Sure. Welcome back, everyone. It was a great first session. Some great questions. Let's move on to the next section of our talks. This session is going to build on what we just heard a little while ago. And we are going into some brass tacks of regular practice, revolve around the fiscal viability of the practice and harness the data that can be collected and we can use it to improve our practices. So we will begin with a couple of questions. So did you have a practice dashboard for key performance indicators before the COVID pandemic? Interesting. So pretty much almost half a yes and half no. Great. Okay. Let's move to the next one. And if you did have a dashboard, have you made any changes in the metrics or the KPIs since the COVID pandemic? That's interesting. I would expect more people will say yes to change something. But that's exactly what we're going to talk about in this talk. What to do? Practice operational metrics. So key performing indicators or KPIs are a set of quantifiable measures used to gauge the performance of an organization in achieving its strategic and operational goals. That's the definition. But what they really are, they are the numbers of what's happening. It is translation of your practice into numbers that can be seen on the screen, on the paper, so that in a snapshot, you can see how the practice is doing and where you can improve things and change things. Since KPIs are an indicator of a practice's health, how good it is doing, what are its strengths or weaknesses, they vary based on where the practice is or what environment that practice is based on. An example is if your practice is hospital-based or it's an academic practice, the KPIs for a practice would look completely different for them compared to a complete private practice. Similarly, if the practices are different, you have to establish your own KPIs, and they are based on your strategic and financial goals. It is very important that whatever KPIs or indicators you choose for your practice, they should be measurable. They should be easily measurable so that the data collected can be used and then can be used to implement the changes as well. And similarly, you have to review your KPIs periodically. Similarly, you have to review your strategy regularly because things change, strategies change, so you have to change your key performing indicators. Key performing indicators can be divided into two main categories, the lagging KPIs and the leading KPIs. Lagging KPIs are the measures that are the goals. These are the indicators that present what you want to do, what exactly the endpoint is. So, that makes them easy to measure, but of course, that's a goal. It makes it hard to change. So, basically, these KPIs are the big picture KPIs. These are the things that you, based on your strategic goals, you create. Leading KPIs, on the other hand, are the ones that are small on the ground things. These are the indicators that lead to your goals, that lead to those lagging KPIs. These are small things. That's why they are somewhat difficult to measure. You can easily change them, but they are difficult to measure. But that's what leads your organization to reach its goal. Now, the example of these lagging and the leading KPIs is one of the things that we faced in our practice recently. So, we have this patient call group, which are the in-house call operators, and when they are overwhelmed and someone is calling and their call is going unanswered after certain bells, it is rolled over to a paid service so that the patients don't have to wait forever or they don't have to hang up. But it costs money. So, what our goal was that we should not have any call rollover. So, that would be the big picture goal that's our lagging KPI, that how many calls are getting rolled over, and our goal was to have no call rollover so that we can save some money there. But to reach that goal or to meet that KPI, which we have set for ourselves, those leading KPIs, which were on the ground, what's happening was how many calls each scheduler was picking up or the call attendant was picking up, how much time they are spending on those calls. Of course, you can see there, it is a little bit more laborious to measure those, but that's what makes the difference. Because when we looked at those calls, number of calls attended by everyone, we set goals for them that they have to answer this many calls per hour. And that actually led to our reaching our lagging KPI, and we ended up achieving that zero call rollover just by meeting our leading KPI by giving those targets to our call attendants. In the next few slides, I'm going to go over some of the common key performing indicators that are used for practices. And as I said, you can choose the type of KPIs that are more important for your type of practice. You have to look at your strategic goals and also the challenges faced by your practices because these things change over time. So, you have to change your KPIs then so that you can improve or face the challenges that are coming to your practice. So, first are the practice metrics that includes the new number of patients. That could be per week, per month, the new patients coming in. As a GI practice, it's very important to see new patients, unlike a family practice where you have a certain number of patients and then you can have their well visits and all those things that they can come back. But in the GI practice, you want to see new patients and there has to be an influx of new patients. So, that key performing indicator is an important thing. Similarly, total patient visits per day, how much of utilization is there of your resources that you have put in. Cancellation and no-shows because many times, months or weeks before the day of visit, the schedule looks full and as the day comes close, there are a number of cancellations. Then you want to look at it, why is it happening? Similarly, you have to look at the production or work that we use for your full-time employees and how much utilization is there for your FTEs. Then are the time management metrics. That includes the schedule utilization. Many times, the practices have the set number of new or the return visit patients they see. So, you have to look at how the schedule is being utilized, appropriately or not. Similarly, new patient or consult wait time. As I mentioned earlier, for the GI practice, it's important to see the new patients because that will generate your procedures as well. So, you want to have a constant flow of new patients and if all the schedule is choked up by old patients, you want to look at ways to ease up the schedule or make more room for new patients. Patient time in the office, that is more of a utilization metric as well to see how much time the patients are spending. So, you want to record when various steps in your practice, the patients checking in, when the nurse is taking in, when they are getting their vitals or when they're in the room, so that you can see if there are any delays and why there are those delays to make your workflow even more fluent. Similarly, the transaction times come into the time utilization as well. Phone response times is also an indicator, as I mentioned earlier and gave you an example of our practice. We did look at our phone response times and actually the physicians, some of us called our offices at the number to see how long does it take for those calls to be responded so that we don't have patients waiting for a long period of time because that increases the dissatisfaction. Utilizing metrics is an important group of KPIs to have in your dashboard, especially these days when there is a crunch of workforce. It's important to know how many people are to be used and how many employees are needed for a job so the resources can be utilized accordingly. So, full-time employees per provider is an important and interesting indicator that can actually give you a snapshot of overall utilization of your employees and staff in your practice. Similarly, there has been an increased utilization of APPs in gastroenterology. So, having an APP per MD as a KPI can show you the growth of your practice and where you need to hire more APPs in certain parts of your practice or not. Similarly, for your call center, if you have one in-house, calls attended by the employees per day is a good key performance indicator to show how many more people you need in your call center or how less people you need that can handle the same call load. Turnover rate, I put it here because we used this KPI recently, as with any other practice, there has been increased turnover in our practice. So, we wanted to see and measure how much staff is just, you know, we are hiring and they're leaving. And what can we do about that? And actually, using this, we were able to first identify there was increased turnover and then by implementing some changes, we did see that it went down, which just indicates a good health of a practice that people are just staying there and not leaving. I'm going to go over some of the financial metrics in detail in the revenue cycle management talk, but here I'm going to go over some of the basic financial metrics that should be in the dashboard for any practice. Per visit value per provider is an important KPI that can show you the value generated by any visit and the changes that can be made there to improve the value of that visit. Similarly, account receivable, as always, is an important financial indicator, should be in all the dashboards. Collections per provider is an important KPI, and it can help you actually screen a lot of the issues if it is pertaining to a provider, like inappropriate coding, et cetera, because it can highlight where there are some issues. Similarly, bad debt has to be in a KPI because it is an important financial issue that has to be looked at, and if it is going above what your benchmark is, then you need to see how to fix that issue. Some of the other practice matrices that can be used as KPI are referrals, and I believe all practices, especially as a speciality, GI practices should track their referrals because it is very important to know when there is a change in the pattern of referrals to really go and see and analyze it, why there is a change before there is a big problem. Because unless you track your referrals, unless you track what your referral sources are, you cannot see the early change. Similarly, patient satisfaction has always been a good quality indicator. It is a good practice matrix to see how satisfied the patients are because that can help you to see the problem, if there is one, really early, and you can find a solution. Adverse incidents usually are mandatory for most of the surgery centers, and it is a part of the KPIs. Patient quality reporting systems, especially with the institution of MIPS, it is important to keep a track of all these measures because now they are financially very important as well to have these KPIs because at the end of the day, it will determine how much money will be coming from the reimbursement as well. So now, based on your practice, based on your goals, strategic and financial, you came up with KPIs, you want to measure these things, but what to do with them now? You have to benchmark them. You can measure things, but how do you know they are good or not? I mean, for some, you know, like MIPS, there are some benchmarks you have to meet which are given by CMS, but say you want to look at how many patients are to be seen or how much value a visitor is producing. Is it good or not? You have to benchmark it. You have to compare it. You have to see what is industry standard, what other people are doing, because that is the only way to find out if you are doing good or not, and if you are not doing good, what is good? How to reach that? You can then figure it out. So, key performance indicators represent a snapshot. They just give you a picture of your practice, what you are doing, but when you benchmark it, it gives you a standard, where to reach, how to reach that standard. You can then figure it out. You can carve your path, but first, you need to know what the goal is, and similarly, it helps you to understand the situation compared to other players in your same industry, other practices, what they are doing. So, there are different ways of finding the benchmarks for your KPIs. There are external benchmarking, and then there is internal benchmarking. As the name suggests, the external benchmarking is when you are getting the data from outside and then comparing it with your own organization. There are pros and cons for both of these. For external benchmarking, it's easier because the work is already done. You already have the data available. You know that's your goal, and then actually, to reach that goal, you can come up with some ingenious ideas, some new ways to reach that. But similarly, there are some issues because sometimes that data is not available, and if you try to get benchmarking data for your practice, say you are a GI practice, and now the data is available from internal medicine practice, the comparison is not going to be the same. Some of them, you can compare some basic things, but still, these are two completely different animals, and it's very difficult to compare them. And that happens all the time that you don't get the data for your type of practice. And similarly, your staff might not be that enthusiastic when they are told that, okay, they have to do what some other person is doing. In internal benchmarking, there is some benefits that usually there is more buy-in from your staff because it is done internally, and also there is more reflection of what you are doing, what you want to do. And similarly, when you are trying to find your own standards, you may discover there were some issues already there that you can just, you know, iron them out, and they are easy to fix. But of course, it's time-consuming. You have to be at the ground level, go through each and every detail, and to really look at how you're going to do it, and what exactly is to be achieved. Now, when we talk about these external benchmarking, there are some sources available. MGMA has a lot of sources available for them for practices, different types of practices. There are certain books available out in the market, but usually, they get outdated pretty quickly. For ASCs, actually, there is a very good resource available from ASGE. Now, I'm going to just briefly talk about what COVID-19 has changed. The changes in the matrices or the indicators that has happened due to COVID-19 is that the comparisons have changed. Previously, you could compare a lot of your finances and similar indicators from year to year. But now, because of those changes, what has happened, be it increased use of PPE, change with the telehealth, it's very difficult to compare some of the data with previous year, although we will have more data available next year because, you know, we have gone through it for a couple of years. But right now, it's still somewhat cumbersome how to reconcile with all that has changed. Similarly, there have been some changes in how to look at these productivity matrix. The procedure mix has changed. Similarly, the cancellation rate and open access volume has changed. We had a sudden influx of open access right when the number of COVID cases went down, and then when there was a resurgence in the delta variant, there was a sudden drop again in the open access. So, it's very difficult to reconcile all these KPIs of having the patient number and the procedure number because of the changes in the pandemic. Similarly, the collections percentages have changed. There has been new codes with the telehealth and reimbursement. So, all these changes have made it difficult to simply compare your quality indicators, simply compare your KPIs or the benchmarks you had. So, that asked for some new thinking, how to do that. So, some of the changes that can be made to counter these upheavals brought in by COVID-19 is to change your matrix frequently. Things that are more prone to be affected by the sudden resurgence of the COVID-19 numbers, you have to look at them more closely. So, if you are looking at some of these numbers monthly, you have to change them to weekly to really see where the change is happening and how you are meeting some of these challenges. Similarly, the cost information has to be seen more closely. They have to be in the dashboard. Utilization metrics, especially as we looked at those staff utilization, they need to be looked at more frequently and regularly to make sure that the utilization of all the resources is appropriate. Similarly, pair mixed review with the changes in the insurance, a lot of people are getting laid off, they're changing their jobs. So, you need to have your pair mixed review more frequently to see where the changes are happening because most people have their insurance through their employment. So, as their employment changes, their insurance changes. So, in the end, some of the ideas are to identify how the COVID pandemic has impacted your practice. Look at your KPIs and adjust them accordingly. Reassess all the workflows. Things that have changed are not going back to what they were. They will stay the way they are right now with these changes in the pandemic. So, we need to determine what we want to measure and what we need to measure in the future. Similarly, all those old metrics, they are still there, but we probably need to retool them. We have to measure the changes that have happened as well because they will determine how the practices are going to work in the future. Thank you.

key performance indicators

KPIs

measuring performance

lagging KPIs

leading KPIs

practice metrics