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Transcript of 1 Benchmarking your pediatric practice Kids First Pediatric Alliance Practice Administrators Meeting...
1
Benchmarking your pediatric practice
Kids First Pediatric AlliancePractice Administrators Meeting
Presented by:Lori A. Foley, CMA, CMM, PHRGates, Moore & [email protected]
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Learning objectives
Define benchmarking and understand its importance
Identify benchmarking resources Identify and explore key areas of benchmark
comparison
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Methods and procedures used to compare yourself (practice) with others
- practices- administrators- physicians
What is benchmarking?
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If you don’t know what the standard is…you cannot compare yourself against it.
And if you don’t know where you stand…..
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Why is benchmarking important?
o Self assessmento Identify areas for improvemento Identify areas of success
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What should you benchmark against?
Self Close Peers – Kids First survey Distant Peers – MGMA National
survey1
1 MGMA Cost Survey for Single Specialty Practices: 2005 Report based on 2004 Data
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Staffing – Kids First Survey
Category Average Min Max
Staff per Provider 3.26 1.76 7.09
RN per Provider 0.63 0.07 1.37
LPN per Provider 0.33 0.00 0.62
MA per Provider 0.86 0.23 2.91
Clinical per Provider 1.50 0.62 3.95
Lab per Provider 0.15 0.07 0.20
Clerical per Provider 0.79 0.21 1.65
Administrative per Provider 0.79 0.19 1.69
Management per Provider 0.28 0.06 0.88
Office Staff per Provider 1.71 0.79 3.14
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Staffing – MGMA Survey
Category Mean
Staff per Provider 3.57
RN per Provider 0.47
LPN per Provider 0.48
MA per Provider 0.78
Clinical per Provider 1.42
Lab per Provider 0.28
Business staff per Provider 0.86
Front office per Provider 1.22
Administrative per Provider 0.23
Non-clinical per Provider 2.08
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Staffing – How do you compare? If under,
- Look at patient flow, wait times, overtime, backlog of work.
- Are providers slowed because of lack of available staff, rooms empty too long, etc?
- Evaluate the “low staff equals low overhead” equation. Overhead can also be lowered by increasing efficiency -> production -> collections!
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Staffing – How do you compare? If over,
-Evaluate who is doing what. Is everyone busy, or just looking that way?
- Is the practice performing higher than the median in terms of productivity (office visits, collections)?
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Billing Efficiency
Accounts Receivable Aging Days in A/R Gross Collection Rate Adjusted Collection Rate
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A/R Aging – Kids First Survey
Age Average Min Max
0-30 days 64% 25% 85%
31-60 days 13% 5% 21%
61-90 days 6% 3% 15%
91-120 days 4% 2% 10%
120+ days 13% 0% 43%
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A/R Aging – MGMA Survey
Age Mean
0-30 days 59.72%
31-60 days 14.36%
61-90 days 7.17%
91-120 days 3.91%
120+ days 14.91%
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Days in A/R – Kids First Survey
Average Min Max
25.5 14.98 55.93
Calculation: Total A/R
x 30
Average monthly charges
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If unfavorable comparison…
Does your practice write off uncollectible accounts or accounts transferred to collections?
Review aging by insurance class to see if there is a carrier problem
Review insurance aging versus patient aging to identify best collection approach
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If unfavorable comparison…
Review detailed A/R report by patient to see how well staff is collecting copayments
Review claims transmission reports Are there any clearinghouse issues?
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If favorable comparison…
Don’t rest on your laurels!
Additional considerations:
Claims pending report versus A/R aging report
Effect of credit balances
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Gross Collection Rate
What percentage is the practice collecting of what it charges?
FFS Collections
FFS Charges = %
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Adjusted Collection Rate
What percentage is the practice collecting of what it is allowed to collect?
FFS Collections
FFS Adjusted Charges* = %
*charges minus mandated adjustments
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Example:
Office visit = $100 BC/BS Allowable = $85 Collected $80
Gross Collection Rate =
$80
or 80%
$100
Adjusted Collection Rate =
$80
or 94%
$100 - $15
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Gross Collection Percent
Kids First Survey
Average 70.4%
Minimum48.5%
Maximum 97.3%
MGMA Survey
Mean 71.52%Excludes capitation
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GCR comparisons…
Unfavorable comparison is not necessarily bad!
How do you compare against your previous periods? Consider effects of
- fee schedule increases- changes to carrier fee schedule
Remember – it is directly based on how your fees are set compared to the reimbursement of your specific payers!
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ACR Comparisons
- Can occasionally exceed 100% due to timing but is not sustainable
- Target is in excess of 95%- Some PM systems will track all collections
related to a particular date of service- Requires detailed adjustment codes and
appropriate use of same
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Provider Productivity
- Average visits per provider- Revenue per visit- Charges per visit- Charges per provider
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Provider Productivity
- Average visits per provider- Charges per visit- Charges per provider
All signs of provider productivity and primarily in the provider’s control.
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Provider Productivity
- Revenue per visit
Another sign of productivity but heavily influenced by billing & collections processes.
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Provider Productivity
Questions to ask:
- Is the physician working as hard as he or she wants?
- Is the physician happy with his or her compensation?
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Provider Productivity
Questions to ask:
- Are all charges being captured for services provided?
- immunizations
- lab tests
- hearing/vision screens
- sibling visits
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Overhead Percentage
How much of each dollar is being spent on opening the doors each day?
Includes operating costs except provider specific expenses (compensation, benefits)
Malpractice is included as an operating cost.
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Overhead Percent
Kids First Survey
Average 65.8%
Minimum35.0%
Maximum 84.5%
MGMA Survey
Mean 56.67%
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Overhead Percent
Know your costs Price shop on an annual basis Monitor inventory – don’t keep too much on
hand Be diligent in collection efforts!
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Thank you!
GATES, MOORE & COMPANY
Tower Place 100, Suite 600
3340 Peachtree Road, N.E.
Atlanta, Georgia 30326
(404) 266-9876
[email protected] www.gatesmoore.com