Date

Presented by: John Budd and Drew Davis

Friday, January 27, 2017

Driving Change Through Measured Performance in the Physician Enterprise

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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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13

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

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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).

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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