As the administrator at Retina & Vitreous of Texas for nearly 8 years, I wear many hats, and no two days look the same. I perform a wide range of diverse tasks at the practice, from assuming all human resources functions, performance improvement, payroll, accounts payable, and accounts receivable.

I split my time about 70/30. Seventy percent is focused on our practice’s business operations, such as where patients are coming from and volume census, and the other 30% revolves around improving efficiency in our clinical operational functions. By nature, I am a numbers guy. Having such a robust, integrated analytics platform is the best technology assistant I could ask for. The more metrics there are, the more excited I am to dive in and uncover the story they tell and how it can help our practice.

THE OVERALL VALUE OF ANALYTICS

To be quite frank, I would not be able to do my job without having an integrated analytics tool. The analytics solution we use from Modernizing Medicine empowers me and others with a wide range of informative metrics right at our fingertips whenever we need it.

Without technology, it would be nearly impossible to measure staff performance against goals, or efforts like patient collections and identifying problematic payers. Without integrated electronic health records (EHR) and practice management (PM) systems combined with analytics tools, it would be difficult to set up the various processes needed to generate the numbers that uncover actionable insights.

ACCESS MISSION-CRITICAL METRICS

The combinations and permutations that I can pull from our analytics platform are seemingly endless. Some of the metrics that I routinely pull are as follows:

• Patient volume per physician
• New patients per physician
• Referral sources (new and existing)
• Payments received compared to historical volume
• Payments received compared to contracts
• Surgical volume by physician
• Overbooking percentages

Every day, I pull mission-critical reports, such as our high-dollar drugs and surgical billings. These reports enable me to see exactly where in the payment cycle every open drug invoice is and identify problems as soon as they happen. Monthly, I pull month-end summaries of visits and cash received and charges billed. Quarterly, I pull lag reports that show what was billed and what is outstanding to identify any accounts receivable opportunities. These and other metrics help ask and answer questions that I and others in our practice can turn into action items for improved results.

USE NUMBERS TO UNCOVER ANSWERS

Every number is generated in some way by a process. If there is an issue, I will track back through the process to identify where the intervention point may be. Could it be a patient throughput issue? Maybe we don’t have enough staff? Perhaps our office layout isn’t ideal? Are we experiencing revenue challenges? What about posting errors? What’s the average time for staff to get through each point of an exam? Where is the bottleneck occurring? Our analytics solution helps reveal the numbers, but to uncover what intervention may be needed, it’s also vital to know the business mechanisms behind those numbers.

For example, our practice has a payor that holds claims pending medical record review and is extremely slow to generate the request for the records. Our analytics system aided in identifying that specific payor and identifying a pattern of what claims were getting held. Once we understood what was happening, we were able to track each claim that fits the pattern and proactively upload the patients’ medical records and track the claim through completion. We were subsequently able to identify claims for which we had uploaded the records and the payor still had not processed. With the proper data in hand, we addressed this with the payer and have seen a nearly 50% reduction in processing time. This is a perfect example of how combining analytics findings and sound business acumen positively impacted revenue for our practice.

AVOID SILOED DATA

We have a handful of individuals who regularly access our analytics platform. Two research coordinators focus on the clinical data and look at metrics for patient populations based on diagnosed diseases. Our billing staff uses it to look into accounts receivable, aging reports, and payers to follow up with for claims, and a counterpart assists me with the business analysis that I regularly perform.

Depending on what I uncover, sometimes I can adjust and make changes on my own. For instance, if the front desk isn’t collecting copays regularly, I can address this one-on-one. Most items, however, are shared with the physicians and the management team. As a group, we can evaluate and decide if we need to adjust a policy or if there is a process issue.

One example is determining if there is an opportunity for improvement in revenue. We can dive into the payer-level data and, based on payment history, we can consider no longer participating with certain payers. I can present recommendations to the physicians to help guide the discussion and decision.

HIGH-RISK BUSINESS: RETINA INJECTIONS

One area that greatly differs in our ophthalmic specialty compared to others is the use of high-dollar retinal injections. Using analytics, we can uncover if there is an issue on the payment side for insurance. As soon as a bill is posted and sent to the insurance company, we have visibility into whether it is being paid appropriately, underpaid, or denied, and whether the various copay assistance programs are paying properly. This gives me and our physicians peace of mind that their high-risk business is not in jeopardy.

MORE THAN JUST A FEELING: STAFF PRODUCTIVITY

When pulling key performance indicators, it is critical not to simply pull numbers for the sake of pulling numbers. The numbers should help you answer questions, such as those tied to staff productivity. Rather than basing performance assessments on anecdotal feedback, we can rely on our analytics solution to help identify internal process challenges as well as coaching opportunities for staff.

It is human nature that when people know that they are being measured or monitored, they tend to perform better. This awareness among staff has helped improve performance. But more importantly, we can see staff productivity levels, whether it is what is being done at the front desk or the number of patients that the clinical staff are putting in rooms. We can use this information to see who is doing well and use their best practices to standardize across the practice. Alternately, we can better identify who could benefit from coaching. It’s a game changer and helps me help the staff improve.

When I put on my human resources hat, I need to quantify who is doing what, and I can’t just base that off of a feeling or anecdotal information. Diving into the numbers provides the ability to address the group, and help identify if the findings warrant a policy change, if it’s an individual challenge, or if an internal process may have fallen short.

TIPS FOR EVALUATING A HEALTH-CARE ANALYTICS VENDOR

Ask questions — lots of them. Here are just some of the questions we posed when vetting vendors:

• What system is generating the base data for the analytics solution?
• What is the data feed cycle?
• Who is building the reports?
• What is the likelihood of enhancement requests?

We compiled a comprehensive, 6-page list of all the reports and functions from our previous analytics system and what we needed out of a new system. We shared this with vendors we were evaluating to see if their solution supported, at the very least, an equivalent function. We also requested a detailed demonstration of the platform so we could really understand and see all the ways in which we could pull the information we knew we wanted to have. My advice is to be hands-on during the demo process. Don’t just agree to a quick overview. Really dive in and spend the time upfront to know what it is you may be agreeing to purchase.

THE STAYING POWER OF AN INTEGRATED SOLUTION

We have greatly benefitted from having an all-in-one solution built specifically for ophthalmology and the retina subspecialty, and I would encourage others to look for the same. We already knew that we did not want to deal with interfacing 2 different systems and battling with 2 different vendors. Now, we have 1 vendor with an integrated solution that knows us and our business, and 1 source to go to when assistance is needed. We feel that there is a higher likelihood of enhancement requests being met by working with a single vendor. Because all the data are sourced from a single system that automatically exports nightly, this doesn’t slow us down or provide outdated data as we experienced with our previous vendor. All of this provides an added level of confidence.

I would encourage others to take the same careful approach when vetting vendors as they do when assessing the practice’s data using analytics. This can save time, money, and headaches in both the short and long term. RP