Effective Practice Management Results in Quality Care for More Patients

实践管理者在门诊护理中扮演着至关重要的幕后角色。他们负责预约、诊所和办公室操作、病人沟通、人事管理、编码和开票、病历管理和实践财务管理。

These functions have become more important than ever as the healthcare industry transitions to a value-based care model. Efficient practice managers balance appointment demand, improve clinic efficiency and optimize time management for physicians—with a measurable effect on both patient and physician satisfaction. Ineffective practice management can lead to poor patient satisfaction, overloaded staff and billing errors. Such problems reduce revenue, raise costs, frustrate physicians and may cause patients to seek care elsewhere.

As part of its system-wide goal to achieve in excess of $60 million in operational improvements, Texas Children’s Hospital—a not-for-profit organization consistently ranked among the top children’s hospitals in the nation—decided to tackle its practice management processes. Specifically, the health system sought to achieve improved practice efficiencies enabling greater access to care for patients and families that they projected would also result in a $20 million improvement. That improvement comes from optimal practice management and enhanced provider productivity.

IMPROVING PRACTICE MANAGEMENT WITHOUT ACCESS TO TIMELY METRICS

由于无法及时获取数据，以及缺乏有效的工具来管理关键流程，德州儿童基金会提高运营效率和生产力的努力受到了阻碍。

Practice managers had to use a time- and resource-intensive process to repeatedly pull, validate and integrate data from five disparate databases in order to calculate key metrics and generate the reports and data visualizations required by leadership to effectively manage physician services. They used this complex process on a regular basis to track basic appointment metrics— the number of scheduled appointments, completed appointments, cancellations, no-shows and “left without being seen.” They also needed to track other key operational metrics such as:

• Percent of clinic schedule template optimization: This measure is designed to assess and manage over- and underutilization of a provider’s time. The ideal goal for practices is to fill 100 percent of providers’ schedules. However, 80-90 percent utilization is considered successful as a result of no shows and physician emergencies.
• Third next available appointment: This metric is defined as “the average length of time in days between the day a patient makes a request for an appointment with a physician and the third available appointment for a new patient physical, routine exam, or return visit exam.”¹The “third next available” appointment is used rather than the “next available” appointment since it is a more sensitive reflection of true appointment availability.

In addition to their problems tracking metrics, practice managers lacked a schedule template utilization tool to help clinics determine if a provider’s schedule was well utilized and to help them reach the 90 percent target. Furthermore, open encounters—encounters not yet dictated, signed and coded—were difficult to manage and close within the desired timeframe, creating issues related to patient service, patient safety, timely billing and revenue optimization. Finally, meaningful use (MU) data²具体到患者门户的使用，实践管理人员不容易访问，这使得很难知道患者是否通过卫生系统的患者门户充分访问了他们的个人健康信息，或者是否满足了门户使用的MU标准。

如果不将临床、财务、业务和其他数据整合到一个单一的真相来源中并使其更容易获得，业务管理者和卫生系统领导层就无法定期对医生服务的表现有一个清晰的视角。需要这种可见性才能最大限度地提高业绩、效率、生产力和收入。

AN ENTERPRISE DATA WAREHOUSE AND ADVANCED ANALYTICS APPLICATIONS

To address its data and analytics needs, Texas Children’s implemented a late-binding enterprise data warehouse (EDW) and an advanced analytics application from Health Catalyst. The EDW aggregates data from all necessary sources and makes it securely accessible through the analytics application.

通过EDW提供的接近实时的数据，诊所经理和领导可以更快地进行干预，以优化生产力和利用率，并改善患者获得护理的机会。目前，分析应用程序提供了一个集成数据视图的仪表板，包括预约统计、调度利用模板和开放会面。The dashboard is expanding to include MU metrics, third next available appointment, referrals, orders, exam room utilization and patient flow (Figure 1).

实践经理现在可以随时访问一个显示实践表现的关键指标的约会统计仪表板(图2)，包括预算的表现、每月的数量趋势和关于完成的约会、取消的约会、没有显示和“离开而不被看到”的数据。这个关于实践是如何执行的视图——每天更新——使管理者能够识别任何与预算预期相比的缺点，并且，更重要的是，能够深入到数据中以确定根本原因，以便实践能够主动地解决问题。提供者也可以访问仪表板来评估它们的表现是否符合预期。

Texas Children’s practice managers now enjoy timely, routine access to schedule template utilization information. Leaders are able to drill down to the provider level at a given location of care (Figure 3). They can visualize scheduled and completed template utilization by specialty, department or provider trended over time—making it easy to identify issues quickly and determine a resolution for more efficient provider time management.

例如，一个业务经理发现一个医疗中心的护士从业人员(NP’s)模板没有按预期填写满。他们发现，原因是这个健康中心的大多数患者更喜欢看医生，而不是NP。他们将这个未充分利用的提供者转移到另一个医疗中心，那里有一个新的和不断增长的门诊服务，她很快就能满足当地对病人护理的高需求。

In the past, practice managers never received open encounter reports on a timely basis. They now have easy access to near real- time open encounter data (Figure 4) and can view open encounters across the various health centers. Metrics include office visits, infusion visits, procedure visits, telephone encounters, refill requests, patient emails and others. This unprecedented visibility is helping them achieve their goal of closing out all patient encounters in a much more timely fashion so they can meet revenue expectations.

Finally, practice managers use the advanced analytics application to track MU metrics from the health system’s electronic health record (EHR), which enables them to visualize each provider’s progress towards improved preventative care and ultimately improved clinical outcomes (Figure 5). This tracking ability increases ownership among practice staff with respect to various MU metrics such as tobacco status, height/weight/BMI/BP, problem lists, allergy lists and medication lists. They are also better able to promote patient use of Texas Children’s online patient portal, which allows patients to participate more effectively in managing their health.

RESULTS

由于其整体数据驱动的愿景交付(DOTV)倡议，德州儿童通过提高质量、提高全系统效率、消除工作流浪费和降低成本，迄今已超过其初始目标，并提高了7400万美元的营业利润率。卫生系统将节省的大约2000万美元归功于医生服务的改善。Performance improvements include:

• Better appointment scheduling and management. Specifically, Texas Children’s has achieved:
  • 进度模板利用率增加了29%。医疗系统现在正在实现90%的预约时间安排的目标。
  • A 40 percent decrease in physician specialties with third next available appointments greater than 14 days
  • A 36 percent decrease in the no-show rate. This improvement has important implications for the bottom line, since providers sitting idle due to no-shows are extremely costly to the health system.
  • 由于改进了时间表模板的利用和更有效地分配可用的提供者资源，改善了患者获得护理的机会。在此之前，50%的医生在两周内没有预约。今天，这一数字下降到了30%。
  • A 16 percent increase in the internal referral rate. As a result of better appointment management and improved patient access, Texas Children’s is increasingly capturing referrals within its own organization. The internal referral rate has surpassed 80 percent.
  • Improved management of open encounters. Practices now manage open encounters in near real-time, resulting in an 80 percent decrease in unsigned encounters and improved revenue.
• A roughly 15 percent improvement in provider productivity
• A dramatic increase—from 8 to 59 percent—of providers meeting the MU patient portal threshold

Furthermore, practice managers are able to spend more time optimizing clinic operations and closing revenue generating encounters rather than cobbling together data, visualizations and reports. Previously, they spent approximately six days each month gathering data from more than ten disparate databases, manually calculating metrics and preparing visualizations and reports. Now they access information quickly and conveniently in the analytics application. The application also streamlines their preparation for quarterly performance reviews with hospital senior leaders. Whereas this preparation took each practice manager six business days in the past, it now takes only one hour for each manager to use the applications to gather the necessary information.

Finally, Texas Children’s leaders now have a single source of truth for assessing performance. This source provides access to all metrics, as well as drill-down capabilities for deeper analysis of problems or concerns. With the near real-time data delivered by the EDW, leaders can make decisions unhampered by data lags or reporting delays.

“Effective practice management leads to enhanced provider productivity. It’s easy to claim that a provider has poor time management skills. But we find that, most often, issues of practice management are really to blame. We look at operational metrics such as: Are we staffing our providers effectively? Utilizing our exam rooms efficiently? If the practice’s operational metrics are clicking well, the physician usually clicks along well too.”

– Mark Mullarkey, Senior Vice President

WHAT’S NEXT

Texas Children’s has identified many opportunities for further improvement in operations beyond practice management where they can further leverage the EDW. They plan to implement additional analytics applications from Health Catalyst designed to help practices manage referrals and orders, exam room utilization and patient flow.

References

1.Third Next Available Appointment(n.d.). from Institute for Healthcare Improvement website.
2.Step 5: Achieve Meaningful Use Stage 1(n.d.). from HealthIT.gov.

ABOUT HEALTH CATALYST

Health Catalyst is a mission-driven data warehousing and analytics company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 50 million patients for organizations ranging from the largest US health system to forward-thinking physician practices.

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