1. Benchmarking Demystifying Data and Myths Nancy Babbitt, FACMPE

2. Learning Objectives Measure against industry norms Do’s and Don'ts Improvement Checklists Using data for ICD10

3. Top Healthcare Trends Healthcare Improvement – Improve Quality – Reduce Cost – Enhance Patient Experience Payment Reform – Payment Methodology – Physician Compensation Organizational Alignment

5. Use DATA and Benchmarking Know where you are Know where you want to go Improvements Concentrate resources to get the most impact Measure Success

6. Data… Internal and External Internal – show progress over time – Historical – establish a baseline – Ongoing – identify problems – Control fraud and embezzlement External – compare to others – MGMA – Specialty Society MGMA Best Practices – Profitability and Cost Management – Productivity, Capacity and Staffing – Accounts Receivable Management

7. Do’s and Don’ts of Benchmarking Use the Median, not the Mean – Median – mid-point of a set of data – Mean – observations divided by observations Don’t default to the highest benchmark – Can represent the best or worst, depending on type of data Use tables with “metrics” that apply – Per FTE Physician – FTE Provider – Per patient

8. Do’s and Don’ts of Benchmarking Be aware of the population – Higher the population, more robust data “Best Fit” data – 1st look for data based on specialty and ownership model – Then review all benchmarks, size, region, number of providers

9. TIPS Illustrate your findings to Physicians and Staff – Graphs – Tables – Dashboards Use Productivity Benchmarks to set reasonable targets – Example: Encounter data to set daily visit goal Create daily, monthly, yearly goals – Update staff regularly Attract and retain quality staff by using compensation and benefit benchmarks

10. KEY Benchmarks Gross Collection Rate Gross Charges per Provider Gross Charges per Patient Number of Procedures Number of Patients Days in Accounts Receivable Patient point of care collection rate Total Accounts Receivable

11. KEY Benchmarks Key Performance Indicators Sample Pediatric Practice ANNUAL201320122011 Charges $3,259,231$3,280,324 Collections $1,549,879$1,700,954 Adjustments $1,659,566$1,559,642 Visits 15,93416,531 New Patients 11561259 Net Collections56%48%52% Adjusted Net Collections104%98%100% Accounts Receivable$201,451$223,894$206,441 Charge Per Visit$200.27$207.68$202.20 Revenue Per Visit$112.39$99.05$105.17 Cost Per Visit $100.50$115.25 Physician Compensation Dr. A $190,000$217,000 Dr. B $189,000$219,000 Overhead % 64% 63% Staff to Provider Ratio2.432.893.11 Total Expenses $1,580,412$1,870,588 Net Income $ 101,256$ -20,589

12. MGMA DataDive Physician Compensation and Production: 2013 Report Based on 2012 Data Family Medicine (without OB) reported by: Geographic Section MetricPhysMed PracsMean10th %tile25th %tileMedian75th %tile90th %tile Total Compensation 5,557881$225,701$141,598$169,826$207,117$262,990$337,869 MetricPhysMed PracsMean10th %tile25th %tileMedian75th %tile90th %tile Eastern1,097269$218,237$135,659$164,766$200,972$256,110$326,910 Midwest2,004147$224,306$143,282$171,340$208,946$258,715$329,224 Southern1,448375$239,047$143,340$171,913$215,056$283,942$379,148 Western1,00890$217,425$140,779$169,853$202,775$251,364$315,759

13. MGMA DataDive Physician Compensation and Production: 2013 Report Based on 2012 Data Surgery: General reported by: Geographic Section MetricPhysMed PracsMean10th %tile25th %tileMedian75th %tile90th %tile Physician Work RVUs 9122757,2713,7385,2966,8809,02311,021 MetricPhysMedPracsMean10th %tile25th %tileMedian75th %tile90th %tile Eastern146477,5973,7845,3867,4559,42911,268 Midwest284587,2744,1115,4736,8798,71710,754 Southern3091257,9043,7115,9687,9059,80311,981 Western173455,8593,3944,4385,8406,7238,327

14. MGMA DataDive Cost Survey: 2013 Report Based on 2012 Data Multispecialty Practices Metric, per Patient CountMean10th %tile25th %tileMedian75th %tile90th %tile Total cost122$598.42$192.57$262.53$488.81$880.55$1,161.05 Total support staff FTE12232.069.4316.4629.0445.1860.35 Physician work RVUs1034.601.462.173.956.828.73 Total gross charges118$956.65$248.16$333.40$692.42$1,364.34$2,334.03

15. MGMA DataDive Cost Survey: 2013 Report Based on 2012 Data Internal Medicine Metric, per Square Foot CountMean10th %tile25th %tileMedian75th %tile90th %tile Total med rev after oper cost21$117.64$38.06$66.28$117.52$175.07$185.75 Metric, per Work RVU CountMean10th %tile25th %tileMedian75th %tile90th %tile Total med rev after oper cost139$13.52-$19.74$1.00$15.84$28.15$44.56

17. Sample Scorecard Metrics

18. Improve Accounts Receivable with Management and Culture Involve all staff and Providers Measure A/R on a regular basis Tie staff bonuses to A/R performance Provide thorough training and ongoing training to staff Educate Physicians on their role Keep everyone updated on policies and changes

19. MGMA Patient Portal data.mgma.com/ptsat

20. How do you measure up?

21. Use the MGMA-ACMPE / SullivanLuallin online patient satisfaction dashboard

22. Be Prepared… Evaluate Differences Before presenting the results consider why your numbers might not be the norm or above average. What is unique about your practice? – Payer Mix – Medicare/Medicaid – Locations – Providers – Level of technology

23. Characteristics of Better Performing Groups Higher Revenue Per Physician Higher Operating Costs Higher Staff to Physician Ratio Increased Collections Greater % of Revenue available for Physician Compensation Smart use of Technology Emphasis on Ancillary Services

24. ICD 10 Preparation Transition Plan Communication with Vendors – Practice Management software – EHR software – Clearinghouse – Billing Service Staff Training

25. ICD 10 Use Data To Help Prepare Identify ICD 9 – Usage reports – Areas where used Watch claim lag Customize Forms/Templates Identify support for ICD 10 code selection

26. Ensure Success Work Smart / Automate Network & learn from other organizations Set goals / Celebrate successes

27. Thanks for Attending! Nancy Babbitt, FACMPE Babbitt & Associates www.BabbittandAssociates.com www.BabbittandAssociates.com

28. Attachments Improvement Checklists

29. Improving Accounts Receivable Patient Scheduling Review account balances when scheduling Verify eligibility, co-pay, well care, before Large obligations, assign a financial counselor The Visit Confirm Insurance status Follow up on missing info Collect all money due at Time of Service Assist Providers with CPT & DX coding Staff Involvement Reward successes Set standards, goals and expectations Cross train front office and A/R process Define clean claims elements Encourage staff to get CPT coding education

30. Improving Accounts Receivable – Page 2 Payer Relations / Contracting Manage relationships / monitor contracts Get to know your representative, if they have one! Make sure contracts define clean claims, timely submission and payment, appeals process, termination causes, times, and methods. Document all interactions with payers Billing & Collections Post and file charges the same day Use electronic remittance advice and deposits Audit reports or EOB - get your contracted rate Follow up on outstanding claims Prioritize claims by amount, age, insurance company Establish payment plans Document all billing calls

31. Improving Provider Productivity Sample Behaviors Establish cultural values that promote work ethic Utilize Productivity based compensation Use mid-level Providers Maintain optimal staffing levels Mentor new physicians Develop recruitment protocols that ensure new physicians understand productivity expectations Design operational systems and facilities to promote productivity Evaluate physicians coding habits Empower supervisors/staff to be decision makers Hold physicians and staff members accountable Essential Metrics Encounters/procedures per physician Revenue per physician Staff per physician Billable days per month per physician No Show rates Referral patterns / trends

32. Improving Financial & Operational Areas Perform annual budget and business planning Monitor your performance against your budget Incorporate financial goals into strategic plan Benchmark and set financial objectives Scrutinize all expenses Regularly bid contracts Participate in Group Purchasing Organization Reward Physicians/Staff for cost savings Give them control and accountability Document, train, and keep policies current Maximize use of technology and automation Develop and manage formal marketing plan Keep physicians involved