Download - Healthcare Provider Productivity
Improving Provider Productivity
with your EHR Matt HoenigsbergProduct Marketing@mhoenigsberg
The information presented in this Webinar is current as of date of live airing – November 19, 2014
The Challenge
The Opportunity
The Solution
Question & Answer
Agenda
http://medicaleconomics.modernmedicine.com/medical-economics/news/why-primary-care-physicians-are-seeing-fewer-patients?page=0,1
Average 89 patient visits per week
Family physicians
Average 99 patient visits per week
2013
Average 85 patient visits per week
Internists
Average 93 patient visits per week
Average number of patient visits is down
in 2014
2014
2013
2014
http://medicaleconomics.modernmedicine.com/medical-economics/news/why-primary-care-physicians-are-seeing-fewer-patients?page=0,1
Family physicians Internists
Median number of hours per week is
consistent
2013
2014
2013
2014
Median 51 Hours Workedper week
Median 50 Hours Workedper week
Median 52 Hours Workedper week
Median 52 Hours Workedper week
The Physician Foundation
81% of physicians feel
over-extended.
http://org.salsalabs.com/o/307/images/Physician%20admin%20time_IJHS.pdf
The average doctor spent
8.7 hoursper week(16.6% of working hours) on administration
16.6%
http://org.salsalabs.com/o/307/images/Physician%20admin%20time_IJHS.pdf
Physicians using entirely paper records spent 15.5 percent of their time on administrative matters,
administration accounted for 17.2 percent of time for those
in practices using entirely electronic medical records.
17.2%
15.5%
Why do providers feel that an EHR slows them down?
• The patient visit is not a one on one encounter between provider and patient … many hand-offs and activities are required between Check-in and Check-out
• Understanding the different work-styles and personalities among staff and providers is key to smooth, efficient patient flow when using an EHR
• athenahealth’s team of researchers decided to find out why the slowdowns occur by using LEAN methodologies
Check-In Intake Exam Sign-off Check-out
About LEAN methodologies
• Lean methodologies were originally introduced by Toyota and have recently been employed by health care providers such as Massachusetts General Hospital, Beth Israel Hospital in Boston, and others to study patient flow
• GOAL: understand the steps in a process and remove or re-engineer wasted steps while preserving and optimizing steps that add real value
athenahealth’s Lean Mapping Study
athenahealth‘s Proprietary 5-Stage Patient Visit
Using this unique 5-stage model, athenahealth researchers measured:
Patient process times and wait times Triggers for patient flow Involvement of resources First-time quality
Check-In Intake Exam Sign-off Check-out
Study Participants: 25 providers + staff at 12 practices More than 300 patients 2 pediatric groups, 2 orthopedic groups,
1 OB/GYN group, and 7 primary care practices
The Challenge
The Opportunity
The Solution
Question & Answer
Agenda
Characteristics of High- and Low-Efficiency Providers
athenahealth discovered distinct provider behaviors that distinguish highly efficient providers from less efficient ones
High Efficiency Providers
Keep busy and focused
Solution oriented…disciplined with their work processes
See 4-5 patients per hour and spend ~5-10 minutes with patient
Work with cross-trained, flexible support staff
Patients may experience longer wait times
Finish today’s work in the office
Low Efficiency Providers
May appear fully utilized buy not working to full capacity
Likely to complain about being overworked
See 2-3 patients per hour and spend ~10-15 minutes with patient
Staffed with only one person
Patients may experience shorter wait times
Bring work home at nights and on weekends
Statistics on 5 Provider Work Styles
Several considerations when measuring a provider’s work style:
• How much face-time does the provider spend with the patient?• How long do patients wait?• How long do patients spend in the office?• How many patients does the provider see per hour?
The study yielded 5 practice work styles.
Physician Work StyleAvg. MD
Face Time (stdv)
Avg. Patient
Wait Time (stdv)
Avg. patient
Duration (stdv)
Avg. Patient
Throughput (stdv)
Truly Lean(n=4 MDs, 49 encounters)
7.2 (3.9) 15.5 (8.0)32.2
(12.1)4.1 (0.7)
Patient Processing Machine (n= 5 MDs, 89 encounters)
6.6 (4.7)53.7
(23.8)72.6
(25.9)5.0 (0.6)
Crazy-Busy (n= 3 MDs, 63 encounters)
7.0 (4.1)39.1
(18.6)61.5
(22.6)6.3 (0.3))
Steady but Opportunistic (n= 8 MDs, 75encounters)
12.7 (5.7)21.2
(15.4)46.7
(17.4)2.7 (0.6)
Falling Behind and Frustrated (n= 5 MDs, 42encounters)
14.1 (7.0)30.2
(18.5)59.5
(23.5)2.4 (0.4)
Financial Implications of Different
Work Styles
Based on a CY 2009 Conversion Factor of $36.0666 per RVU
Truly LeanAverage monthly work RVUs = 509
~1.134 work RVU per apptObs. Day patient density = 4 per
hour
Falling BehindAverage monthly work RVUs = 316~0.789 work RVU per apptObs. Day patient density = 2.1 per hour
Translates into $7,000
difference per month
The Challenge
The Opportunity
The Solution – 5 Tips for Improving Productivity
Question & Answer
Agenda
The Provider Productivity End-Goal
Close all patient encounters by the end of the day
Why? Because – All encounters are then
moved into the administrative phase where they can be billed
Patient charts can be shared with others
It clears the deck for patients coming in the following day
And… It helps providers strike a
work-life balance
Tip #1: Work with cross-trained staff that can handle intake and
documentation.
Providers should work with whichever staff member is available rather than always relying on a certain one
Staff should be responsible for inputting certain patient documentation
A more efficient workflow (like the 5-Stages) allows for more efficient handoffs of tasks between administrative staff, clinical support staff, and providers
Truly lean providers make use of multiple staff resources in the first hour and throughout the day
Falling Behind and Frustrated
Steady but Opportunistic
Crazy Busy
Patient Processing
Machine
Truly Lean
0% 10% 20 30% 40% 50% 60% 70% 80%
90% 100%
Tip #2: Document encounters during and immediately after visits, but consider
impact on patient flow.
Knowing which data fields you need to fill in (versus your staff can fill in) within your EHR will increase efficiency
Make sure your EHR automatically provides P4P rules so that you are capturing the data that will provide additional revenue
When falling behind, consider switching to paper documentation during the exam
Physician Work Style
Complete before Patient
Departure
Complete by Day End
Q308 Avg.*Patient Wait
Time
Patient Processing Machine
94%71%*81%86%*
100%100%100%100%
91%99%99%99%
47.3 (20.5)70.8 (28.1)47.4 (18)
54.2 (15.8)
Truly Lean
67%69%70%73%
100%100%100%100%
99%97%99%99%
11.7 (5.8)14.5 (6.9)17.5 (9.1)17.3 (9.0)
Falling Behind and Frustrated
38%0%0%45%30%
75%0%0%45%30%
15%27%31%58%36%
23.9 (8.8)32.5 (14.9)22.1 (20.3)30.8 (17.0)41.1 (20.9)
Tip #3: Close all patient encounters by the end of the day.
Providers’ ability to close encounters on the same day is the leading indicator of the overall efficiency of a practice’s patient workflow
Providers should complete as much documentation as possible during the day without holding up the flow of patients
Wrap-up complex documentation at day’s end
Encounter closed
Billing completed
Practice paid
✔✔✔
Aggregated data confirms busy providers can keep up
Monthly Visits
Number of Providers
0 - 49 6,735
50 - 99 4,454
100 - 299 4,658
300 - 499 819
500 - 699 195
700 + 99
Same Day Encounter Close RateQ3 – 2014 – by monthly appt volume (all specialties)
100
%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%700-500700+ 500-300 300-100 100-50 <50
72%
71%
73%
74%
75%
75%
75%
75%
71%
71%
66%
67%
SDECR Provider avg
SDECR Weighted Avg
Tip #4: Delegate responsibility for document handling
effectively.
Staff and vendors should handle routing documents whenever possible
Staff should be able to handle administrative forms and routine negative test results without physician involvement
Choose an EHR vendor that provides document handling services, such as:
• Opening and sorting mail
• Receiving faxes and lab work results
• Routing documentation to the appropriate place
You can’t improve what you can’t measure.
You need an EHR vendor that can give you ongoing visibility into your practice’s productivity
Your EHR system should be able to provide data on the following 6 questions:
1) Are my providers closing all patient encounters every day?
2) Are my providers maximizing staff use during intake?
3) How much time do my providers spend documenting each patient encounter?
4) How much time do my providers spend on documentation while a patient is in the office and how much after the patient has left?
5) Is my practice routing documents efficiently and delegating responsibility for document handling appropriately?
6) How does my practice stack up against comparable practices across the country?
athenahealth’s award-winning services can help you thrive
through change
athenahealth today• 50,000+ providers on athenaNet®
• Clients ranging from 1 to 5,000 + providers
• 50 states and 92 medical specialties
• $9 billion in client collections per year
• Acquired Epocrates March, 2013
“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
#1 Overall
Software Vendor
#1 Overall
Physician Practice Vendor
#1 PatientPortal
#1 Practice
Management
System(1-10, 11-75 physicians)
#2 EHR
(1-10, 11-75 physicians)
2013 Best in KLAS
KLAS in 2013 rated athenaClinicals as most usable
EHR at go live and today
“Ambulatory EMR Usability 2013: More Nurture than Nature,” May, 2013. © 2013 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com