Tools to improve your group practice
By Hobart Collins, CMPE Principal, MGMA Health Care Consulting Group
To help you evaluate your integrated delivery system, this simple worksheet summarizes key factors affecting integrated systems. Your answers will help you identify important challenges and initiate internal improvements.
The worksheet is a subjective measure of the major aspects of systems performance, not a comprehensive test. "No" answers to any of the questions, however, may indicate poor system performance, and addressing them can offer important opportunities for improvement.
Print out this assessment and answer the questions to learn where your integrated delivery system stands.
I. Physician issues
1. Leadership, governance and equity
Integrated systems that have not incorporated physicians into leadership and functional management roles usually experience poor performance. Organizational structures must be in place to promote physician involvement.
Questions to ask: Are physicians well represented in system management and on your boards and committees? Do they have genuine authority and accountability in the system? Do they have the opportunity to share in system success?
Your self-assessment: Good Satisfactory Poor
2. Productivity
Physician productivity is a critical factor in financial performance, and integrated delivery systems that provide compensation disproportionate to productivity experience poor performance.
Questions to ask: Has your system established performance expectations in connection with
compensation? Has physician productivity been benchmarked? Has it been compared to similar systems using comparative productivity data? Do physicians know where they stand in relation to benchmark norms?
Your self-assessment: Good Satisfactory Poor
3. Compensation
Successful physician compensation systems promote an entrepreneurial spirit, linking work and effort to reward as a means of achieving organizational goals.
Questions to ask: Is physician compensation based on production, market norms or both? Does the compensation system reward performance? Does it contain incentives for contributing to organizational success? Do physicians understand system expectations?
Your self-assessment: Good Satisfactory Poor
4. Managed care participation
As the actual providers of care, physicians have great influence over clinical costs. Cost-effective care management often requires education to change physician behavior.
Questions to ask: Are physicians in involved in addressing clinical variation? Are practice guidelines, disease management and similar clinical programs that promote preventive care in place? Are physicians involved and committed to program goals?
Your self-assessment: Good Satisfactory Poor
II. Strategy and governance
1. Physician participation
Physician involvement is necessary, not only in routine decision making, but also in planning and
implementing strategies for effective physician networks. In addition, strong relationships between primary care physicians and specialists are vital.
Questions to ask: Are both primary care physicians and specialists represented in governance? Are appropriate primary care networks and specialist affiliations in place? Are they organized to accept risk and manage patient care? Are physicians actively involved in developing and implementing these strategies?
Your self-assessment: Good Satisfactory Poor
2. Strategic planning: Mission and vision
Like any business, an integrated system needs a strategic plan that includes a mission and vision
incorporating physician goals and objectives.
Questions to ask: Are physicians actively involved in developing strategic initiatives? Does the plan contain specific and measurable goals to gauge organizational performance over time?
Your self-assessment: Good Satisfactory Poor
3. Managed care and contracting
Although risk contracting has yet to materialize in many markets, it continues to be attractive to payers. Systems organized to accept and manage risk have a competitive advantage.
Questions to ask: Does your system have a contracting initiative in place? Does the initiative have the support and commitment of physicians? Is it structures so as not to limit opportunities for patient growth (an important issue for systems that sponsor health plans)?
Your self-assessment: Good Satisfactory Poor
III. Operations, Financial Management and Cost Control
1. Clinic/Practice operations
Inefficient operations — from patient scheduling to billing — can contribute to poor productivity and unnecessary cost.
Questions to ask: Has an operational assessment been conducted to identify areas needing improvement? Have all practice sites been reviewed? Have recommendations for improvement been implemented? Have other opportunities for improvement been explored, including standardization and consolidation of practices with excess capacity?
Your self-assessment: Good Satisfactory Poor
2. Facilities and capital improvement
When systems acquire established physician practices, they often find themselves owning facilities of widely varying quality, and there is a temptation to invest heavily in facility upgrades.
Questions to ask: Have upgrades been analyzed to determine whether they will yield a direct return? Are all existing facilities necessary? Are there opportunities for facility consolidation?
Your self-assessment: Good Satisfactory Poor
3. Staffing
Converting independent practice staff to hospital employment often results in new costs, since hospital salaries and benefits are typically more generous. When these additional costs are allocated back to the practice, it's easy to see why once-profitable practices are now in the red. Too many people are an obvious expense, but so are too few. Benchmarks should be established to optimize staffing. Importantly, less costly staff and providers, such as physician assistants and nurse practitioners, may be able to minimize costs and help raise productivity.
Questions to ask: Have staffing needs been analyzed to determine whether the number of staff is appropriate? Are staffing ratios consistent throughout the system? Are mid-level providers involved in the delivery system?
Your self-assessment: ` Good Satisfactory Poor
4. Accounts receivable management
When a system acquires independent practices, it often acquires a variety of billing and collections systems with a variety of performance levels. The transition from practice control to system control can be costly, especially since payers have become more rigid in claims management.
Questions to ask: Have sufficient resources been directed toward consolidating and standardizing billing practices? Are systems in place to minimize A/R days outstanding? Does the billing staff receive guidance on individual payer requirements for co-pays, deductibles, pre-authorizations and referrals? Are delinquent accounts pursued beyond the time they might be viewed as write-offs by the practice?
Your self-assessment: Good Satisfactory Poor
5. Coding and compliance
Appropriate coding and documentation are critical for reimbursement and regulatory compliance. And as government scrutiny of integrated systems continues to increase, larger matters of compliance must be addressed. Physicians and staff are central to optimizing reimbursement and minimizing denials and compliance risks.
Questions to ask: Do physicians and staff receive ongoing training in proper coding procedures? Is the training specific to individual specialties? Are all providers audited regularly? Are organizational relationships in compliance with relevant rules and regulations? Are compliance programs implemented and observed throughout the system?
Your self-assessment: Good Satisfactory Poor
6. Information systems
Physicians generally make minimal investments in practice management systems, typically only to handle billing. As a result, integrated system are often tempted to initiate IS upgrades after practice acquisition.
Questions to ask: Are the upgrades cost-effective and appropriate to individual practice settings? Have opportunities been explored to consolidate information-related functions, both to minimize cost and improve efficiency? Will upgrading yield data relevant to physician practice management?
Your self-assessment: Good Satisfactory Poor
7. Utilization management
Moving from fee-for-service to risk-based reimbursement requires changes in physician behavior. As reimbursement continues to decline, utilization costs must be understood.
Questions to ask: Has your system taken advantage of advances in utilization and disease
management, outcomes measurement and medical informatics to improve quality, productivity and cost efficiency? Is there a formulary management system in place? Are clinical teams in place to develop programs and educate physicians?
Your self-assessment: Good Satisfactory Poor
If you have answered No or POOR to any of these questions, contact our office for a free assessment of your practice!!!
www.msosolutions.com
315.701.5821
© 2002 Medical Group Management Association. All rights reserved.
Updated 2006
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