Benchmarking
Demystifying Data and Myths
Nancy Babbitt, FACMPE
Learning Objectives
• Measure against industry norms
• Do’s and Don'ts
• Improvement Checklists
• Using data for ICD10
Top Healthcare Trends
• Healthcare Improvement
– Improve Quality
– Reduce Cost
– Enhance Patient Experience
• Payment Reform
– Payment Methodology
– Physician Compensation
• Organizational Alignment
Use DATA and Benchmarking
• Know where you are
• Know where you want to go
• Improvements
• Concentrate resources to get the most impact
• Measure Success
Data… Internal and External
• Internal – show progress over time
– Historical – establish a baseline
– Ongoing – identify problems
– Control fraud and embezzlement
• External – compare to others
– MGMA
– Specialty Society
• MGMA Best Practices
– Profitability and Cost Management
– Productivity, Capacity and Staffing
– Accounts Receivable Management
Do’s and Don’ts of Benchmarking
• Use the Median, not the Mean
– Median – mid-point of a set of data
– Mean – observations divided by observations
• Don’t default to the highest benchmark
– Can represent the best or worst, depending on type of data
• Use tables with “metrics” that apply
– Per FTE Physician
– FTE Provider
– Per patient
Do’s and Don’ts of Benchmarking
• Be aware of the population
– Higher the population, more robust data
• “Best Fit” data
– 1st look for data based on specialty and ownership model
– Then review all benchmarks, size, region, number of providers
TIPS
• Illustrate your findings to Physicians and Staff
– Graphs
– Tables
– Dashboards
• Use Productivity Benchmarks to set reasonable targets
– Example: Encounter data to set daily visit goal
• Create daily, monthly, yearly goals
– Update staff regularly
• Attract and retain quality staff by using compensation and benefit
benchmarks
KEY Benchmarks
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Gross Collection Rate
Gross Charges per Provider
Gross Charges per Patient
Number of Procedures
Number of Patients
Days in Accounts Receivable
Patient point of care collection rate
Total Accounts Receivable
Key Performance Indicators
KEY Benchmarks
Sample Pediatric Practice
ANNUAL
Charges
Collections
Adjustments
Visits
New Patients
Net Collections
Adjusted Net Collections
Accounts Receivable
Charge Per Visit
Revenue Per Visit
Cost Per Visit
Physician Compensation
Dr. A
Dr. B
Overhead %
Staff to Provider Ratio
Total Expenses
Net Income
2013
2012
56%
104%
$201,451
$200.27
$112.39
2.43
2011
$3,259,231
$1,549,879
$1,659,566
15,934
1156
48%
98%
$223,894
$207.68
$99.05
$100.50
$3,280,324
$1,700,954
$1,559,642
16,531
1259
52%
100%
$206,441
$202.20
$105.17
$115.25
$190,000
$189,000
64%
2.89
$1,580,412
$ 101,256
$217,000
$219,000
63%
3.11
$1,870,588
$ -20,589
MGMA DataDive
Physician Compensation and Production: 2013 Report Based on 2012 Data
Family Medicine (without OB) reported by: Geographic Section
Metric
Total Compensation
Metric
Eastern
Midwest
Southern
Western
Phys
Med Pracs
Mean
10th %tile
25th %tile
Median 75th %tile
90th %tile
5,557
881
$225,701
$141,598
$169,826
$207,117
$262,990
$337,869
Phys
1,097
2,004
1,448
1,008
Med Pracs
269
147
375
90
Mean
$218,237
$224,306
$239,047
$217,425
10th %tile
$135,659
$143,282
$143,340
$140,779
25th %tile
$164,766
$171,340
$171,913
$169,853
Median 75th %tile
$200,972 $256,110
$208,946 $258,715
$215,056 $283,942
$202,775 $251,364
90th %tile
$326,910
$329,224
$379,148
$315,759
MGMA DataDive
Physician Compensation and Production: 2013 Report Based on 2012 Data
Surgery: General reported by: Geographic Section
Metric
Phys
Physician Work RVUs
Metric
Eastern
Midwest
Southern
Western
912
Med Pracs Mean
275
7,271
10th %tile25th %tileMedian 75th %tile90th %tile
3,738
5,296
6,880
9,023
11,021
Phys MedPracs Mean 10th %tile25th %tile Median 75th %tile 90th %tile
146
47
7,597
3,784
5,386
7,455
9,429
11,268
284
58
7,274
4,111
5,473
6,879
8,717
10,754
309
125
7,904
3,711
5,968
7,905
9,803
11,981
173
45
5,859
3,394
4,438
5,840
6,723
8,327
MGMA DataDive
Cost Survey: 2013 Report Based on 2012 Data
Multispecialty Practices
Metric, per Patient
Count
Total cost
122
$598.42
$192.57
Total support staff FTE
122
32.06
Physician work RVUs
103
Total gross charges
118
Mean
10th %tile 25th %tile
Median
75th %tile
90th %tile
$262.53
$488.81
$880.55
$1,161.05
9.43
16.46
29.04
45.18
60.35
4.60
1.46
2.17
3.95
6.82
8.73
$956.65
$248.16
$333.40
$692.42
$1,364.34
$2,334.03
MGMA DataDive
Cost Survey: 2013 Report Based on 2012 Data
Internal Medicine
Metric, per Square Foot
Count
Total med rev after oper cost
21
Metric, per Work RVU
Count
Total med rev after oper cost
139
Mean
10th %tile
25th %tile
Median
$117.64
$38.06
$66.28
$117.52
Mean
10th %tile
25th %tile
Median
$13.52
-$19.74
$1.00
$15.84
75th %tile 90th %tile
$175.07
$185.75
75th %tile 90th %tile
$28.15
$44.56
Sample Scorecard Metrics
Improve Accounts Receivable
with Management and Culture
• Involve all staff and Providers
• Measure A/R on a regular basis
• Tie staff bonuses to A/R performance
• Provide thorough training and ongoing training to staff
• Educate Physicians on their role
• Keep everyone updated on policies and changes
MGMA Patient Portal
data.mgma.com/ptsat
How do you measure up?
Use the MGMA-ACMPE / SullivanLuallin
online patient satisfaction dashboard
Be Prepared… Evaluate Differences
• Before presenting the results consider why your numbers might not be
the norm or above average.
• What is unique about your practice?
– Payer Mix – Medicare/Medicaid
– Locations
– Providers
– Level of technology
Characteristics of Better Performing Groups
• Higher Revenue Per Physician
• Higher Operating Costs
• Higher Staff to Physician Ratio
• Increased Collections
• Greater % of Revenue available for Physician Compensation
• Smart use of Technology
• Emphasis on Ancillary Services
ICD 10 Preparation
• Transition Plan
• Communication with Vendors
– Practice Management software
– EHR software
– Clearinghouse
– Billing Service
• Staff Training
ICD 10 Use Data To Help Prepare
• Identify ICD 9
– Usage reports
– Areas where used
• Watch claim lag
• Customize Forms/Templates
• Identify support for ICD 10 code selection
Ensure Success
• Work Smart / Automate
• Network & learn from other organizations
• Set goals / Celebrate successes
Thanks for Attending!
Nancy Babbitt, FACMPE
Babbitt & Associates
www.BabbittandAssociates.com
Attachments
Improvement Checklists
Improving Accounts Receivable
Patient Scheduling
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Review account balances when scheduling
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Verify eligibility, co-pay, well care, before
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Large obligations, assign a financial counselor
The Visit
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Confirm Insurance status
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Follow up on missing info
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Collect all money due at Time of Service
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Assist Providers with CPT & DX coding
Staff Involvement
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Reward successes
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Set standards, goals and expectations
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Cross train front office and A/R process
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Define clean claims elements
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Encourage staff to get CPT coding education
Improving Accounts Receivable – Page 2
Payer Relations / Contracting
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Manage relationships / monitor contracts
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Get to know your representative, if they have one!
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Make sure contracts define clean claims, timely submission and payment, appeals process, termination
causes, times, and methods.
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Document all interactions with payers
Billing & Collections
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Post and file charges the same day
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Use electronic remittance advice and deposits
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Audit reports or EOB - get your contracted rate
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Follow up on outstanding claims
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Prioritize claims by amount, age, insurance company
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Establish payment plans
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Document all billing calls
Improving Provider Productivity
Sample Behaviors
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Establish cultural values that promote work ethic
Utilize Productivity based compensation
Use mid-level Providers
Maintain optimal staffing levels
Mentor new physicians
Develop recruitment protocols that ensure new physicians understand productivity
expectations
Design operational systems and facilities to promote productivity
Evaluate physicians coding habits
Empower supervisors/staff to be decision makers
Hold physicians and staff members accountable
Essential Metrics
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Encounters/procedures per physician
Revenue per physician
Staff per physician
Billable days per month per physician
No Show rates
Referral patterns / trends
Improving Financial & Operational Areas
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Perform annual budget and business planning
Monitor your performance against your budget
Incorporate financial goals into strategic plan
Benchmark and set financial objectives
Scrutinize all expenses
Regularly bid contracts
Participate in Group Purchasing Organization
Reward Physicians/Staff for cost savings
Give them control and accountability
Document, train, and keep policies current
Maximize use of technology and automation
Develop and manage formal marketing plan
Keep physicians involved