Are your metrics in harmony?

If I ask each person in your practice to name one metric or measure that is important to them in their daily work, could they?  And would it be the same metric or measure which you think is most important for them?   In other words, are your medical practice metrics explicitly defined, in a meaningful way, to employees?  If not, you may find people have their own self-defined metrics which have nothing to do with the practice’s success. 

Every medical practice should have some way of measuring their success.  Metrics are one such way.  When a medical practice defines a metric, it identifies a critical need or care requirement, determines how to measure success or failure, and establishes targets against which results can be scored.  (Hint:  if you don’t have metrics, you might want to really think about this next paragraph.)

Three typical success metrics (the typical term is “performance metric”, but I like the more affirming term “success metric”) include: 1. Unfilled appointment slots (No Shows); 2. Collections percentage; and 3. Employee turnover.  For a mature practice, a 5% “No Show” rate is a reasonable guideline.  For collections percentage, collecting 95% of expected (which is different from billed) charges is a typical benchmark.  And for employee turnover, an annualized average staff turnover rate of 10% or lower is a good goal.

Let’s look at No Shows.  Say you currently have a 15% no-show rate, but for financial success, your goal is no more than 5% over a rolling 30 day average.  So you tell your staff, “We have too many no shows.  Reduce it.”  One obvious solution here is to call all patients prior to their appointment.  But the front desk staff is too busy to add 30-60 calls a day to their growing to-do list.  The nursing staff is still struggling with that new update to the EHR and puts up resistance, and your biller is too busy figuring out next year’s CPT changes to be bothered with phone calls.  So, one person might determine there are too many time slots per hour and reduce them.  Someone else might schedule patients heavy in the morning and light in the afternoon thinking that will help.  Someone else might think they need to book even more patients per hour to make up for no shows.  So, without a plan, you can’t be sure of the result.  You’ve lost control and predictability, and so has your staff.

Here is an approach which may yield better results.   Explain to everyone how a reduced no show rate will benefit them.  Then explain that you are going to experiment with some solutions and ask that they help with their own constructive ideas and feedback.  You start with a 30 day trial period where staff call all patients the day before their appointment, and measure how that impacts the no show rate.  Maybe that reduces it, but the office manager notes that the employee turnover rate is increased (due to increased workload), patient check-in and insurance verification times are increased because of the increase in outbound calls at the front desk.  And there is an increase in the number of patient complaints regarding the time it takes to check in, and more calls are rolling over to the answering service. 

So, for the next 30 day trial period you have staff look at upcoming appointments and identify those patients who have missed at least one appointment in the past two years.  Staff marks the chart for future reference, then make reminder calls to the balky patients one day prior to their appointment.  At the end of the 30 days the office manager reviews the metrics.  Staff turnover is back to normal levels, workload is eased, and patient complaints reduced.  However, no shows are reduced to 8%, not yet reaching the 5% goal. 

So for the next 30 day period the practice continues calling habitual no shows, but, during the patient visit, the nursing staff also praises the patient (and documents in the chart) for keeping their appointment.  Also, the doctor now discusses ( and documents) the no show issue with the patient to see if there is some underlying issue for the patient’s no show behavior such as economic need or a transportation issue.  The goal is to change the patient’s behavior so as to end the no-show cycle. 

At the end of 30 days, the office manager looks to their metrics and sees the No Show rate is reduced to 4%, employee turnover is normal, patient satisfaction is good, and financially it has been a winner for the practice.  Office pizza party!

Regardless of how you handle no shows, I hope you see why it’s important to define your medical practice’s success metrics to staff in terms which are meaningful to them, and to monitor your metrics to avoid discord as you work to meet your goals. 

Straight ahead,

Bob