 $12,837,673 Monthly Target $23,679,428 $23,679,428 $23,679,428 Ahead/Behind Target $(48,948) $580,871 $1,561,755 Tracking the Cash...... $(10,000,000) $- $10,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 $60,000,000 10/13/15 10/14/15 10/15/15 10/13/15 10/14/15 10/15/15 Daily Target $19,840,909 $22,045,455 $24,250,000 Actual Charges Entered $19,492,824 $21,455,630 $23,515,196 Monthly Target $48,500,000 $48,500,000 $48,500,000 Ahead/Behind Target $(348,085) $(589,825) $(734,804) Daily Charge Targets 7
- 8. Analytics, Billing & Collections Processes (cont.) Monthly: The Department tracks the DSO/Days in A/R as a whole, by payer and by SIM Department. The monthly breakdown is shared with the staff through charts and graphs. They are held accountable to take necessary actions to keep their assigned A/R within our threshold. Management meets with staff regarding their assigned insurance carrier. We include our Billing Team so they can incorporate any new claim edits, or modifications to claim edits, that run during the pre-bill process. Management has monthly meetings with our Insurance Provider Representatives to discuss any A/R or Revenue Cycle issues/concerns. Quarterly: Net Collection Ratio (NCR)---we look at our NCR using a Contractual Analysis report from our PM. 8
- 9. Process Development: Key Initiatives for Efficient Revenue Cycle - Billing and Collection 1. Clean claims editing. Billing team to ensure that claims are being submitted free of errors. 2. Implementing denial management process. 3. Uploading insurance rate contracts in PM. 4. Self Pay collection Process: a. Limit the amount of paper statements to patients to reduce cost associated with mailing. b. After two statements and thirty days, the patient’s account is outsourced to a pre-collection agency for one month. This agency represents our practice. After an additional month, the account is forwarded to an outside collection agency where their role is to try to collect payment before reporting to credit bureaus. c. Create electronic payment plans for patients. Use of in-house patient portal, front-end kiosk, and deductible app. 9
- 10. ....SELF-PAY AR INFORMATION We classify patient payments based on how/where the payment is received: With co-pay and deductibles increasing, the use of our patient kiosk to collect at the time of service is critical. Increasing the percent collected by Front Desk and in-house collections over Collection Agencies is more cost effective. Payment Method Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Mar-15 Feb-15 Jan-15 Care Credit 2.50% 2.96% 3.11% 2.41% 1.95% 1.47% 1.08% 1.15% 1.46% 1.24% 1.13% 1.52% Collection Agencies 3.17% 3.58% 3.16% 3.57% 2.53% 2.17% 2.06% 1.73% 1.71% 2.69% 2.87% 2.89% Front Desk at TOS 67.12% 67.18% 66.85% 66.86% 66.77% 65.82% 60.41% 62.00% 62.25% 58.51% 61.43% 65.64% Online through our website 4.56% 4.66% 5.23% 5.29% 6.14% 6.17% 6.59% 5.34% 5.36% 6.22% 5.17% 4.27% Payment/Budget Plans 1.32% 1.33% 1.42% 1.36% 1.34% 1.35% 0.98% 0.99% 0.80% 0.79% 0.73% 0.77% Prompt Pay Discount-- Front Desk 3.21% 2.96% 2.87% 2.63% 2.80% 2.57% 2.57% 2.65% 2.27% 2.64% 2.64% 3.31% Revenue Cycle Phone Queue 3.01% 3.20% 3.36% 3.30% 3.41% 3.58% 3.15% 3.07% 2.97% 3.30% 3.10% 2.71% US Postal Service 13.91% 12.97% 12.79% 13.52% 14.09% 16.24% 22.52% 21.76% 20.46% 23.99% 22.06% 17.26% SRC Team 0.05% 0.04% Percentage of Total Self-Pay Payments 10
- 11. Holding pattern-- waiting to see if pymts rec'd from calls & statements Escallate, Outside Collection Agency, process begins 1st Statement sent via LetterLogic 2nd Statement sent via LetterLogic Holding pattern-- waiting to see if pymts rec'd from statements New Process!! Outbound calls from ENTA on higher balances!! 61-90 Days 91-120 Days 121-150Days 150+ Days0-30 Days 31-60 Days Weekly automated phone calls by Century Mgmt. Pre- Collection Review; reports sent to offices Self-Pay Balance Timeline 11
- 12. Patient Copay, Coinsurance and Deductibles 12
- 13. Home-Grown Deductible Calculator App 13
- 14. ENTA uses various metrics data analytics across various categories which can serve as a checklist for our physicians. They serve as performance benchmarks. These analytical reports are intended as instructive suggestions based on data collection and trend analysis. They are not rules and in no sense represent a standard of care, however averages and medians tell a good story. Key Report/ Data Metrics Practice Optimization Report Individual Physician Productivity Report Practice locations Patient Count Report broken out by Physicians Physician Referral Reports Charges and Collections Reports Utilization Reports across various categories etc. Use of Data Analysis to Gauge Optimization 14
- 15. Rendering status Tot Patients New Patients Ratio Est New PCT NEW Level4 PCT EST LEvel45 Avg TOTPat Per Mth Avg New Pat Per Mth Proc Per Enc Pct E&M w Proc Endo Per Enc Endo Per New PT Endo Per Est PT Cerumen Per Enc Ratio 31231 31575 MD 1 Existing Associate 1860 507 2.67 0.00% 79.44% 265 72 0.82 78.95% 0.42 0.52 0.39 0.26 21.47 MD 2 Existing Partner 2659 1288 1.06 0.88% 38.60% 379 184 0.80 88.22% 0.54 0.63 0.46 0.21 1.99 MD 3 Existing Partner 1819 425 3.28 28.78% 44.95% 259 60 1.02 97.88% 0.77 0.74 0.78 0.07 0.21 MD 4 Existing Associate 2118 900 1.35 0.17% 44.78% 302 128 1.00 84.93% 0.49 0.58 0.42 0.30 4.83 MD 5 Existing Partner 3254 1256 1.59 0.39% 13.29% 464 179 0.71 64.90% 0.41 0.54 0.33 0.25 1.51 MD 6 Existing Partner 2771 1185 1.34 0.00% 44.70% 395 169 0.67 66.03% 0.41 0.49 0.35 0.22 3.45 MD 8 Existing Partner 3204 761 3.21 0.00% 75.87% 457 108 1.02 81.60% 0.67 0.75 0.64 0.19 2.64 MD 9 New Associate 1757 425 3.13 7.38% 15.57% 251 60 1.23 75.84% 0.61 0.73 0.57 0.32 3.52 MD 10 Existing Partner 3464 1268 1.73 0.18% 9.45% 494 181 0.95 72.23% 0.58 0.78 0.47 0.21 1.11 MD 11 Existing Associate 2222 994 1.24 8.28% 24.40% 317 142 0.72 64.28% 0.41 0.50 0.34 0.17 3.92 MD 13 Existing Partner 1956 678 1.88 0.22% 5.29% 279 96 0.73 79.93% 0.36 0.51 0.28 0.34 3.26 Partner Average Existing Partner 2405 755 2.18 4.42% 26.38% 343 107 0.86 78.62% 0.45 0.55 0.40 0.25 3.10 Partner Existing Partner 2401 748 2.11 0.91% 23.85% 342 106 0.81 80.35% 0.44 0.54 0.39 0.24 1.98 Advanced Practice Procedure Optimization Report Empirical Analysis: Below is a sample of ENTA coding optimization report for our ENTs only. It aggregates productivity across categories using existing partner averages as benchmarks. It is an advanced matrix that boils down otolaryngology practice optimization into an algorithm of Procedures, E&Ms, Audio Collections and Hearing Aids per patient, then normalizing for patient volume and comparing to the average. • This is a key tool in delivering physician productivity reviews. Essentially, it is daily work reflected in numbers. 15
- 16. Dashboard – Data Display – Realization Analysis 16
- 17. Dashboard – Data Display – Monthly Summary Analysis 17
- 18. What can practices do to get started Benchmarking? A standardized monthly report to help physician track productivity with the categories of Charges, Collections, Total Patient, Total New Patients, Charges per Patient excluding Surgery, Monthly Surgery Charges, Physician Day Count. Group physicians into peer groupings of no more than 6 like-minded individuals. These groups should reflect similarities in training, start date, location etc. At a glance, this report provides an indication of process, growth and where opportunities needs to be seized and created. Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 TOT 2014 TOT YTD 2014 Doctor A 261,959 178,797 248,647 231,646 219,770 228,207 2,597,659 1,600,017 Doctor B 461,483 426,729 271,544 586,100 579,764 547,645 5,857,907 3,267,217 Doctor C 281,133 243,225 231,654 267,658 276,985 223,041 3,071,345 1,766,361 Doctor D 177,846 188,186 243,033 149,508 4,464 9,168 1,656,057 786,184 Doctor E 423,006 303,542 383,050 337,724 351,362 379,752 4,302,088 2,596,289 Doctor F 130,595 108,512 133,023 107,627 136,024 137,360 1,615,297 887,367 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 TOT 2014 TOT YTD 2014 Doctor A 81,191 72,547 88,029 112,703 97,647 100,025 1,119,383 651,770 Doctor B 134,510 116,617 160,423 116,446 177,023 153,331 1,781,027 984,482 Doctor C 96,844 116,278 126,584 131,396 148,052 112,707 1,471,259 858,999 Doctor D 71,447 61,591 69,903 66,720 32,681 13,982 620,277 322,441 Doctor E 143,429 115,242 150,449 166,529 150,728 132,064 1,724,046 1,009,608 Doctor F 69,143 60,952 68,475 75,747 65,797 72,031 929,697 513,968 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 TOT 2014 TOT YTD 2014 Doctor A 307 296 295 391 383 383 4,138 2,466 Doctor B 360 325 293 401 409 365 4,319 2,525 Doctor C 307 360 334 381 427 329 4,189 2,490 Doctor D 246 228 203 236 24 6 2,273 973 Doctor E 416 343 482 448 427 444 4,954 2,990 Doctor F 268 245 291 268 321 300 3,579 2,002 Monthly Patients Monthly Collections Physician Stats Monthly Reporting Monthly Charges 18
- 19. Understand the inputs – garbage in/ garbage out Start with the data available more easily – patient counts, charges, collections, RVUs Ratio of established to new patients. Clinical vignette There is a tangible difference between a physician who reinforces the need for a patient to come back and the one who just says come back if you are not feeling better. And that difference manifests itself at the back desk. When the back desk says says "When do you want to come back for your next appointment," this is LESS effective than saying "Dr. Jones would like to see in you in 12 weeks, I've got December 9th, is morning or afternoon BETTER? How’s 3:10PM" Physician Referral Reports A/R understanding & Utilization Reports across various categories etc. Top 5 things to point out to a practice just starting to Benchmark 19
- 20. Select Specialty Internal Medicine 12-month Utilization New Patient Office Visits 99201 New Patient - Focused 50 3.57% 99202 New Patient - Expanded 100 7.14% 99203 New Patient - Detailed 850 60.71% 99204 New Patient - Comprehensive 350 25.00% 99205 New Patient - Complex 50 3.57% Office Visits - Established 1,400 99211 Est Patient - Minimal 100 3.57% 99212 Est Patient - Focused 200 7.14% 99213 Est Patient - Expanded 1700 60.71% 99214 Est Patient - Detailed 700 25.00% 99215 Est Patient - Comprehensive 100 3.57% 2,800 New Pt Code Actual Medicare Difference 99201 3.57% 0.60% +2.97 points 99202 7.14% 5.50% +1.64 points 99203 60.71% 26.90% +33.81 points 99204 25.00% 44.60% --19.6 points 99205 3.57% 22.40% --18.83 points Est Pt Code Actual Medicare Difference 99211 3.57% 4.50% --0.93 points 99212 7.14% 3.90% +3.24 points 99213 60.71% 45.00% +15.71 points 99214 25.00% 41.10% --16.1 points 99215 3.57% 5.50% --1.93 points 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 99201 99202 99203 99204 99205 New Pt E/M Utilization: Actual vs. National Medicare Averages Actual Medicare 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 99211 99212 99213 99214 99215 Established Pt E/M Utilization: Actual vs. National Medicare Averages Actual Medicare E&M – Benchmarking tool 20
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- 22. 22 Drew Franklin, MBA, FACMPE, Director of Business & Revenue Strategies ENT and Allergy Associates® [email protected] - 914.333.5779 Margaret Hargrove, CPC, Director of Revenue Cycle ENT and Allergy Associates® [email protected] – 914.333.5865
- 23. To Complete the Program Evaluation The URL below will take you to HFMA on-line evaluation form. You will need to enter your member I.D. # (can be found in your confirmation email when you registered) Enter this Meeting Code: 16AT12 URL: http://www.hfma.org/awc/evaluation.htm Your comments are very important and enables us to bring you the highest quality programs! 23