The CEO’s Ultimate Dashboard for Medical Group Practices
What to Check Weekly, Monthly, Quarterly, and Yearly
by Studer Group’s Matthew Bates, MPH, senior leader of physician services
and Michael Coppola, FACHE, physician services
Adapted from Quint Studer’s popular 2013 Becker’s Hospital Review article “The CEO’s Ultimate Dashboard.”
A CEO’s job can be overwhelming. If you’re not careful, you can spend most of your valuable time responding and reacting instead of focusing on the issues that drive results.
Since creating structure is the solution to reducing chaos, the best way to move the needle on performance is to take aggressive action on the metrics that matter most. Medical group practice performance metrics generally fall into four “buckets”: productivity/access, volume, clinical quality, and service. Studer Group recommends that health system CEOs with medical group practices ask about and monitor these checkpoints:
Metrics and issues to monitor weekly:
Does your system have adequate access for patients? Ask your group practice manager to track and report these metrics:
1. Visit volume by provider—How many patient visits did each provider have? Depending on the type of provider and type of visit mix, most providers should average somewhere around 18 to 24 visits for a full clinic day. Be sure to also aggregate the data by clinic and specialty to get a complete picture of your practice.
2. Same-day appointments—What percentage of patients requesting a same-day appointment are you accommodating? To become a certified patient centered medical home (PCMH), the ability to provide same-day access is a must. For practices not yet ready to support same day access, measuring the third next available appointment time is a common alternative.
3. Average wait times—What are patient wait times to see a provider? Systems today can help monitor wait times at various flow points in an appointment, such as times for check-in, escorted to exam room, and provider in exam room. These should be studied to identify bottlenecks. Today’s standard is for patients to be seen by their provider within 15 minutes of their scheduled appointment time.
4. No-show rates—There are always some patients who make an appointment and then fail to show up. Well-managed practices actively work to decrease their no-show rates and should be able to maintain no-show rates below five percent.
Metrics and issues to monitor monthly:
1. CG CAHPS results—CG stands for “clinician and group.” CAHPS—or “Consumer Assessment of Healthcare Providers and Systems ®”—measures your patients' experience. It’s a family of patient surveys that rate your whole practice team. Depending on your payer mix, you may need to conduct different flavors of this survey to meet the needs of CMS/Medicare, Medicaid, and private payers. To become certified as a patient-centered medical home, you will need to conduct the PCMH CHAPS version of the CG CAHPS survey family. (For a quick primer on CG CAHPS 101, watch a short video at StuderGoup.com/CGCAHPS101.)
(A side note: CMS is planning to begin publically reporting CG CAHPS results for medical groups of 100 or more eligible providers in 2015. They will also be publically reporting results for all medical groups participating in CMS ACO pilot programs. Over the next several years, they intend to publically report CG CAHPS data for all provider groups, ultimately reporting the data by individual clinicians.)
2. Revenue cycle metrics—Track days in accounts receivable and the net collection percentage, so you ensure efficient receivables and maximize the amount you actually collect versus what you expect to collect. Be sure to break out metrics by your major payers and also in aggregate for patients' portion to ensure all your core revenue sources are on target.
3. Major engagement issues—Are any physicians upset? This is the time to address major issues in morale. It can impact all sorts of things, so make physician satisfaction a regular item at your department head and medical executive committee meetings.
Metrics and issues to monitor quarterly:
While most of these issues need to be looked at continually, we recommend an intensive review of them at least four times a year.
1. Quality metrics—Beginning in 2015, the Physician Quality Reporting System (PQRS) will apply a payment penalty to eligible physicians who do not satisfactorily report data on quality measures for covered services to Medicare Part B beneficiaries.
2. Employee metrics—Are employees in your group practices satisfied? How are turnover rates? Employee satisfaction is essential to high-performance organizations. We suggest holding employee forums quarterly to hear how things are going and also to give employees a chance to be heard.
3. Physician metrics—In addition to measuring physician satisfaction, ask yourself how well the organization is responding to the four things that drive physician engagement: quality care for patients, efficiency, opportunity for meaningful input, and appreciation.
4. Performance metrics—Review performance trends on quality metrics (e.g., PQRS and HEDIS), “meaningful use,” and patient perception of care (e.g., CG CAHPS) to prepare for shifting physician compensation from volume to value.
5. Board communication—Given the intense hospital focus on physician engagement and the ever-changing healthcare landscape, it’s critical that the Board is up to speed on any challenges that arise with employed group practices. (In fact, monthly Board updates would be even better.) The best way for a CEO to ensure Board support when Board members are contacted by unhappy physicians is to ensure the Board understands the reimbursement environment—and its impact on changing physician compensation—in advance.
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