{"id":3650,"date":"2023-09-26T16:03:40","date_gmt":"2023-09-26T16:03:40","guid":{"rendered":"https:\/\/glomedbusiness.com\/staging\/?p=3650"},"modified":"2023-10-11T11:57:41","modified_gmt":"2023-10-11T11:57:41","slug":"foundational-benchmarks-and-kpis-for-medical-practice-operations-in-2023","status":"publish","type":"post","link":"https:\/\/glomedbusiness.com\/staging\/2023\/09\/26\/foundational-benchmarks-and-kpis-for-medical-practice-operations-in-2023\/","title":{"rendered":"Foundational benchmarks and KPIs for medical practice operations in 2023"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"3650\" class=\"elementor elementor-3650\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-740d254 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"740d254\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1e6bb4c\" data-id=\"1e6bb4c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-117bda9 elementor-widget elementor-widget-text-editor\" data-id=\"117bda9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 20-09-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><span style=\"font-weight: 400;\">High-performing medical practice reach success with more than just best practices \u2014 they measure key performance indicators (KPIs) and benchmark against other organizations to understand where they can improve and sustain that excellence.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">During a recent MGMA member-exclusive webinar, MGMA\u2019s Andrew Hajde, CMPE, director of content and consulting, and Ashley Ager, MSM, organizational membership account manager, detailed how measurement and tracking of specific metrics can inform decision-making that leads to being a better-performing practice.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">This type of data work has shown over time to be valuable and widely used in the industry: More than 8 in 10 healthcare leaders report <\/span><a href=\"https:\/\/mgma.com\/data\/data-stories\/benchmarking-for-success\"><span style=\"font-weight: 400;\">using benchmarking data to address issues<\/span><\/a><span style=\"font-weight: 400;\"> in their businesses, as it allows administrators and other medical group leaders to transform data into action.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">\u201cBetter performers blend new skills and perspectives for better outcomes while keeping a close eye on the well-being of clinicians and staff in their roles as leaders,\u201d Ager said. MGMA\u2019s DataDive surveys track this through the <\/span><a href=\"https:\/\/mgma.com\/data\/benchmarking-data\/better-performers\"><span style=\"font-weight: 400;\">Better Performers data set<\/span><\/a><span style=\"font-weight: 400;\">, which covers survey data from more than 4,000 medical groups to highlight top performance in the areas of operations, profitability, productivity and value.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">In key areas such as productivity and expenses, benchmarking data year over year can quickly tell the story of what is happening in an individual clinic, a broader group or even the entire industry.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">Case in point: the <\/span><a href=\"https:\/\/mgma.com\/data\/benchmarking-data\/costs-revenue-data\"><i><span style=\"font-weight: 400;\">MGMA DataDive Cost and Revenue<\/span><\/i><\/a><span style=\"font-weight: 400;\"> data set offers benchmarks for total encounters per full-time-equivalent (FTE) physician (Table 1) that, trended over time, help reveal how different ownership models fared from pre-COVID-19 pandemic years to recovery.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><\/p><h3><span style=\"font-weight: 400;\">Learning from data<\/span><\/h3><p><span style=\"font-weight: 400;\">Deciding on which KPIs to track will enable operational and workflow changes in certain scenarios, as Hajde outlined:<\/span><\/p><ul><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient access \u2014 a major concern amid limited staffing and the need to sustain revenue \u2014 should be tracked by same-day appointment availability and time to third-next-available appointment (TNAA), with reviews of visit types of appointment durations.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To address staffing shortages, cross-training and optimization of advanced practice providers (APPs) can be used in conjunction with benchmarks for hiring and retention incentives to ensure your compensation is competitive.<\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">\u201cWe&#8217;re also seeing many practices utilizing nontraditional clinical staff that we wouldn&#8217;t have always seen in a practice setting: CNAs, EMTs, and others to help them out, especially in those areas across the country where they can&#8217;t find medical assistants (MAs) and or can&#8217;t retain people,\u201d Hajde said. \u201cUsing staffing benchmarks to see what ratios you should be having per physician FTE and other information [helps you] make really wise decisions based on what others are doing in your specialty.\u201d<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">Ager echoed the staffing difficulties, noting that medical practices can \u201cget creative and invest in tools that deepen an MA\u2019s connection to the patient care,\u201d such as disease-specific, care-enabled pathways \u201cthat empower the MAs to identify patients who need expedited care.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">In one group where this approach helped MAs ask the right questions in order to identify patients at higher risk, the time spent by physicians reviewing patient data went down by 10 to 15 minutes per patient. \u201cIn some cases, that can be an entire added patient to the provider schedule,\u201d Ager noted.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">Ager also offered the example of a urology group using a method to identify patients with chronic cystitis who would benefit from a remote cystitis clinic. \u201cWhen patients would present with symptoms, the MA would order lab tests to identify microbial DNA, RNA urine,\u201d Ager said. \u201cThis approach would prove to be more effective in treating UTIs and patients with cystitis than traditional urine dipstick analysis,\u201d as the remote clinic was able to help more than 100 patient avoid urgent or emergency care in a year, while also generating almost $70,000 in revenue for chronic care management.<\/span><\/p><p>\u00a0<\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5630 size-full\" src=\"https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1708\" srcset=\"https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-scaled.jpg 2560w, https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-300x200.jpg 300w, https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-1024x683.jpg 1024w, https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-768x512.jpg 768w, https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-1536x1025.jpg 1536w, https:\/\/glomedbusiness.com\/staging\/wp-content\/uploads\/2023\/10\/documents-meeting-and-startup-team-in-workshop-fo-2023-01-11-22-26-10-utc-1-2048x1366.jpg 2048w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/><\/p><p>\u00a0<\/p><h3><span style=\"font-weight: 400;\">Revenue cycle management<\/span><\/h3><p><span style=\"font-weight: 400;\">Focusing on revenue cycle optimization amid rising costs and reimbursement challenges is a top priority for most medical groups in 2023, and using data to make operational decisions in this domain is another important piece of your benchmarking and KPI tactics, Ager said.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><\/p><p><span style=\"font-weight: 400;\">Use of a claims scrubbing tool and using best practices in coding, documentation and denials management all aid in improving days in A\/R, but it also requires dedication to running reports on these metrics \u2014 at least monthly for administrative leaders and more frequently for billers.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><\/p><p><span style=\"font-weight: 400;\">Ager added that technological tools such as automated check-in, prompts for balances, and methods for patients to enter their demographic and insurance information before a visit are some of the top ways for practices to become more efficient and avoid errors that can lead to bad debt and unnecessary write-offs.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><\/p><p><span style=\"font-weight: 400;\">\u201cA lot of our Better Performers collect more A\/R in the first 30 days as compared to the industry benchmark,\u201d Ager said, underscoring the usefulness of creating scripts for your front office staff to have proactive conversations with patients about payments.<\/span><\/p><h3>\u00a0<\/h3><h3><span style=\"font-weight: 400;\">Code-specific benchmarking<\/span><\/h3><p><span style=\"font-weight: 400;\">Hajde emphasized that several survey data sets often have a wealth of benchmarks that might fly under a user\u2019s radar and be underutilized, such as the MGMA DataDive Procedural Profile data set, which allows users to do CPT\u00ae-level benchmarking.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">Whether you\u2019re in orthopedic surgery, cardiology or some other specialty, this tool can help you look at all of the CPT\u00ae codes submitted in those specialties. Not only can you find typical CPT\u00ae code average volume \u2014 you can also see exactly what is being billed for a typical clinician and the associated volumes of each code. You can see what specialties are expanding their services, such as CPT\u00ae codes that were traditionally performed by dermatologists or plastic surgeons expanding into other specialties, or even the volumes of each type of new and traditional surgical procedure a heart surgeon or other specialist is performing. You can even filter this data by ownership type, geographic location and many other factors to see the specific segment you want.<\/span><\/p><h3>\u00a0<\/h3><h3><span style=\"font-weight: 400;\">Data visualization<\/span><\/h3><p><span style=\"font-weight: 400;\">Another important tool to use in your data work is the Pay-to-Production Plotter, which visualizes the relationship between data, such as provider compensation and productivity (see Figure 1), and help validate findings and make decisions about physician compensation plan changes.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">\u201cThis is particularly useful when you have part-time physicians who are paid solely on a compensation-per-work-RVU basis,\u201d Ager said. \u201cIt&#8217;s a great illustration of where physicians\u2019 compensation and productivity lines up with MGMA\u2019s actual respondents within the same specialty \u2026 and it helps you identify your outliers and keep track of them.\u201d This plotter is often used in conjunction with fair market valuations of physician compensation for medical groups, hospitals, health systems.<\/span><\/p><p><span style=\"font-weight: 400;\">Top operational and billing\/RCM KPIs<\/span><\/p><p><span style=\"font-weight: 400;\">The following operational KPIs are important for practice leaders to track and analyze on a regular basis:<\/span><\/p><ul><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician\/APP wRVU productivity<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician\/APP total encounters<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician\/APP panel size<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician\/APP FTE status [i.e., full-time (1.0\/40 hours), part-time (0.5\/20hours)]<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CPT\u00ae codes (E\/M and total procedures)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">FTE staffing ratios for clinical\/nonclinical staff by location<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Including provider to nonprovider ratios<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient portal use<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Wait times (throughput)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Same-day appointments<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Third-next-available appointments (By type \u2013 new\/established)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">No-show rates<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cancellation rates<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Turnover\/retention rate<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Phone call stats (including volume, length, abandonment rate)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient satisfaction scores (Blended top box)\u00a0<\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">The following billing and revenue cycle KPIs are also recommended for regular tracking and analysis:<\/span><\/p><ul><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Total medical revenue after operating costs<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gross revenues<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Net fee-for-service (FFS) or other net revenues<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Collection ratios\/average reimbursement rate<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Claims denial rates and denial write-offs<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bad debt<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Payer mix<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A\/R days and A\/R aging comparisons (by bucket: 0-30, 31-60, 61-90, 91-120, 120+ days)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Charge posting and billing lag time<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Copay collections<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient-due collections<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CPT\u00ae codes (E\/M comparison to CMS\/MGMA Procedural Profile and procedures)<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician\/APP wRVU productivity<\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">Attendees of the webinar noted that they typically will review which KPIs they are tracking either quarterly or annually to ensure the right metrics are being reported and then reviewed in some combination of data visualization software, web-based tool, EHR-embedded tool or commercially available RCM tools, such as <\/span><a href=\"https:\/\/mgma.com\/data\/landing-pages\/datadiscovery\"><span style=\"font-weight: 400;\">MGMA DataDiscovery<\/span><\/a><span style=\"font-weight: 400;\">. Finding the right combination for your specific situation is crucial, Hajde noted.<\/span><span style=\"font-weight: 400;\"><br \/><\/span> <span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">\u201cThe more you can automate, where you don&#8217;t have to have so much manual labor on a monthly basis or quarterly basis \u2026 makes this so much easier to do,\u201d Hajde said.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">Ultimately, helping others within the organization understand why these benchmarks are important will be a factor in the overall success of your efforts, as well as seeking input from others about what it is being measured and analyzed.<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">\u201cGathering input from your team members is going to make them feel valued and make them feel part of this change,\u201d Ager said. \u201cThat\u2019s going to increase the chances of long-term success. \u2026 Make sure you clearly communicate the reasons for the change, the expected outcomes, and the steps that need to be taken to implement this change.\u201d<\/span><\/p><p><em><em><strong>Reference:<\/strong> \u00a0<\/em><\/em><i><span style=\"font-weight: 400;\">Foundational benchmarks and KPIs for medical practice operations in 2023<\/span><\/i><span style=\"font-weight: 400;\">.<\/span><\/p><p><span style=\"font-weight: 400;\">Available at: https:\/\/mgma.com\/articles\/foundational-benchmarks-and-kpis-for-medical-practice-operations-in-2023-2 (Accessed: 29 September 2023).\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Alzheimer\u2019s disease (AD) is characterized&#8230;<\/p>\n","protected":false},"author":1,"featured_media":5601,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[22],"tags":[],"class_list":["post-3650","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-initiatives"],"_links":{"self":[{"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/posts\/3650","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/comments?post=3650"}],"version-history":[{"count":74,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/posts\/3650\/revisions"}],"predecessor-version":[{"id":6921,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/posts\/3650\/revisions\/6921"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/media\/5601"}],"wp:attachment":[{"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/media?parent=3650"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/categories?post=3650"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glomedbusiness.com\/staging\/wp-json\/wp\/v2\/tags?post=3650"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}