February 17, 2015
Let’s face it. There are very few things that your CHC can do to immediately and profoundly increase income. Sadly you can’t magically increase your encounter rate, get your largest commercial payer to pay 20% more or suddenly compel your patients to pay more (or anything for that matter). What you can do however is increase the average number of visits per hour seen by your core providers (i.e., doctors, NPs, PAs, CNMs, CDEs, etc.). So the question… how many visits per hour do you see currently and how many should you be seeing?
Well, maybe the first question is how you determine the available hours. Let’s say your CHC affords your core providers 4 weeks of Paid Time Off (i.e., PTO which can be sick, vacation, hooky, whatever). And, let’s assume (dangerous, I know) you also afford 20% of a forty-hour work week for administrative time… so 32 hours to see patients.
Let’s agree the above assumptions are sensible or at least a good starting point. There are several theoretical ways to calculate visits based on CHC core providers who follow 48 work-weeks/year and 32 work-hours/week:
- Medicare Cost Report… 4,200 visits/doc. We know Medicare has moved to the elevated PPS making the “4,200” visits per FTE perhaps a tad passé. However, let’s simply divide 4,200 by 48 weeks (resulting quotient is 87.5) and divide this quotient by 32 hours. The final, important quotient is 2.73 visits per hour. Again, this is just the average, some core providers see more, some less.
- UDS Averages. According to national UDS data (2013, i.e., http://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2013&state), the national CHC average of visits per hour (using 48 work-weeks per year and 32 work-hours per week) is 2.0… for medical providers. Dentists are at 1.7/hour and behavioral health providers, .78/hour. Again, these are averages and we know UDS data is questionable in terms of data integrity BUT you need to at least consider this data (we think) in order to make informed business decisions.
- National Family Practice Average. Forgetting dental and behavioral health, the average for Family Practice is, to me interestingly, 2.74 or just barely above the number Medicare historically expected CHC providers to see. (Read the full article at http://www.washingtonpost.com/news/to-your-health/wp/2014/05/22/how-many-patients-should-your-doctor-see-each-day/). These are national averages for Family Practice and so a comingled data set of for profit, not-for-profit, academic, and other employed providers. Interestingly, the average number of weekly hours in face-to-face contact with patients is 34… slightly above the 32 we used.
- Hire certified coders to alleviate the coding burden for providers. If they see (literally) one more visit per day (i.e., 5/week or 2,040/ year) at a UDS average of $114/visit, you make an additional $232,000. Don’t know how much certified coders make in your market but it’s not greater than $200,000.
- Optimize your EMR by finding your most productive provider and making them your star. What do they need to see even more patients? More support staff, a scribe, more optimal clinic setting? We say get them what they need! Keep in mind that one extra patient per day means more than $200,000 with which we can play.
- Implement incentive based compensation. For some of your providers, having the opportunity for them to personally make more money… that is enough. For others, think of it like “restricted” or “targeted” fund raising. They need to produce X to get Y. Want a Certified Diabetic Educator? Expanded mobile outreach? Homeless health services? Whatever. Show them how much money you need and how increasing visits per hour can make it happen.
So, what do you do with all of this? First, calculate your numbers and share them with your providers. Initially, it will mean very little to them… maybe even to you. My Dad has told me since I was a kid… compare yourself to others and only two outcomes exist: vanity or jealousy. Your providers will either be proud of being the leader, embarrassed about being the laggard, or find excuses for being in any rank-order position. Let’s move past judgment and blame and go to the next level…OPTIMIZATION. Here are some options to elevate production:
Listen, we are not naïve enough to think this is easy but you must change the current paradigm or you just remain stuck where you are. How much additional clinical income would replace, entirely, your 330-grant income? What would your CHC look like in a totally fee-for-service (FFS) world vs. encounter rate AND how many visits per hour would keep you fiscally solvent? What is your average payment visit compared to average expense per visit and how do we close the gap or expand the positive delta?
There are other questions or motivations but make no mistake, with some attention and team focus your CHC can decrease wait time, elevate efficiency, and capitalize on an expanding base of ACA-Medicaid and aging (expanding) Medicare patient base.
Act now. Be a leader. And watch your CHC prosper for years to come.