What’s My Schedule Worth?M. Sean Molley

Principal Architect, athenahealth

MGMA Annual Conference

October 2012

Learning Objectives

This session will provide you with the knowledge to: 1: Identify and calculate the key

performance indicators of office scheduling• Quantify the impact your patients have on the schedule

…

• … and the impact that YOU have on the schedule

2: Estimate future collections based on your schedule• Study past revenue realization by appointment type …

• … to put a cash value on what you’ve got booked right now

BONUS! Follow best practices to optimize the front end of your practice’s revenue cycle• You manage the schedule …

• … it doesn’t manage you!

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About the data used in this presentation

All statistics in this presentation are drawn from a de-identified data set including all active athenaCollector® practices with a primary care or family medicine specialty who have been live on the system for at least six months

No guarantee that the “typical” or “median” values discussed in this talk will match your experience

Cash-flow forecasting is intrinsically uncertain

I am not your attorney, your accountant, your IT guy, or your advisor in any legally binding capacity

Pop quiz: Who coined this famous phrase?

There are three kinds of lies: lies, damned lies, and statistics.

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Learning Objective #1:Identify and Calculate

the Key Performance Indicators

of Office Scheduling

Key Performance Indicators for Scheduling

There are three primary KPIs that you want to monitor: Patient Cancellation / No-Show Rate

• Overall rate matters, but the rate by provider matters more

• Track the length of time between the appointment being made and the appointment being cancelled – you’ll be surprised!

Practice “Bump” Rate• Are you turning away more patients than you think you

are?

• Another kind of bump occurs when some providers don’t open their schedule at all – you need to look at total available slots

Rescheduling Rate• Same-day cancellations (cancellations within 24 hours)

• Ideally you would also know who booked the original appointment and who made the call to reschedule

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1: Patient Cancellation / No-Show Rate

Track these instances separately, but combine them into a single metric

Also track same-day cancellations (cancellations within 24 hours)

2: Practice “Bump” Rate

You call a patient to reschedule their appointment, or they show up but cannot be seen because the waiting room is too full / provider falls behind

3: Rescheduling Rate

Count both the raw number of successful reschedules and the “multi-reschedule” rate

Pop Quiz #1

Think about all the times when a patient either cancels his or her appointment or just doesn’t show up. What percentage of those patients actually

call and cancel their appointment, and what percentage of those patients just don’t show up at all?

What do you think the median rates are on each of these Key Performance Indicators for a family practice? Patient Cancellation / No-Show Rate Practice “Bump” Rate Rescheduling Rate

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Pop Quiz #2

Think about a typical primary care practice. What would you estimate these values to be? Available appointment slots per provider

per week for the median provider• Percentage of those slots that result in a patient being

seen

Schedule density (percentage of available appointments that are booked) • 24 hours out

• 7 days out

• 30 days out

• 90 days out

What’s the busiest day of the week in primary care? 9

Learning Objective #2:Estimate Future Collections

Based on Your Schedule

Pop Quiz #3

What would you guess about the following statistics? Median dollar value (cash collections) of a

new patient appointment, without regard to payer

Median dollar value of an established patient visit

Yes or No: Is there a meaningful difference in revenue realization rate for new vs. established patient visits (regardless of insurance category)?

Yes or No: After normalizing for payer mix, is there a meaningful difference in revenue realization rate between the highest-performing provider and the lowest-performing provider in a typical practice?

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Knowing is Half the Battle

Why construct a cash-flow model using your schedule? Your intuitive sense might not be correct

• What is the lifetime expected value of a new patient?

• How much of your future cash collections will come in within the first week? First month? First three months? Ever?

Once you can assign an estimated cash value to every single appointment, your behavior will change• Certain patients suddenly become a LOT more important

• Front desk staff can prioritize who they call first

The variance among individuals can be extreme• This is true across every dimension: individual patients,

individual providers, individual payers, individual staff

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Past Performance IS Indicative of Future Results

There are a few things you need to know in order to construct a cash-flow forecast: Historical revenue realization rates

• By code + modifier, by “root” code, by appointment type

• By payer category (at least: patient vs. primary insurance)

• By time of payment (collections at time of service, within 30 days, within 90 days, within 1 year)

• Don’t forget about adjustments / write-offs (contractual and bad debt are generally the two largest categories by far)

It’s worth learning a little bit of Excel Kung Fu

Billing system reports are usually Transactional• … but what you need to build is a Matched data set

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The Math is Surprisingly Easy

Here is a simple formula for estimating the future cash value of an appointment: Expected Gross Charges for the

Appointment Type … • Optional: for the typical CPT codes you perform during

that type of appointment, or you can use a blended value

… multiplied by the Revenue Realization Rate …• The Revenue Realization Rate varies dramatically by

payer…

• … so you can use your historical payer mix as a baseline for this if you don’t have an appointment booked in the slot yet

… yields the Expected Cash• The timing of the Expected Cash falls into those buckets

that we identified earlier (time of service, 30 / 90 / 360 days, etc.)

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Overall Net Reimbursement by Payer Category (% of Charges)

Revenue Run Rate by Payer Category by Month Since Billing

Average Gross Charges by Payer Category

Cash-Flow Forecast: Charges x Net Reimbursement x Run Rate

BONUS Learning Objective:Optimize the Front End

of Your Practice’s Revenue Cycle

Pop Quiz #4

Which of these do you think has the highest rate of patient cancellations and no-shows? Appointments made within 24 hours Appointments made within 7 days Appointments made within 14 days Appointments made within 30 days Appointments made more than 30 days out

What would you guess is the “recidivism rate” for patients? (If they cancel their first appointment and reschedule, what percentage of the time do they also cancel or reschedule the rescheduled appointment?)

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We Have Met the Enemy, and He Is Us

Best practices for optimizing your scheduling KPIs (and therefore your financial outcomes) include: Prioritize Who Gets Called and How Quickly

• Some appointments are more valuable than others

• Some patients are harder to reschedule than others

… and a few of them may not be worth it!

Don’t Mistake Activity for Achievement• Measuring the reschedule rate is necessary but not

sufficient

• Understand the pattern of cancel – rebook – cancel

Manage the Waiting Room like a Concierge• Every day is filled with chaos, but it can be controlled

• Double-booking, same-day reschedules, and who gets bumped

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I’d Give them a Piece of My Mind if I Could Find It

While we are talking about the front desk, here are some more best practices that you will now have a greater ability to influence: Maximize Collections at Time of Service

• You knew this already, but now you can quantify it

• Show your staff the difference between dollars at time of service and the eventual revenue realization rate

Minimize Denials due to Bad Demographics• Again, you knew this already, but …

• Make sure every individual staff member knows their personal rate, the team’s overall rate, and the financial impact

• Individuals should have their “personal best” tracked but only the TEAM should be rewarded/punished for the results 20

Conclusions and Call to Action

Call to Action

Three things you can do as soon as you get home: Calculate your performance on the

scheduling KPIs• Patient no-shows, practice bumps, and reschedule rate

• Other front-desk mishaps (bad demographics and TOS collect)

• Set targets and measure to improve in each of these areas

Understand the cash value of each appointment• Past performance IS indicative of future results!

• Forecast the value of your appointment book (and prioritize!)

Collect every dollar you can at the front desk• Four magic words: time of service collections

• Garbage in, garbage out (patient demographics)

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Contact Information

M. Sean Molleysmolley@athenahealth.com

(770) 777-3513

http://www.athenahealth.com

http://www.anodynehealth.com