MGMA, Surveys and Practice Performance

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MGMA, Surveys and Practice Performance

• Gulf Coast MGMA, Houston
• May 1, 2002
• Dan Stech, MGMA Survey Operations Director

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Agenda

• MGMA The administrators partner
• Surveys Whats the value?
• Benchmarks and Best Practices

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MGMA The Administrators Partner
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MGMAThe Administrators Partner

• Basics
• 19,000 Individual Members
• Over 10,000 health organizations
• Over 7,200 medical groups (200,000 providers)
• What we do
• Information, Education, Networking and Advocacy

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MGMA Information

• Information Center (Library)
• Documents, IEs, reference and other resources
• Publications
• Books, Connexion and web-site - www.mgma.com
• Products and Services
• Surveys, Consulting, Adminiserve and
  HealtheCareers

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MGMA Education

• Annual and Regional Conferences
• Specialty Conferences
• Audio Conferences
• Distance Learning
• American College of Medical Practice Executives
• Professional Development and Credentialing

2002 Las Vegas Our Profession Change, Choice,
Destiny Oct 27 - 30
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MGMA Networking

• Assemblies and Societies
• AAA, APA, CSCA, PCA, OBGA...
• Specialty Conferences
• E-mail Forums
• Dont recreate the wheel
• Learn from your peers

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MGMA Advocacy

• Government Affairs Resource
• Education and Compliance
• HIPAA, Stark, Reimbursement
• Grassroots Lobbying
• StarkCompliance.com
• Washington Connexion

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MGMA Advocacy
MGMA Washington Connexion 4-23-02

• This information is provided by the MGMA
  Department of Government Affairs. This is a post
  only service. Please do not click reply to
  respond to this e-mail, MGMA members with
  questions or comments may e-mail MGMA Government
  Affairs directly at govaff_at_mgma.com. 1. CMS
  IMPLEMENTS MGMA QUARTERLY COMPENDIUM
  RECOMMENDATIONIn January 2000, MGMA convened an
  Administrative Complexity Advisory Group to
  develop a list of the most burdensome
  administrative aspects of the Medicare program.
  This list included a recommendation that CMS
  publish a list of regulations released in the
  last 90 days. In response, CMS released the first
  edition of the quarterly compendium on their
  website at http//www.cms.hhs.gov/providerupdate
  The quarterly compendium lists changes published
  in the last 90 days and those planned to be
  published in the next quarter. These publications
  include Federal Register documents, Program
  Memorandums and Carrier Transmittals. The update
  will list the regulations, the publication date,
  the page number, and a short summary. The website
  provides access to the list by the type of
  facility or type of practitioner affected by the
  rules. The compendium will be published on the
  first day of January, April, July, and October.
  In addition, CMS announced that they plan to
  publish regulatory documents on the fourth Friday
  of each month in the Federal Register. CMS will
  test this schedule with pilot publication dates
  of April 26, May 24 and June 28, 2002.2.
  DELAYED PAYMENT FOR ALL NON-COVERED SERVICE
  OUTPATIENT CLAIMS Due to a problem in the
  revised software, reimbursement for all
  non-covered service outpatient claims processed
  by six Medicare carriers will be delayed until
  the end of April. Claims sent to the following
  carriers are affected Mutual of Omaha (48
  states) Associated Hospital Service of Maine
  (Maine/Massachusetts) Rhode Island Blue
  Cross/Blue Shield (Rhode Island) Anthem Health
  Plans of New Hampshire (New Hampshire/Vermont)
  Palmetto GBA (North Carolina) and Premera Blue
  Cross (Alaska/Washington). A QA will be posted
  to the CMS website on April 25, 2002.3.
  IMPROVED PROCESSING OF MISDIRECTED
  MEDICARECHOICE CLAIMS CMS has instructed their
  carriers to use a new remittance advice code to
  inform providers when a claim should be sent to
  an HMO. For instances where a claim for a
  MedicareChoice beneficiary is mistakenly sent to
  a carrier, reason code 109 will now inform
  practices that the service should be billed to
  the patient's managed care plan. The Transmittal
  is available at http//www.hcfa.gov/pubforms/trans
  mit/R1747B3.pdf

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MGMAThe Administrators Partner

• A commitment to practice excellence
• A desire to support and promote performance
  improvement
• A dependable resource for over 75 years
• A forward-thinking association
• Your partner in practice management
• The home for your profession

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MGMA Surveysand Reports
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MGMA Surveys

• Whats in it for Me?
• Why Participate?
• How do I apply the data?

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MGMA Surveys

• Establishment surveys of medical practices and
  other health delivery organizations
• Census of MGMA members...and non-member
  organizations
• Focus on financial and operational performance,
  and physician compensation and production

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MGMA Survey Reports

• Data for more than 2000 unique organizations each
  year30,000 physicians
• Most of our processing time is spent editing and
  validating the data
• Reports are prepared for multispecialty and
  specialty groups
• Data is standardized by a variety of measures
  (FTE physician, provider, as a of revenue)
• A variety of statistics are indicated (mean,
  median, standard deviation, tiles)

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Surveys Cost Survey

• Full spectrum of operating costs for
  multi-specialty and single specialty medical
  group practices

• 47 categories of practice costs,19 categories of
  staffing and general operating costs, 8
  categories of provider costs
• Performance measures presented by practice and
  productivity standards
• Represents 1,161 medical group practices in 50
  states
• Parent of other Cost Surveys

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Surveys Physician Compensationand Production

• Compensation and production information for over
  60 physician specialties
• Compensation methods for new and established
  physicians
• Compensation and gross charges data for part-time
  physicians and non-physician providers
• Represents 30,584 providers in 50 states

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Surveys ManagementCompensation

• Compensation and retirement benefit data for 36
  supervisory positions and 2 physician executive
  positions
• Compensation data presented by practice and
  individual characteristics
• Compensation Trend Analysis on 24 positions from
  1996 - 2000
• Represents 5,277 managers from 50 states

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Surveys Performanceand Practices of Successful
Medical Groups

• Compare operational and financial performance
  with groups that excel in
• Profitability and Cost Management
• Productivity, Capacity and Staffing
• Accounts Receivable and Collections
• Managed Care Operations
• Review case study success storiesbest
  practices
• Identify the latest trends and hot topics

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Surveys Academic Compensationand Production
Survey for Faculty and Management

• Comparison of academic provider compensation and
  productivity to private sector
• Information on nearly 100 physician and non
  physician provider specialties and
  subspecialities
• Administrative position data, including
  centralized practice plan positions
• Starting salaries for faculty hired out of
  residency or fellowship

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Surveys Other Cost andPerformance Surveys
Cost Surveys
IDS CVS/Card Hem/Onc
Pathology Ortho 02
Performance Surveys
CD ROMs
MSO ASC
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MGMA Surveys Why Participate?
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Survey Participation

• Who?
• Eligible health organizations
• medical groups, regardless of ownership
• not just MGMA members
• When?
• Big 4 1st Quarter, others follow
• More information?
• www.mgma.com/surveys

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Participation Value

• The more participants, the better the data
• Understanding of the most fundamental operational
  and financial characteristics of your practice
• Ability to benchmark and compare your practice

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Participation Tangible Benefits

• More knowledge
• A Ranking Report for your practice (all
  participants)
• Insights and ideas
• A foundation for practice improvement
• A copy of the final report (members only)

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• Main Street Medical Group
• Orthopedic Surgery
• Indicator Reported/Calculated Data Count Median t
  ile Ranking Variance
• Staffing and Practice Data
• Total FTE physicians 7.00 122 8.00 41 -12.5
• Accounts Receivable Data, Collections Percentages
  and Financial Ratios
• Total AR/physician 333,333 116 301,212 59 10.66
  
• Gross FFS collection 90.75 120 50.37 gt90 80.1
  7
• Adjusted FFS collection 100.00 104 97.94 85 2
  .10
• Net cap rev of gross cap chrg -6.19 13 40.84 lt
  10 -115.17
• Staffing, Physician Total and Work RVUs,
  Patients, Procedures, and Square Footage
• (per FTE physician)
• Total MLP FTE .36 79 .33 55 7.14
• Total support staff FTE 5.82 122 4.97 68 17.22
• General administrative .29 116 .25 56 14.29
• Business office 1.07 118 .99 61 8.29
• Managed care administrative .14 25 .13 54 14.29
• Information technology .14 48 .11 62 36.00
• Housekeeping, maint, security .14 24 .14 50 0.00
  

Sample Ranking Report Cost Survey 2001 Report
based on 2000 Data
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Participation Other...

• First time can be difficulttime consuming
• Participate on paper or electronically
• Evaluating web-based surveys
• Be eligible for consideration as a better
  performing practice

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Benchmarking and Best Practices
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Benchmarking Basics

• Process of establishing a standard of excellence
  and comparing activities to that standard
• Provides goals for process improvement
• Provides understanding of the changes to
  facilitate improvement
• An ongoing process - not a one-time event

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Benchmarking Benefits

• Understand your strengths and weaknesses
• Objectively evaluate your own performance
• Compare measurements externally against peers and
  better performers
• Analyze what others do, so you can learn from
  their experience (and not make the same mistakes)
• Convince internal audiences of the need for change

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Benchmarking 10 Step Process

• 1. Establish practice objectives and strategy
• 2. Identify performance indices
• 3. Identify benchmark sources available
• 4. Data collection
• 5. Perform data comparison
• 6. Communicate findings
• 7. Develop action and assessment plans
• 8. Implement plans and monitor progress
• 9. Assess practice objectives evaluate
  benchmark
• standards recalibrate measurements
• 10. REPEAT!

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Benchmarking Key Indices

• Financial indicators
• Revenue (FFS revenue per physician, per RVU)
• Expense (total operating expense per physician,
  per RVU)
• A/R (Adjusted collection , days in A/R)
• Physician costs (compensation per physician)
• Operating expense ratios (total operating expense
  as a of net medical revenue)
• Staffing levels (per FTE physician, per FTE
  provider, as a of medical revenue)
• Payor Mix

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Key Indices Financial (a)
Source MGMA Cost Survey 2001 Report based on
2000 Data Note Oper Cost and Supp Staff Cost
are TOTALS
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Key Indices Financial (b)
Source MGMA Cost Survey 2001 Report based on
2000 Data
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Benchmarking Key Indices

• Operational indicators
• Productivity (RVUs,procedures, gross charges per
  physician)
• Quality (canceled appointments, x-ray
  repeats/rejects, post surgery complication rate)
• Time (patient waiting times, time per procedure
  or encounter)
• Patient satisfaction
• Managed care (encounters per member per year)

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Key Indices Operational
Source MGMA Physician Compensation and
Production Survey 2001 Report based on 2000 Data
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Benchmarking Key Indices

• Clinical indicators
• Outcomes
• Use of pathways and protocols
• Length of stay
• Utilization and demand management
• Health maintenance and prevention
• Referral management
• Procedural volume
• Ambulatory case mix

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Key Indices Clinical (a)
Source CMS 2001
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Key Indices Clinical (b)

• What is the power of that information?
• Compliance
• Educate your physicians about appropriate coding
• Revenue
• Normalize your physicians coding frequencies and
  multiple it by your fee schedule

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Benchmarking and Best Practices
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Best Practices Defined

• proven service, function, or process that has
  been shown to produce superior outcomes or result
  in benchmarks that meet or set a new standard.
• its whats best for your organization.
• Data provides the foundation
• Observation provides the explanation

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Best Practices The next level of benchmarking

• Establish higher expectations
• Learn from others
• Guidance for Implementing change
• Save time and money
• Develop competitive advantage
• Be recognized as a leader

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Best Practices Performance Indicators

• Profitability and Cost Management
• Productivity, Capacity and Staffing
• Accounts Receivable and Collections
• Managed Care Operations
• Quality and Patient Satisfaction

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Best Practices Profitability and Cost Management

• Criteria
• greater than the median for Revenue after
  Operating Cost and
• less than the median for Operating Cost per
  Medical Procedure (inside the practice).

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Best Practices Profitability and Cost Management
Data (a)
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices Profitability and Cost Management
Data (b)
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices Profitability and Cost Management
Data (c)
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices Profitability and Cost Management
(d)

• Better performers dont do it cheaper than
  everyone elsethey actually spend more per doc
• Whats the difference?
• THEY FOCUS ON REVENUE and COST MANAGEMENT

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Best Practices Profitability and Cost Management
(e)

• What do they do different?
• Leverage the physicians time to see more
  patients.
• Understand that more time with patients does not
  mean higher patient satisfaction.
• Brief physicians before appointments
• Ensure adequate support staff
• Design efficient facilities
• Flexible or extended schedules
• Optimize ancillary revenue

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Best Practices Other Traits of Better Performers

• Productivity, Capacity and Staffing Criteria
• greater than the median for In-House Professional
  Procedures per Square Foot and
• greater than the median for Total Procedures per
  FTE Physician

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Best Practices Other Traits of Better Performers

• Staffing

BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices Other Traits of Better
Performers Ancillaries
Per FTE Physician
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Benchmarking and Best Practices in A/R Management
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Best Practices A/R Management Adjusted
Collections Percentages
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices A/R ManagementA/R per FTE
Physician
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices A/R ManagementDays in A/R
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices A/R ManagementBus. Off. Support
Staff per FTE Physician
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices A/R Managementage of Claims
Denied, First Submission
BP Better Performing Practices
Source 2001 Performance and Practices of
Successful Medical Groups
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Best Practices A/R ManagementWhat Better
Performers Do (a)

• Manage the Entire Revenue Cycle
• Health Plans and Contracts
• Staff Training and Operational Policies
• Patient Interactions
• Coding, Billing and Collection Procedures and
  Performance

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Best Practices A/R ManagementWhat Better
Performers Do (b)

• Health Plans and Contracts
• Meet regularly with each major payor
• Manage the contract
• Know allowances for CPT codes billed by group
• Definition of a clean claim
• Time limits on take-backs
• Disallow retroactive denials
• Credential providers ASAP
• Train staff on contract terms and conditions
• Regularly audit payors

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Best Practices A/R ManagementWhat Better
Performers Do (c)

• Staff Training and Operational Policies
• Train/cross-train staff on all aspects of the
  process
• Focus on Customer Service, not victimization
• Written Policies and Procedures
• Assign staff by payor
• Make full use of technology and electronic claims
  submission
• Emphasis on submission of a clean claim

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Best Practices A/R ManagementWhat Better
Performers Do (d)

• Patient Interactions
• Validate insurance and address information
• Verify insurance and benefits eligibility
• Provide new patients with written financial
  policy
• Have written policy for when co-payment must be
  paid and the few times when co-payment can be
  deferred
• Collect all payments at time of service

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Best Practices A/R ManagementWhat Better
Performers Do (e)

• Coding, Billing and Collection Performance and
  Procedures
• Capture all charges for all work- inpatient and
  office
• Match appointment schedule to charge tickets
• Match surgical charge tickets to OR log
• Study and refine the process of capturing
  inpatient charges
• Code properly and document work performed
• Train physicians and staff on proper coding

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Best Practices A/R ManagementKey Benchmarks (f)

• Adjusted Collection Percentage
• Gross Collection Percentage
• Adjustments to FFS Charges per FTE Physician
• Total Accounts Receivable per FTE Physician
• Days Gross FFS Charges in Accounts Receivable
• Bad Debt per FTE Physician
• Total Accounts Receivable lt 30 Days
• Total Accounts Receivable gt 120 Days
• Claims processed per Billing Staff Member
  (internal

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MGMA, Surveys and Performance Improvement
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MGMA, Surveys and Performance Improvement

• More Information
• Medical Group Management Association
• 104 Inverness Terrace East
• Englewood, CO 80112
• 1-877-275-6462
• www.mgma.com
• Dan Stech, Director
• MGMA Survey Operations Department
• dps_at_mgma.com
• Ext. 238