How to Develop, Report & Analyze Effective Metrics for Your Practice and Payers. Scott Parker Executive Director.

Transcription

1 How to Develop, Report & Analyze Effective Metrics for Your Practice and Payers Scott Parker Executive Director Northwest Georgia Oncology Centers, P.C. 21 MD s 17 Mid-Levels 10 Locations 5.04 FTE s / Provider Medical Onc / Hem Only CON State 1

2 Payor Mix Volume Medicare 35% Medicare Adv 12 % BCBS 16% UHC 10% Medicaid 8% Aetna 5% Cigna 5% *(63%) Therapy Mix by Volume Cancer 51% Hem 49% Breast 18% Lung 10% Colon 6% NHL 4% Myelomas 3% 2

3 If you ve seen one oncology practice you ve seen one oncology practice..whoever IT Solutions EMR Varian (Crystal Reporting) PMS Centricity (Reflect Reporting) Data Mgmt. Reflect, Microsoft Access Accounting Peachtree Website McKesson / USON 3

4 Standard Reports From Centricity and Varian (Centricity ) (Varian) (MS Access) (Peachtree) Standard Reports Dashboard.. 4

5 Sequestration Projected Impact Existing Patient Impact (Varian) (MS Excel) Reporting, Tracking, Bench Marking, Analyzing Our Areas of Focus Billing / Collections Staffing / Productivity COGS Payors, Quality Measures, Incentive Programs Retail Rx 5

6 Billing and Collections Get it Out Clean ACE Editing Software Average DOS to Keyed 1.5 Days Average Keyed to Accepted 1 Day Average.5% Failure at Ace Level <.5% Failure Rate at Clearinghouse & Payor Level 6

7 Don t Lose it. (MS Access) (McKesson Website) Collect it Timely (MS Access) 7

8 Multiple ways to Monitor (MS Access) Continued Shift to Patient.. (MS Access) 8

9 Foundation Tracking.. (MS Access) External Factors (MS Access) 9

10 Staffing / Productivity.. P&L, Production, Staffing & Internal Bench Marking MD's Business Days E&M / Admin Drug Charges COGS GP Labor Lab Med Supplies Office/Utilities Office Indirect Total Cost Profit(loss) B MD Exp MD Exp Excess Inc Over MD Exp Distribution Excess Inc Over MD Comp Contribution to Practice Overhead (MS Access) (Peachtree) 10

11 Inventory FTE's FTE FO FTE MA FTE MA Lab FTE RN FTE PE FTE Rx Tech Total FTE's OV's Off Consults/New Patients Hosp Consults Hosp Admits Hosp Visits Hosp Discharges Initial Hyd Initial IV Initial Chemo Push Initial Hr Chemo Total Infusions Stats OV& Consults/ MA Total Infusions/RN&Rx Tech OV& Consults /FO Total Production / FTE's Cancer Consults Hem Consults Cancer Consults Hematology Consults Cancer Encounters Hem Encounters FTE's / MD & Provider Per MD Per Provider MA/Lab Per Provider RN/Rx Tech Per Provider FO Per Provider Gross Profit per FTE Income before MD Exp / FTE Stats / Month / MD Net Total Charges / MD Net Chemo Charges / MD GP / MD Income before MD Exp / MD Production / MD / Month OV's Off Consults Hosp Consults Hosp Admits Hosp Visits Hosp Discharges Initial Hyd Initial IV Initial Chemo Push Initial Hr Chemo Total Infusions Total Production Generated by MD Production / Provider / Month Net Charges OV's Office Consults Hospital Consults Initial Hr Chemo Net Charges / MD Production / MD / B.Day OV's Off Consults Hosp Consults Hosp Admits Hosp Visits Hosp Discharges Initial Hyd Initial IV Initial Chemo Push Initial Hr Chemo Total Infusions Stats Per Business Day 11

12 Cost / MD Labor Lab Med Supplies Office/Utilities Office Indirect Total Cost Profit(loss) B MD Exp Payor Mix by Encounter Cancer COGS 12

13 Drug Cost vs. Reimbursement (MS Access) (McKesson Website) GPO Tools. (McKesson) 13

14 Payors, Quality Measures and Incentive Programs Fee Schedule Change Impact (MS Access) 14

15 Incentive Programs - PQRS Incentive Programs - E-prescribing.. Varian and MS Access 15

16 Incentive Programs Meaningful Use.. Quality Measures Somewhat Automated By Office, Date Range, Measures to Review (Varian) Telephone Triage Report (Varian) 16

17 Telephone Triage Report. (Varian) Hospice Data.. Days on Hospice By Payor, Office Regimen, Date Hospice Admit, DOD, Days Diff (Varian) 17

18 Chemo Last Administered.. Days from Last Chemo Admin to DOD By Payor, Provider, Office Regimen, Tx Start/End, Last Admin, DOD, Days Diff (Varian) COA s Patient Satisfaction Survey. 18

19 Payor Modeling.. EOC Pilot.. Historical Look at Adjuvant & Metastatic, Breast, Lung & Colon By Date Range, Regimen, Support Meds, Hospitalizations Current Fee Schedule vs. EOC Fee (Varian) (Excel) 19

20 Fee Schedule + Pay for Reporting Medicare E&M 5,138,551 Admin 2,748,333 Total 7,886,884 2% 157,738 5% 394,344 Commercial Payor E&M 1,424,911 Admin 2,336,091 Total 3,761,002 2% 75,220 5% 188,050 (Excel) Shared Savings Assumptions 20

21 Payment Model Fee Schedule + Gain Share Breast, Lung, Colon (COA Quality Measures ) Medicare Annualized Total Spend Medical NGOC Inpatient Radiology Total 30.8% 23.3% 22.4% Breast 16,356,912 5,037,929 3,811,161 3,663,948 Potential Savings 10% 503, , ,395 50/50 Split 50% 251, , , ,652 Lung 14,147,237 4,357,349 3,296,306 3,168,981 Potential Savings 10% 435, , ,898 50/50 Split 50% 217, , , ,132 Colon 11,782,468 3,629,000 2,745,315 2,639,273 Potential Savings 10% 362, , ,927 50/50 Split 50% 181, , , ,679 (Varian) (Excel) 13,024,278 1,617,463 Payment Model Fee Schedule + Gain Share Breast, Lung, Colon (COA Quality Measures ) Commercial Payor Annualized Total Spend Medical NGOC Inpatient Radiology Total 30.8% 23.3% 22.4% Breast 12,424,122 3,826,630 2,894,820 2,783,003 Potential Savings 10% 382, , ,300 50/50 Split 50% 191, , , ,223 Lung 2,852, , , ,915 Potential Savings 10% 87,851 66,459 63,891 50/50 Split 50% 43,925 33,229 31, ,100 Colon 5,713,821 1,759,857 1,331,320 1,279,896 Potential Savings 10% 175, , ,990 50/50 Split 50% 87,993 66,566 63, ,554 (Varian) (Excel) 6,464, ,877 21

22 Retail Rx.. Retail Pharmacy Capture (Varian) (MS Access) 22

23 Rx Capture Why This Works for US. A Focused Priority Practice Willing to Invest Time and $ s to Gain Value & Generate ROI Great Team with a Creative, Can-do, Persistent Approach to Challenges Myth All Data Extraction and Report Writing Must be Done In-house 23