developing a practice dashboard mgma anesthesia administration assembly may 2008 joe laden mgma...

Developing a Practice DashboardMGMA Anesthesia Administration Assembly

May 2008

Joe LadenMGMA member since 1981

AAA Member since inception

Business ManagerAnesthesia Associates of Louisville, PSC

joeladen@aalouisville.com

What is a

Dashboard?

Merriam-Webster

Dashboard

1.a screen on the front of a usually horse-drawn vehicle to intercept water, mud, or snow

2.a panel extending across the interior of a vehicle (as an automobile) below the windshield and usually containing instruments (as a speedometer) and controls

What is a

Business Intelligence Dashboard?aka

Digital DashboardElectronic Dashboard

Information DashboardScorecard

The UltimateAnesthesia Dashboard

What is a not a dashboard,

But might look like a dashboard?

Click above to activate calculator, click here to go to next slide

Click above to activate calculator, click here to go to next slide

Click above to activate calculator, click here to go to next slide

Click above to activate calculator, click here to go to next slide

Dashboard definition and characteristics of good dashboard

design.

Stephen Few . . . .

“Visual display Of

the most important information needed to achieve one or more objectives

Which Fits entirely on a single computer screen

So it can be

Monitored at a glance”Stephen Few

www.perceptualedge.com

Visual Display

• Text Units 12,000 12,300 11,700 13,024 12,670Hours 1,200 1,230 1,195 1,200 1,140

• Graphics

Achieve Objectives

•Monitor Anesthesiologist/ACT Work Output:•Units •Minutes•Cases

•Monitor Reimbursement for Work Performed•Monitor Collection Efficiency •Monitor Hospital Efficiency (O.R. Utilization)•Make decisions about staffing•Determine need for hospital subsidies

Monitor Single Screen at A Glance

• Static• Text • Graphics • Mixed

• Dynamic• Selectors• Drilldown

•Portal to Reporting System

May be OK to have multiple screens/pages

YTD-2008 Budget YTD-2007

Patient Revenue 145,000 140,000 160,000

Hospital Subsidy 15,000 15,000 10,000

Billing Expense 8,700 8,400 9,600

Corporate Expense 2,650 3,000 2,750

CRNA Expense 58,500 55,000 5,300

MD Expense 75,500 72,000 74,000

Net 14,650 16,600 78,350

Mini G/L

Additional Characteristics of Good Dashboards

Small, clear, concise and intuitive display mechanisms

Customized to each person, group or function

Replace hunt and peck data gathering from many reports

Fine tuned to deliver insight in a powerful way

Problems with “Dashboard” Model for Business Intelligence

• Vehicle dashboard is real time

• Provides no trending & historical data

• Provides no comparisons

• Monitors relatively few indicators

Audience for Your Practice Dashboard

•Board of Directors•Shareholders•Practice Manager•Billing Manager

Dashboard contents should be targeted to its readers

Where are anesthesia dashboards available today?

• Anesthesia Billing Software Vendors• Anesthesia Billing Companies• Anesthesia Practice Management Companies• Report Hosting Companies• DIY for Small – Medium Size Groups

Tools to Produce You Own Dashboard

•Excel / Word Text DashboardCheap and Easy

•Excel Charts (graphs)Cheap, but more difficult

•Excel Pivot TablesPowerful but need transaction data

•Xcelsius/EngageExpensive & Complicated but more powerful

•Custom Programming IT expertise and expense, specialized

software

Steps to Prepare You Dashboard

•Determine Your Audience

•Review Current One Page Reports

•Decide Which Key Performance Indicators to Display

•Determine How to Gather Data

•Decide on Dashboard Construction Tool

KPIAnesthesia Key Performance Indicator

Categories

1. Anesthesiologist/ACT Production2. Billing & Collection3. Practice Operations

ExpensesPersonnel

Anesthesiologist/ACT Production KPI

• Cases• Units

• Base• Time• Flat Fee Procedures

• Minutes/Hours• Gross Billing

Billing & Collection KPI

• Payments

• Gross and Net Collection Ratio

• A/R Aging

• Days in A/R

Practice Operations KPI

• Personnel & Cost•MD•CRNA

• Overhead• Corporate• Billing Costs

KPI Coupled with Timing

Per

MonthDayYearQuarterWeek

KPI Coupled with Comparative Timing

• Year vs year• Year to Date vs. Last Year to date• Quarter vs Same Quarter last year• Trailing 12 months vs. Trailing 12 months prior year

KPI vs. Comparative Benchmarks

• Facility vs. Facility• MD vs. MD• Payer vs. Payer• MGMA Physician Compensation and Production Survey• MGMA Single Specialty Practice Cost Survey

KPI Top and Bottom

Top 10 and Bottom 10:

• Surgeons (collected per hour)• Anesthesiologists (units per year)• CRNA’s (hours billed/ hours paid)• Payers (collected per unit)• ASA Codes (units per case)

Other Combinations

•Units per case, MD, CRNA, Hour•Revenue per O.R., MD, Case, Hour•Units, Hours and revenue per Surgeon

Operating Room or Facility

The Data to Ink Ratio: (Edward Tufte)

Ink that represents data vs.

Ink that is not data such as:Company informationDecoration Graph LinesColor gradients

Dashboard Design Mistakes

• Size greater than one screen• Excessive detail or precision• Choosing non-meaningful measure• Inappropriate display media• Meaningless variety• Poorly designed display media• Poor arrangement• Useless decoration• Misuse of overuse of color• Failing to highlight important data• Unattractive visual display

Characteristics of a Good Display

• Excellent organization• Condensed with summaries and exceptions• Customized to user’s needs and objectives• Clear and direct media display

Change Change

2007 vs 2007 vs

2005 2006 2007 2006 2005

Production (units)

Hospital 1 250,954 261,575 274,901 5.1% 9.5%

Hospital 2 97,705 112,521 112,744 0.2% 15.4%

Both OR's 348,659 374,096 387,645 3.6% 11.2%

Revenue (collections)Hospital 1 Collections 7,281,869Hospital 2 Collections 3,163,032Total OR Collections 10,444,901

Hospital 1 Collections/OR 520,133Hospital 2 Collections/OR 451,862Average Collections/OR 497,376 OR's 21Pain Collections 555,650

Total Collections 11,000,550

2005 2006 2007 2008

Collected / Unit (6/hr) $30.61 $31.03 $32.19 $30.44

Collected / Unit (4/hr) $38.27 $38.79 $40.24 $38.04

Change in Collected/Unit 1.4% 3.7% -5.5%

Collect per OR case $ 628 $ 665 $ 705 $ 673

Collect per Pain Case $ 203 $ 197 $ 214 $ 211

Which is Better:

Table Or Chart ?

Category Current 31 - 60 61 - 90 91 - 120 120 - 150 151 +

ALL PATIENTS 37.0% 32.2% 8.9% 6.5% 3.7% 11.7%

MEDICARE 57.5% 27.9% 1.7% 5.1% 1.0% 6.8%

BLUE CROSS 44.3% 36.5% 10.2% 3.6% 0.9% 4.6%

PATIENT 4.9% 37.7% 21.8% 12.1% 6.3% 17.2%

HUMANA 60.6% 9.2% 2.5% 3.1% 3.6% 20.9%

TRICARE 32.5% 41.7% 4.5% 3.8% 1.3% 16.1%

UNITED HEALTH 46.9% 40.4% 1.5% -0.2% 4.7% 6.7%

A/R By Percent Outstanding by Carrier

Excel Dashboard Charts

Charles Kydwww.exceluser.com

Kyd Principles

• Dashboards should be produced on paper

• Many tiny graphs using Excel

• Set up workbooks to update easily

Constructing a Dashboard

with

Microsoft Excel . . . .

Producing an Xcelsius Dashboard

1.Construct Excel spreadsheet

2.Layout graphic elements

“CHEATER” DASHBOARD CONSTRUCTION

1. Start with blank PowerPoint Slide2. Display component to place on dashboard3. Capture component with Vista Snipping Tool 4. Paste onto slide5. Resize and reposition

Anesthesia Associates of the United States – May 2008

Presentation Mode

•Paper • Physical• PDF

•Computer Screen1. Spreadsheet2. Web 3. PDF4. PowerPoint5. Flash

Method of Delivery

• Private Web Site• Email

• Spreadsheet• PDF• Flash • Web Link

• Physical Delivery (paper)• DVD/Thumb Drive

Questions Anesthesiologists Ask:

How is the business going?

What will the end of the year look like?

Will your dashboard provide answers?

Take Away Ideas

Dashboards take time, talent and toil to make

Resist the urge to favor flash over function.

Encourage your vendor to produce dashboards

Vendor dashboards must display the data you need, not the data that is easy to display.

Often a paper report with limited graphics is best

Additional Resources

The Effective Use Of Electronic Dashboards To Promote & Improve Overall Practice Performance: An Exploration Into The Use of Electronic Dashboards In A Group Practice Setting.

ACMPE Paper by David G. Owens, FACMPE. Available on the MGMA web site

Dashboard To Monitor Clinical Productivity of Anesthesiology Groups Amr E. Abouleish, M.D., M.B.A., Jody A. Locke, M.A., et al.

Click Here For Web Link

Dashboard Resources On the Web

www.perceptualedge.comwww.edwardtufte.com

www.exceluser.comwww.xcelsius.com

www.dashboardmd.comwww.dundas.com

www.dashboardspy.comwww.mrexcel.com

www.idashboards.comwww.corda.com

http://www.cognos.com/products/now/operational-dashboards.html

For Questions, Comments, Help or to Share Your Ideas:

Joe Laden, Business ManagerAnesthesia Associates of Louisville, PSC

332 W Broadway Louisville, Kentucky 40202

WWW.JOELADEN.COM

JoeLaden@AALOUISVILLE.COM