Date
Presented by: John Budd and Drew Davis
Friday, January 27, 2017
Driving Change Through Measured Performance in the Physician Enterprise
CONFIDENTIAL
CONFIDENTIAL
Agenda
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I. Introduction
II. Building a Common Cultural Foundation
III. Measuring Operational Performance
IV. Implementing Performance Management
V. Case Studies
Attachment A — Creating Your Dashboard
Attachment B — Case Study Exhibits
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2
Introduction
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Introduction Presenters
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John Budd
John brings his extensive background in delivery
network transformation to lead clients in the
discovery of value and opportunity across their
physician enterprise. At ECG, John has worked
with a wide range of integrated health systems
and large physician practices to expand
operations and develop new approaches to
improve existing services. John’s experience in
senior operational leadership positions enables
him to navigate diverse performance areas to craft
and activate ambulatory strategies that recognize
scale, enhance communication, and deliver on the
promise of promoting wellness.
Senior Manager
Drew Davis
Drew works in ECG’s Revenue Cycle practice.
With experience in revenue cycle operations and
management, he has worked in both private
practice and academic medicine settings. Drew’s
project focus at ECG capitalizes on his experience
in revenue cycle performance optimization,
integration of hospital and professional revenue
cycle operations, and healthcare information
technology. Prior to joining ECG, Drew served as
a revenue cycle department manager at a large
academic health system and was heavily involved
in the organization’s transition to Epic.
Manager
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Introduction Objectives
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Providing an understanding of the limitations of current
performance measurement techniques. 1
Offering a framework to design and structure performance
measurement and management tools that align with
strategic goals.
2
Reviewing best practice and case study examples that can
be tailored to help organizations better measure their
performance.
3
This session will focus on the creation and implementation of actionable
performance standards within the physician enterprise, helping to position system
leaders, managers, and staff to effectively drive change and deploy resources
across their ambulatory networks by:
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Across the nation, healthcare systems and physician groups recognize the stark
economic realities and quality challenges that face the industry, but when it comes
to impacting change, results have been mixed.
How are healthcare leaders doing when it comes to
transforming care delivery?
In an ECG survey of
integrated medical
group executives,
more than 85% of
respondents
reported that they
were engaged in at
least one quality
improvement
initiative across
their enterprise but
their level of
satisfaction with the
results was largely
only somewhat
satisfied or less.
Patient
Access
Revenue
Cycle
EHR
Optimization
Cost and
Staffing
75% 63% 67% 67%
Introduction Rethinking Current Transformation Efforts
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While many MSSP and
Pioneer ACOs demonstrated
improvement, 189
combined for $1.1
billion dollars in losses.
29.5% increase in median
cost per physician from
2013–2015
33% of patients report having
a “cost-related” issue
when accessing care.
Compared to the rest of the
population, professional
burnout among physicians is
twice that of the rest of
the workforce.
Introduction Rethinking Current Transformation Efforts (continued)
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Especially with the implementation of MACRA,
enhanced performance management is no
longer a competitive advantage; it is
imperative for financial viability.
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Performance management is the organizational framework
and accompanying tools and competencies to gauge and
effectively drive successful implementation of
organizational strategy.
What Is
Performance Management?
A recent national study found that 58% of executives believe their current performance
management approach drives neither employee engagement nor high performance.
For healthcare leaders to deliver the transformation essential for future
sustainability, organizations and senior leadership must develop the performance
management tools and competencies to drive results.
Introduction What Is Performance Management?
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Introduction Why Is Performance Management Important?
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Measuring performance is essential to managing the increasingly complex
organizational and network goals required to manage care across the continuum
and generate value for patients.
There are often complex
networks of different
parties involved in the
delivery of care. It is
crucial that goals and
best practices are
standardized and being
met system-wide.
Assessing physician
productivity can help to
ensure that work efforts
are appropriately
aligned with
compensation while
enabling leadership to
point out any areas for
improvement.
In order to reduce
errors and
appropriately allocate
limited resources, it is
necessary to
understand and
rationalize cost and
risk.
Financial and
Risk
Management
Physician
Engagement
and
Compensation
Patient
Satisfaction
Network
Management
Informed
Decision
Making
Understanding
patient needs and
assessing
satisfaction leads to
a more engaged
consumer base and
improved reputation.
While many organizations measure various performance
elements, they often fall short of effectively managing it.
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Introduction What’s Not Working?
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All too often, the reasons for performance measurement inadequacies are the
result of common pitfalls and benchmark creep. Successfully implementing an
effective strategy relies on developing a cohesive framework for management.
Common
Reasons for
Failed
Performance
Management
Available or reported data
is not trustworthy.
Measures are misaligned
with organizational vision
and goals.
Data is not actionable.
Measures are too
complex or difficult to
interpret.
Distribution frequency is
low or inconsistent.
Reported measures don’t
correspond to employee
role.
The organization or
business unit has limited
accountability.
There is no comparison
mechanism to determine
effectiveness or success.
Elements of
Successful
Performance
Management
» Developing a
common cultural
foundation
» Creating the tools to
measure and manage
performance
» Making measurable
and testable changes
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10
Building a Common Cultural Foundation
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Building a Common Cultural Foundation Mission and Vision
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Effective performance management relies on a shared understanding across the
organization of what is important and why staff and leaders have chosen the goals
and path they are on.
What is our mission? Do we have a purpose with an identified community, services, and a specific
cost?
What is our vision? Do we have an aspirational end state for our organization?
What are our values? Does our organization have a common set of criteria that
we use as a guide for all decisions?
Is our staff empowered? Can our staff control their work situation in ways
consistent with the organization’s cultural
foundation?
Foundations of Excellence in Healthcare Organizations
Using the ACHE
foundations as a
guide, medical
group leaders can
help create and
refine a shared
cultural foundation
to manage
performance.
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At the core of a common cultural foundation is a strong mission and vision that will
be used to shape performance.
Working together with the Native
Community to achieve wellness
through health and related
services.
Southcentral
Foundation
A Native Community that enjoys
physical, mental, emotional, and
spiritual wellness.
To provide quality healthcare to
all we serve.
Schneck
Medical Center
To be a healthcare organization
of excellence: every person,
every time.
We deliver health and healing to
all people through trusting
relationships.
AtlantiCare
AtlantiCare builds healthy
communities.
Mis
sio
n
Vis
ion
What do the above statements do well, and do they meet the criteria
outlined by ACHE? What would you change?
Building a Common Cultural Foundation Sample Missions and Visions
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Measuring Operational Performance
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Measuring Operational Performance Measuring Success
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To effectively evaluate “how well did we do?” success criteria should be
measurable. Dynamic measures of high importance can be quantified as metrics
and trended and monitored as key performance indicators (KPIs) over time to
determine effectiveness.
» Agreed-upon concept of
quantification
» Develops standard that
allows for basis of
comparison
» Similar to measure and
often used
interchangeably
» Includes a goal or
performance nuance
» Comparative metric
quantifiable to industry,
department, or task
» Evaluated over a period
of time
Measure Metric KPI
Miles Per Hour (MPH) 65 MPH Speed Limit Drive at or Below Speed
Limit With 95% Consistency
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Measuring Operational Performance Key Performance Indicators
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Components of Effective KPIs
By regularly collecting data, organizations can use
specific metrics to measure how well they are performing
against targets or expectations and show trends to
demonstrate progress over time.
These metrics are often compared to national
benchmarks to help the organization understand how it’s
doing compared to its peers and where there may be
areas for improvement
KPIs can include:
» Process Measures — independent variables or inputs
to influence the outcome; “how are things done?”
» Outcome Measures — dependent variables that are
the result of processes; “what is the result?”
» Structural Measures — capacity and conditions of an
organization
Using our example of speed limits, what considerations can we make
by each KPI component? In our own practices, what KPIs do we
use, and how do these components bear out?
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Average Days
to
Appointment Measure
Target 14
January 2016 11
February 2016 15
March 2016 22
Q1 2016 16
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After appropriate KPIs are developed, the selected metrics can be monitored
through a dashboard. A dashboard is a tool that aggregates organizational KPIs and
displays them in a simple, easy-to-read format.
Measuring Operational Performance Dashboards
Makes comparisons.
Shows trends over time.
Shows distribution of data to identify
outliers.
Demonstrates relationships between
process parts and the overall
organization.
A Good Dashboard:
Example Dashboard
Exceeded
target only in
January
Performance
slips to near
target measure
Performance
exceeds over
50% of target
Overall,
performance
averages near
target measure,
but room for
improvement
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Measuring Operational Performance Define — Identifying Your Audience
Dashboards should be structured to:
Cascade down or build up within an organization.
Be applied across similar operating units.
Indicate an organization’s progress toward its goals.
A dashboard should be developed to address the needs of its unique audiences
(e.g., physician needs versus the needs of a financial executive). Metrics that are
operationally relevant at each level will vary significantly by audience type.
Audience Type of Report
Number of
Metrics Granularity of Data
Report
Frequency
Board/CEO Strategic 5 or Fewer High-Level Summary Quarterly
VP/Senior Director Performance 5 to 10 Summary Monthly
Site Manager Operational 10 to 15 Detailed Daily/Weekly
Physician Performance, Operational 5 to 10 Detailed Monthly
Sample Dashboard Characteristics by Audience
1
2
3
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Measuring Operational Performance Elements of an Effective Dashboard
An effective dashboard is dynamic, outcomes focused, frequently monitored, and
updated regularly to ensure it reflects organizational strategic priorities. ECG has
identified six essential elements for an effective dashboard.
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The dashboard must be updated regularly and report
accurately in order to be considered a viable decision-
support tool that can be used to effectively change
behaviors.
CREDIBLE
Structures must be in place to ensure the dashboard is
continually populated and integrated into
organizational strategy and management processes.
USABLE
The metrics reported must be specific and defined
such that the audience can take action to guide,
stabilize, or improve performance.
ACTIONABLE
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Measuring Operational Performance Elements of an Effective Dashboard (continued)
Data does not need to be perfect, but it
should be believable, transparent, and
actionable on a daily basis. 0100.015\383482(pptx)-E1 DD 1-27-17 19
The scorecard should be used as a management tool.
Meetings should be conducted according to the scorecard,
with progress reports that link scorecard performance
(results) to annual performance reviews and compensation.
Dashboards can often become too complex and lead
to information overload. The targeted audience should
be able to quickly identify performance issues without
wading through minutiae.
SIMPLE
Dashboards should contain 8 to 10 key measures.
The selection of specific data elements is determined
by the strategy and priorities of a given organization.
CONCISE
MANAGEABLE
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20
Implementing Performance Management
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Implementing Performance Management Overview
Organizational change management through measured performance should be
facilitated by a broad group of participants. This ensures suggested outcomes are
relevant, achievable, and in support of already-defined organizational objectives.
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Monitor
Align
Measure
Analyze
Define
DEVELOPMENT
PROCESS
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Implementing Performance Management Define
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Typically, medical group performance can be measured in six core areas. Within
each of these areas, there are a number of widely available and easily benchmarked
competencies.
22
PATIENT ACCESS
» Appointment availability
» Scheduling processes
» Referral management
» Telemedicine
OPERATIONAL PROCESSES
» Front- and back-office work flows
» Clinical work flows
» Staff deployment and management
span of control
» EHR/PM usage
QUALITY AND VALUE-
BASED PERFORMANCE
» Performance on current
P4P plans
» Opportunities for
improvement
ORGANIZATIONAL INFRASTRUCTURE
» Provider governance
» Ambulatory leadership roles
» Key functional support needs and gaps
PHYSICIAN COMPENSATION
AND PRODUCTIVITY
» Provider productivity levels
» Physician compensation plan and
congruence with organizational goals
FINANCIAL INDICATORS
» Revenue cycle performance
» Staffing levels
» Expense management
» Payor contract assessment
MEASURABLE
SUCCESS
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Implementing Performance Management Analyze
After defining the areas for measure, the next step is to compile the data necessary to
calculate the measures, in a process known as “ETL” (extract, transform, load).
Compile and review.
Load data in
production system.
Transform or scrub
data.
Generate data
extract.
Define key metrics and
identify available
data.
» Correctly outputting useful data at each point in the process is
critical to ensure the final measures are “clean.”
» After the “compile and review” process has been validated, this
step can be turned into dashboard creation.
» The ETL and dashboard creation steps typically repeat in an
automated fashion each time the dashboard is refreshed.
Hospital
EHR
Hospital
Billing
Ambulatory
EHR
Practice
Management
LIS/
PACS
GL/
AP
Outputs of several
systems may require
review:
See ATTACHMENT A for a detailed overview
of the ETL process using Microsoft Excel
as a primary tool.
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Implementing Performance Management Measure
With the data aggregated and normalized, leaders can begin to calculate their KPIs
and identify benchmark sources for comparison. A list of sample value-based
measure categories is provided below.
Measure Category Metrics Available Target Source
Objective/Associated
Strategic Priority
Physician Productivity RVUs, net collections, visits MGMA Create value for our patients
Productivity-Adjusted
Compensation
Compensation per WRVU ECG Compensation and Production
Create value for our patients
Physician Panel Size
(Primary Care)
Raw panel size, complexity-adjusted panel size PCMH Provide high-quality care
Staffing Per Physician
FTE (Clinic Level)
Clinical staff per physician FTE, front-office staff per
physician FTE
AMGA Create value for our patients
Patient Satisfaction by
Physician
Percentage of patients who would recommend this
provider
Press Ganey Enhance the patient experience
HEDIS Performance by
PCP
Immunization status, screening rates, chronic
condition management indicators
HEDIS Provide high-quality care
Clinic Access Measures Day(s) out to the third-next-available appointment,
referral access to specialists
MGMA Practice Operations Survey
Enhance the patient experience and provide high-quality care
Customer Service
Indicators
Patient visit throughput times, response times to
patient messages and refill requests
Internal Surveys or Secret Shoppers
Enhance the patient experience
Meaningful Use
Objective Thresholds
Demographics recorded, smoking status indicated,
vital signs reported (by eligible professional)
Institute for Healthcare Improvement (IHI)
Provide high-quality care
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Implementing Performance Management Align
Once organizational KPIs have been calculated and benchmarks selected, leaders
can then begin to create cascading balanced scorecards.
Position Sample Position Objectives Sample Related KPIs
CEO » Creditworthiness
» Sufficient financial performance
» Bond rating
» Net revenue
CFO » Financial solvency
» Productive operations and workforce
» Days cash on hand
» Total operating margin
Vice President,
Revenue Cycle
» Maximized cash collections
» Maximized cash acceleration
» Efficient operating costs within unit
» Total cash collections
» Days in A/R
» Cost to collect
Director,
A/R Management
» Maximized cash collections
» Maximized cash acceleration within unit
» Efficient operating costs within unit
» Days in A/R
» A/R >120 days
» Denial rates
» Staff productivity/quality scores
Manager,
Commercial Payor
A/R
» Maximized cash collections
» Maximized cash acceleration within unit
» Efficient operating costs within unit
» Days inventory on-hand
» Average invoice age
» Avoidable denial write-offs
» Staff productivity/quality scores
Patient Account
Representative
» Maximized cash collections
» Maximized cash acceleration within unit
» Invoices worked per day
» Quality of worked invoices
These position-level
KPIs should be a
key component of
employee
performance
reviews. This
impacts change in
daily work,
routines,
compensation, and
rewards.
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Implementing Performance Management Monitor
As available measures become more advanced and more dashboards are developed,
several areas of the clinical enterprise can demonstrate quantifiable value. Some of
these functional areas and sample results are listed below.
Revenue Cycle Management — Identify
and reduce unbilled charges and improve
collections and gross margins.
Supply Chain — Distribute timely
information to clinical units to improve
accountability and reduce waste.
Patient Satisfaction — Monitor
patient responses and implement
informed changes.
Population Management —
Identify high-risk and noncompliant
patients to target for intervention.
Labor Productivity — Understand
downstream effects of staffing
changes to take corrective actions.
Clinical Efficiency — Monitor hospital and
ambulatory data to reduce patient wait time
and improve patient flow.
These are just examples. What demonstrable results have your organizations
already shown? Looking ahead, what opportunities exist to demonstrate
the value of an effective dashboard system?
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27
Case Studies
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University of
Kansas
Hospital
University of
Kansas
Physicians
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Case Study A Situation
The University of Kansas’s hospital and faculty practice created a new organizational
entity to provide more efficient and enhanced patient care. The new organization
needed a formal way to manage performance across a robust and growing physician
enterprise.
ECG partnered with leaders across the newly
formed health system to provide interim
leadership and develop a supporting
ambulatory and physician enterprise
management infrastructure.
University of
Kansas Health
System
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Case Study A Approach
A core group of physician and non-physician stakeholders was assembled to address
four key objectives defined by health system leadership.
Identify Synergies
Determine KPIs Identify
Opportunities
Measure
Develop a way to measure
current state performance
across multiple disparate IT
platforms and corporate
entities.
Perform a
comprehensive
performance review and
identify gaps and new
management needs.
Define success
measures and identify
appropriate targets.
Determine community-
based and faculty
practice mutual benefits.
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Case Study A Approach (continued)
After defining a new vision and mission for ambulatory services, ECG developed
initial performance reviews using the approach below.
» Incorporate Revisions
» Revise Baseline Exhibits
» Provide Finalized Exhibits
to Each Department/Group Income
Statements,
Operational
Validate Initial
Data and Baseline
Performance
Identify Areas for
Enhancement
Assess Potential Impact
Prioritize Areas and Quantify
Impact
Step 1 — Collect Data and
Conduct Initial Analysis
Step 2— Finalize Baseline Performance
Assessment and Exhibits
Step 3 — Identify Opportunities
for Improvement
Month 1 and 2 Month 3 and 4 Month 5
Revenue
Cycle, Patient
Access,
Claims Data
Deliverables
» Draft set of baseline
performance exhibits by
department/group
Deliverables
» Finalized baseline exhibits
Deliverables
» Prioritized list of opportunities
for improved performance
under integration
» Estimated financial impact of
potential changes
A sample executive dashboard from this
process can be found in ATTACHMENT B.
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Case Study A Solution
ECG and organizational stakeholders were successful in implementing several
strategic changes to the ambulatory services framework.
Primary Outcomes
Development of a new management structure for all
ambulatory services.
Creation of a three year roadmap for performance measurement
and tool development.
Integration of the community-based, hospital-employed
physician practices within the new ambulatory division.
Development of shared and core services in support of the
ambulatory environment.
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Case Study B Situation
The Management Services Organization (MSO) of a mountain-west university’s
School of Medicine (SOM) was challenged to provide revenue cycle services to the
SOM clinical departments due to misaligned priorities and objectives.
MSO Duties SOM Support Accountability
» The MSO’s revenue
cycle managers and
their staff were
assigned to support
specific SOM
departments.
» Managers prepared
performance reports
and reviewed in
SOM department
revenue cycle
meetings.
There were high levels
of inconsistency
across MSO-SOM
department support:
» Reports provided
» Metrics reviewed
» Meeting content
» Reports were
unreliable or
unfocused.
» SOM departments
had misaligned
organizational
priorities.
» SOM departments
had varying levels of
revenue cycle
education.
The MSO’s
relationship was
strained with its
SOM customers
and it sought to
improve on a
number of items,
most notably, its
reporting content
and delivery.
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Case Study B Approach
After identifying clear project objectives, the MSO executed several key activities to
determine the most appropriate solution.
Advisory
Group
Assembled
Data Review
and Report
Development
Survey Issued
» The MSO knew they did
not fully understand the
needs or expectations of
their SOM customers
» A 5-minute online
survey was issued to all
business administrators
to understand SOM
perspectives
» A group of 10 MSO and
SOM stakeholders was
identified
» The group determined
MSO reports did not
contain much usable or
actionable data
» A new report packet
would be required with
metrics that supported
SOM objectives
» SOM objectives were
defined
» Available revenue cycle
data was reviewed to
determine what could be
measured
» Industry performance
measures were
considered against
internal objectives and
final metrics/KPIs were
selected
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Case Study B Solution
After SOM objectives were clearly understood, the MSO created a meaningful suite
of reports, a web-based on-demand report tool, and several other structural changes.
A sample executive summary report is
provided in ATTACHMENT B.
PR
IMA
RY
OU
TC
OM
ES
SE
CO
ND
AR
Y O
UT
CO
ME
S Executive Summary Report
» Key Performance Metrics
» Key Performance Trends
» A/R Metrics
» Denial Metrics
» Payor Mix Variations
» Write-off Detail
Additional Metrics Reports
» Billing Activity
» Worked RVUs Year-Over-Year
» Matched Collections
» Aged Trial Balance
» Charge Lag
SOM Stakeholder Education
Sessions
Changes to Meeting Format
» Materials, format, and
agenda items
» Prerequisites and timeline
Standardization of Roles and
Responsibilities
Revised MSO Structures
» Creation of liaison position
» MSO revenue cycle team
focus
Enhanced Revenue Cycle
Performance
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Questions & Discussion
35
CONFIDENTIAL
OPERATIONS TECHNOLOGY
STRATEGY FINANCE Tackling today’s complex and interconnected healthcare
problems requires knowledge and expertise across multiple
disciplines, and that’s what ECG delivers to our clients every
day. With four core competencies of strategy, finance,
operations, and technology, we provide smart counsel and
sustainable solutions that are transforming healthcare
delivery.
More than 225 professionals operate out of ECG’s offices in
Atlanta, Boston, Chicago, Dallas, Minneapolis, San Diego,
San Francisco, Seattle, St. Louis, and Washington, D.C.
We’re leading healthcare forward, one organization at a time.
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About ECG
36
THIS IS A DPC
NOTE — DO
NOT DELETE
Keep “strategy,
finance,
operations, and
technology” in
red.
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37
Attachment A Creating Your Dashboard
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CONFIDENTIAL
Remember to specify the time frame, grain of
data (visit versus transaction), unique identifier,
and functional rationale for each requested
field to ensure sufficient context to generate
the right data set with minimal iterations.
Unique
identifier.
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Creating a file request requires several basic elements: the time period to measure,
the grain of data to be analyzed, and the attributes required to identify trends in
metrics.
Extracting Data
A-1
CONFIDENTIAL
Crosswalk — A table that shows equivalent elements (or "fields") in more than one database schema. It
maps the elements in one schema to the equivalent elements in another schema.
Joined from Financial Class
crosswalk using VLOOKUPS
Calculated based on last comment
date and date of report
Calculated from adjacent cell
using a nested IF statement.
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Transforming Data
Additional attributes can be assigned to data with calculations, while hierarchies not
maintained in the source system can be added by joining your data with crosswalks.
A-2
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A-3
Transforming Data (continued)
Once source data is joined with crosswalked and calculated data, it is possible to
isolate populations of claims requiring targeted intervention or further investigation.
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These aging tables provide a high-level
overview of the status of outstanding
A/R while allowing the user to click into
any “bucket” to further analyze an account
population presenting financial risk (i.e.,
timely filing write-off).
CONFIDENTIAL
Filter for balance
>$1000.
Filter for >30 Days
since last user
comment. Group data by
payor type.
Task force deployed
to evaluate
collectability and
attempt to secure
payment.
Group data by Days to Timely
Filing Deadline category created
with a nested IF statement.
A-4
Transforming Data (continued)
The table below shows accounts nearing or past their original timely filing deadline
that are over $1,000 and have not been reviewed in over 30 days.
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This tool allowed ECG to identify approximately
$5 million in unworked claims that were nearing
or past their timely filing deadline. A targeted
effort from the collections staff resulted in 50%
of the accounts receiving intervention to avoid
timely filing write-offs.
CONFIDENTIAL
Staging and
Calculation
» Data Warehouse — A central repository of data created by integrating data from one or
more disparate sources and storing both current and historical data
» Staging Table — A temporary location for source data to be manipulated before being
loaded into a final table
A-5
Loading Data
In the absence of a data warehouse, key metrics can be tracked and trended in Excel
workbooks as an interim reporting solution.
0100.015\383482(pptx)-E1 DD 1-27-17
CONFIDENTIAL
Specification of drill-down
research expectations
utilizing data extracts
Goals for the most
critical metrics
Change from
previous week
Historical averages and trend
lines to quickly identify outliers
and provide context
A-6
Loading Data (continued)
0100.015\383482(pptx)-E1 DD 1-27-17
Once data was extracted, transformed, and loaded into the Billing and Collections
Dashboard workbook, management could monitor trends and manage to goals. Key
elements are highlighted below.
CONFIDENTIAL
44
Attachment B Case Study Exhibits
0100.015\383482(pptx)-E1 DD 1-27-17
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 1 of 6
Executive SummaryGenerated On: 8/15/2016 2:39:24 PM
Key Performance Metrics
Productivity Measures
Actual Year
over Year
Variance
4.51 %
11.54 %
15.02 %
4.50 %
Performance Measures
Actual Year
over Year
Variance
0.38
(1.57)
-0.09 %
2.20 %
-1.35 %
-1.84 %
2.06 %
2.09 %
-2.05 %
-0.74 %
Note: If variance cell grayed-out, there is no established goal.
Period: 201604 Department: OBSTETRICS GYNECOLOGY
Division: All Adult, Peds or All: All
Description Fiscal Year to Date Actual
Fiscal Year to Date
Financial Plan
Fiscal Year to Date
Actual Variance from
Financial Plan Prior Fiscal Year to Date Actual
Charges $51,482,690.23 $55,679,541.39 92.46 % $49,260,375.93
Total Payments $17,099,006.96 $17,201,399.11 99.40 % $15,329,906.98
CPT Volume 108,217 94,088
Work RVUs 175,445.10 167,896.86
Description
75th % Based on
FPSC
Benchmarks for
Specialty
90th % Based on
FPSC
Benchmarks for
Specialty
Fiscal Year to Date
Actual
Prior Fiscal Year to
Date Actual
Fiscal Year to
Date Actual,
Variance from
75th %
Fiscal Year to
Date Actual,
Variance from
90th %
Charge Lag (DOS / DOP) 13.45 13.06
Days in AR 34.85 28.90 36.00 37.57 1.15 7.10
Total AR $6,031,324.98 $6,036,641.37
Percent of AR > 90 Days 23.00 % 19.00 % 22.68 % 20.48 % -0.32 % 3.68 %
Percent of AR > 180 Days 6.30 % 7.65 %
Insurance AR as a % of Total AR 79.57 % 81.41 %
Patient AR as a % of Total AR 19.10 % 17.04 %
Gross Collection Rate 33.21 % 31.12 %
Net Collection Rate 94.00 % 96.00 % 88.33 % 90.39 % -5.67 % -7.67 %
Controllable Allowances as a % of Charges 1.86 % 2.60 %
Case Study B - Exec Summary Sample_383873(xlsx)||Table 1
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 2 of 6
Key Performance Trends
Case Study B - Exec Summary Sample_383873(xlsx)||Table 1
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 3 of 6
Accounts Receivable Metrics
Insurance AR by Original Payer
Total AR by Division
Insurance Payer
Insurance AR Insurance AR > 180 Days
Amount Due # of Invoices Amount Due # of Invoices
Amt > 180 days as
a % of this
Insurance AR
Amt > 180 days as a %
of total Insurance AR
MANAGED CARE $2,221,899.83 3,941 $63,715.84 195 2.87 % 1.33 %
MEDICAID $1,688,065.78 2,348 $85,951.00 98 5.09 % 1.79 %
GOVT MANAGED CARE $541,046.26 830 $43,628.61 74 8.06 % 0.91 %
MEDICARE $269,688.83 493 $4,154.48 13 1.54 % 0.09 %
SELF PAY $68,612.94 64 $532.00 2 0.78 % 0.01 %
DISCOUNTED FFS $6,556.00 4 $4,841.00 1 73.84 % 0.10 %
INDEMNITY $3,394.00 9 $1,405.00 4 41.40 % 0.03 %
CAPITATED $161.00 5 0.00 %
Totals: $4,799,424.64 7,694 $204,227.93 387
Division
Total AR Total AR > 180 Days
Amount Due # of Invoices Amount Due # of Invoices
Amt > 180 Days
as a % of Division
Insurance AR
# of Invoices > 180
Days as a % of
Number of Invoices
for Division Insurance
AR
MATERNAL AND FETAL MEDICINE $2,164,157.40 7,242 $173,325.95 627 8.01 % 8.66 %
GYNECOLOGY $1,557,929.06 2,937 $66,978.71 226 4.30 % 7.69 %
GYNECOLOGY ONCOLOGY $790,744.83 891 $37,536.89 50 4.75 % 5.61 %
REPROD ENDOCRINOLOGY INFERTILITY $458,483.28 1,520 $32,092.91 140 7.00 % 9.21 %
FAMILY PLANNING $369,821.98 518 $19,847.56 33 5.37 % 6.37 %
FETAL SURGERY $301,984.27 45 $14,008.35 8 4.64 % 17.78 %
FEMALE AND RECONSTRUCTIVE SURGERY $242,866.30 460 $21,270.24 22 8.76 % 4.78 %
OBSTETRICS $78,649.35 74 $5,421.94 9 6.89 % 12.16 %
HOSPITALIST $66,688.51 204 $9,683.14 27 14.52 % 13.24 %
Totals: $6,031,324.98 13,891 $380,165.69 1,142
Case Study B - Exec Summary Sample_383873(xlsx)||Table 1
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 4 of 6
Insurance Invoices Over 365 Days from DOS by Division
Denial Metrics
First Pass Denial Rate
201504
6.40%
Rejection Volume
Division Amount Due # of Invoices
>365 Amount Due as
a % of Div Total AR
FETAL SURGERY $5,776.05 1 1.91 %
GYNECOLOGY ONCOLOGY $161.00 1 0.02 %
GYNECOLOGY $1,090.00 4 0.07 %
MATERNAL AND FETAL MEDICINE $14,680.65 23 0.68 %
OBSTETRICS $430.00 1 0.55 %
REPROD ENDOCRINOLOGY INFERTILITY $910.78 2 0.20 %
Totals: $23,048.48 32
201505 201506 201507 201508 201509 201510 201511 201512 201601 201602 201603 201604
6.10% 5.92% 6.33% 6.90% 4.87% 5.25% 5.33% 5.98% 6.02% 5.86% 6.00% 5.15%
Rejection Type
201602 201603 201604 3-Month Average
Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections
APPLICATIONS 0.00 % 0.00 % 0.00 % 0 0.00 %
AUTH/REFERRAL 102 5.01 % 126 3.50 % 114 5.97 % 114 4.53 %
BENEFIT 549 26.99 % 739 20.50 % 484 25.33 % 591 23.47 %
BUNDLED 300 14.75 % 386 10.71 % 331 17.32 % 339 13.47 %
CLAIM INFO 2 0.10 % 5 0.14 % 0.00 % 2 0.14 %
CODING 142 6.98 % 159 4.41 % 146 7.64 % 149 5.92 %
COORD OF BENEFITS 141 6.93 % 135 3.74 % 76 3.98 % 117 4.66 %
CREDENTIALING 4 0.20 % 0.00 % 32 1.67 % 12 0.72 %
DIAGNOSIS 38 1.87 % 31 0.86 % 28 1.47 % 32 1.28 %
DUPLICATE 236 11.60 % 162 4.49 % 158 8.27 % 185 7.36 %
MANAGED CARE CONTRACTING 0.00 % 1 0.03 % 0.00 % 0 0.04 %
MED REC REQST 48 2.36 % 88 2.44 % 102 5.34 % 79 3.15 %
NEEDS INFO 167 8.21 % 648 17.98 % 135 7.06 % 317 12.58 %
NON COVERED 73 3.59 % 95 2.64 % 76 3.98 % 81 3.23 %
Case Study B - Exec Summary Sample_383873(xlsx)||Table 1
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 5 of 6
Rejection Volume (continued)
No Auth/Referral Write-Off by Division
Payer Mix Variations
Rejection Type
201602 201603 201604 3-Month Average
Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections Count
% of Total
Posted
Rejections
PLACE OF SERVICE 19 0.93 % 3 0.08 % 6 0.31 % 9 0.37 %
PROVIDER 45 2.21 % 723 20.06 % 83 4.34 % 284 11.27 %
REGISTRATION 86 4.23 % 236 6.55 % 89 4.66 % 137 5.44 %
REIMBURSEMENT 21 1.03 % 30 0.83 % 25 1.31 % 25 1.01 %
TIMELY FILING 61 3.00 % 38 1.05 % 26 1.36 % 42 1.66 %
Totals: 2,034 100.00 % 3,605 100.00 % 1,911 100.00 % 2,517 100.00 %
Division # of Invoices Amount
FAMILY PLANNING 3 $451.00
FEMALE AND RECONSTRUCTIVE SURGERY 1 $10,243.00
GYNECOLOGY ONCOLOGY 1 $256.00
GYNECOLOGY 7 $12,628.00
HOSPITALIST 2 $357.00
MATERNAL AND FETAL MEDICINE 4 $498.00
OBSTETRICS 1 $126.00
REPROD ENDOCRINOLOGY INFERT 7 $2,599.00
Totals: 26 $27,158.00
Payer Category % Change from Previous Reporting Period
CAPITATED -0.09 %
MANAGED CARE 0.13 %
MEDICARE 0.47 %
SELF PAY -0.16 %
DISCOUNTED FFS 0.17 %
GOVT MANAGED CARE -0.66 %
INDEMNITY 0.00 %
MEDICAID 0.15 %
MEDICALLY INDIGENT 0.00 %
Case Study B - Exec Summary Sample_383873(xlsx)||Table 1
CONFIDENTIAL
DISCUSSION DRAFT
1-27-17
ATTACHMENT B
Page 6 of 6
Provider Type Total CFTE Benchmark CFTE
Production
Included 2014 Actual YTD Visits
Visits Per Year
Target at 80% Utilization
Physician Providers 20.8 19.5 106,778 36,121 70,080 52%
Nonphysician Providers 8.6 4.6 17,999
Department Totals 29.4 24.2 124,777 Available Rooms 44
Metric Low Average High Revenues
Arrived 60% 63% 65% Net Professional Fees
Bumped 2% 2% 3% Other Revenues
Canceled 22% 24% 26% Total Revenues
No Show 10% 10% 11%
Past Pending 0% 0% 0% Clinical Expenses
Rescheduled 0% 0% 0% Support Staff
Billing and Collection
UKP Administration
Other Operating Cost
Total Clinical Expenses
Metric Clinical Support
Front-Office
Support
Business
Operations
Per 10,000 WRVUs 33 56 10
Per Physician FTE 71 86 10
Per Provider FTE 44 69 10
Benchmark Average 49 70 10
Metric Amount
Gross Charges XXXXXXX
Net Charges XXXXXXX
Net Payments XXXXXXX
Bad Debt XXXXXXX
Gross Collections Rate 40%
Net Collections Rate 86%
Inpatient Hospital 9.1
Outpatient Hospital 11.8
Office 7.5
1Capacity based on the Space Utilization report provided by UKP and includes exam rooms at the MOB and Prairie Village.
2Patient access data based on the Monthly Arrived Appointments by Status report provided by UKP for the period between July and November 2014.
3Financial summary based on budget conversion report data provided by the ECG integration team.
4Benchmarks based on the MGMA Cost Survey: 2014 Report Based on 2013 Data benchmarks for pediatric practices.
5Reports and analysis based on the June 2014 McKesson 1406 Monthly Stats report.
6Charge lag based on the average for dates of service during FY 2014 and calculated as the date of charge posting minus the date of service.
Revenue Cycle
Collection Rates 5
Percentage of A/R By Age
Charge Lag 6
155,500
250,000
Staffing 3,100,000
Benchmark Percentile 4 8,505,500$
5,000,000$
UNIVERSITY OF KANSAS HOSPITAL
UNIVERSITY OF KANSAS PHYSICIANS
AMBULATORY ORGANIZATIONAL DESIGN
FY 2014 PEDIATRICS BASELINE SUMMARY
Productivity Capacity 1
Patient Access 2
Finances 3
9,000,000$
700,000
9,700,000$
33
56
10
71 86
10
44
69
10
0
20
40
60
80
100
Clinical Support Front-Office Support Business Operations
Per 10,000 WRVUs Per Physician FTE Per Provider FTE
0.532843479
0.157756731
0.076736778
0.069751128
0.035699029 0.052797393
0.074415462
0-30 31-60 61-90 91-120 121-150 151-180 181+
48% 52%
Available Capacity Utilization
53 47 52 47 47 47
40
45
50
55
Physician Providers Nonphysician Providers Department Totals
Academic Benchmark Percentile Community Benchmark Percentile
$40.07
$72.13 $1.25 $2.00
$24.84
$-
$10
$20
$30
$40
$50
$60
$70
$80
Expenses Per WRVU Net Professional FeesPer WRVU
Other Operating Cost UKP Administration
Billing and Collection Support Staff
KUHS Dashboard_383874(xlsx)||Departmental Summary