1. Practice Management Curriculum 2010

2.  Financial Management  Human Resource Management  Risk Management  Business Operations  Governance and Decision Making  Information Management  Patient Care Systems  Quality Management

3.  Where to start?  Who is your audience?  Do you/they know their goals & objectives?  What data/information will we need?  How will we define success?

5.  To provide third year residents with the tools for identifying problems or issues and organizing information/data to effect positive improvement/change.  By: -Providing structure to the assessment -Identifying useful tools. -Organizing data and using benchmarks.

6.  Finance.  Coding/Documentation/Compliance.  Business Office- accounts receivable management.  Front Office Efficiency.  Clinical Efficiency.

7.  They trust.  They understand.

8.  What are we trying to accomplish? ◦ Reach consensus  How will we know that a change is an improvement? ◦ Establish measures  Identify the key players  Identify the needed information  Conduct interviews

9. IDENTIFY THE PROBLEM/ISSUE Overhead too high? Productivity too low? Inefficiency?

10. Not the symptoms! Then develop your hypotheses

11. Organize/analyze the data Benchmark key indicators Develop trend analysis

12. Does the data support the Hypothesis? Prepare your recommendations Develop the presentation

13. Present to decision makers Present to affected staff Get consensus Develop Implementation plan

14. Implementation

16. Time in clinic demand Number of patients scheduled Level of service provided Time slot distribution (templates) Staff efficiency Staff competency Staff training Price Payer mix Coding Severity Age Intelligence dnka

17.  Staffing  Scheduling  Process

18.  Seasonality  Appointment times  Appointment templates

19. Example: Family Practice (Not Hospital Owned) Total Support Staff per Physician Registered Nurses Licensed Practical Nurses Unlicensed Assistive Personnel Clinical lab Radiology & Imaging Total Clinical Staff per Physician % of Total Support Staff MGMA Cost Survey 2002 FTE 4.41.49.50.83.38.19 2.39 54%

20.  Chart prep  Nurse groundwork ◦ Vital signs, meds, lab, chief complaint  Visit protocols

21.  Have the appropriate staffing  Make your processes as efficient as possible  Reduce the amount of non-visit care  Delegate if possible  Use staff to their fullest potential

22.  Evaluation and Management code frequency analysis  Sources: MGMA Coding Profile Source Book Centers for Medicare and Medicaid Services

23. Charges Adjusted charges Revenues RVU’s Hybrid

24.  Monitor charges by service line - E&M, Surgery, Laboratory, Drugs, etc.  Use a YTD total and Monthly Average Column  Use previous period data  Establish your internal benchmarks or compare with external benchmarks 24

25.  Good reports create the context within which data can be evaluated. 25 Numbers in isolation of benchmarks or trends have limited value.

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30.  Drilling Down ◦ Charges, Adjustments and Receipts by service type ◦ To understand where revenue is derived ◦ To verify profitability of service lines 30

31.  Adjustments are monitored by payer  Bad debt and “Other” are separated from “contractual” adjustments  Totals and averages allows a quick review for outliers  Monitor bad debt and “other” write-off 31