Benchmarking Metrics to Improve
Medical Care & Financial Performance
Benchmarking Within Your
Practice for Consistent SOC & Fees
• Consistent Service, Medical Care & fees?
•
VSG initial meeting Fee Case Study metrics tool
• Using tool to benchmark the practice staff’s adherence to the
practice’s Standards of Medical Care
• Using tool to benchmark the practice staff’s adherence to the
practice’s fee schedule
• Using tool to quantify the financial effect of “compliance gap”
• “Compliance Gap”
• Medical care and Fee differences between doctors within same
practice for the same case presentation.
http://www.veterinarystudygroups.com
Case Study Methodology for
SOC & Fee Compliance Review
• Outline a relatively straight forward medical/surgical problem
• Request at least 3 doctors prepare invoices at 3 end points with
no collusion
• Initial workup
• Surgery and post op 12 hour care
• Hospitalization 48 hours to resolve medical issues
•
Practice manager enters services with fees into master spreadsheet
•
The final result is an invoice from each provider in your hospital
entered into a master spreadsheet for each stage of the problem’s
resolution. This allows the medical director and practice manager to
compare the application of the practice’s fee schedules and the
suggested level of patient medical care between doctors in the same
practice.
Pyo Case Study
• A six-year-old intact, 20-pound female
Schnauzer was presented for signs of
anorexia of 36 hours, lethargy, vomiting
of 12 hours duration and PU/PD. She
was in season approximately 4 to 6
weeks ago. Her physical exam and vital
stats were unremarkable other than
febrile, a tense abdomen which made
palpation difficult, scleral injection & 5
percent dehydration. She was an early
morning unscheduled urgent care visit.
Client authorizes whatever is medically
best for the patient.
Diagnostic Plan at
Initial presentation
• Examination unscheduled urgent care exam
• CBC, Chemistry Profile, or CBC/Chem profile (if you bill them together)
• Electrolytes (if not included with Chem Profile above)
• Urinalysis lab fee (Cysto or catheterization collection)
• Urine culture & Sensitivity Submitted
• X-ray of the abdomen (2 views)
• Film (2 views)
• Interpretations of two views
• Abdominal ultrasound if available
Findings of Diagnostics
• X ray: uterine enlargement
• Ultrasound: large tubular hypoechoic mass in
abdomen
• Chem profile: increased BUN 120, creatinine 3.3,
moderate leukocytosis and neutrophilia with a
left shift and a mild macrocytic normochromic
anemia
• Urinalysis: 1.014 SG, 300 proteinuria, +2 white
blood cells (WBC), and RBCs TNTC.
• TDx: pyometra, uremia, dehydration, anemia,
renal disease, possible UTI
Case Study Initial Workup (1)
INITIAL WORKUP
Exam
PCV / TS
CBC
Chemistry Profile
Electrolytes
CBC/Chemistry Profile/Electrolytes (if packaged)
Blood Collection (if separate)
Urine Collection (if separate)
Urinalysis
Urinalysis and Collection (if packaged)
Urine Culture and Sensitivity
X ray abdomen 2 views
Film 2 views
Interpretation 2 views
Film 2 views and interpretation (if packaged)
Abdominal Ultrasound in house
Abdominal Ultrasound outside service
Daytime Housing Fee
Intensive Care Hospitalization
Hospital Feeding and Lodging
Daily Doctor Evaluation & Treatment
Daily Intensive Nursing Care
Hospitalization All Inclusive Package
Misc
TOTAL
Dr. A
$44
$16
Dr. B
Dr. C
$86
$98
$35
$44
$16
$98
$35
$169
$32
$39
$32
$39
$32
$39
$154
$154
$154
$171
$370
$171
Dr. A
$61
$90
$118
Dr. B
$61
Dr. C
$61
$19
$53
$84
$24
Dr. A
$48
$27
$48
$176
$14
Dr. B
Dr. C
$48
$27
$48
$176
$14
$48
$48
$176
$14
$60
$60
$60
$150
$150
$150
$85
$170
$170
$170
$85
$170
$118
$33
$33
$20
$50
$162
$81
$51
$81
$51
$166
$81
$51
$171
$299
$92
$37
$80
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Case Study Initial Workup (1)
INITIAL WORKUP
Exam
PCV / TS
CBC
Chemistry Profile
Electrolytes
CBC/Chemistry Profile/Electrolytes (if packaged)
Blood Collection (if separate)
Dr. A
$44
$16
Dr. B
$86
Dr. C
$44
$16
$98
$35
$98
$35
$169
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Case Study Initial Workup (1)
INITIAL WORKUP
Exam
PCV / TS
CBC
Chemistry Profile
Electrolytes
CBC/Chemistry Profile/Electrolytes (if packaged)
Blood Collection (if separate)
Urine Collection (if separate)
Urinalysis
Dr. A
$61
$90
$118
$33
Dr. B
$61
Dr. C
$61
$19
$53
$84
$24
$118
$33
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
$20
$50
Case Study Initial Workup (1)
INITIAL WORKUP
X ray abdomen 2 views
Film 2 views
Interpretation 2 views
Film 2 views and interpretation (if packaged)
Abdominal Ultrasound in house
Abdominal Ultrasound outside service
Dr. A
$85
$170
Dr. B
$170
$170
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Dr. C
$85
$170
Day One Work Up (1)
High to Low
% Difference $ Difference
•
•
•
•
•
•
•
•
•
•
249%
233%
131%
125%
105%
80%
78%
69%
55%
45%
$ 709
$ 1,052
$ 484
$ 480
$ 331
$ 437
$ 497
$ 406
$ 323
$ 252
% Difference
•
•
•
•
•
•
•
•
•
•
27%
26%
18%
18%
15%
14%
12%
9%
7%
3%
$ Difference
$
$
$
$
$
$
$
$
$
$
208
168
165
113
112
116
88
76
131
26
Case Study – Pyo Surgery (2)
PYO SURGERY
Culture Sensitivity
EKG Preanesthetic
IV Catheter and fluid set up
IV of choice fluids
IV fluids of choice and pump
IV pump
Propofol Induction
Ketamine Valium Induction
Pentobarb Injection
Pre Anesthetic Pain Modifier Injection
Anesthetic Monitoring (Electronic)
Blood Pressure Monitoring
Pyometra Surgery
Laser Fee
Surgery Assistant
OR Pack and Supplies
Operating Room
Isoflorane Inhalation Anesthetic
Sevoflorane Inhalation Anesthetic
PDS Suture Material
Gut Suture Material
Vicryl Suture Material
$
135
$
40
$
$
$
217 $
40 $
575 $
414 $
80 $
575 $
$
45 $
45 $
$
39
$
55
$
15
414
80
575 $
66 $
88
$
$
550 $
61
19
$
$
61
39
$
393
$
196
$
164
$
164
$
$
61 $
19 $
33
50
$
17
550 $
550
$
364
$
165
$
164
39
26
$
39
$
83
$
$
50
$
$
$
Dr. C
Dr. B
Dr. A
Dr. C
Dr. B
Dr. A
Dr. C
Dr. B
Dr. A
110
111
*fees shown are for illustration
only
are not suggested
fees
nor actual fees charged
Feespurposes
shown are
for&illustration
purposes
only
Case Study Pyo Surgery (2)
PYO SURGERY
Culture Sensitivity
EKG Preanesthetic
IV Catheter and fluid set up
IV of choice fluids
IV fluids of choice and pump
IV pump
Dr. A
$
135
$
40
Dr. B
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Dr. C
Case Study Pyo Surgery (2)
Propofol Induction
$
Ketamine Valium Induction
Pentobarb Injection
Pre Anesthetic Pain Modifier Injection
$
Anesthetic Monitoring (Electronic)
Blood Pressure Monitoring
Pyometra Surgery
$
Laser Fee
Surgery Assistant
OR Pack and Supplies
Operating Room
Isoflorane Inhalation Anesthetic
Sevoflorane Inhalation Anesthetic $
55
15
$
550 $
110
$
83
$
$
33
50
550 $
550
$
165
26
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Case Study – Pyo Surgery (3)
(cont’d)
PYO SURGERY
Skin Staples
Prolyne Suture Material
Tramadol Oral Tablets
Rimadyl Injections
Fentyl Patch
Cerenia injection
Anzemet Injection
Meteclopramide Injection
Cimetidine Injection
Famidodine Injection
Analgesic injectables
Injectable Antibiotics
Non Antibiotic Injectable meds
Intensive Care Hospitalization
Hospital Feeding and Lodging
Daily Doctor Evaluation & Treatment
Daily Intensive Nursing Care
Hospitalization All Inclusive Package
Sucrafate Tablets
Laser Pain Management
Miscellaneous
TOTAL
Dr. A
Dr. B
Dr. C
Dr. A
Dr. B
Dr. C
$13
$30
$15
$89
Dr. A
$18
Dr. B
Dr. C
$24
$12
$24
$10
$41
$23
$38
$37
$37
$92
$92
$103
$404
$58
$116
$55
$37
$104
$81
$236
*fees shown are for illustration
purposes
only & are purposes
not suggested
Fees shown
are for illustration
only fees nor actual fees charged
$92
Case Study Pyo Surgery (2)
PYO SURGERY
Analgesic injectables
Injectable Antibiotics
Non Antibiotic Injectable meds
Intensive Care Hospitalization
Hospital Feeding and Lodging
Daily Doctor Evaluation & Treatment
Daily Intensive Nursing Care
Hospitalization All Inclusive Package
Dr. A
$
89
$
116
Dr. B
Dr. C
Dr. A
Dr. B
$
18
$
55
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Dr. C
$
10
$
41
Case Study Pyo Surgery (2)
Propofol Induction
Ketamine Valium Induction
Pentobarb Injection
Pre Anesthetic Pain Modifier Injection
Anesthetic Monitoring (Electronic)
Blood Pressure Monitoring
Pyometra Surgery
Laser Fee
Surgery Assistant
OR Pack and Supplies
Operating Room
Isoflorane Inhalation Anesthetic
Sevoflorane Inhalation Anesthetic
PDS Suture Material
$
$
$
217 $
40 $
575 $
414 $
80 $
575 $
414
80
575
$
45
$
45
$
50
$
66
$
88 $
111
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
Pyo Surgery & Same Day
Post op Care (2)- High to Low
% Difference $ Difference
•
•
•
•
•
•
•
•
•
•
102%
68%
48%
43%
29%
28%
24%
23%
20%
19%
$622
$362
$663
$294
$203
$278
$135
$160
$438
$194
% Difference $ Difference
•
•
•
•
•
•
•
•
•
•
17%
16%
15%
14%
12%
9%
8%
8%
8%
6%
$143
$ 82
$120
$183
$ 57
$ 48
$ 74
$ 95
$ 86
$ 53
Case Study – Post Op Care (4)
*fees shown are for illustration purposes only & are not suggested fees nor actual fees charged
POST OP
Intensive Care Hospitalization
Hospital Feeding and Lodging
Daily Doctor Evaluation & Treatment
Daily Intensive Nursing Care
Hospitalization All Inclusive Package
IV Catheter and fluid set up
IV fluids of choice
IV fluids of choice and pump
IV pump
Meteclopramide Injection
Cerenia injection
Anzemet Injection
Pain Modifier Injection
Laser Treatments
Antacid Injection
Antacid Tablets
Antibiotic Injections
Non Antibiotic injectables
Other Dispensed Meds
Zenoquin Antibiotic 25mg Tablets #14
Amoxicillin Antibiotic 200mg Tablets #28
Post OP Blood Chemistry Rechecks
CBC Rechecks
Chemistry Profiles Rechecks
CBC/Chemistry Profiles Rechecks
Blood Pressure Monitoring
PCV / TS Rechecks
Sucrafate Tablets 1 gm # 10
Urinalysis
Miscellaneous
TOTAL
Dr. A
$
$
Dr. B
84
62
$
Dr. C
84
$
31
$
62
$
67
$
74
$
78
$
40
$
94
$
26
$
48
$
$
$
$
$
$
Dr. A
21
31
41
25
96
83
$
$
$
270
28
-
$
$
34
20
$
270
$
26
$
76
$
76
$
74
Dr. B
$
38
$
28
$
37
Dr. C
$
76
$
76
$
74
Dr. A
$
232
Dr. B
$
232
Dr. C
$
232
$
$
$
79
$
40
149
158
$
84
$
74
$
74
$
108
$
90
$
178
$
178
$
178
$
36
$
65
$
64
$
65
$
$
$
$
70
34
126
56
$
390
$
255
$
390
$
70
$
70
$
$
35
43
$
$
17
41
$
70
$
86
Post-Op Care Differences
2 Days Post-op (3) High to Low
•
•
•
•
•
•
•
•
•
•
% Difference
299%
202%
155%
128%
124%
113%
76%
58%
57%
51%
$ Difference
$541
$595
$533
$518
$221
$365
$211
$347
$262
$223
•
•
•
•
•
•
•
•
•
•
% Difference
$ Difference
46%
44%
40%
28%
17%
13%
12%
12%
12%
8%
$162
$142
$259
$115
$101
$130
$127
$127
$95
$63
Total Case Study Fees
High to Low (not including overnight fees)
% Difference $ Difference
•
•
•
•
•
•
•
•
•
•
82%
63%
52%
49%
27%
25%
24%
24%
21%
16%
$1,991
$1,026
$696
$643
$601
$512
$548
$535
$348
$331
% Difference $ Difference
•
•
•
•
•
•
•
•
•
•
13%
13%
13%
12%
10%
10%
8%
5%
4%
2%
$305
$300
$232
$256
$150
$287
$427
$72
$142
$59
Case Study Summary
High to Low
Initial Work Up
% Diff
$ Diff
Pyo Surgery
% Diff
•
233% $
1,052
48%
•
69% $
406
102%
•
249% $
709
24%
•
125% $
480
16%
•
27% $
208
68%
•
14% $
116
29%
•
15% $
112
8%
•
78% $
497
8%
•
26% $
168
43%
•
55% $
323
15%
•
12% $
88
6%
•
45% $
252
23%
•
80% $
437
19%
•
131% $
484
17%
•
105% $
331
9%
•
9% $
76
28%
•
7% $
131
20%
•
18% $
113
12%
•
18% $
165
14%
•
3% $
26
8%
High
249% $
1,052
102%
Low
3% $
26
6%
AVG
66% $
309
26%
*does not include overnight care fees
Post Op
$ Diff
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
663
622
135
82
362
203
95
74
294
120
53
160
194
143
48
278
438
57
183
86
663
48
215
% Diff
58%
299%
76%
28%
13%
202%
113%
17%
124%
155%
40%
44%
128%
57%
51%
12%
12%
46%
12%
8%
299%
8%
75%
Total Case Study*
$ Diff
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
347
541
211
115
130
595
365
101
221
533
259
142
518
262
223
127
95
162
127
63
595
63
257
% Diff
82%
63%
52%
49%
27%
25%
24%
24%
21%
16%
13%
13%
13%
12%
10%
10%
8%
5%
4%
2%
82%
2%
24%
$ Diff
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
1,991
1,026
696
643
601
512
548
535
348
331
305
232
300
256
150
287
427
72
142
59
1,991
59
473
High Low Summary
100 Practices
Initial
Workup
Pyo Surgery
Low
0%
High
249%
AVERAGE
40%
* Overnight fees not included
0%
105%
28%
Post Op
2%
341%
74%
Total Case
Study*
1%
82%
26%
Pyo Case Total Fees Invoiced
Average of the last 100 VMG practices:
26% difference high to low total fees within
practice
Differences range from 1% to 82% difference
“Disparity Gap”
What Does This Mean
to Practice Financially
Practice Revenue
$2,000,000
½ of 26% or 13%
$260,000
20% Vet compensation + 15% COGS= 35% variable expenses
If 65%/$260,000 profit = $169,000
Potential of additional $52,000 vet compensation
Same SOC - Different Estimate
• How can associates in the
same practice make similar
treatment recommendations
yet have totally different
invoice amounts?
• Fee schedule compliance?
• Leadership?
Same History, PE & Diagnostic info
Yet Different Recommendations
• Why do some associates
come up with quite a
different diagnostic and
treatment plan given the
same presentation history
and lab findings ?
• Standards of Care?
• Leadership?
Take Home
• There is a significant variation in standards
of care and charging within most practices
• Establish SOC with group input
• Simplify your fee schedule “KISS”
• Capture 50% of fee disparity in your
hospital
Consider This…
If you don’t
address the issues
that lead to
differing fee
presentation &
levels of care
within your
hospital…
•
How does this impact medical
outcomes in your hospital?
•
What is the client’s perception
regarding a consistent level of
care?
•
What does it mean to the
associate’s income?
•
What does it mean to your
bottom line?
What are You Going to Change?