Their challenges include incredibly tight margins, recruiting the right clinical and administrative talent, and navigating an ever-changing policy landscape. But to move beyond survival and to truly thrive in the most complex healthcare environment in memory, practices need to do even more.
Becker’s Healthcare recently spoke with Bret Connor, COO at athenahealth, about the climate for medical group leaders and how organizations optimize practice performance through technology-enabled benchmarking.
Productivity requires matching patient demand with provider supply + shortening the revenue cycle
It can be difficult for medical groups to ensure they’re getting the right patients in the door at the right moment. It’s not simply that patient mix between low- and high-acuity individuals impacts reimbursements – it’s about adopting strategies that enable the practice to intervene at the ideal time to deliver the best possible outcome.
“Managing providers’ schedules effectively and ensuring patients show up for appointments enables clinicians to deliver better care,” Mr. Connor said. “But it also means providers deliver the right care – and are compensated appropriately for their hard work.”
Getting proper reimbursement is only possible if practices are focused on their revenue cycle management. Challenges include documenting claims properly, sending claims to payers in a timely manner and following up with both payers and patients about claims and bills. But the most difficult challenge may be obtaining appropriate pre-authorization for procedures before patients arrive. “Running a medical group is complex and fast paced,” Mr. Connor said. “A lot of the time, administrative staff don’t have all of the information they need at their fingertips to optimize decision-making. The practices that effectively utilize technology and automation to do so put themselves in a position to succeed.”
Opportunities exist to bring more benchmarking information and other data-driven insights to bear as practice leaders are making decisions. athenahealth provides technology solutions that drive greater visibility into practice performance, as well as automated solutions that reduce the administrative burden on employees and enable practices to run more efficiently.
” It’s powerful to have the right information at your fingertips and to compare your organization’s performance with what’s possible,” Mr. Connor said. “By benchmarking against practices like yours, you can supercharge your operations, and deploy technology to close both care gaps, and gaps within your own staff.”
Benchmarking sheds light on 3 key aspects of running a medical group
As medical groups engage in benchmarking, they must focus on three dimensions: patient, provider and payment. In each of these areas, opportunities exist to improve performance.
Patient
“On the patient side, high-performing practices look at their ability to minimize no-show rates and quickly refill vacated schedule slots,” Mr. Connor said. “Benchmarking and technology can enable both, while also improving the patient experience. If people are canceling or rescheduling at the last minute, you can easily tap into a waitlist and bring in patients who need care that day, driving down no-show rates and enabling more care delivery – and more opportunities for revenue.”
Provider
When it comes to provider performance, medical groups can benchmark whether providers are using the EHR system and all of the accelerators to get through patient encounters efficiently and effectively.
“Opportunities also exist to benchmark whether providers are following the right playbook to manage the cost of care and close key care gaps,” Mr. Connor said. “This is particularly important in value-based care practices.”
Payment
On the payment side, several benchmarks shed light on whether medical groups are being reimbursed quickly and fully. If a practice has a 50% patient payment rate and a typical patient panel, for example, it’s not doing very well compared to other high-performing practices.
athenahealth serves more than 155,000 providers on its nationwide network and submits nearly 300 million claims annually to payers. For the practices and providers that athenahealth serves, the company aggregates data across these organizations to reveal what high performance looks like.
“We know, payer by payer, how long it should take to get reimbursed, as well as what net collection rates, denial rates and clean claim rates should be,” Mr. Connor said. “These are all things that impact the speed and amount that practices are reimbursed for their services. All practices should continually benchmark their performance on a payer-by-payer basis.”
athenahealth’s Insights Dashboard enables medical groups to see how they are performing across many different dimensions – all in a single, intuitive interface. They can filter that information and benchmark measures against a peer group of similar practices.
“As one example, we have significant market share in the orthopedic surgery space,” Mr. Connor said. “We look at medical group performance based on percentage of accounts receivable over 90 days, the charge entry lag and the speed at which the group is paid. We’ve found that we can consistently help orthopedic surgery practices elevate their performance across those dimensions by using athenahealth for clinical documentation and better payer management.”
Though it may seem complex to shift from one EHR system to another, getting a higher collections yield and shortening the revenue cycle makes the move to athenahealth worthwhile for many practices.
“Benchmarking helps us demonstrate to practices that there is a path to higher performance,” Mr. Connor said. “We can show them exactly how our practices perform by specialty and by geography. We can compare that to their current performance using a different system.”
Where to start with benchmarking
For practice leaders who want to adopt benchmarking, a good starting point is mapping the organization’s current performance across the patient, provider and payer dimensions. Compare those performance levels with those of other, similar organizations. Then, assess if process changes are needed and whether targets can be put in place to drive improved outcomes.
“Medical organizations must increasingly think about how to use technology to automate and offload work,” Mr. Connor said. “The goal is to make it easier for employees to focus on the delivery of care, rather than managing insurance companies and back-office work. athenahealth can help through our cloud-based software suite and technology-enabled services for outsourcing administrative work. We are building and enabling a thriving healthcare ecosystem that delivers accessible, high-quality and sustainable care for all.”
