Has Your Practice Had an Annual Exam? Check These ‘Vital Signs’ to Assess the Health of Your Operations

If you work in the healthcare industry today, you’re more than aware of the many benefits associated with annual exams and preventative services. A patient can significantly reduce his or her health risks through proactive maintenance and routine check-ups. At Coker, we believe physician practices deserve the same consideration, and we highly recommend proactive prevention. Our Physician Services team partners with health systems and medical groups to improve operations and prevent chronic threats to organizational health. We specialize in diagnosing and treating the health of physician practice operations, strategy, and financial sustainability. We’ve summarized several “vital signs” below that can be used to evaluate the health of your physician enterprise and develop the right care plan for your organization.

‍Patient Access

‍Patient Access is critical to understand because, if your practice isn’t effectively accommodating patients, the negative impact on demand will diminish any other benefits of operational efficiency. Effectively is the pivotal word in that last sentence. Some organizations require a cultural shift to move away from the patient-can-wait-to-see-us mentality, and patient perception is the reality in this case. Increasingly competitive markets continue to drive consumer discretion, and many patients will choose their provider based on how easily they can navigate a health system rather than the perceived quality of its providers or services. With this in mind, addressing the questions below can help determine if your practice is using its resources most effectively to accommodate the right patients at the right time with the right providers.

• How variable are provider visit lengths, appointment types, and scheduling rules/restrictions? Is there an internal best practice within a particular specialty or clinic location?
• Which patient or visit types do we need to accommodate most urgently? How long would a patient need to wait for each appointment type if they called today?
• Do we have a waitlist? If so, why is there a backlog of appointments, and do those patients have an alternative within our office?
• How many and what type of appointments frequently go unfilled on providers’ schedules? Why?
• Do appointment durations match the actual time a patient spends with the provider?
• How well does the scheduling team understand providers’ schedules and preferences? How variable are those preferences, and can the schedules be simplified? Are those team members empowered to make scheduling decisions that are best for the patient and provider?
• Do we consistently document cancellations/no-shows and follow up appropriately?

Operational Throughput‍

With a better understanding of patient access, let’s turn our attention to operational workflows, protocols, and processes. Getting patients in the door is the first major hurdle, but once they arrive, workflow clots can obstruct your ability to process them efficiently. We recommend assessing your operational throughput to identify blockages that restrict patient flow, productivity, and efficient utilization of resources. Consider the following questions and keep in mind that these areas may address the “what” behind your processes, but patients today are more cognizant than ever of “how” your team delivers care.

• Do we have clearly defined and documented operating protocols/workflows?
• Are the roles and responsibilities within our clinic(s) well-defined and consistent regardless of provider or location?
• Are the patient visit stages clear, and do we effectively manage patient handoffs?
• Do providers and staff effectively utilize technology? Is documentation completed on time with appropriate resources? How are tasks prioritized and communicated?
• Do we conduct huddles or other checkpoints to prepare for the day/clinic session? If so, do the providers participate?
• How do we consistently train employees and providers and then reinforce accountability?

Revenue Management

‍Patient access and operational throughput are critical to physician services success as they primarily drive practice revenues. It is similarly important to understand how well your practice manages its revenue and then invests back into the operation. Financial management is like oxygen levels for your practice. No matter how well you do everything else, you can’t survive without keeping this matter in check. Consider the following questions to determine if your practice efficiently and effectively breathes in revenue.

• Do we have the right amount of revenue cycle resources and expertise organized efficiently?
• Are we verifying insurance and capturing demographic information prior to a patient’s visit?
• Do we have consistent processes and protocols for point-of-service collections (co-pay, self-pay, etc.), and do we collect efficiently?
• Does our team have adequate customer service training?
• What are our denial rates and the primary reasons for returned claims?
• What are the details of our accounts receivable and expected reimbursement timeframe?
• Do we have proper protocols in place for insurance follow-up?
• Are we utilizing billing, coding, and collections data to inform our priorities and dictate action items?

Expense Management

‍Revenue can sustain a practice’s life, but long-term survival will also require prudent management of expenses. Each organization defines “fixed” vs. “variable” expenses differently, but it’s important to know what is manageable within your environment to ensure adequate resources and maintain high-quality care delivery. The questions below can help diagnose areas of opportunity.

• Year-to-year, are expenses growing at a faster rate than revenues? Why?
• Do providers have adequate support staff who operate at the top of their licensure or training?
• Would an investment in additional support staff or central resources generate incremental returns in the form of patient volume, quality of care, or additional revenue?
• Is net expense per wRVU higher than net revenue per wRVU?
• Are providers on a sustainably affordable compensation plan that meets fair market value and commercial reasonableness standards? Does the compensation plan align incentives for providers and the medical group/health system?
• Do we have a formal process by which we evaluate capital investments or growth strategies? Have our growth strategies historically aligned with patient demand and/or strategic objectives?

If your medical group is regularly checking its vital signs, you are likely well-positioned to address areas of concern or opportunity. Unfortunately, many organizations have already diagnosed their problems but struggle to quantify, prioritize, or implement sustainable solutions. The questions and considerations above are intended to provide a high-level framework for assessing key performance indicators that can help your practice proactively manage its growth and viability. Similar to your personal vital signs, however, the findings may not tell the whole story.