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Using the Right Metrics to Improve
Physician Practice Management
Drew Franklin, MBA, FACMPEDirector of Business & Revenue Strategies
ENT and Allergy Associates®
Margaret Hargrove, CPCDirector, 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)
ENT & Allergy Associates Locations1999 2005 2012
28 MDs, 10 offices 62 MDs, 24 offices 128 MDs, 36 offices
2
2015 and BEYOND!
41 Locations – 160+ Physicians!
3
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
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.
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.
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-$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
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.
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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.
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....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
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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
Patient Copay, Coinsurance and Deductibles
12
Home-Grown Deductible Calculator App
13
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
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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
Dashboard – Data Display – Realization Analysis
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Dashboard – Data Display – Monthly Summary Analysis
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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
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
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Select Specialty Internal Medicine
12-month UtilizationNew 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 1,40099211 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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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
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Enter this Meeting Code: 16AT12
URL: http://www.hfma.org/awc/evaluation.htm
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