In the physical therapy industry, there is always discussion around metrics and key performance indicators (KPIs).
Data is power when it comes to reimbursement, making business decisions, and standing out from referral competition. The more real-time data an owner has on the health of the practice, the more they are able to translate metrics into actions whether it be increased marketing, more strategic scheduling, or practice hiring decisions.
Now, more than ever, it is time to celebrate a practice’s success through the use of value data and KPIs. There are many ways to track a practice’s operational, financial, and consumer successes. Here are several of these key functions that are important to outpatient therapy practices:
VERIFICATION OF BENEFITS
It is critical to collect any patient responsibility for a visit when a patient is physically in the practice. The chances of collecting a copay decrease 20% immediately after a patient walks out the door.1 Given the slim margins that practices operate on, the patient responsibility portion of the visit can be the difference between making a profit and losing money. The best way to be able to collect up front is to ensure there is an accurate verification of benefits information available. The patient can be made aware upfront how much they will be paying out of pocket and have it paid in the office instead of sending patient statements after the plan of care is completed. This is an easy way to show a front desk staff member’s success by tracking the percent of copays collected.
CONTRACTING AND CREDENTIALING
Understanding insurance contracts and how they are reimbursed is a major key in operating a practice. Knowing that a payer always requires an authorization before a visit could ultimately save significant money across a plan of care. Knowing that certain carriers only reimburse four units/visit and other nuances of payer contracts can help a practice schedule patients more appropriately based on the payer’s guidelines. Another key metric under contracting is revenue/visit and what percentage of the fee schedule a practice is receiving from each carrier. This metric could lead to additional needs to renegotiate with insurance companies.
Another important front-end step to ensure success is an efficient credentialing process. Insurance companies make this a significant burden for providers by requiring every clinician be attached to the clinic’s NPI. This is a critical piece to the new hire onboarding process that involves the front office, clinical and billing departments communicating and operating on the same page. By having a successful process in place, practice owners can set their entire team up for less headaches and more paid visits.
CANCELLATION AND NO SHOW RATES
Given COVID-19, this metric is currently looked at differently, but this is still a reflection of care provided. Anytime a patient cancels or does not show for an appointment, it is costing the practice time and money and is costing the patient the benefits of therapy. However, given the inevitably of cancellations, there should be someone at the practice dedicated to filling open slots on the therapist’s schedules when this occurs.
The cancellation metric also highlights the therapist’s success in explaining to their patients the importance of completing plans of care. A high rate of unexcused cancellations can be a sign that a therapist is not effectively selling the importance of their goals for their patient.
VISITS/FULL-TIME EQUIVALENT/DAY
This will tell on average how many visits a full-time therapist is seeing per day. This doesn’t matter who the provider is, what the diagnosis of the patient is, whether or not the patient is being seen in the pool or on land. It provides an overall average. The intended goal for this number may differ depending on those items listed, however, this number alone will determine if the practice is staffed appropriately according to the current caseload and volume of patients.
UNITS/VISIT
This will tell on average how many units a therapist is delivering per visit. This number will tie to multiple criteria based on clinical outcomes but it will also tie into the practice’s financial outcomes. This is a good way to have a pulse on the care delivery model from a high level overview. For instance, if the outcomes score of a clinic is lower than the national average and the units/visit are approximately 2/visit, that may determine a different care delivery model is needed.
THERAPIST AND PATIENT OUTCOMES
Outcomes data is essential when marketing the success of a practice, why therapists should want to work for the practice, why physicians should refer their patients to the practice, and why payers should pay the practice at increased rates. In a value-based care model, a practice needs to be able to show why and how they measurably outshine the competition.
How effective is the therapy team at getting patients better? This is why clinicians go into physical therapy – they want to heal! Tracking this and being able to educate staff on raw numbers can make a difference in a practice’s bottom line and with a therapist’s mindset in how they treat their patients. There are tools that are able to drill down on effectiveness under each diagnosis. By using tools, an owner can evaluate their therapists more objectively. This can lead owners to determine that providers may need continuing education on best practices and treatments.
Outcomes data is also something that can be marketed to specialists and referring physicians. This also shows a practice’s value across the continuum of care and the efficiency of the plan of care to these referral sources and to the patients they are referring to for therapy.
This is also data a practice can use when trying to renegotiate payer contracts. If a practice can show that their outcomes are better than average, they can argue that they should be paid at higher rates. Physical therapy is constantly fighting decreased reimbursement. By providing quality and efficiency data, a practice can guard against these fights with actual data on how they are making a difference in a patient’s lives.
NET REVENUE PER VISIT
This is the ultimate metric that tells a practice if and how they are going to make a profit. To calculate this number, a practice needs to consider everything that goes into the overhead of running the business and then divide this number by the number of patients seen in a given month. This number is the cost per visit. If the cost per visit is higher than the revenue per visit, a re-evaluation of the operations of the practice are likely needed. Once a practice has a good baseline of how these metrics average, they can set business goals, make hiring decisions, and strategically think about their payer mix and referral sources.
NET PROMOTER SCORE AND PATIENT SATISFACTION
A practice’s growth is tied to how happy a patient is when they complete their plan of care. Patients should be treated as though they are family. A large percentage of referrals at clinics are return patients. These patients return because they are happy with the care they received and these patients will also refer their friends and family for services. There should be consistent marketing to previous patients for this reason.
While a practice can do everything they can to create a positive patient culture, there will always be those who are unhappy with the care they received. In the same vein as following-up with patients who scored their experience higher, it is important to follow-up with those who did not so a practice can learn how they can be better for the future.
A well-monitored clinic will create happy patients, positive clinical outcomes, and increased financial success. The metrics discussed here are just a few of the ways a practice can highlight individual successes and plan for the future. However, it is also a critical time that as an industry, therapists and practice owners come together to share their successes with payers, referral sources, and government agencies to guard against declining reimbursement levels and other challenges that are facing outpatient therapy. Stay healthy and advocate for our industry!