Communicating With Your Physicians Through Dashboard Data Developing a Practice Dashboard

transcript

Communicating With Your Physicians Through Dashboard Data

Developing a Practice Dashboard

MGMA Anesthesia Administration Assembly

May 2010

Joe LadenMGMA member since 1981

AAA Member since inception

Business ManagerAnesthesia Associates of Louisville, PSC

joeladen@aalouisville.com

Following this session you will be able to:

Develop a strategy to produce an effective practice dashboard

Identify key information that should be communicated to physicians

Gain insight as to the spreadsheets and graphic software available

04/21/23 11:34 AM

Anesthesia practice administrators are responsible for gathering, interpreting and disseminating financial data from business systems. The communication of this data

must be precise, concise and understandable.

What information is important for physicians and their management

of their practices?

How can this be presented in the most efficient and effective

manner?

What is anAnesthesia Practice

Dashboard?

An anesthesia business dashboard can be any form of

display that quickly communicates business practice management

information to anesthesiologists.

In other words . . .

I can’t define dashboard, but I know one when I see it.

Examples of Anesthesia Dashboards

From Practice Management System Billing

Software

Constructed by Practice

July 2010

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

100,000

120,000

140,000

160,000

180,000

200,000

220,000

240,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

MinutesPayments

2010 2009 2010 2009 2010 2009

Cases 950 925 6,100 5,925 12,500 11,7002.7% 3.0% 6.8%

Units 11,400 11,100 73,200 71,100 150,000 140,4002.7% 3.0% 6.8%

Minutes 137,750 134,125 884,500 859,125 1,812,500 1,696,5002.7% 3.0% 6.8%

Gross 1,425,000 1,387,500 9,150,000 8,887,500 18,750,000 17,550,0002.7% 3.0% 6.8%

Recepits 467,400 455,100 3,001,200 2,915,100 6,150,000 5,756,400

June YTD Trail 12Production and Receipts All Locations

Income and Expenses YTD 2010 Budget YTD 2009 Patient Revenue 1,450,000 1,400,000 1,500,000Hospital Subsidy 150,000 150,000 100,000Billing Expense 87,000 84,000 96,000Corporate 26,500 30,000 27,500CRNA Expense 585,000 550,000 530,000MD Expense 755,000 720,000 740,000Net 146,500 166,000 206,500

Medicare

Medicaid

Commercial

Blue Shield

United Health

No Pay

Workers Comp

Payments Q1

Medicare

Medicaid Commerc

Blue Shield

United Health

No Pay

Workers Comp

Billed Charges Q1

MD Month YTD Month YTDArnold 865 3,564 $38,918 $962,280Baker 837 4,350 $37,673 $1,174,500Cook 865 3,606 $38,918 $973,620Dashi 794 3,681 $35,745 $993,735Farnsley 612 5,189 $27,518 $1,400,895Guari 766 3,754 $34,470 $1,013,580Henry 804 4,947 $36,169 $1,335,555Iliri 870 4,951 $39,165 $1,336,770Jones 667 5,195 $30,015 $1,402,515Kellog 720 5,084 $32,419 $1,372,545Lambert 639 5,334 $28,740 $1,440,045Mikos 789 3,501 $35,516 $945,270Norman 901 4,338 $40,534 $1,171,125Ogden 792 4,470 $35,633 $1,206,900Peters 879 4,352 $39,536 $1,174,905Zoroster 686 4,666 $30,881 $1,259,820Total 12,486 70,978 $561,848 $19,164,060

Units Collected

Facility Month Last Mo. YTD 13 Months

Units 7,620 7,649 45,760

$ $327,671 $359,491 $1,967,659

Units 4,980 4,927 29,321

$ $209,146 $211,843 $1,260,782

Units 1,375 1,314 8,359

$ $60,518 $55,199 $351,078

Units 972 763 5,124

$ $41,785 $35,877 $215,208

St. Pete

Adenia

SurgeCenter

Spine Hosp.

April 2010

Benchmarks$/Unit $40 $/OR $480 U/MD 12,400OR % 65%% Gvt. 38%AR Days 34

$/mo. $1,500k$/MD 575kOR % 68%OT <40 hr/wWe hrs < 24c/ASC 400/wk

Anesthesia Associates of the United States – May 2010

23,379,323 19,071,824 18,672,864

333,990 328,824 333,444

1,994,806 1,909,840 1,938,273

17,142 17,536 18,557

10,043,530 8,783,497 9,003,829

357,503 2,126,748 15,845 11,167,180392,767 2,320,187 17,816 12,123,496387,580 2,303,624 17,711 11,750,800372,893 2,189,443 16,863 11,599,222347,279 2,035,823 15,881 11,396,124336,375 1,983,692 15,850 10,649,168335,396 2,015,794 16,459 10,444,874

25,024,314 23,379,323 19,071,824 18,672,864

347,559 333,990 328,824 333,444

2,099,677 1,994,806 1,909,840 1,938,273

17,865 17,142 17,536 18,557

10,814,667 10,043,530 8,783,497 9,003,829

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

50,000

100,000

150,000

200,000

250,000

Jan-08 Feb-08

Mar-08

Apr-08 May-08

Jun-08 Jul-08 Aug-08

Sep-08

Oct-08 Nov-08

Dec-08

Jan-09 Feb-09

Mar-09

Apr-09 May-09

Jun-09 Jul-09 Aug-09

Sep-09

Oct-09 Nov-09

Dec-09

Jan-10

2008-2010 Norton+Pavilion OR Minutes and Revenue (Receipts)

OR Minutes

Revenue

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Receipts

12 per. Mov. Avg. (Receipts)

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Units with Linear Trend Line

From Third Party Dashboard Company

To communicate with physicians effectively, the dashboard should have a

sufficient number of data points, but not too many.

04/21/23 11:34 AM

Dashboard Data Sources

• Billing System Reports

• Accounting System Reportso General Ledgero Payroll

•User Constructed Spreadsheets Currently Produced by

Practice

Where are Anesthesia Dashboards Available today?

• Anesthesia Billing Software Vendors• Anesthesia Billing Companies• Anesthesia Practice Management Companies• Report Hosting Companies

DashboardMD iDashboards•Anodyne

• DIY for Small – Medium Size Groups

Sources of Data for The Dashboard

1. Excel Spreadsheets

prepared by You

Billed Q1 Q1 Q3 Q4Medicare 3,221,500 3,510,500 3,238,500 3,740,000Medica id 610,500 586,500 613,500 652,500Commercia l 1,410,000 1,631,250 1,455,000 1,436,250Blue Shield 2,387,000 2,150,500 2,178,000 2,233,000Aetna 1,012,500 1,045,000 1,065,000 1,050,000United Heal th 826,000 880,000 814,000 816,000No Pay 200,000 216,000 205,000 202,500Workers Comp 312,000 294,750 305,250 295,500Tota l 9,979,500 10,314,500 9,874,250 10,425,750

Payments Q1 Q1 Q3 Q4Medicare 580,500 3,391,500 3,629,500 3,536,000Medica id 61,650 562,500 588,000 600,000Commercia l 1,077,500 1,567,500 1,556,250 1,428,750Blue Shield 1,340,500 2,376,000 2,189,000 2,145,000Aetna 1,612,500 1,087,500 1,060,000 1,005,000United Heal th 245,400 824,000 768,000 846,000No Pay 83,200 198,000 207,000 201,000Workers Comp 86,400 324,000 327,750 306,000Tota l 5,087,650 10,331,000 10,325,500 10,067,750

Medicare Medicaid

Commercial

Blue Shield

United Health

No Pay

Workers Comp

Payments Q1

Medicare

MedicaidCommerci

Blue Shield

United Health

No Pay Workers Comp

Billed Charges Q1

Medicare Medicaid

Commercial

Blue Shield

United Health No Pay

Workers Comp

Payments Q1

Medicare

Medicaid Commercial

Blue Shield

United Health

No Pay

Workers Comp

Billed Charges Q1

YTD-2010 Budget YTD-2009

Patient Revenue 145,000 140,000 160,000

Hospital Subsidy 15,000 15,000 10,000

Billing Expense 8,700 8,400 9,600

Corporate Expense 2,650 3,000 2,750

CRNA Expense 58,500 55,000 5,300

MD Expense 75,500 72,000 74,000

Net 14,650 16,600 78,350

Mini Income/Expense Statement

Income and Expenses YTD 2010 Budget YTD 2009 Patient Revenue 1,450,000 1,400,000 1,500,000Hospital Subsidy 150,000 150,000 100,000Billing Expense 87,000 84,000 96,000Corporate 26,500 30,000 27,500CRNA Expense 585,000 550,000 530,000MD Expense 755,000 720,000 740,000Net 146,500 166,000 206,500

Production and Receipts All Locations June YTD Trail 12 2010 2009 2010 2009 2010 2009Cases 950 925 6,100 5,925 12,500 11,700 2.7% 3.0% 6.8% Units 11,400 11,100 73,200 71,100 150,000 140,400 2.7% 3.0% 6.8%

Minutes 137,750 134,125 884,500 859,125 1,812,500 1,696,500 2.7% 3.0% 6.8%

Gross 1,425,000 1,387,500 9,150,000 8,887,500 18,750,000 17,550,000 2.7% 3.0% 6.8%

Receipts 467,400 455,100 3,001,200 2,915,100 6,150,000 5,756,400

Category Current 31 - 60 61 - 90 91 - 120 120 - 150 151 +

ALL PATIENTS 37.0% 32.2% 8.9% 6.5% 3.7% 11.7%

MEDICARE 57.5% 27.9% 1.7% 5.1% 1.0% 6.8%

BLUE CROSS 44.3% 36.5% 10.2% 3.6% 0.9% 4.6%

PATIENT 4.9% 37.7% 21.8% 12.1% 6.3% 17.2%

HUMANA 60.6% 9.2% 2.5% 3.1% 3.6% 20.9%

TRICARE 32.5% 41.7% 4.5% 3.8% 1.3% 16.1%

UNITED HEALTH 46.9% 40.4% 1.5% -0.2% 4.7% 6.7%

A/R By Percent Outstanding by Carrier

AR Days Payer Dec-07 Dec-08 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10

Humana 16.1 18.4 16.7 13.7 13.4 9.6 15.7Anthem 22.0 25.3 37.3 19.3 22.4 20.7 19.4UHC 21.5 18.0 23.1 14.2 14.2 20.0 23.6Medicare 17.0 28.9 22.3 23.7 27.3 26.5 29.3Commercial 50.8 58.1 45.8 48.4 50.8 46.5 48.6Tricare 29.6 28.0 23.9 16.0 20.5 15.6 20.3Medicaid 36.6 72.2 52.6 64.5 62.1 51.9 59.6Workers Comp 60.3 75.8 45.7 49.3 58.7 61.3 68.5Patient 185.3 190.5 177.1 213.0 173.5 178.2 129.9

Overall 26.0 35.9 31.8 31.0 32.9 31.5 34.3

72.5%74.6%

73.1%70.4%

66.3%64.5%

8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 23:59

7:30 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00

OR Utilization by Hour

April 2010

04/21/23 11:34 AM

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

25,000

27,000

29,000

31,000

33,000

35,000

37,000

Receipts and Units Billed - Two Years

Receipts

04/21/23 11:34 AM

ValuesRow LabelsCases. Base U Time U FF U Minutes.Jan 1,589 9,459 17,948 5,097 176,302Feb 1,604 9,368 18,185 4,794 176,077Mar 1,776 10,605 20,264 5,318 198,179Apr 1,771 10,165 20,424 5,565 199,241May 1,663 9,626 18,541 4,960 180,574Jun 1,822 11,036 21,117 4,902 206,665Jul 1,365 8,780 17,446 3,213 171,051Aug 1,171 8,081 15,903 1,677 156,029Sep 1,339 9,418 18,697 2,456 182,090Oct 1,403 9,670 19,034 2,574 185,840Nov 1,519 10,362 20,274 2,889 196,446Dec 1,772 12,163 23,886 3,414 233,286Total 18,794 118,733 231,719 46,859 2,261,780

Tabular Data vs. Graphic Display

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

100,000

120,000

140,000

160,000

180,000

200,000

220,000

240,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

MinutesPayments

Excel 2010 Sparkline

2.Reports and Displays

from Billing System

3.Accounting System

Reports

4.Benchmarks and Goals

BenchmarksRevenue per Unit $40 Revenue per OR $475kUnits per MD 12,400Units per OR 14,500OR Utilization 65%% Government Payers 38%A/R Days 46A/R % over 90 Days 18%

$/Unit $40$/OR $480U/MD 12,400OR % 65%% Gvt. 38%AR Day 34

Benchmarks

Internal Practice Goals

Revenue per Month $1,500k

Revenue per MD 575k

OR Utilization 68%

CRNA OT < 40 hrs./wk

Weekend Hours < 24

Cases @ ASC 1 400/week

MD Month YTD Month YTDArnold 865 3,564 $38,918 $962,280Baker 837 4,350 $37,673 $1,174,500Cook 865 3,606 $38,918 $973,620Dashi 794 3,681 $35,745 $993,735Farnsley 612 5,189 $27,518 $1,400,895Guari 766 3,754 $34,470 $1,013,580Henry 804 4,947 $36,169 $1,335,555Iliri 870 4,951 $39,165 $1,336,770Jones 667 5,195 $30,015 $1,402,515Kellog 720 5,084 $32,419 $1,372,545Lambert 639 5,334 $28,740 $1,440,045Mikos 789 3,501 $35,516 $945,270Norman 901 4,338 $40,534 $1,171,125Ogden 792 4,470 $35,633 $1,206,900Peters 879 4,352 $39,536 $1,174,905Zoroster 686 4,666 $30,881 $1,259,820Total 12,486 70,978 $561,848 $19,164,060

Units Collected

Facility Month Last Mo. YTD 13 Months

Units 7,620 7,649 45,760

$ $327,671 $359,491 $1,967,659

Units 4,980 4,927 29,321

$ $209,146 $211,843 $1,260,782

Units 1,375 1,314 8,359

$ $60,518 $55,199 $351,078

Units 972 763 5,124

$ $41,785 $35,877 $215,208

St. Pete

Adenia

SurgeCenter

Spine Hosp.

April 2010

Benchmarks$/Unit $40 $/OR $480 U/MD 12,400OR % 65%% Gvt. 38%AR Days 34

67 10:56 PM

Creating Dashboards Can Be Difficult

• Many Sources• Varied Source Formats• Tools not easy to use• Compact Layout• Complex Formatting• Determining relevant data• Relevant data may change• Different Audiences

How Do We Easily Make a Powerful Dashboard?

04/21/23 11:34 AM

Construction Software

• Excel 2003,2007,2010• Word• PowerPoint• PDF Creation Software• Snipping Tool (screen capture)

SnagitJing

Why Excel as Primary DIY Tool?

• You Probably Own Excel• Low Cost • Universality• Excellent Data Exchange• Charts• Pivot Tables• Ease of Use• Training Available• Advanced, Mature Product• Runs on PC or Mac

Excel 2010 New Features

• Sparklines• Cell Bars• Slicers• PowerPivot• DAX Formulas

Steps to Prepare You Dashboard

• Determine Your Audience

• Review Current One Page Reports

• Decide Which Key Performance Indicators to Display

• Determine if Billing System Data Can Be Easily Copied.

• Decide on Dashboard Construction Tools

One Approach to Constructing Your Own Dashboard

Cut and Paste Dashboard Construction

1. Start with blank PowerPoint Slide2. Display components to place on dashboard3. Capture components with Snipping Tool or Copy & Paste4. Paste onto slide5. Resize and reposition6. Add Logo, Background Other Beautifying Graphs7. Print as a PDF and distribute.

Construction Demo Video

More Difficult Method 1:

Prepare all elements of spreadsheet on one worksheet in Excel from

multiple worksheets with tables and graphs and use Excel Camera to

produce dashboard.

Example follows . . . . .

Excel Camera Example Video

More Difficult Method 2:

Dynamic tables and charts in Excel prepared on dashboard sheet from pivot tables based on externally imported data.

Advantage: Dashboard automatically update when current data is imported.

Example follows . . . . .

Excel 2010 Pivot Table With Slicers Video

Third Party Dashboard Solutions

• Interface With Practice Management Systems• Produce Dashboard Reports Automatically• Store Report Data Independently • Provide Web Access and Distribution Services

Can Be Time Consuming to Set UpThere will be a Cost

Examples:www.DashBoardMD.comwww.iDashboards.com

www.anodynehealth.com

Additional Methods to Produce Your Own Dashboard

•Xcelsius/EngageExpensive & Complicated but powerful

•Download to Handheld Device

•Custom Programming IT expertise and expense, specialized

software(Dundas)

Presentation & Delivery Methods

• Physical Paper •Company Web Site •PowerPoint Slide•Spreadsheet (Excel)•DVD•Secure USB Drive (with dataset)•Mobile Device, iPhone, iPad

What Needs to Be Communicated to

Physicians?

04/21/23 11:34 AM

Types of information

• Production • Cases, Units, Minutes• Gross Billing

• Payments, W/O, Adjustments• Accounts Receivable• Charges/Payments/WO• General Ledger/Income &Expenses• Payroll

04/21/23 11:34 AM

What Do Doctors Want to Know

• The future

• How the past will predict the future

• What if things go on as in the recent past

• What can be changed to improve finances

• What are areas of concern

What Can Anesthesiologists Do With Dashboard Information?

• Monitor Anesthesiologist/ACT Work Output:(Units / Minutes / Cases)

• Monitor Reimbursement for Work Performed(Payments/Unit or Hour)

• Monitor Collection Efficiency (AR Days)• Monitor Hospital Efficiency (O.R. Utilization)• Make decisions about staffing • Determine need for hospital subsidies

Key Metrics

• Revenue Per O.R.• Revenue Per Unit Billed• O.R. Utilization Rate• % Hours Billed/Worked After Normal OR Shift• CRNA Cost per Hour/Unit Billed• MD:CRNA Ratios (Concurrency)• Weeks Worked per Year• Units per Hour• Units Billed per MD FTE

Internal Comparisons

• Facility vs. Facility• MD vs. MD• Payer vs. Payer• Surgeon vs. Surgeon• Time-Based

• Month, Quarter, Year, Week• Trailing 12 months• Period vs. Previous Period

External Benchmark Comparisons

• MGMA Physician Compensation and Production Survey

• MGMA Single Specialty Cost ReportSurvey – Anesthesia

• ASA Payer Survey

KPI Top and Bottom

Top 10 and Bottom 10:

• Surgeons (collected per hour)• Anesthesiologists (units per year)• CRNA’s (hours billed/ hours paid)• Payers (collected per unit)• ASA Codes (units per case)

Other Combinations

•Units per case, MD, CRNA, Hour•Revenue per O.R., MD, Case, Hour•Units, Hours and revenue per Surgeon

Operating Room or Facility

Questions Anesthesiologists Ask:

How is the business going?

What will the end of the year look like?

Will your dashboard provide answers?

Take Away Ideas

Dashboards take time, talent and toil to make

Resist the urge to favor flash over function.

Encourage your vendors to produce dashboards

Often a paper report with limited graphics is best

Additional Resources

The Effective Use Of Electronic Dashboards To Promote & Improve Overall Practice Performance: An Exploration Into The Use of Electronic Dashboards In A Group Practice Setting. ACMPE Paper by David G. Owens, FACMPE. Available on the MGMA web site

Dashboard To Monitor Clinical Productivity of Anesthesiology Groups Amr E. Abouleish, M.D., M.B.A., Jody A. Locke, M.A., et al.

Click Here For Web Link

Dashboard Resources On the WebMGMA Excel Community

www.DashboardsByExample.comYoutube: ExcelIsfun

www.perceptualedge.comwww.edwardtufte.com

www.exceluser.comxcelsius.com

www.dashboardmd.comwww.idashboards.com

www.anodynehealth.comwww.dundas.com

www.dashboardspy.comwww.mrexcel.com

www.corda.comCognos / DataClarify

www.TableauSoftware.com

This Presentation Will Be Available To Download at:

www.joeladen.com

Have We Met the Objectives?

Develop a strategy to produce an effective practice dashboard

Identify key information that should be communicated

Gain insight as to the spreadsheets and graphic software available

Please Complete Your Evaluation

For Questions, Comments, Help or to Share Your Ideas:

Joe Laden, Business ManagerAnesthesia Associates of Louisville, PSC

332 W Broadway Louisville, Kentucky 40202

Office: (502) 583-0909Cell (502) 403-7489

www.joeladen.com

joeladen@aalouisville.com

Communicating With Your Physicians Through Dashboard Data Developing a Practice Dashboard

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