In the Revenue Cycle (RCM) world, we live and die by our performance metrics: lag days, days in AR, error rates, cash conversion cycles, bad debt ratios, aging categories – if it can be measured there is probably a report for it. We combine this avalanche of data with individual key performance indicators (KPIs) in an effort to measure the health of our business, teams, and individual resources.
How do we determine what information is important from a team metric perspective and more importantly what we should share with our teams? The best data is easily understood and consumable by the average team member. Choose metrics that are directly impacted or driven by the performance of the team / resource – yet are relevant to the work effort of the individual – this should include team level KPIs. It wouldn’t make sense to show a “waterfall report” to a charge poster or a “lag day” report to a payment poster, choose data that is actionable.
It’s difficult enough to decide what data is important to share at the team level, deciding when to share it can be as challenging. The reality of a busy CBO is we simply don’t have time to sit down with our teams and take valuable production time to review metrics. CE recommends daily team huddles as part of an overall team management strategy. Huddles which normally last no more than ten minutes are an excellent time to communicate daily goals and metrics – for example daily cash posting or charge posting goals. A collections team might discuss a daily call volume goal or the number of accounts worked, but a broader review of AR management reports or metrics requires an expanded conversation. Weekly or monthly team meetings are the recommended venue for covering more complex or extended metrics requiring additional explanation or discussion.
The way we present data is as important as the data itself. In a team huddle, where we want to communicate simple data points in an efficient manner, stick to data points that can be verbally communicated and understood by team members. Team meetings normally provide adequate time to use hand-outs or on-screen presentations for communicating salient data points. Both approaches are important in the communication of metrics and data to team members. The reality is most production resources will not retain this data beyond the huddle or meeting. It is important that management provide a visual reminder of important metrics. CE recommends strategically deploying wall mounted screens that can be seen by your production resources. Display a rotation of both daily, weekly and monthly statistics relevant to each discipline. An example might be in the charge posting group displaying: daily charge posting totals, lag day statistics, and front-end claim rejection rates. All pertinent data points for this team. The visual presentation allows for a repetitive reminder of expected performance and a positive affirmation of progress. Choose clear tables and graphs where available so that your teams can easily see and understand their performance.
Data is an important tool for communicating both positive and negative performance trends, as well as establishing executive expectations. Choose data that is easily consumable and understood, combine this with multiple methods of presentation to achieve the greatest absorption and impact rates. Most people want to do a good job, providing positive affirmation through data is an excellent strategy for motivating your team and maintaining positive moral.
The “KPI” has become one of those over-used terms that tends to be applied to any report or data point that supports the narrative of the person using it. We can segment KPIs into two major categories:
Individual
Organizational
These are just some basic examples of data points that are used for KPIs. As an organization it is important to remember two things: the KPI is only as good as the data it is derived from and KPIs require context when considering the true import of the measure.
The Data – many systems track basic patient and financial data, tying that data back to a user to develop a performance indicator is not always as simple as it seems. I may know how many patients, charges, payments, or collection notes were entered in a particular time frame, but if I can’t tie that to a user then the value of the data is significantly diminished. The same applies for enterprise / organizational reporting – write-offs or denials that don’t tie back to detailed reasons codes do not provide adequate granularity to drive process improvement or identify potential data integrity issues. These examples demonstrate the importance of understanding the data you have to work with and how it potential impacts the quality of the KPIs you are developing.
As we discussed in an earlier article data context is as important as the data itself. Data in a vacuum doesn’t provide an accurate measure of performance. We have to understand the outside forces that impact the data we are evaluating, the technology environment, data sources, workflows, and outsourced services are just a few of the variables that can impact the resources being measured. Context provides the filter with which we need to evaluate the content of our KPI data.
The purpose of the KPI is to provide insight into the performance of our resources and our organization – is it important… absolutely. However, the value of KPIs is dependent on properly measuring the data and understanding the context in which that data is developed. Choose KPIs that can be validated, provide an adequate degree of granularity and most importantly are truly relevant to the overall performance goals you have set for your staff and organization. There are plenty of industry experts that will be glad to tell you what you need, but without a thorough understanding of your goals and environment these generic recommendations will more than likely miss the mark.
]]>Unfortunately this reflexive move appears to be a sound strategy on the surface, but doesn’t address a number of contributing factors that must be incorporated into any resource planning process. “I don’t know what I don’t know” is the challenge most organizations don’t see coming. Whose data should I use… MGMA, HFMA, my colleague in Dayton that runs a multi-specialty clinic? Unfortunately, all of these sources may provide what seems like a valid data point in your calculations, but they lack context – and this is the trap.
Context… for this discussion simply means the accuracy of the variables that impact the validity of our model. In our experience the minimum variables that must be considered are as follows:
This is a starting point to begin understanding the variables that impact staff productivity. Each of these must be considered when developing team level workflows and the associated environment specific productivity metrics (KPI) for each of your disciplines – this is your specific context.
Now that you know what variables impact your metrics, you can begin to evaluate your teams based on each of their disciplines (responsibility). If you are not already tracking individual productivity now is the time to start, a fair starting point is the average between your high achievers and those in the middle range. We do not consider the lowest performers in establishing our baseline as experience has shown that most organizations have approximately one third of their resources underperforming – you do not want to build negative performance levels into your metrics.
A baseline performance metric based on an understanding of our environment provides the basis for building our manpower to volume ratios allowing you to forecast resource needs based on projected growth or acquisition. Remember to consider the impact changing any of your identified variables may have on overall productivity. If you add upgraded technology or integrate an EHR system that interfaces demographics and/or changes the workflow, the productivity of your teams can be dramatically altered. Recast your baseline metrics whenever a significant technology or workflow change is encountered to avoid the manpower to volume ratio trap.
]]>Provider expectation realignment is a key ingredient in creating the perception of success. As cynical as this sounds it is important as a leadership or project team that we remember who our primary client is; the provider and their perception of success or failure will rapidly become your reality.
Today’s providers face challenges and decision points never anticipated a decade ago and generally are not adequately equipped to handle the myriad of disparate data points we ask them to assimilate on a daily basis. Its an overwhelming task at times; business decisions, clinical decisions, staff workflow, IT, EMR, meaningful use and never mind the portal questions HIE, patient, health system, etc. Is it any wonder that the average physician is convinced none of us know what we are doing and in their eyes our project is failing miserably. Who of us on the front lines hasn’t heard the phrase: “you are not installing that in my office…” So we resort to a collection of strategies ranging from executive coercion, peer pressure, and financial incentives and while these may ultimately prod many physicians to grudgingly play along they do not solve the perception problem.
So the question becomes how do we manage through this and create successful enterprise wide EMR deployments that meet both the needs of health systems as well as, affiliated physicians? There is no single strategy or magic bullet that will solve the problem but the following recommendations will create a foundation of communication and understanding within your physician community that foster a greater perception of success and during the implementation phase of a deployment that may be the most useful tool at your disposal.
Three key components for success:
A comprehensive governance plan: The governance plan operates as a master communication tool for maintaining synchronized understanding and alignment of expectations among all project constituents. This is a living document and is normally maintained by a steering or executive committee.
Communications program: Communications programs must serve multiple masters during the course of the project. There should be specific internal documentation and communication protocols within the project and leadership teams. Equally important is the external communication plan. Project teams should employ multiple mediums to communicate with physicians and patients. Goals would include both physician and patient education, practice preparedness, communication of successes, and milestones.
Stakeholder engagement: There are a number of areas where the community of physicians can participate in the success of the project and it is important to foster this sense of community. Physician advisory boards contributing input on EMR configuration, data sharing, communication protocols, and privacy issues are all important areas where physician input is valuable.
There is no magic or silver bullet that will guarantee a successful project or cooperative physician base, however as simple as these three steps may seem project teams ignore them at their own peril. It is important to understand that in the independent physician community perception is reality. Vendors learned this lesson a long time ago and project teams that do not pay attention to the “talk” among their physician communities are destined to repeat the mistakes we are all so fond of attributing to vendors.