Peak Practice Performance: Productivity & Growth

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Have you noticed a lull in your appointments? Does it seem that as the temperature rises higher and higher, the number of patients you see sinks lower and lower? A study published by ZocDoc indicates that summer is the slowest season for many doctors. Vacations mean patients aren’t around to schedule appointments, and between those vacations, summer camps, and other activities, budgeting is often constrained. Some patients are deterred by the July Effect, in which recent (supposedly inexperienced) med-school graduates begin their residencies.
In our fee-for-service world, you may wonder — or even worry — how these sharp declines in volume impact your profitability and how your practice can maintain a steady stream of visits during this seasonal slowdown.
Productivity and growth are the focus of this installment of my five-part “Peak Practice Performance” blog series. Here we’ll identify several key strategies that can help you collect more of every dollar owed to you, and save a penny or two.
Considering the seasonal issues described above, do you know how your productivity impacts your profitability? This question can be examined by taking a deeper dive into a few provider productivity metrics that are easy to calculate.

Understanding Provider Complement

In order to ensure that your practice is functioning optimally, be sure to set reliable benchmarks based on your medical specialty. Medical Group Management Association has great tools and resources to understand where your practice falls in relation to benchmarks for your specialty and practice size.
Once you determine a reputable benchmarking resource, the next step is to calculate your full-time equivalents (FTEs) for your practice. For example, if you have a standard outlining that each full-time provider works Monday through Friday with one half-day for administrative time, then you can estimate that 1.0 FTE = 36 hours. As a result of this standard, each provider working this number of hours would equal 1.0 FTE. Anything less can be prorated based on the example in the table below:

This calculation will provide you with your provider complement, which is a measure of your practice’s baseline staffing metric, or to put it differently, a measure of your capacity to see patients. Understanding your provider complement guides your practice and helps you determine the number of patients you can see relative to your FTE status. However, the complexity of your patient population’s health needs will also affect this output. Therefore, to account for this complexity, you should next consider your scheduling efficiency.

How Is Your Scheduling Efficiency?

Based on the FTEs calculated during your provider complement exercise, your practice can determine how productive your providers are against industry benchmarks. One of these benchmarks for productivity is scheduling efficiency.
Ensuring that your schedules are full based on clinical FTEs is a great method to assess whether your practice matches benchmarks for productivity and profitability. During the summer months, many patients and providers take vacations, so one way to maximize appointment availability is to use telehealth or virtual visits for patients. Not only do you regain productivity, but you enable your patients to have access to care from the comfort of their own air-conditioned home.
Additionally, this may be a great time to expand your practice by adding patients. Considering the summers are slow-paced for many providers, it is often easier to fit in new patients. We generally like to ensure that primary care physicians welcome at least 10 percent new patients every year in order to account for natural patient attrition that comes as a result of individuals moving to a different area or changing providers.

Optimizing Documentation

Once your practice has a full schedule, be sure that your providers are maximizing profitability by checking your metrics against benchmark targets for work-related value units (wRVUs) based on your group’s medical specialty.
Here’s how it works. Each specific procedure code is assigned a wRVU number. See the table below which is a comparison of two Established Patient CPT codes, referenced from E&M University as an example:

The more complex the procedure code, the higher the wRVU value. This figure accounts for how detailed the patient’s health history is, any medical exams and medical decision-making involved, and the time spent evaluating the patient. For instance, a 99125 code requires 40 minutes of face-to-face time as opposed to 15 minutes for a 99213 procedure. Similarly, the criteria for a 99215 procedure require high complexity decision-making and comprehensive history and exams as opposed to a 99213 procedure’s low complexity decision-making and problem-focused history and exam, which are less intensive.  
Benchmarking your provider wRVU values will allow your group to understand where you stand in relation to similar groups in your specialty, specifically how complex are your coding practices compared to other groups and each other.
However, documentation for complex procedures can be difficult. Employing scribes or virtual dictation software can increase productivity and create a better quality of life for physicians, resulting in decreased burnout. Considering more streamlined and efficient documentation practices will allow for a more productive workday as well as a better life outside the office so you can enjoy the warm weather and extra hours of daylight.
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