Better efficiency without the fuss
Better efficiency without the fuss
Charge tickets do the work for you
Data collection doesn’t have to involve the complete shakedown of your office’s medical records or require your physicians to spend more time filling out paperwork. The Carle Clinic in Urbana, IL, gleans much of what they need from charge tickets.
Few would disagree that managing capitation without monitoring physician productivity and efficiency can lead to reduced profit or, in some cases, a loss. But practices struggle with finding ways to measure these things and often go to great lengths to invent new data collection processes or find new data to collect.
But most of the information the Carle Clinic uses to measure costs and productivity come directly from the organization’s billing system. The only added step has been the creation of tables to match each provider with a cost center. Other than that, a physician submits a charge ticket as he or she normally would, complete with the performed procedure identified and its corresponding charge.
"We have a monthly reporting system based off our billing system," says Rick Reifsteck, manager of financial analysis at the Carle Clinic. "Right now, it is as simple as looking at the billing provider and dumping the data into their section of the report."
Carle Clinic is a for-profit, physician-owned multispecialty group of 280 physicians. The group also owns its own HMO. Carle Clinic is currently about 40% capitated.
Productivity data in a capitated environment is important in determining the efficiency of an organization. Unlike the fee-for-service setting, if expenses increased 5%, fees could be increased 5% as well to maintain the same profit margin. Capitation forces practices to get the most out of what they have, including lowering expenses while delivering the same amount of services.
"We know revenue will not increase as it did in the past," Reifsteck says. "If you’re capitated for 35% of your business and you know Medicare and Medicaid are not going to pay any more than they have, you’re going to have to increase productivity and efficiency."
The monthly reports include individual physician productivity, midlevel provider productivity and cost analysis by cost center. The productivity reports are distributed to each physician and managers, while cost center data are given to managers only.
The system works off a procedure that is common to physicians filling out the charge ticket, which is used to determine payment. While Carle Clinic is capitated, the physicians are paid on a fee schedule. The information from the charge ticket – procedure, cost, and physician/midlevel provider is entered into the clinic’s information system.
The only additional step Carle Clinic had to implement was creating charge tickets for each of the organization’s cost centers in order to separate data by cost center.
Also, because the charge ticket is still a paper record, Carle Clinic employs a staff to input the data and create the reports. "Nowhere in the charge tickets was a cost center identified, so we had to build tables that identified a doctor and the cost center information where the data would be assigned to," Reifsteck says. "We are hoping, as we become more automated, to have an on-line charge ticket. All you would have to do is swipe a cost center, and we would not have to build a table."
What the reports will show is individual patient production, including the number of patient visits for the month with comparisons to the previous year. The same information is culled for midlevel providers.
On the cost center side, a monthly budget report will show the number of visits and expenses as a result of the visits and cost per full-time equivalent.
Carle Clinic, however, has not been able to match individual productivity and visit information with expense data. Because a charge or claim is not the only expense involved in an outpatient visit, other expenses, such as office staff and overhead, are difficult to assign to each visit.
"One of the problems with a group practice is that physicians have their own revenue, but expenses are shared among the 280 physicians," Reifsteck says.
Picture of productivity
While productivity and expense data can be useful in determining whether individual physicians are pulling their weight, there is the danger of using the data to compare financial performance of individual physicians in two different cost centers or two cost centers with different types of patients.
For that reason, Reifsteck would like to see the clinic implement relative value units (RVU) into the productivity and cost center expense equations. In short, RVUs will be the measure of productivity, while practice expense per RVU will be the measure of efficiency.
"My hope down the road is to use RVU activity information and break that it into components of physician expenses and practice expenses, which I call overhead," he says. "We would be able to have some sort of measure where we can take cost center expenses that do not belong to physicians and divide them by practice expense per RVU. Now we can compare urology to family practice when we couldn’t in the past."
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