Developing a Practice Dashboard MGMA Anesthesia Administration Assembly May 2008 Joe Laden MGMA member since 1981 AAA Member since inception Business Manager Anesthesia Associates of Louisville, PSC

What is a Dashboard?

Merriam-Webster Dashboard 1.a screen on the front of a usually horse-drawn vehicle to intercept water, mud, or snow 2.a panel extending across the interior of a vehicle (as an automobile) below the windshield and usually containing instruments (as a speedometer) and controls

What is a Business Intelligence Dashboard? aka Digital Dashboard Electronic Dashboard Information Dashboard Scorecard

The Ultimate Anesthesia Dashboard

What is a not a dashboard, But might look like a dashboard?

Click above to activate calculator, click here to go to next slide

Dashboard definition and characteristics of good dashboard design. Stephen Few....

“Visual display Of the most important information needed to achieve one or more objectives Which Fits entirely on a single computer screen So it can be Monitored at a glance” Stephen Few

Visual Display Text Units 12,000 12,300 11,700 13,024 12,670 Hours 1,200 1,230 1,195 1,200 1,140 Graphics

Achieve Objectives Monitor Anesthesiologist/ACT Work Output: Units Minutes Cases Monitor Reimbursement for Work Performed Monitor Collection Efficiency Monitor Hospital Efficiency (O.R. Utilization) Make decisions about staffing Determine need for hospital subsidies

Monitor Single Screen at A Glance Static Text Graphics Mixed Dynamic Selectors Drilldown Portal to Reporting System May be OK to have multiple screens/pages

YTD-2008BudgetYTD-2007 Patient Revenue145,000140,000160,000 Hospital Subsidy15,000 10,000 Billing Expense8,7008,4009,600 Corporate Expense2,6503,0002,750 CRNA Expense58,50055,0005,300 MD Expense75,50072,00074,000 Net14,65016,60078,350 Mini G/L

Additional Characteristics of Good Dashboards Small, clear, concise and intuitive display mechanisms Customized to each person, group or function Replace hunt and peck data gathering from many reports Fine tuned to deliver insight in a powerful way

Problems with “Dashboard” Model for Business Intelligence Vehicle dashboard is real time Provides no trending & historical data Provides no comparisons Monitors relatively few indicators

Audience for Your Practice Dashboard Board of Directors Shareholders Practice Manager Billing Manager Dashboard contents should be targeted to its readers

Where are anesthesia dashboards available today? Anesthesia Billing Software Vendors Anesthesia Billing Companies Anesthesia Practice Management Companies Report Hosting Companies DIY for Small – Medium Size Groups

Tools to Produce You Own Dashboard Excel / Word Text Dashboard Cheap and Easy Excel Charts (graphs) Cheap, but more difficult Excel Pivot Tables Powerful but need transaction data Xcelsius/Engage Expensive & Complicated but more powerful Custom Programming IT expertise and expense, specialized software

Steps to Prepare You Dashboard Determine Your Audience Review Current One Page Reports Decide Which Key Performance Indicators to Display Determine How to Gather Data Decide on Dashboard Construction Tool

KPI Anesthesia Key Performance Indicator Categories 1. Anesthesiologist/ACT Production 2. Billing & Collection 3. Practice Operations Expenses Personnel

Anesthesiologist/ACT Production KPI Cases Units Base Time Flat Fee Procedures Minutes/Hours Gross Billing

Billing & Collection KPI Payments Gross and Net Collection Ratio A/R Aging Days in A/R

Practice Operations KPI Personnel & Cost MD CRNA Overhead Corporate Billing Costs

KPI Coupled with Timing Per Month Day Year Quarter Week

KPI Coupled with Comparative Timing Year vs year Year to Date vs. Last Year to date Quarter vs Same Quarter last year Trailing 12 months vs. Trailing 12 months prior year

KPI vs. Comparative Benchmarks Facility vs. Facility MD vs. MD Payer vs. Payer MGMA Physician Compensation and Production Survey MGMA Single Specialty Practice Cost Survey

KPI Top and Bottom Top 10 and Bottom 10: Surgeons (collected per hour) Anesthesiologists (units per year) CRNA’s (hours billed/ hours paid) Payers (collected per unit) ASA Codes (units per case)

Other Combinations Units per case, MD, CRNA, Hour Revenue per O.R., MD, Case, Hour Units, Hours and revenue per Surgeon Operating Room or Facility

The Data to Ink Ratio: (Edward Tufte) Ink that represents data vs. Ink that is not data such as: Company information Decoration Graph Lines Color gradients

Dashboard Design Mistakes Size greater than one screen Excessive detail or precision Choosing non-meaningful measure Inappropriate display media Meaningless variety Poorly designed display media Poor arrangement Useless decoration Misuse of overuse of color Failing to highlight important data Unattractive visual display

Characteristics of a Good Display Excellent organization Condensed with summaries and exceptions Customized to user’s needs and objectives Clear and direct media display

Change 2007 vs Production (units) Hospital 1250,954261,575274,9015.1%9.5% Hospital 297,705112,521112,7440.2%15.4% Both OR's348,659374,096387,6453.6%11.2%

Revenue (collections) Hospital 1 Collections7,281,869 Hospital 2 Collections3,163,032 Total OR Collections10,444,901 Hospital 1 Collections/OR520,133 Hospital 2 Collections/OR451,862 Average Collections/OR497,376 OR's21 Pain Collections555,650 Total Collections11,000,550

Collected / Unit (6/hr)$30.61$31.03$32.19$30.44 Collected / Unit (4/hr)$38.27$38.79$40.24$38.04 Change in Collected/Unit1.4%3.7%-5.5% Collect per OR case $ 628 $ 665 $ 705 $ 673 Collect per Pain Case $ 203 $ 197 $ 214 $ 211

Which is Better: Table Or Chart ?

CategoryCurrent ALL PATIENTS37.0%32.2%8.9%6.5%3.7%11.7% MEDICARE57.5%27.9%1.7%5.1%1.0%6.8% BLUE CROSS44.3%36.5%10.2%3.6%0.9%4.6% PATIENT4.9%37.7%21.8%12.1%6.3%17.2% HUMANA60.6%9.2%2.5%3.1%3.6%20.9% TRICARE32.5%41.7%4.5%3.8%1.3%16.1% UNITED HEALTH46.9%40.4%1.5%-0.2%4.7%6.7% A/R By Percent Outstanding by Carrier

Excel Dashboard Charts

Charles Kyd Kyd Principles Dashboards should be produced on paper Many tiny graphs using Excel Set up workbooks to update easily

Constructing a Dashboard with Microsoft Excel....

Producing an Xcelsius Dashboard 1.Construct Excel spreadsheet 2.Layout graphic elements

“CHEATER” DASHBOARD CONSTRUCTION 1. Start with blank PowerPoint Slide 2. Display component to place on dashboard 3. Capture component with Vista Snipping Tool 4. Paste onto slide 5. Resize and reposition

Anesthesia Associates of the United States – May 2008

Presentation Mode Paper Physical PDF Computer Screen 1.Spreadsheet 2.Web 3.PDF 4.PowerPoint 5.Flash

Method of Delivery Private Web Site Spreadsheet PDF Flash Web Link Physical Delivery (paper) DVD/Thumb Drive

Questions Anesthesiologists Ask: How is the business going? What will the end of the year look like? Will your dashboard provide answers?

Take Away Ideas Dashboards take time, talent and toil to make Resist the urge to favor flash over function. Encourage your vendor to produce dashboards Vendor dashboards must display the data you need, not the data that is easy to display. Often a paper report with limited graphics is best

Additional Resources The Effective Use Of Electronic Dashboards To Promote & Improve Overall Practice Performance: An Exploration Into The Use of Electronic Dashboards In A Group Practice Setting. ACMPE Paper by David G. Owens, FACMPE. Available on the MGMA web site Dashboard To Monitor Clinical Productivity of Anesthesiology Groups Amr E. Abouleish, M.D., M.B.A., Jody A. Locke, M.A., et al. Click Here For Web Link

Dashboard Resources On the Web

For Questions, Comments, Help or to Share Your Ideas: Joe Laden, Business Manager Anesthesia Associates of Louisville, PSC 332 W Broadway Louisville, Kentucky