 Business Intelligence: Use Metrics and Benchmarks to make Smarter Decisions Mona Reimers, FACMPE, CPC Director, Revenue Services, Orthopedics Northeast

1. Review commonly used business intelligence metrics and benchmarks 2. Determine which metrics and benchmarks are most applicable to orthopedic practices 3. Examine a practice that has used this data and evaluate results

 Defense: Knowing your practice and where it stands compared to the industry, allows you to identify what to work on next  Offense: Without innovation and change, you become extinct ◦ Allows you a competitive advantage, if you use it. ◦ Or you will have a competitive disadvantage without using benchmarking and BI

 Benchmarking is the comparison of data ◦ Against comparable alternatives ◦ Against prior time periods ◦ Can be external and internal

 Improving Clinical Care, Financial Performance and Operational Workflows by integrating previously disparate data to realize higher level decision-making and effectiveness in areas such as: ◦ Patient care ◦ Cost Containment ◦ Customer Satisfaction ◦ Organizational Performance

 The practice experience thus far for ONE is mostly limited to EHR and PM data  Future data sets for reporting include: ◦ Phone system data ◦ Time clock data ◦ General ledger/Accounts payable

 When going through this journey you will find that many times you have to rehash who enters data, who uses the data and define the meaning of data sets with a variety of stakeholders  Important to assign ownership for the quality of each data set  Important that all stakeholders understand ◦ When data entered in to the systems ◦ Is it changed throughout a process or changeable?

Review commonly used business intelligence metrics and benchmarks

 Confirms what you probably already know or suspect (we’re good, we’re losing ground)  Provides a definition to most things measured  But it has downsides ◦ Doesn’t really know your business ◦ Delay in data makes it difficult to use for nimble strategic advantage ◦ Not usually available at the process/workflow level

 MGMA-ACMPE and other organizations have helped to create many standardized benchmarks ◦ How many patients per day or per half day ◦ Collections/Costs per RVU or per wRVU ◦ Days in A/R ◦ Physician compensation ◦ Operating expenses ◦ Costs/Revenue per member per month ◦ Salary Surveys

 Number of days worked per provider?  Number of cases per month?  Top Referrers  Changes in Referrals  # of Appeals/Denials  Lag Days to Charge Posting  Revenue per patient/per unique patient  Time to next available appointment or ◦ 3 rd next available appointment or ◦ Per doctor/specialty

Determine which metrics and benchmarks are most applicable to orthopedic practices

 All of the common benchmarks listed above? PLUS  Costs per patient?  Operating costs?  Payer Mix?  Increase or decrease in charges, payments adjustments by month, by provider, by payer?  Number of phone calls per day?

Page 254…  Number of no shows  Number of minutes on hold  Number of calls in the queues  Unique patients per provider  Number of new consults to yield surgery

It Depends What You Want to Know? And What You Hope To Do With The Data?

Benchmarking is not for Eyore!

 F53.83 Fatigue/overworked  R48.8 Occupational neurosis that includes writers cramp  Y93.C1 Activity, like computer use of a keyboard

Examine a practice that has used this data and evaluate results

 Good, better, best, best-er, bestest, bested!  BI Tools provide historical, current and predictive views of business operations ◦ Use large amounts of data ◦ Allow for efficient and effective implementation of new strategies ◦ Help identify and develop new opportunities

 Technology has improved and data storage costs are cheaper than ever and seem to be going down further.  It’s about competitive advantage through FOCUS. ◦ The tools make it easier for you to “see” the data and where you are today, where you were yesterday and predict where you are headed.

 It started with a desire to have “dashboards”  Wanted to know the trends  Wanted to be alerted about the bad and the good operational and financial performance indicators  Wanted a crystal ball – but would have settled for anything better  Wanted to reduce backend work & re-work  Wanted timely access to data without slowing down the system and re-running reports

 It became an enterprise-wide strategic initiative  We’ve automated processes and error-proofed many tasks  Simplified reporting of data – less is more  Cut down on data entry  Improved the quality of our data  We are always trying to manage key information for analytic purposes ◦ Increased evidence-based decision making ◦ Developed a culture that values data more than ever

 A commitment from the top down for efficiency  The team: ◦ A consultant who understood our issues ◦ A D.B. Administrator (actually the IT team) ◦ Committed managers and staff ◦ Big dreamers looking for easier, better, faster

 Created report file in our share-drive with various tables of data to allow managers to create their own reports on the fly ◦ Liberated us from many “custom reports” using the 3 rd party software our PM vendor recommends ◦ Allows liberal use of Pivot Tables beyond what our PM vendor could provide  Customized to the employee’s role

 AUTOMATED notifications when certain events occur ◦ Several reports are ed daily without anyone running them  Interested parties get notified if a surgeon signs out of their blocked O.R. time  Created new tools for our end users and middle managers ◦ Saved hours of running reports either merging several reports in to one (e.g. front office manger’s report and supervisor of clinical office staff)

 AUTOMATED recording of our Time To Third next available appointment per provider every day  AUTOMATED dashboard reports out to CEO ◦ Top and bottom referring sources ◦ Rolling YTD to LTD, charges and payments by division (rolling average) ◦ & Other data  CREATED our own kiosk – less $ spent  CREATED On Time Board

DAYS TO THIRD NEXT APPOINTMENT By Appointment Type as of October 1, 2014 ProviderNewFollow Up Dr. A. Simon82 Dr. Cannon66 Dr. Dawson1233 Dr. Fleming1525 Dr. Gibson1115 Dr. Gutierrez55 Dr. Hardy1913 Dr. Hudson826 Dr. King21 Dr. Lynch41 Dr. Medina1811 Dr. S. Simon22 Dr. Vasquez33 Dr. Walker55 Dr. White41 Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado Copyright

 AUTOMATED to certain ATC’s in the field with appointment opportunities for the next day – they can fill from the field/court  AUTOMATED tools to sort and prioritize pre- cert and triage appeals by timeline and type

 How many patients in queue for x-ray, casting, in lobby ◦ Predict demand per quarter-hour, per building  Order in EHR from last appointment  Whether the last appointment was a surgery  With logic “per surgeon”  Was cast applied at last visit  Using predictive analytics to determine which patients are likely to “no-show” ◦ Give those patients special encouragement to show/cancel ◦ Automated daily s recommending next day add-ons by provider (linked to potential no-shows pts)

 Will have created our own internal appointment reminder calling service (& text/ service)  We have nearly completed an A/R dashboard and Front Office Dashboard (automated and ed to key stakeholders) ◦ WITHOUT running reports

Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado Copyright

Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado Copyright

 If you think it doesn’t matter – you’re right ◦ “My practice can’t go up against a big health plan.” ◦ “We can’t fight Obamacare.”  Understand the things you can change ◦ Your practice can be more efficient ◦ Your practice can help patients get better results by aligning resources ◦ Your practice can reduce operating expenses ◦ Your practice can be ready for the future of healthcare – whatever that might be

Mona Reimers, CPC, FACMPE