Improving Provider Productivity

with your EHR Matt HoenigsbergProduct Marketing@mhoenigsberg

The information presented in this Webinar is current as of date of live airing – November 19, 2014

The Challenge

The Opportunity

The Solution

Question & Answer

Agenda

http://medicaleconomics.modernmedicine.com/medical-economics/news/why-primary-care-physicians-are-seeing-fewer-patients?page=0,1

Average 89 patient visits per week

Family physicians

Average 99 patient visits per week

2013

Average 85 patient visits per week

Internists

Average 93 patient visits per week

Average number of patient visits is down

in 2014

2014

2013

2014

http://medicaleconomics.modernmedicine.com/medical-economics/news/why-primary-care-physicians-are-seeing-fewer-patients?page=0,1

Family physicians Internists

Median number of hours per week is

consistent

2013

2014

2013

2014

Median 51 Hours Workedper week

Median 50 Hours Workedper week

Median 52 Hours Workedper week

Median 52 Hours Workedper week

The Physician Foundation

81% of physicians feel

over-extended.

http://org.salsalabs.com/o/307/images/Physician%20admin%20time_IJHS.pdf

The average doctor spent

8.7 hoursper week(16.6% of working hours) on administration

16.6%

http://org.salsalabs.com/o/307/images/Physician%20admin%20time_IJHS.pdf

Physicians using entirely paper records spent 15.5 percent of their time on administrative matters,

administration accounted for 17.2 percent of time for those

in practices using entirely electronic medical records.

17.2%

15.5%

Why do providers feel that an EHR slows them down?

• The patient visit is not a one on one encounter between provider and patient … many hand-offs and activities are required between Check-in and Check-out

• Understanding the different work-styles and personalities among staff and providers is key to smooth, efficient patient flow when using an EHR

• athenahealth’s team of researchers decided to find out why the slowdowns occur by using LEAN methodologies

Check-In Intake Exam Sign-off Check-out

About LEAN methodologies

• Lean methodologies were originally introduced by Toyota and have recently been employed by health care providers such as Massachusetts General Hospital, Beth Israel Hospital in Boston, and others to study patient flow

• GOAL: understand the steps in a process and remove or re-engineer wasted steps while preserving and optimizing steps that add real value

athenahealth’s Lean Mapping Study

athenahealth‘s Proprietary 5-Stage Patient Visit

Using this unique 5-stage model, athenahealth researchers measured:

Patient process times and wait times Triggers for patient flow Involvement of resources First-time quality

Check-In Intake Exam Sign-off Check-out

Study Participants: 25 providers + staff at 12 practices More than 300 patients 2 pediatric groups, 2 orthopedic groups,

1 OB/GYN group, and 7 primary care practices

The Challenge

The Opportunity

The Solution

Question & Answer

Agenda

Characteristics of High- and Low-Efficiency Providers

athenahealth discovered distinct provider behaviors that distinguish highly efficient providers from less efficient ones

High Efficiency Providers

Keep busy and focused

Solution oriented…disciplined with their work processes

See 4-5 patients per hour and spend ~5-10 minutes with patient

Work with cross-trained, flexible support staff

Patients may experience longer wait times

Finish today’s work in the office

Low Efficiency Providers

May appear fully utilized buy not working to full capacity

Likely to complain about being overworked

See 2-3 patients per hour and spend ~10-15 minutes with patient

Staffed with only one person

Patients may experience shorter wait times

Bring work home at nights and on weekends

Statistics on 5 Provider Work Styles

Several considerations when measuring a provider’s work style:

• How much face-time does the provider spend with the patient?• How long do patients wait?• How long do patients spend in the office?• How many patients does the provider see per hour?

The study yielded 5 practice work styles.

Physician Work StyleAvg. MD

Face Time (stdv)

Avg. Patient

Wait Time (stdv)

Avg. patient

Duration (stdv)

Avg. Patient

Throughput (stdv)

Truly Lean(n=4 MDs, 49 encounters)

7.2 (3.9) 15.5 (8.0)32.2

(12.1)4.1 (0.7)

Patient Processing Machine (n= 5 MDs, 89 encounters)

6.6 (4.7)53.7

(23.8)72.6

(25.9)5.0 (0.6)

Crazy-Busy (n= 3 MDs, 63 encounters)

7.0 (4.1)39.1

(18.6)61.5

(22.6)6.3 (0.3))

Steady but Opportunistic (n= 8 MDs, 75encounters)

12.7 (5.7)21.2

(15.4)46.7

(17.4)2.7 (0.6)

Falling Behind and Frustrated (n= 5 MDs, 42encounters)

14.1 (7.0)30.2

(18.5)59.5

(23.5)2.4 (0.4)

Financial Implications of Different

Work Styles

Based on a CY 2009 Conversion Factor of $36.0666 per RVU

Truly LeanAverage monthly work RVUs = 509

~1.134 work RVU per apptObs. Day patient density = 4 per

hour

Falling BehindAverage monthly work RVUs = 316~0.789 work RVU per apptObs. Day patient density = 2.1 per hour

Translates into $7,000

difference per month

The Challenge

The Opportunity

The Solution – 5 Tips for Improving Productivity

Question & Answer

Agenda

The Provider Productivity End-Goal

Close all patient encounters by the end of the day

Why? Because – All encounters are then

moved into the administrative phase where they can be billed

Patient charts can be shared with others

It clears the deck for patients coming in the following day

And… It helps providers strike a

work-life balance

Tip #1: Work with cross-trained staff that can handle intake and

documentation.

Providers should work with whichever staff member is available rather than always relying on a certain one

Staff should be responsible for inputting certain patient documentation

A more efficient workflow (like the 5-Stages) allows for more efficient handoffs of tasks between administrative staff, clinical support staff, and providers

Truly lean providers make use of multiple staff resources in the first hour and throughout the day

Falling Behind and Frustrated

Steady but Opportunistic

Crazy Busy

Patient Processing

Machine

Truly Lean

0% 10% 20 30% 40% 50% 60% 70% 80%

90% 100%

Tip #2: Document encounters during and immediately after visits, but consider

impact on patient flow.

Knowing which data fields you need to fill in (versus your staff can fill in) within your EHR will increase efficiency

Make sure your EHR automatically provides P4P rules so that you are capturing the data that will provide additional revenue

When falling behind, consider switching to paper documentation during the exam

Physician Work Style

Complete before Patient

Departure

Complete by Day End

Q308 Avg.*Patient Wait

Time

Patient Processing Machine

94%71%*81%86%*

100%100%100%100%

91%99%99%99%

47.3 (20.5)70.8 (28.1)47.4 (18)

54.2 (15.8)

Truly Lean

67%69%70%73%

100%100%100%100%

99%97%99%99%

11.7 (5.8)14.5 (6.9)17.5 (9.1)17.3 (9.0)

Falling Behind and Frustrated

38%0%0%45%30%

75%0%0%45%30%

15%27%31%58%36%

23.9 (8.8)32.5 (14.9)22.1 (20.3)30.8 (17.0)41.1 (20.9)

Tip #3: Close all patient encounters by the end of the day.

Providers’ ability to close encounters on the same day is the leading indicator of the overall efficiency of a practice’s patient workflow

Providers should complete as much documentation as possible during the day without holding up the flow of patients

Wrap-up complex documentation at day’s end

Encounter closed

Billing completed

Practice paid

✔✔✔

Aggregated data confirms busy providers can keep up

Monthly Visits

Number of Providers

0 - 49 6,735

50 - 99 4,454

100 - 299 4,658

300 - 499 819

500 - 699 195

700 + 99

Same Day Encounter Close RateQ3 – 2014 – by monthly appt volume (all specialties)

100

%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%700-500700+ 500-300 300-100 100-50 <50

72%

71%

73%

74%

75%

75%

75%

75%

71%

71%

66%

67%

SDECR Provider avg

SDECR Weighted Avg

Tip #4: Delegate responsibility for document handling

effectively.

Staff and vendors should handle routing documents whenever possible

Staff should be able to handle administrative forms and routine negative test results without physician involvement

Choose an EHR vendor that provides document handling services, such as:

• Opening and sorting mail

• Receiving faxes and lab work results

• Routing documentation to the appropriate place

You can’t improve what you can’t measure.

You need an EHR vendor that can give you ongoing visibility into your practice’s productivity

Your EHR system should be able to provide data on the following 6 questions:

1) Are my providers closing all patient encounters every day?

2) Are my providers maximizing staff use during intake?

3) How much time do my providers spend documenting each patient encounter?

4) How much time do my providers spend on documentation while a patient is in the office and how much after the patient has left?

5) Is my practice routing documents efficiently and delegating responsibility for document handling appropriately?

6) How does my practice stack up against comparable practices across the country?

athenahealth’s award-winning services can help you thrive

through change

athenahealth today• 50,000+ providers on athenaNet®

• Clients ranging from 1 to 5,000 + providers

• 50 states and 92 medical specialties

• $9 billion in client collections per year

• Acquired Epocrates March, 2013

“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

#1 Overall

Software Vendor

#1 Overall

Physician Practice Vendor

#1 PatientPortal

#1 Practice

Management

System(1-10, 11-75 physicians)

#2 EHR

(1-10, 11-75 physicians)

2013 Best in KLAS

KLAS in 2013 rated athenaClinicals as most usable

EHR at go live and today

“Ambulatory EMR Usability 2013: More Nurture than Nature,” May, 2013. © 2013 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com