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
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
$0
$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
Aetna
United Health
No Pay
Workers Comp
Payments Q1
Medicare
Medicaid Commerc
ial
Blue Shield
Aetna
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
Goals
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
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
0
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
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Mar
-98
Jun-
98Se
p-98
Dec-
98M
ar-9
9Ju
n-99
Sep-
99De
c-99
Mar
-00
Jun-
00Se
p-00
Dec-
00M
ar-0
1Ju
n-01
Sep-
01De
c-01
Mar
-02
Jun-
02Se
p-02
Dec-
02M
ar-0
3Ju
n-03
Sep-
03De
c-03
Mar
-04
Jun-
04Se
p-04
Dec-
04M
ar-0
5Ju
n-05
Sep-
05De
c-05
Mar
-06
Jun-
06Se
p-06
Dec-
06M
ar-0
7Ju
n-07
Sep-
07De
c-07
Mar
-08
Receipts
12 per. Mov. Avg. (Receipts)
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
M-0
7
M-0
7
J-0
7
S-0
7
N-0
7
J-0
8
M-0
8
M-0
8
J-0
8
S-0
8
N-0
8
J-0
9
M-0
9
M-0
9
J-0
9
S-0
9
N-0
9
J-1
0
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
Aetna
United Health
No Pay
Workers Comp
Payments Q1
Medicare
MedicaidCommerci
al
Blue Shield
Aetna
United Health
No Pay Workers Comp
Billed Charges Q1
Medicare Medicaid
Commercial
Blue Shield
Aetna
United Health No Pay
Workers Comp
Payments Q1
Medicare
Medicaid Commercial
Blue Shield
Aetna
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
38.0%
72.5%74.6%
73.1%70.4%
66.3%64.5%
61.4%
50.6%
41.1%
4.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
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
$0
$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
Rece
ipts
Uni
ts
Receipts and Units Billed - Two Years
Units
Receipts
10%
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
$0
$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
$/mo. $1,500k$/MD 575kOR % 68%OT <40 hr/wWe hrs < 24c/ASC 400/wk
Goals
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
Goals
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
100
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
