Communicating With Your Physicians
Through Dashboard Data
Developing a Practice Dashboard
MGMA Anesthesia Administration Assembly
May 2010
Joe Laden
MGMA member since 1981
AAA Member since inception
Business Manager
Anesthesia Associates of Louisville, PSC
joeladen@aalouisville.com
Following this session you will be able to:
Develop a strategy to produce an effective
practice dashboard
Identify key information that should be
communicated to physicians
Gain insight as to the spreadsheets and
graphic software available
Anesthesia practice administrators are
responsible for gathering, interpreting and
disseminating financial data from business
systems. The communication of this data
must be precise, concise and
understandable.
4/13/2015 4:11:20 AM
What information is important for
physicians and their management
of their practices?
How can this be presented in the
most efficient and effective
manner?
What is an
Anesthesia Practice
Dashboard?
An anesthesia business
dashboard can be any form of
display that quickly communicates
business practice management
information to anesthesiologists.
In other words . . .
I can’t define dashboard,
but I know one when I see it.
Examples of Anesthesia
Dashboards
From Practice
Management
System Billing
Software
Constructed by
Practice
July
2010
Income and
Expenses
YTD 2010
Budget YTD 2009
Patient Revenue 1,450,000 1,400,000 1,500,000
Hospital Subsidy
150,000 150,000 100,000
Billing Expense
87,000
84,000
96,000
Corporate
26,500
30,000
27,500
CRNA Expense
585,000 550,000 530,000
MD Expense
755,000 720,000 740,000
Net
146,500 166,000 206,500
240,000
$4,500,000
$4,000,000
220,000
$3,500,000
200,000
$2,500,000
160,000
$2,000,000
Units
11,400
3.0%
11,100
Minutes
137,750
Gross
1,425,000
134,125
884,500
467,400
Workers Billed
Comp
No Pay
United
Health
Aetna
Minutes
Payments
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
$1,000,000
1,387,500
1,812,500
3,001,200
Charges Q1
1,696,500
6.8%
8,887,500
18,750,000
3.0%
455,100
140,400
6.8%
859,125
9,150,000
17,550,000
6.8%
2,915,100
United
Health
Workers
No
Comp
Pay
6,150,000
5,756,400
Payments Q1
Medicaid
Medicare
Commer
cial
Medicare
Aetna
Blue
Shield
$500,000
$0
150,000
3.0%
2.7%
Recepits
71,100
3.0%
2.7%
2009
11,700
6.8%
73,200
2.7%
$1,500,000
140,000
100,000
2.7%
$3,000,000
180,000
120,000
Cases
June
2010
950
Production and Receipts All Locations
YTD
Trail 12
2009
2010
2009
2010
925
6,100
5,925
12,500
Commerc
ial
Medicaid
Blue
Shield
Goals
$/mo. $1,500k
$/MD 575k
OR % 68%
OT
<40 hr/w
We hrs < 24
c/ASC 400/wk
MD
Arnold
Baker
Cook
Dashi
Farnsley
Guari
Henry
Iliri
Jones
Kellog
Lambert
Mikos
Norman
Ogden
Peters
Zoroster
Total
Benchmarks
$/Unit
$40
$/OR
$480
U/MD 12,400
OR %
65%
% Gvt.
38%
AR Days
34
Units
Collected
Month YTD
Month
YTD
865
3,564 $38,918
$962,280
837
4,350 $37,673 $1,174,500
865
3,606 $38,918
$973,620
794
3,681 $35,745
$993,735
612
5,189 $27,518 $1,400,895
766
3,754 $34,470 $1,013,580
804
4,947 $36,169 $1,335,555
870
4,951 $39,165 $1,336,770
667
5,195 $30,015 $1,402,515
720
5,084 $32,419 $1,372,545
639
5,334 $28,740 $1,440,045
789
3,501 $35,516
$945,270
901
4,338 $40,534 $1,171,125
792
4,470 $35,633 $1,206,900
879
4,352 $39,536 $1,174,905
686
4,666 $30,881 $1,259,820
12,486 70,978 $561,848 $19,164,060
Facility
St. Pete
Month
Units
$
Adenia
Units
$
SurgeCenter
Units
$
Spine Hosp.
Units
$
April 2010
7,620
Last Mo.
7,649
YTD
45,760
$327,671 $359,491 $1,967,659
4,980
4,927
29,321
$209,146 $211,843 $1,260,782
1,375
1,314
8,359
$60,518
$55,199
$351,078
972
763
5,124
$41,785
$35,877
$215,208
13 Months
Anesthesia Associates of the United States – May 2010
1,400,000
2008-2010 Norton+Pavilion OR Minutes and Revenue (Receipts)
40,000
250,000
Receipts
Units with Linear Trend Line
$1,400,000
35,000
1,200,000
30,000
$1,200,000
1,000,000
200,000
25,000
$1,000,000
800,000
20,000
150,000
$800,000
OR Minutes
600,000
15,000
Revenue
$600,000
100,000
$400,000
10,000
400,000
5,000
200,000
12 per. Mov. Avg. (Receipts)
M-07
M-07
J-07
S-07
N-07
J-08
M-08
M-08
J-08
S-08
N-08
J-09
M-09
M-09
J-09
S-09
N-09
J-10
$200,000
0
0
Mar-98
Jun-98
Sep-98
Dec-98
Mar-99
Jun-99
Sep-99
Dec-99
Mar-00
Jun-00
Sep-00
Dec-00
Mar-01
Jun-01
Sep-01
Dec-01
Mar-02
Jun-02
Sep-02
Dec-02
Mar-03
Jun-03
Sep-03
Dec-03
Mar-04
Jun-04
Sep-04
Dec-04
Mar-05
Jun-05
Sep-05
Dec-05
Mar-06
Jun-06
Sep-06
Dec-06
Mar-07
Jun-07
Sep-07
Dec-07
Mar-08
0
50,000
$0
Jan-08 Feb08
Mar- Apr-08 May- Jun-08 Jul-08 Aug08
08
08
Sep- Oct-08 Nov08
08
Dec- Jan-09 Feb08
09
Mar- Apr-09 May- Jun-09 Jul-09 Aug09
09
09
Sep- Oct-09 Nov09
09
Dec- Jan-10
09
Units with Linear Trend Line
40,000
35,000
25,024,314 23,379,323
19,071,824
18,672,864
23,379,323
19,071,824
18,672,864
30,000
347,559
333,990
328,824
333,444
333,990
328,824
333,444
25,000
2,099,677
1,994,806
1,909,840
1,938,273
1,994,806
1,909,840
1,938,273
20,000
17,865
17,142
17,536
18,557
17,142
17,536
18,557
15,000
10,814,667 10,043,530
8,783,497
9,003,829
10,043,530
8,783,497
9,003,829
10,000
5,000
1,000,000
500,000
0
Apr-98
Aug-98
Dec-98
Apr-99
Aug-99
Dec-99
Apr-00
Aug-00
Dec-00
Apr-01
Aug-01
Dec-01
Apr-02
Aug-02
Dec-02
Apr-03
Aug-03
Dec-03
Apr-04
Aug-04
Dec-04
Apr-05
Aug-05
Dec-05
Apr-05
Aug-06
Dec-06
Apr-07
Aug-07
Dec-07
12 per. Mov. Avg.
(Receipts)
357,503
392,767
387,580
372,893
347,279
336,375
335,396
2,126,748
2,320,187
2,303,624
2,189,443
2,035,823
1,983,692
2,015,794
15,845
17,816
17,711
16,863
15,881
15,850
16,459
11,167,180
12,123,496
11,750,800
11,599,222
11,396,124
10,649,168
10,444,874
J-10
N-09
J-09
S-09
M-09
J-09
M-09
N-08
J-08
S-08
M-08
J-08
M-08
N-07
J-07
S-07
M-07
Receipts
M-07
0
1,500,000
From Third Party
Dashboard Company
To communicate with physicians
effectively, the dashboard should
have a sufficient number of data
points, but not too many.
Dashboard Data Sources
• Billing System Reports
• Accounting System Reports
o General Ledger
o Payroll
•User Constructed Spreadsheets
Currently Produced by Practice
4/13/2015 4:11:20 AM
Where are Anesthesia Dashboards
Available today?
• Anesthesia Billing Software Vendors
• Anesthesia Billing Companies
• Anesthesia Practice Management
Companies
• Report Hosting Companies
DashboardMD
iDashboards
•Anodyne
• DIY for Small – Medium Size Groups
Sources of Data for
The Dashboard
1.
Excel Spreadsheets
prepared by You
Billed
Medi ca re
Medi ca i d
Commerci a l
Bl ue Shi el d
Aetna
Uni ted Hea l th
No Pa y
Workers Comp
Tota l
Q1
Q1
3,221,500 3,510,500
610,500
586,500
1,410,000 1,631,250
2,387,000 2,150,500
1,012,500 1,045,000
826,000
880,000
200,000
216,000
312,000
294,750
9,979,500 10,314,500
Q3
3,238,500
613,500
1,455,000
2,178,000
1,065,000
814,000
205,000
305,250
9,874,250
Q4
3,740,000
652,500
1,436,250
2,233,000
1,050,000
816,000
202,500
295,500
10,425,750
Payments
Medi ca re
Medi ca i d
Commerci a l
Bl ue Shi el d
Aetna
Uni ted Hea l th
No Pa y
Workers Comp
Tota l
Q1
Q1
Q3
580,500 3,391,500 3,629,500
61,650
562,500
588,000
1,077,500 1,567,500 1,556,250
1,340,500 2,376,000 2,189,000
1,612,500 1,087,500 1,060,000
245,400
824,000
768,000
83,200
198,000
207,000
86,400
324,000
327,750
5,087,650 10,331,000 10,325,500
Q4
3,536,000
600,000
1,428,750
2,145,000
1,005,000
846,000
201,000
306,000
10,067,750
No Pay
Billed Charges Q1
United
Health
Workers
Comp
Workers
Comp
United
Health
Payments Q1
No Pay
Medicare
Aetna
Medicaid
Medicare
Commerci
al
Aetna
Blue
Shield
Commerci
al
Billed Workers
Charges Q1
United No Pay
Health
Blue
Shield
Medicaid
United
No Pay
Health
Comp
Workers
Comp
Payments Q1
Medicare
Aetna
Medicare
Commercial
Aetna
Blue Shield
Commercial
Medicaid
Medicaid
Blue
Shield
Mini Income/Expense Statement
YTD-2010
Patient Revenue
Hospital Subsidy
Budget YTD-2009
145,000 140,000
160,000
15,000
15,000
10,000
Billing Expense
8,700
8,400
9,600
Corporate Expense
2,650
3,000
2,750
CRNA Expense
58,500
55,000
5,300
MD Expense
75,500
72,000
74,000
Net
14,650
16,600
78,350
Income and
Expenses
YTD 2010
Budget YTD 2009
Patient Revenue 1,450,000 1,400,000 1,500,000
Hospital Subsidy
150,000 150,000 100,000
Billing Expense
87,000
84,000
96,000
Corporate
26,500
30,000
27,500
CRNA Expense
585,000 550,000 530,000
MD Expense
755,000 720,000 740,000
Net
146,500 166,000 206,500
Cases
Units
Minutes
Gross
Receipts
Production and Receipts All Locations
June
YTD
Trail 12
2010
2009
2010
2009
2010
2009
950
925
6,100
5,925
12,500
11,700
2.7%
3.0%
6.8%
11,400 11,100 73,200 71,100 150,000 140,400
2.7%
3.0%
6.8%
137,750 134,125 884,500 859,125 1,812,500 1,696,500
2.7%
3.0%
6.8%
1,425,000 1,387,500 9,150,000 8,887,500 18,750,000 17,550,000
2.7%
3.0%
6.8%
467,400 455,100 3,001,200 2,915,100 6,150,000 5,756,400
A/R By Percent Outstanding by Carrier
Category
Current 31 - 60 61 - 90 91 - 120 120 - 150
151 +
ALL PATIENTS
37.0%
32.2%
8.9%
6.5%
3.7% 11.7%
MEDICARE
57.5%
27.9%
1.7%
5.1%
1.0%
6.8%
BLUE CROSS
44.3%
36.5%
10.2%
3.6%
0.9%
4.6%
PATIENT
4.9%
37.7%
21.8%
12.1%
6.3% 17.2%
HUMANA
60.6%
9.2%
2.5%
3.1%
3.6% 20.9%
TRICARE
32.5%
41.7%
4.5%
3.8%
1.3% 16.1%
UNITED HEALTH
46.9%
40.4%
1.5%
-0.2%
4.7%
6.7%
AR Days
Payer
Humana
Anthem
UHC
Medicare
Commercial
Tricare
Medicaid
Workers Comp
Patient
Overall
Dec-07 Dec-08
Dec-09
Jan-10 Feb-10 Mar-10 Apr-10
16.1
22.0
21.5
17.0
50.8
29.6
36.6
60.3
185.3
18.4
25.3
18.0
28.9
58.1
28.0
72.2
75.8
190.5
16.7
37.3
23.1
22.3
45.8
23.9
52.6
45.7
177.1
13.7
19.3
14.2
23.7
48.4
16.0
64.5
49.3
213.0
13.4
22.4
14.2
27.3
50.8
20.5
62.1
58.7
173.5
9.6
20.7
20.0
26.5
46.5
15.6
51.9
61.3
178.2
15.7
19.4
23.6
29.3
48.6
20.3
59.6
68.5
129.9
26.0
35.9
31.8
31.0
32.9
31.5
34.3
OR Utilization by Hour
80.0%
72.5%
74.6%
April 2010
73.1%
70.4%
70.0%
66.3%
64.5%
61.4%
60.0%
50.6%
50.0%
41.1%
40.0%
38.0%
30.0%
20.0%
10.0%
4.3%
0.0%
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
23:59
7:30
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
Receipts and Units Billed - Two Years
37,000
$1,400,000
$1,200,000
35,000
$1,000,000
Units
10%
$800,000
31,000
Receipts
33,000
$600,000
29,000
$400,000
27,000
25,000
$200,000
$0
Units
4/13/2015 4:11:20 AM
Receipts
Tabular Data vs. Graphic Display
Values
Row Labels
Cases. Base U Time U FF U Minutes.
Ja n
1,589
9,459 17,948 5,097 176,302
Feb
1,604
9,368 18,185 4,794 176,077
Ma r
1,776 10,605 20,264 5,318 198,179
Apr
1,771 10,165 20,424 5,565 199,241
Ma y
1,663
9,626 18,541 4,960 180,574
Jun
1,822 11,036 21,117 4,902 206,665
Jul
1,365
8,780 17,446 3,213 171,051
Aug
1,171
8,081 15,903 1,677 156,029
Sep
1,339
9,418 18,697 2,456 182,090
Oct
1,403
9,670 19,034 2,574 185,840
Nov
1,519 10,362 20,274 2,889 196,446
Dec
1,772 12,163 23,886 3,414 233,286
Total
18,794 118,733 231,719 46,859 2,261,780
240,000
$4,500,000
$4,000,000
220,000
$3,500,000
200,000
$3,000,000
180,000
$2,500,000
160,000
$2,000,000
$1,500,000
140,000
120,000
100,000
Minutes
Payments
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
4/13/2015 4:11:20 AM
$1,000,000
$500,000
$0
Excel 2010 Sparkline
2.
Reports and Displays
from Billing System
3.
Accounting System
Reports
4.
Benchmarks and Goals
Benchmarks
Revenue per Unit
Revenue per OR
Units per MD
Units per OR
OR Utilization
% Government Payers
A/R Days
A/R % over 90 Days
$40
$475k
12,400
14,500
65%
38%
46
18%
Benchmarks
$/Unit
$40
$/OR
$480
U/MD
12,400
OR %
65%
% Gvt.
38%
AR Day
34
Internal Practice Goals
Revenue per Month
$1,500k
Revenue per MD
575k
OR Utilization
68%
CRNA OT
< 40 hrs./wk
Weekend Hours
< 24
Cases @ ASC 1
400/week
Goals
$/mo. $1,500k
$/MD 575k
OR % 68%
OT
<40 hr/w
We hrs < 24
c/ASC 400/wk
Goals
$/mo. $1,500k
$/MD 575k
OR % 68%
OT
<40 hr/w
We hrs < 24
c/ASC 400/wk
MD
Arnold
Baker
Cook
Dashi
Farnsley
Guari
Henry
Iliri
Jones
Kellog
Lambert
Mikos
Norman
Ogden
Peters
Zoroster
Total
Benchmarks
$/Unit
$40
$/OR
$480
U/MD 12,400
OR %
65%
% Gvt.
38%
AR Days
34
Units
Collected
Month YTD
Month
YTD
865
3,564 $38,918
$962,280
837
4,350 $37,673 $1,174,500
865
3,606 $38,918
$973,620
794
3,681 $35,745
$993,735
612
5,189 $27,518 $1,400,895
766
3,754 $34,470 $1,013,580
804
4,947 $36,169 $1,335,555
870
4,951 $39,165 $1,336,770
667
5,195 $30,015 $1,402,515
720
5,084 $32,419 $1,372,545
639
5,334 $28,740 $1,440,045
789
3,501 $35,516
$945,270
901
4,338 $40,534 $1,171,125
792
4,470 $35,633 $1,206,900
879
4,352 $39,536 $1,174,905
686
4,666 $30,881 $1,259,820
12,486 70,978 $561,848 $19,164,060
Facility
St. Pete
Month
Units
$
Adenia
Units
$
SurgeCenter
Units
$
Spine Hosp.
Units
$
April 2010
7,620
Last Mo.
7,649
YTD
45,760
$327,671 $359,491 $1,967,659
4,980
4,927
29,321
$209,146 $211,843 $1,260,782
1,375
1,314
8,359
$60,518
$55,199
$351,078
972
763
5,124
$41,785
$35,877
$215,208
13 Months
Creating Dashboards Can Be
Difficult
• Many Sources
• Varied Source Formats
• Tools not easy to use
• Compact Layout
• Complex Formatting
• Determining relevant data
• Relevant data may change
• Different Audiences
67 10:56 PM
How Do We Easily Make
a Powerful Dashboard?
Construction Software
•
•
•
•
•
4/13/2015 4:11:20 AM
Excel 2003,2007,2010
Word
PowerPoint
PDF Creation Software
Snipping Tool (screen capture)
Snagit
Jing
Why Excel as Primary DIY Tool?
• You Probably Own Excel
• Low Cost
• Universality
• Excellent Data Exchange
• Charts
• Pivot Tables
• Ease of Use
• Training Available
• Advanced, Mature Product
• Runs on PC or Mac
Excel 2010 New Features
•
•
•
•
•
Sparklines
Cell Bars
Slicers
PowerPivot
DAX Formulas
Steps to Prepare You Dashboard
• Determine Your Audience
• Review Current One Page Reports
• Decide Which Key Performance
Indicators to Display
• Determine if Billing System Data Can Be
Easily Copied.
• Decide on Dashboard Construction Tools
One Approach to Constructing
Your Own Dashboard
Cut and Paste Dashboard Construction
1. Start with blank PowerPoint Slide
2. Display components to place on
dashboard
3. Capture components with Snipping Tool
or Copy & Paste
4. Paste onto slide
5. Resize and reposition
6. Add Logo, Background Other Beautifying
Graphs
7. Print as a PDF and distribute.
Construction Demo Video
More Difficult Method 1:
Prepare all elements of spreadsheet
on one worksheet in Excel from
multiple worksheets with tables and
graphs and use Excel Camera to
produce dashboard.
Example follows . . . . .
Excel Camera Example Video
More Difficult Method 2:
Dynamic tables and charts in Excel
prepared on dashboard sheet from pivot
tables based on externally imported data.
Advantage: Dashboard automatically
update when current data is imported.
Example follows . . . . .
Excel 2010 Pivot Table With Slicers Video
Third Party Dashboard Solutions
• Interface With Practice Management Systems
• Produce Dashboard Reports Automatically
• Store Report Data Independently
• Provide Web Access and Distribution Services
Can Be Time Consuming to Set Up
There will be a Cost
Examples:
www.DashBoardMD.com
www.iDashboards.com
www.anodynehealth.com
Additional Methods to Produce Your Own
Dashboard
•Xcelsius/Engage
Expensive & Complicated
but powerful
•Download to Handheld Device
•Custom Programming
IT expertise and expense, specialized software
(Dundas)
Presentation & Delivery Methods
•
•
•
•
•
•
•
Physical Paper
Company Web Site
PowerPoint Slide
Spreadsheet (Excel)
DVD
Secure USB Drive (with dataset)
Mobile Device, iPhone, iPad
What Needs to Be
Communicated to
Physicians?
Types of information
• Production
• Cases, Units, Minutes
• Gross Billing
• Payments, W/O, Adjustments
• Accounts Receivable
• Charges/Payments/WO
• General Ledger/Income &Expenses
• Payroll
4/13/2015 4:11:20 AM
What Do Doctors Want to Know
• The future
• How the past will predict the future
• What if things go on as in the recent past
• What can be changed to improve finances
• What are areas of concern
4/13/2015 4:11:20 AM
What Can Anesthesiologists Do With Dashboard
Information?
• Monitor Anesthesiologist/ACT Work Output:
(Units / Minutes / Cases)
• Monitor Reimbursement for Work Performed
(Payments/Unit or Hour)
• Monitor Collection Efficiency (AR Days)
• Monitor Hospital Efficiency (O.R. Utilization)
• Make decisions about staffing
• Determine need for hospital subsidies
Key Metrics
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Revenue Per O.R.
Revenue Per Unit Billed
O.R. Utilization Rate
% Hours Billed/Worked After Normal OR Shift
CRNA Cost per Hour/Unit Billed
MD:CRNA Ratios (Concurrency)
Weeks Worked per Year
Units per Hour
Units Billed per MD FTE
100
Internal Comparisons
• Facility vs. Facility
• MD vs. MD
• Payer vs. Payer
• Surgeon vs. Surgeon
• Time-Based
• Month, Quarter, Year, Week
• Trailing 12 months
• Period vs. Previous Period
External Benchmark Comparisons
• MGMA Physician Compensation and
Production Survey
• MGMA Single Specialty Cost Report
Survey – Anesthesia
• ASA Payer Survey
KPI Top and Bottom
Top 10 and Bottom 10:
• Surgeons (collected per hour)
• Anesthesiologists (units per year)
• CRNA’s (hours billed/ hours paid)
• Payers (collected per unit)
• ASA Codes (units per case)
Other Combinations
•Units per case, MD, CRNA, Hour
•Revenue per O.R., MD, Case, Hour
•Units, Hours and revenue per Surgeon
Operating Room or Facility
Questions Anesthesiologists Ask:
How is the business going?
What will the end of the year look like?
Will your dashboard provide answers?
Take Away Ideas
Dashboards take time, talent and toil to make
Resist the urge to favor flash over function.
Encourage your vendors to produce dashboards
Often a paper report with limited graphics is best
Additional Resources
The Effective Use Of Electronic Dashboards To Promote & Improve
Overall Practice Performance: An Exploration Into The Use of
Electronic Dashboards In A Group Practice Setting. ACMPE Paper by
David G. Owens, FACMPE. Available on the MGMA web site
Dashboard To Monitor Clinical Productivity of Anesthesiology Groups
Amr E. Abouleish, M.D., M.B.A., Jody A. Locke, M.A., et al.
Click Here For Web Link
Dashboard Resources On the Web
MGMA Excel Community
www.DashboardsByExample.com
Youtube: ExcelIsfun
www.perceptualedge.com
www.edwardtufte.com
www.exceluser.com
xcelsius.com
www.dashboardmd.com
www.idashboards.com
www.anodynehealth.com
www.dundas.com
www.dashboardspy.com
www.mrexcel.com
www.corda.com
Cognos / DataClarify
www.TableauSoftware.com
This Presentation Will Be Available To
Download at:
www.joeladen.com
Have We Met the Objectives?
Develop a strategy to produce an effective
practice dashboard
Identify key information that should be
communicated
Gain insight as to the spreadsheets and
graphic software available
Please Complete Your Evaluation
For Questions, Comments, Help or to Share
Your Ideas:
Joe Laden, Business Manager
Anesthesia Associates of Louisville, PSC
332 W Broadway
Louisville, Kentucky 40202
Office: (502) 583-0909
Cell (502) 403-7489
www.joeladen.com
joeladen@aalouisville.com