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    David N. Gans
    David N. Gans, MSHA, FACMPE


    With years of experience working with medical practice leaders to unlock data that their practice management (PM) systems don’t automatically provide, Nate Moore, CPA, MBA, FACMPE, president and chief executive officer, Moore Solutions, has a keen eye for how a year of COVID-19 pandemic strain has changed how healthcare administrators approach key performance indicators (KPIs).

    Moore wrote in August 2020 about how KPIs and metrics used in practices have changed in response to the pandemic. At the time, an MGMA Stat poll found that 33% of healthcare leaders had changed these metrics amid COVID-19.

    Despite the significant changes in safety protocols, schedules, social distancing and personal protective equipment (PPE) in the past year, Moore noted that one area where practice operations have not changed much is in the PM system. “We’re still looking at charges, payments and adjustments like we were 20 years ago,” Moore said. “And the practices I work with are frustrated at that level of information” as their PM systems have not kept up with their evolving information needs.


    One of the key changes that some healthcare leaders have made in recent months is boosting the frequency when they review KPIs and other data. “I’m seeing practices push to get data weekly that they used to be happy with monthly,” Moore noted, cautioning that automation is needed to make that change sustainable. “It’s got to tell us what we need to know without a lot of work on our part: Show us exception reports, only show me what’s out of whack. … I need to know what’s different now and what I need to act on now.”

    Moore also said that more practices he works with are adding cost information on their dashboards, tapping into accounting systems to pull data to compare against PM system data and break it down by provider, location and/or department to better “understand where my costs are in relation to charges, payments and adjustments,” he said.

    As I note in our discussion, good management is based on good data, and Moore says using SQL Server — the underpinning technology of many PM systems — and a reporting function (such as Power BI or SQL Server Reporting Services) combine to provide the levels of data that help administrative and physician leaders better understand current performance and ask the right questions on how to strategically approach topics such as provider productivity, compensation and more.
     
    For example, a group that bases physician compensation on work RVUs (wRVUs) will have physicians focused on producing wRVUs to maximize their personal income. For that setting, one of the better metrics to look at, Moore asserts, is payments received per wRVU. One of the main factors driving that metric might be payer mix: If one doctor handles more Medicaid patients while another focuses on commercially insured patients, one physician will have a higher payment per wRVU than the other.

    At the same time, Moore says it’s important to look at procedure mix in a wRVU-based system. He offers the example of a surgical practice in which a physician hopes to capitalize on each new patient visit into a surgical case, based on the incentive. But when that happens, it likely will shift some new patient visits — those who may not clearly look like they will convert to a surgery — to another physician. This could result in scheduling gaps for the surgery-focused doctor.

    Moore also notes that practice leaders are looking at their data to determine which patients are most likely to be referred to an ancillary service to ensure spots for radiology, labs or other services are not left empty when other appointments become scarce due to reduced schedules, which were common in the early months of the pandemic.

    All these ways to reimagine your practice’s operational workflows and compensation plans rely on the ability to quickly report KPIs with minimal added effort, maximizing the time available to analyze and create new tactics and strategies for the future.
     
    If leading a practice through the pandemic is anything like being behind the wheel of a car, the time to think and propose new ways forward helps administrative and physician leaders do more than just look at the speedometer, Moore says. “I want to know why I'm going so fast, or how I can go faster? Did I go faster last week? … If you can get access to raw data, in tools like pivot tables, or reporting services, or Power BI, then you can use that data to navigate and do better.” Especially for mid-sized medical groups, whose larger competitors and payers already have access to advanced analytics tools, Moore says this faster and strategic approach to data helps “level the playing field.”

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    David N. Gans

    Written By

    David N. Gans, MSHA, FACMPE

    David Gans, MSHA, FACMPE, is a national authority on medical practice operations and health systems for the Medical Group Management Association (MGMA), the national association for medical practice leaders. He is an educational speaker, authors a regular Data Mine column in MGMA Connection magazine and is a resource on all areas of medical group practice management for association members. Mr. Gans retired from the United States Army Reserve in the grade of Colonel, is a Certified Medical Practice Executive and a Fellow in the American College of Medical Practice Executives.


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