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Measurement Mike Davies, MD FACP Mark Murray and Associates

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Text of Measurement Mike Davies, MD FACP Mark Murray and Associates

  • MeasurementMike Davies, MD FACPMark Murray and Associates

  • Review importance of measurementReview what to measureReview how to measure itToolsInterpretation of measures

  • Importance of MeasurementWhat is our aim?What will we change?How will we know a change is an improvement?

  • Kinds of DataJudgmentResearchPerformance appraisal do something TO youImprovementProcess improvement effortsdo something WITH you

  • Key MetricsPrimary Care

    DelayDemandSupplyPanel Size ContinuityNo showLead time

  • Backlog

    SupplyActivityDemandLead TimeDelayDelayABHow to See Universe from which demand comes

  • Solution A for DelayDemandSupply

  • Solution B for DelayDemandSupply

  • Perfect FlowDemandSupply

  • DelayHow long do patients wait?

  • DelayThird next available appointment (time to open space)Future open capacity (amount of open space)Actual Waiting (A to B)

  • ABCThree Ways to Measure DelayD

  • Days to 3rd Next Available

  • Measurement of DelayActual Waiting MethodAB

  • Future Open Capacity60-80-85%

  • Future Open CapacitySelect a time period Count total (open and full) appointment slots within the period. This is the denominator.Then, count how many of those are open. This is the numerator.Graph this data on a run chart similar to the third next available appointment run chart.

  • DemandHow much work is there?

  • Demand ForAppointmentsPanelUniverse From Which Demand Comes Is

  • DemandDemand

  • Two Kinds of DemandExternal demand work that comes from the worldWalk inCall inWrite inReferred inInternal demand work we make for ourselvesAppointments we ask for in the future

  • Measuring Patient DemandDemand = My patients appointment requests made today for today or futureMy patients walk-ins to the clinicPatients deflected to Urgent Care / Walk-in Clinic / Emergency Room/PartnerDone by hash marks on a paper

  • Predict Demand External From the worldWalk inCall inWrite inIncludes deflections to other venuesInternal From the provider herself

  • Which of these are counted as demand?Patient is seen today & rescheduled in 1 week?Patient walks in asking for appointment?Patient calls in requesting a med refill?Patient writes a letter requesting appointment?Pt. calls in asking the doctor to call her back?Pt. requests appointment, but were full, so theyre sent to the ER?Pt. e-mail medical question to the nurse?Patient asks for appt. today and receives it?Pt. schedules appt. for 1 year from today?

  • How do I measure demand?Option 1: Tic marks on paperOften done 1 week per monthAllows one to categorize demand easilyTakes time to train staff and implement Option 2: (If schedule computerized) Computer report of number of appointments madeMisses requests for appointments ultimately not scheduled

  • Understanding DemandDemand is predictableMust understand total or true demandMust measure demand to really understand it

  • Demand Dr. Green Oct 14-18

  • InternalDemandExternalDemand

  • Check by hour of day

  • SupplyHow much resource is there to meet the demand?

  • Supply MeasureSupply

  • Measuring SupplyNumber of appointments available in a given day.Must consider appointment length and bookable hours available

  • How It Works Backlog Of ApptsSupplyActivity OrSupplyUsed

  • Measuring Supply21 appointments per day (20 minutes each for 7 hours)24 appointments per day (15 minutes each for 7 hours)7 appointments per day (1 hour each for 7 hours)15 appointments per day (20 min for 4 hours plus 1 hour each for 3 hours)

  • Supply Dr. Green Oct 14-18

  • Balance Supply and Demand

  • Dr. Green Supply/Demand Oct 14-18

  • Putting it Together

  • Individual Clinic Trend

  • Understand D and S Bottom Line1. Establish equitable panels/case loads2. Measure demand for appointments3. Measure supply of appointments4. Measure activity (supply used)5. Use the information to plan and track improvements!

  • Panels in PCCase Load in SC

  • Demand ForAppointmentsPanelUniverse From Which Demand Comes Is

  • PanelsWhy are panels important?They define which patients have established a healing relationship with which providersThe establish and promote continuityThey equitably distribute the work (in PC)They are the universe from which demand comes

  • Factors Affecting Panel SizeSupport Staff (10%+ variation)Rooms (5%+ variation)Midlevels (72% of MD panel size)Experience (Young providers less)New Providers (Take 15-18 months to build a full panelPart time vs Full time (equally productive)

  • Sheet1

    Age and Gender Panel Adjustments

    Age (Mo.s)Rel. Wt.

    LowHighMaleFemale

    0115.024.66

    12233.282.99

    24352.051.97

    36471.721.62

    48591.471.46

    601190.981.00

    1201790.740.79

    1802390.540.72

    2402990.470.70

    3003590.600.82

    3604190.630.84

    4204790.660.86

    4805390.690.89

    5405990.760.98

    6006590.871.10

    6607191.001.20

    7207791.171.31

    7808391.361.46

    8408991.551.60

    9009591.681.70

    96010191.701.66

    102099991.571.39

    Sheet2

    Sheet3

  • PanelEffect of Panel Size

    Panel

  • Chart1

    0.751

    1.151

    1.181

    1.521

    1.531

    0.81

    0.761

    11

    0.981

    1.11

    11

    0.751

    0.781

    0.91

    0.951

    0.651

    0.781

    0.851

    0.821

    %

    "Over and Under" Appointments - Provider 1 # of Appt slots Filled / # of Appt Slots Available

    UP & UNDER APPTS

    "Over and Under" Appointments

    Provider 1AVG

    2-Jun75%100%

    4-Jun115%100%

    6-Jun118%100%

    17-Jun152%100%

    25-Jun153%100%

    30-Jun80%100%

    7-Jul76%100%

    14-Jul100%100%

    16-Jul98%100%

    18-Jul110%100%

    23-Jul100%100%

    31-Jul75%100%

    5-Aug78%100%

    7-Aug90%100%

    12-Aug95%100%

    16-Aug65%100%

    20-Aug78%100%

    2-Sep85%100%

    5-Sep82%100%

    AVG100%

    Provider 2AVG

    2-Jun75%100%

    8-Jun65%100%

    10-Jun98%100%

    13-Jun65%100%

    19-Jun125%100%

    24-Jun120%100%

    30-Jun88%100%

    8-Jul88%100%

    11-Jul88%100%

    17-Jul88%100%

    22-Jul85%100%

    25-Jul95%100%

    7-Aug98%100%

    12-Aug85%100%

    15-Aug68%100%

    20-Aug68%100%

    25-Aug98%100%

    28-Aug98%100%

    4-Sep110%100%

    AVG100%

    Provider 3AVG

    3-Jun80%100%

    6-Jun65%100%

    11-Jun82%100%

    16-Jun88%100%

    19-Jun78%100%

    24-Jun89%100%

    27-Jun60%100%

    10-Jul78%100%

    15-Jul75%100%

    18-Jul98%100%

    23-Jul85%100%

    30-Jul85%100%

    4-Aug100%100%

    7-Aug98%100%

    18-Aug120%100%

    25-Aug85%100%

    28-Aug88%100%

    3-Sep85%100%

    AVG100%

    Provider 4%AVG

    2-Jun100%100%

    6-Jun98%100%

    16-Jun75%100%

    24-Jun80%100%

    27-Jun75%100%

    2-Jul95%100%

    8-Jul100%100%

    11-Jul65%100%

    23-Jul78%100%

    26-Jul70%100%

    1-Aug100%100%

    6-Aug50%100%

    11-Aug98%100%

    14-Aug100%100%

    26-Aug78%100%

    29-Aug90%100%

    4-Sep48%100%

    AVG100%

    UP & UNDER APPTS

    Percentage

    "Over and Under" Appointments - Provider 1 # of Appt slots Filled / # of Appt Slots Available

    Sheet2

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    "Over and Under" Appointments - Provider 2 # of Appt Slots Filled / # of Appt Slots Available

    Sheet3

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    "Over and Under" Appointments - Provider 3 # of Appt Slots Filled / # of Appt Slots Available

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    "Over and Under" Appointments - Provider 4 # of Appt Slots Filled / # of Appt Slots Available

  • Panel Report Example

    Sheet1

    FY 99PRIMARY CARE PCMM ASSIGNMENTSEFFECTIVE3/29/02

    PTS/PERPRIMARY CARE***

    CLCLINIC HRS.PC STANDARDCURRENTOVER CAPACITY

    HR.FTEEPROVIDEROCTPER WEEKPANEL SIZEPANEL SIZEUNDERCAPACITYPANEL SIZE STANDARD

    1351.0DR. HASAN AKHTAR175956091435pts per clinic hr.

    2280.6DEB OKERSON, PA7.521024838for physicians

    3351.0vacant provider position000

    4280.6SHIRLEY RODDY, NP7.52102726228pts per clinic hr.

    5281.0JAMES WOEHL, NP4611336446399for mid-levels

    6351.0DR. J.SCHWARZENBACH41401477

    7281.0DAR. OKERSON, PA18504485-1935pts per clinic hr.

    8301.0DR. SARAH BROWN13455581126

    9281.0JANICE WAGNER, NP14392314-78

    10351.0Dr. RODNEY LARSEN19665654-11

    3109.2HS TOTALS12.335353773238

    1350.1DR. MICHAEL DAVIES1.553542

    2350.6DR. SHEILA ECKRICH14490482-8Note: negative numbers

    3351.0DR. ROBERT VOSLER7.5263381119indicate under capacity.

    4351.0DR. STEVEN MASSOPUST14.5508492-16

    5351.0DR. (coverage by Locum)14.5508506-2

    6351.0DR. LANA FISCHER1138545974

    7351.0DR. REED FOSSOM1242045333

    8281.0MARDONNA HULM, NP22616615-1

    9351.0DR. GARY OTT14.55085081Note: Clinic hour assignments have

    10281.0MARGERY WOUDEN, NP11308450142not been made for Rural Health, Pierre,

    11351.0DR. ASHOK KUMAR5175390215