In today’s health care environment, it is no longer enough to think you are providing quality care to your patients. You need to have data to prove it. If benchmarking your practice internally and against your peers is something you have been planning to do “someday,” then that day should be now. With healthcare payers’ focus on patient satisfaction and move toward pay for performance, it is imperative to know where you stand.
Here are tips from 2 experts on what you need to know now about benchmarking.
Duane Reynolds, director of consulting at The Advisory Board Company, which has its headquarters in Washington, D.C., said benchmarking today should be focused on the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). Under this legislation are 2 major new payments models, but Reynolds said most providers will be using the Merit-Based Incentive Payment System (MIPS).
Knowing this, practices must understand how they perform under measures used to gauge payment under MIPS. Reynolds recommends looking at finance and productivity, quality, access, and patient satisfaction.
Under the umbrella of finance, Reynolds said there are some standard benchmarks to measure, including work relative value units (RVUs) per clinical full-time employee. These can be compared internally and externally and even on a national scope. Another benchmark is salary per clinical full-time employee to ascertain how you compare to other groups.
Under quality, there are a host of measurements to take. The most important point here is to understand your own business and which of the Centers for Medicare and Medicaid Services metrics will be important for your group. You can look at process measures. These include determining if you are consistently using electronic prescription renewals; if you are providing patients with printed education materials related to their condition during a visit; and patient outcomes, such as the percentage of patients with uncontrolled diabetes.
When it comes to access, Reynolds said you have to determine your vision for what good patient access is and how to make it operational. Here you can measure the number of encounters per session for each provider; no-show and cancellation rates; and average time to appointment (for a specialist, the time from call in to visit would optimally be no longer than 2 weeks, he said).
The final realm is patient/employee/physician satisfaction. The best thing to do here is to have an internal mechanism to understand complaints and how they are resolved, he said. Externally, you can look to metrics measured by Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS).
Shannon Wheeler, director of supply chain consulting solutions at Intalere, of St. Louis, Missouri, said providers should be cautious about how they use benchmarking data. One reason is that the data may be unreliable. “A lot of times providers think their system isn’t very good [because of what the data indicate], but the problem is more around the process of entering the information,” he said.
For instance, you may not have an efficient way for buyers to enter data for supply chain benchmarking that is sustainable and can be replicated, Wheeler said. He recommends working with third-party groups and internal resources to ensure your data is trustworthy before using it to make changes within the organization.
He also recommends starting with internal evaluations before expanding the scope outside of the practice.
“The trendy part of benchmarking is people wanting to know what their neighbors are doing and how they compare,” he said.
Comparing yourself to other groups, however, may just be resource-straining without much result. For instance, Wheeler worked with an organization that wanted to compare itself to other like groups. The problem was that the organization was so specialized that there were few other comparable organizations. At some point, they were going to be comparing apples to oranges.
“It doesn’t make sense to look at what your neighbors are doing unless they are doing the same thing you are,” Wheeler said.
If you are going to compare yourself to other practices, use numbers that translate well. For example, compare your cost data with peers performing the same services. If treating a patient with chronic kidney disease consistently costs you more compared with practices – and you get similar results – you may need to think about making some changes.
The Healthcare Financial Management Association (HFMA) created the MAP (measure, apply, perform) initiative to provide some industry standards for benchmarking measurements. HFMA’s MAP Keys are:
- Point-of-service collection rate
- Percent of patient schedule occupied
- Total charge lag days
- Professional services denial percentage
- Practice net days in accounts receivable
- Practice cash collection percentage
- Practice operating margin ratio
- Total physician compensation percentage of net revenue