New Years Resolutions

You've finally cleared out the empties from New Year's Eve and have even been the gym a few times as one of your resolutions.  But what about your practice?  How can your practice "lose 15 pounds?"

We start with an an annual assessment.  Making changes in your office is made easier with some data, some measurements.  So, what would I look at if I owned a practice?

  • I'd start with last year's resolutions.  What promises did I make to myself last year?  Did I address any of the long-term issues that are bothering me about my practice?  I wouldn't beat myself up that I haven't reached perfection yet, but if my list of challenges remains long, I always tell myself: JUST PICK ONE.  Pick one item off that list - my overdue patients, my overdue hardware upgrade, getting rid of that one bad staff person - and just do it.  I always feel better.
  • I have to remind myself: there is nothing magic about January 1.  H1N1 has no idea what the date is.  I have to remember that comparing the 12 months ending 12/31/14 compared to 12/31/13 makes for an arbitrary and potentially misleading exercise.  Take a look at these flu rates over the years - in some seasons, the peak is before the end of the year, in others it's in the following year. [shamelessly stolen from the CDC]ili-summary-large

    A reminder: I can't do much to control the timing of outbreaks in my community.  I need to keep that in mind when I look at my "productivity."

  • Before I start to do, I have to ask: What significant changes did my practice go through last year?  Did I get an EHR or change to a new one??  Did I hire any new clinical staff?  Did I start recalling patients?  Did I join a new IPA?  Did I have to let anyone go?  Although some of these changes are difficult to measure, I have to keep them in the front of my mind before I look at...
  • data.  What do I look at first?
    • I look at my E&M coding.  ARe my 99214s + 99215s going up, going down, or staying steady?  Did the coding class I had my docs take in July help at all?  Did their coding improve in August and September but slowly drop off?
    • Look at the rest of my many of my well visits have 96110s, vision and hearing screens?  Am I using the 90471/90472 only when it makes sense?
    • I'm going to race right to my favorite: Revenue Per Visit.  Up?  Down?  Although it can be profoundly affected by some of the items before, it's one of the most powerful measures I can use.While I'm at it, I'm also going to look at my Charges Per Visit as well.  I'm also going to break both of these measures down by payor AND clinician.  How have things changed?  Is my CPT-per-visit changing, too?
    • Patient volume is at the forefront of my mind, but this is a complex issue.  Was my practice scheduled for as many shifts as I was last year?  Did I expand any hours to the weekends or evenings?Once I make even some subjective adjustments for what my expectations were, how did I do?  Were we as busy as I think we were?  Were we as busy as we should have been?

      We could have a tangent here about schedules, patients-per-hour, etc., but let's stay at the high level for now.

    • What was my visit profile?  Did my effort to get more well visits in pay off?  What's my Sick:Well ratio?  What percentage of my visits are for chronic disease management?  Are they moving in the direction I expect them to?
    • How did my diagnoses change last year?  What trends to I need to get in front of this year?  Are there educational materials I should work on now instead of the one I failed to do last year?
    • How is my pricing? When is the last time I checked it? Am I writing off too little anywhere?

    At this point, I'll bail out and ask you: what do YOU look for to wrap up your year?  Note that I never look at the total $$ figures - I'm not as focused on that.  And don't forget: context is everything.

    Tell me, what do you measure every January?