benchmarking as a tool for effective

Benchmarking as a tool for Effective Performance Management: A Case Study

Jose ValeroVP of Data AnalyticsdashboardMD Powered by Azalea Health Miami, Florida

Presenters report no conflicts of interest at time of presentation.

• Explain how to leverage benchmarking data to set and communicate goals

• Describe how to implement a Performance Improvement Initiative successfully

• Identify KPI’s to monitor across multiple performance areas, including Scheduling, Productivity, Coding, Billing, Collections, A/R, Denials and Clinical Quality

Learning Objectives

- 3 -©2021 MGMA. All rights reserved.

- -©2021 MGMA. All rights reserved.

Benchmarking Basics

Why benchmarks and how do I use them?


If you don’t know where you’re going, you might wind up someplace else.

Yogi Berra

Definitions


Benchmarking

• Performance Metrics• Key Performance Indicators, KPIs• Clinical Quality Measures• Internal vs. External Benchmarks• Percentiles• Goals and Targets• FTE Physician

Why use benchmarks?


Benchmarking

• Analyze and Improve Performance• Gain Market Insights• Identify Areas with Opportunities for Improvements• Promote Accountability

Scheduling KPIs


Benchmarking – Key Performance Indicators

• Access• 3rd Next Available Appointment• No Show Rates• Cancellation Rates• Bump Rates• Utilization Rates

• Patient Flow• Average Wait Time• Total Appointment Time

Productivity KPIs



• Patient Visit Counts• Established Patients• New Patients• Unique Patients

• Average Visits per Day Worked• wRVUs

Billing KPIs



• Gross Charges• Days to Post• Days to Bill• Clean Claim Rates• Unbilled Charges

• Claims on Hold• Unbilled Appointments

• Appointments without a charge

Collection KPIs



• Payments• Adjustments

• Contractual • Non Contractual

• Expected vs Allowed

Accounts Receivable KPIs



• A/R Percentage over 90 Days• Days in AR• Average Days to Pay

Denials KPIs



• Denial Rate• Resolution Rate• Write Off Rate

Clinical Quality Measures



• Documentation of Current Medications• Diabetes A1C Poor Control• Controlling High Blood Pressure• BMI Screening• Cancer Screenings

• Colorectal Cancer Screening• Breast Cancer Screening• Cervical Cancer Screening


Performance Management

The systematic process of measuring performance using KPI metrics, analyzing and responding to results.


You can’t manage what you don’t measure.

Robert Kaplan, Harvard Business School

A formal plan to improve performance in a specific area

Performance Improvement Initiative


• What do we want to improve?

• How are we going to accomplish this improvement?• List out Process Changes and Action Items

• Who can drive performance improvements?• Identify Stakeholders that can affect change

• How are we going to track performance improvements or shortfalls?• Identify KPIs

• Measure • Monitor • Analyze

Performance Management Process


• Identify Key Performance Indicators, KPIs

• Gather Baseline Measure Results

• Compare to internal and external benchmarks

• Define Performance Goals

• Keep your eyes on the prize

• Compare KPI Results to Goals on a daily, weekly or monthly basis

• Communicate results with the Stakeholders

• Offer Assistance

• Analyze results against expectations• Listen to the Stakeholders• Discuss solutions • Consider Additional Process Improvements• Learn from the process• Apply your newly gained knowledge to the

process

Repeat!


Case Study

Practice Performance Improvements using a wRVU based Compensation Bonus Model.


You can observe a lot just by watching.

Yogi Berra

Case Study - Setting


• Advanced Primary Care Services with 18 Providers• All Providers are working hard• Business is growing and hiring new providers

• Most Providers are at or below the 50th percentile• Two providers are above the 70th percentile

Case Study - Challenge


• Learn from the better performing providers

• Improve provider performance across the board

• Better align provider performance with compensation

• Assist in Provider Recruitment

Case Study - Plan


• Apply a compensation bonus plan based on wRVU and achieving performance benchmark tiers

• Effectively communicate performance results vs. goals to strive for on a weekly and monthly basis

Case Study - Results


• Improved Coding Accuracy• Codes were being overlooked and deemed unimportant

• Improved Productivity• Improved visit volumes

• Close notes and bill in a more timely manner• Providers made sure to close out any open charges in time for

month end• Increased Collections

• Both the providers and the practice saw a notable increase in revenue

Jose Valero, VP of Data [email protected]

mailto:[email protected]

benchmarking as a tool for effective

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