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ROI from Hospital-Owned
Physician Practices
HFMA Presentation – March 20, 2015
2
Agenda
• Bio - Penn Krause, FACHE
• ROI from Hospital-Owned Physician Practices
• PTS Overview
Our Roadmap for ROI is your Pathway to Success
1
2
3
3
Speaker Bio
Penn Krause, FACHE
CEO, PTS Physicians
• Executive roles - CHS
• CEO - Pittsburgh Mercy Health System (Top 100 Most-Wired)
• Transitioned to IT – HMS
• Cofounded Treatspace
• CEO - PTS
Our Roadmap for ROI is your Pathway to Success
INTRODUCTION1
4
PTS : Who We Are
Our Company: Commitment
• Focus on physician analytics for hospital-owned practices
• Clarity to physician practice performance
• Trustworthy data
• Proven roadmap for maximizing ROI
Our Roadmap for ROI is your Pathway to Success
INTRODUCTION1
5
Cardinal Health and PTS Physicians – Strategic Alliance
1 INTRODUCTION
6
ROI FROM HOSPITAL-OWNED
PHYSICIAN PRACTICES
Our Roadmap for ROI is your Pathway to Success
2
7
Who Said This?
“Despite the remarkable progress we have made in hospital management in
this country, the lot of the hospital administrator is not a happy one because
medical care is complex, professionals are scarce and costs are high”
ROI2
8
Who Said This?
Dr. Jack Masur
Assistant Surgeon General and Chief
Bureau of Medical services
1955
ROI2
9
Top Concerns for Hospital CEOs 2014
• Financial Challenges
• Healthcare Reform
• Hospital-physician relations
• Technology
ACHE Survey
ROI2
10
Resulting Strategy: Hospital-Owned Physician Network
• Negotiate with Payors
• Capture market share and downstream revenue
• Reduce Leakage
• Secure referral channels
• Increase volume
• Position for healthcare reform
Leverage employment relationship to optimize top drivers of financial
performance in transition to value-based
“In the C-suite, the return on investment was to come from two sources:
avoiding the penalties that came from hospital readmissions and, not least,
from the downstream revenue”
- Bill Sonn, SE2
ROI2
11
Growing Pains: Physician Practice Investment (Losses)
• Typical range of $150,000 - $250,000 for loss per physician per year
• Median loss of $180,000
- Study by McKinsey, the Brookings Institution, Harvard Business School
and the Kennedy School
• Median loss for primary care of $141,000
• Median loss for specialists of $274,000
- PTS Physicians DataPath
“Most practice costs went up after a hospital system purchased a physician
group or practice”
- Member poll by American College of Physician Executives
ROI2
12
Growing Pains: Owned Primary Care 1% of Bottom Line
• 3% of patients in the last 5 years first engaged the hospital system at a
hospital-owned physician primary care office
• 1% of hospital contribution margin
“The vaunted downstream revenue…turned out to be a fiction”
- Bill Sonn, SE2
“42% of hospitals don’t track downstream revenue from their physicians.
Most reported that this data was difficult to obtain or not available.”
- Kentucky Hospital Association
• How is indirect revenue captured?
ROI2
13
How to Define Downstream Contribution Margin?
• 22% hospital net revenue less direct and indirect variable expense
• 22% hospital net revenue less direct expense
• 33% hospital net revenue less fully allocated variable and fixed expenses
• 23% hospital track only net revenue
Report by Dean Dorton Allen Ford
ROI2
14
Specialties with Best Downstream Revenue
• Hematology/Oncology
• Cardiology (Invasive)
• Cardiac/Thoracic Surgery
• General Surgery
• Neurosurgery
• Orthopedics
“The significant hospital revenues and contribution margins that hospitals
and health systems generate from these specialties generally create an
overall positive financial return notwithstanding the larger physician practice
losses.”
- Dean Dorton Allen Ford
ROI2
15
Growing Pains: Medicare Bonuses Wiped Out by Readmission
Penalties
Analyzed cost-to-charges ratios and readmissions penalty data to determine whether
excess readmission revenue, minus the variable cost related to those admissions, is
greater or less that the readmissions penalty
• 55% received bonuses for providing comparatively good care
• Less than 50% will actually receive money due to penalties
• 400+ beds – Average bonus of $213,000, penalty of $1.2 million
• 200-Beds – Average bonus of $32,000, penalty of $131,000
• 28% of hospitals will break even or receive extra money
Healthcare Financial Management
Kaiser Health News
Advisory Board
ROI2
16
Growing Pains: Medicare Bonuses Wiped Out by Penalties
• 23% of hospitals would have been better off by at least $100,000 if they
had eliminated excess readmissions alone
• Even facilities not currently being penalized should be mindful of
readmission statistics
• CMS predicts that 2,638 hospitals will incur total penalties of $428 million in
fiscal year 2015 under the program
Healthcare Financial Management
ROI2
17
Readmissions: Impact of Follow up Visits
• Substantial variation exists in hospital-level rates of early outpatient follow-
up after discharge
• Effective interventions can vary by condition and admission type
• Detailed analysis can reveal who and what is effective
• By Condition
• By Physician
• By Follow up time span
American Hospital Association
2 ROI
18
Physician Compensation: Key Metrics
• 67% RVU productivity model
• 64% physician-based quality indicators
• 36% hospital and health system goals
Dean Dorton Allen Ford
19
Financial Improvement: How Are Hospitals Doing with CEO
Top Concern?
• Study showed financial improvement was the top strategic priority for
hospitals of all types
• 88% had improvement goals
• 15% are achieving targets
• Lack of accountability and difficulty measuring savings top drivers of under-
performance
HIMSS
Becker’s Hospital Review
ROI2
20
CEO Top Concern: Technology
• None of several studies that have looked at healthcare IT have been able to
gauge the true effect of IT on the healthcare system
• Value of IT Hard to Pin Down
American Journal of Care Management
ROI2
21
Technology: Big Data and Analytics
Big data is insightful, but what can I actually change that can make a
difference?
• Measure actionable drivers of performance
• Identify actions to affect the most change
• Track progress
ROI2
22
PTS OVERVIEW
Our Roadmap for ROI is your Pathway to Success
3
23
Using Technology to Improve Financial Performance:
Two Key Analytical Pathways for Hospital-Owned
Physician Practices
1. Accurately understand total ROI from the financial performance of
physician practices and their impact on the revenue stream
2. Optimizing readmissions
PTS OVERVIEW3
24
Who We Are
Our People: Experience and Expertise
• Deep experience in healthcare management, information technology, and
innovative benchmarking analytics
• Specialized expertise and strong client relationships built over the past five
years
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
25
Who We Are
PTS OVERVIEW3
Our Roadmap for ROI is your Pathway to Success
Clients include:Our Growth:
26
What We Do
PTS DataPath
• A Physician Performance Analytics and Benchmarking solution, unique in the
healthcare industry for using transaction-level raw data to produce precise
benchmarks and performance metrics by specialty, by practice and down to
individual physician level.
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
27
What We Do
PTS Patient Care OptimizerTM (PCO)
• Patient Care Optimizer provides visibility for healthcare executives across
the continuum of care to optimize patient outcomes, mitigate problem areas
and maximize profitability. Its six analytic pathways deliver clear insight into
physician referral patterns, revenue streams, readmissions, follow up visits
and other analysis to optimize reimbursement and reduce penalties.
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
28
Analytics you can trust.
• Precise Data
• Timely Information
• Trustworthy Analysis
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
29
Not only software, but a process.
• PTS Delivers a Proven Process
• Healthcare professionals can spend their time taking action on improvement
rather than collecting and categorizing data
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
“Reliability is the number one thing PTS has
been able to deliver to us that none of the
other benchmarks can do.”
- Les Mitchell, Corporate Director of Physician Affiliations, Mercy Health
30
Reliable. Measurable. Actionable.
PTS OVERVIEW3
Our Roadmap for ROI is your Pathway to Success
Value Realization Continuum
31
Reliable. Measurable. Actionable.
PTS OVERVIEW3
Our Roadmap for ROI is your Pathway to Success
PTS Process
32
Targeted and Collaborative
PTS OVERVIEW3
Our Roadmap for ROI is your Pathway to Success
Results
Client Study
NE Ohio Hospital
$1.5M annual ongoing savings
47% reduction in total practice investment
ROI in excess of 25:1
Developed a culture of partnership with the
physicians.
“This element may have been the most beneficial.”
(client sponsor)
33
Not only analytics, but a roadmap.
• PTS Delivers a Workable, Collaborative Roadmap
• We help healthcare executives understand the complete ROI from their
employed physicians and provide a roadmap to significantly improve their
economic performance.
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
“PTS improves our return on investment.”
- Thomas Stover, MD, CEO, Akron General
34
Table of Contents
• PTS DataPath Screenshots
• PTS Patient Care Optimizer® Screenshots
Our Roadmap for ROI is your Pathway to Success
1
2
35
PTS DATAPATH
Our Roadmap for ROI is your Pathway to Success
1
36
PTS DataPath Scorecard for 16 Metrics
Provides the specialty specific benchmark for 16 key performance metrics across compensation, productivity and
expense. It allows you to compare your practice’s performance to one another (peer comparison) as well as to the
benchmark median.
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
37
PTS DataPath Physician Scorecard
Provides 7 key Physician level metrics (not inclusive of physician extenders)
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
38
PTS DataPath Practice Trend Analysis
Provides trend analysis for all performance metrics available in the Scorecard for 16 Metrics.
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
39
PTS DataPath CPT Code Analysis
Compares individual practices or physicians to database average for CPT code billing
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
40
PTS DataPath Financial Impact Scorecard
Allows you to calculate the potential financial impact of shifting selected performance metrics along the scale from low,
average to high performance for each of your practices based on current actual performance and your future goals.
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
41
Overall Comparison to Benchmarks
An index is computed to be 100 at the
median. Your index is the average of your
practices’ actual performance relative to that
benchmark. In other words, your index is a
percentage of the median.
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
*Compensation = Physician Compensation / # of Physician FTEs
**Productivity = Work RVUs generated by physicians / # of Physician FTEs
Practice Specialty Group *Compensation
Compensation
Index
**Productivity
Productivity
Index
Pegasus Cardiology Cardiology $539,701 92.81 10,643 109.88
Orion Neurosurgery Neurosurgery $819,634 80.47 11,672 86.12
Dorado Specialists Neurosurgery $1,259,039 121.47 17,692 133.07
Leo Surgery Associates General Surgery $659,916 158.40 10,799 139.52
Carina Internal Medicine Internal Medicine $211,413 102.11 4,417 94.20
Apus Family Medicine Family Medicine $251,202 121.04 5,367 107.01
Pleiades Surgeons General Surgery $384,137 93.75 5,919 78.16
Andromeda Neurosurgeons Neurosurgery $1,473,512 142.71 15,549 116.13
Family Medicine of Saturn Family Medicine $224,967 113.58 4,240 86.09
Overall Compensation Index = 112.96
Overall Productivity Index = 95.78
PTS DataPath Compensation vs. Productivity
This report allows you to identify practices that do not align in terms of compensation and productivity (work RVUs),
when compared to the benchmark median.
42Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
PTS DataPath Opportunity Analysis: Apus FM
The analysis below highlights opportunities for a selected practice. These observations are presented to each client
during our face-to-face performance review.
Scorecard for 16 Metrics
• The practice ranked in the worst quartile in terms of net loss/physician FTE in 2013
• Patient volume, work RVU production, and net revenue compared favorably to the PTS median
• Work RVUs/patient visit ranked well below the median (0.97 vs. 1.23)
• Are the physicians performing different types of procedures, or is there a coding issue?
• Physician compensation was above the median, but practice overhead seemed to be the main
contributor to net losses
• “Physician Practice Overhead” accounted for 48% of total expenses – what is included in this
item? What opportunities for office consolidation or more cost effective operations?
CPT Code Analysis
• The practice billed fewer 99214’s and more 99213’s than the PTS dataset
• High frequency of zero work RVU procedures (lab tests, blood draws, injections, etc.)
Financial Impact Scorecard
• The practice ranked in the 3rd percentile in work RVUs/patient visit (0.97)
• Improving 20 percentile points to 1.13 would result in $550K of additional revenue
43
PTS PATIENT CARE OPTIMIZERÂŽ
Our Roadmap for ROI is your Pathway to Success
2
44
PCO Revenue Stream Tracking
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Demonstrates the net revenue impact of employed Physician Practices across their entire revenue stream - their own
patient encounters as well as revenue from referrals across the system (to specialties and to facilities).
45
PCO Revenue Stream Tracking – Practice Detail
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Break out detail analysis calculates the Net Gain/Loss after physician compensation and practice expenses.
At physician group Level, by specialty, by practice including the specific categories of referral revenue and expense.
Allows drill down on the referrals to see specific Service Lines and Specialties for the referred services. From there,
you can drill down to individual patient encounters.
46
PCO Referral Tracking Dashboard
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Near real time views of referrals from Primary Care to Specialties, to facilities within your health system.
47
PCO Provider Referrals by Specialty
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Observe changes in referral patterns quickly providing an opportunity to engage. Referrals can be tracked down to the
Physician level showing referrals in both “From” and “To” perspectives.
48
Follow up Visits for Patients with Critical Conditions
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Demonstrates the impact of follow up visits after discharge. Calculates differences in readmission rates in followed-up
and non-followed-up cases. Calculates the financial implications in terms of total case charges when expected follow
up visits occur or not.
49
Readmissions Dashboard
Our Roadmap for ROI is your Pathway to Success
Patient Care OptimizerÂŽ2
Our Readmissions Dashboard highlights key metrics as well as presents your readmit trend over time.
We include readmission rates for the CMS Critical Conditions as well as client-selected conditions of interest
50
In Summary
• Committed Partner
• Experienced People
• Superior Solutions
Our Roadmap for ROI is your Pathway to Success
SUMMARY
QUESTIONS?

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Western PA Spring HFMA Penn Krause

  • 1. ROI from Hospital-Owned Physician Practices HFMA Presentation – March 20, 2015
  • 2. 2 Agenda • Bio - Penn Krause, FACHE • ROI from Hospital-Owned Physician Practices • PTS Overview Our Roadmap for ROI is your Pathway to Success 1 2 3
  • 3. 3 Speaker Bio Penn Krause, FACHE CEO, PTS Physicians • Executive roles - CHS • CEO - Pittsburgh Mercy Health System (Top 100 Most-Wired) • Transitioned to IT – HMS • Cofounded Treatspace • CEO - PTS Our Roadmap for ROI is your Pathway to Success INTRODUCTION1
  • 4. 4 PTS : Who We Are Our Company: Commitment • Focus on physician analytics for hospital-owned practices • Clarity to physician practice performance • Trustworthy data • Proven roadmap for maximizing ROI Our Roadmap for ROI is your Pathway to Success INTRODUCTION1
  • 5. 5 Cardinal Health and PTS Physicians – Strategic Alliance 1 INTRODUCTION
  • 6. 6 ROI FROM HOSPITAL-OWNED PHYSICIAN PRACTICES Our Roadmap for ROI is your Pathway to Success 2
  • 7. 7 Who Said This? “Despite the remarkable progress we have made in hospital management in this country, the lot of the hospital administrator is not a happy one because medical care is complex, professionals are scarce and costs are high” ROI2
  • 8. 8 Who Said This? Dr. Jack Masur Assistant Surgeon General and Chief Bureau of Medical services 1955 ROI2
  • 9. 9 Top Concerns for Hospital CEOs 2014 • Financial Challenges • Healthcare Reform • Hospital-physician relations • Technology ACHE Survey ROI2
  • 10. 10 Resulting Strategy: Hospital-Owned Physician Network • Negotiate with Payors • Capture market share and downstream revenue • Reduce Leakage • Secure referral channels • Increase volume • Position for healthcare reform Leverage employment relationship to optimize top drivers of financial performance in transition to value-based “In the C-suite, the return on investment was to come from two sources: avoiding the penalties that came from hospital readmissions and, not least, from the downstream revenue” - Bill Sonn, SE2 ROI2
  • 11. 11 Growing Pains: Physician Practice Investment (Losses) • Typical range of $150,000 - $250,000 for loss per physician per year • Median loss of $180,000 - Study by McKinsey, the Brookings Institution, Harvard Business School and the Kennedy School • Median loss for primary care of $141,000 • Median loss for specialists of $274,000 - PTS Physicians DataPath “Most practice costs went up after a hospital system purchased a physician group or practice” - Member poll by American College of Physician Executives ROI2
  • 12. 12 Growing Pains: Owned Primary Care 1% of Bottom Line • 3% of patients in the last 5 years first engaged the hospital system at a hospital-owned physician primary care office • 1% of hospital contribution margin “The vaunted downstream revenue…turned out to be a fiction” - Bill Sonn, SE2 “42% of hospitals don’t track downstream revenue from their physicians. Most reported that this data was difficult to obtain or not available.” - Kentucky Hospital Association • How is indirect revenue captured? ROI2
  • 13. 13 How to Define Downstream Contribution Margin? • 22% hospital net revenue less direct and indirect variable expense • 22% hospital net revenue less direct expense • 33% hospital net revenue less fully allocated variable and fixed expenses • 23% hospital track only net revenue Report by Dean Dorton Allen Ford ROI2
  • 14. 14 Specialties with Best Downstream Revenue • Hematology/Oncology • Cardiology (Invasive) • Cardiac/Thoracic Surgery • General Surgery • Neurosurgery • Orthopedics “The significant hospital revenues and contribution margins that hospitals and health systems generate from these specialties generally create an overall positive financial return notwithstanding the larger physician practice losses.” - Dean Dorton Allen Ford ROI2
  • 15. 15 Growing Pains: Medicare Bonuses Wiped Out by Readmission Penalties Analyzed cost-to-charges ratios and readmissions penalty data to determine whether excess readmission revenue, minus the variable cost related to those admissions, is greater or less that the readmissions penalty • 55% received bonuses for providing comparatively good care • Less than 50% will actually receive money due to penalties • 400+ beds – Average bonus of $213,000, penalty of $1.2 million • 200-Beds – Average bonus of $32,000, penalty of $131,000 • 28% of hospitals will break even or receive extra money Healthcare Financial Management Kaiser Health News Advisory Board ROI2
  • 16. 16 Growing Pains: Medicare Bonuses Wiped Out by Penalties • 23% of hospitals would have been better off by at least $100,000 if they had eliminated excess readmissions alone • Even facilities not currently being penalized should be mindful of readmission statistics • CMS predicts that 2,638 hospitals will incur total penalties of $428 million in fiscal year 2015 under the program Healthcare Financial Management ROI2
  • 17. 17 Readmissions: Impact of Follow up Visits • Substantial variation exists in hospital-level rates of early outpatient follow- up after discharge • Effective interventions can vary by condition and admission type • Detailed analysis can reveal who and what is effective • By Condition • By Physician • By Follow up time span American Hospital Association 2 ROI
  • 18. 18 Physician Compensation: Key Metrics • 67% RVU productivity model • 64% physician-based quality indicators • 36% hospital and health system goals Dean Dorton Allen Ford
  • 19. 19 Financial Improvement: How Are Hospitals Doing with CEO Top Concern? • Study showed financial improvement was the top strategic priority for hospitals of all types • 88% had improvement goals • 15% are achieving targets • Lack of accountability and difficulty measuring savings top drivers of under- performance HIMSS Becker’s Hospital Review ROI2
  • 20. 20 CEO Top Concern: Technology • None of several studies that have looked at healthcare IT have been able to gauge the true effect of IT on the healthcare system • Value of IT Hard to Pin Down American Journal of Care Management ROI2
  • 21. 21 Technology: Big Data and Analytics Big data is insightful, but what can I actually change that can make a difference? • Measure actionable drivers of performance • Identify actions to affect the most change • Track progress ROI2
  • 22. 22 PTS OVERVIEW Our Roadmap for ROI is your Pathway to Success 3
  • 23. 23 Using Technology to Improve Financial Performance: Two Key Analytical Pathways for Hospital-Owned Physician Practices 1. Accurately understand total ROI from the financial performance of physician practices and their impact on the revenue stream 2. Optimizing readmissions PTS OVERVIEW3
  • 24. 24 Who We Are Our People: Experience and Expertise • Deep experience in healthcare management, information technology, and innovative benchmarking analytics • Specialized expertise and strong client relationships built over the past five years Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3
  • 25. 25 Who We Are PTS OVERVIEW3 Our Roadmap for ROI is your Pathway to Success Clients include:Our Growth:
  • 26. 26 What We Do PTS DataPath • A Physician Performance Analytics and Benchmarking solution, unique in the healthcare industry for using transaction-level raw data to produce precise benchmarks and performance metrics by specialty, by practice and down to individual physician level. Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3
  • 27. 27 What We Do PTS Patient Care OptimizerTM (PCO) • Patient Care Optimizer provides visibility for healthcare executives across the continuum of care to optimize patient outcomes, mitigate problem areas and maximize profitability. Its six analytic pathways deliver clear insight into physician referral patterns, revenue streams, readmissions, follow up visits and other analysis to optimize reimbursement and reduce penalties. Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3
  • 28. 28 Analytics you can trust. • Precise Data • Timely Information • Trustworthy Analysis Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3
  • 29. 29 Not only software, but a process. • PTS Delivers a Proven Process • Healthcare professionals can spend their time taking action on improvement rather than collecting and categorizing data Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3 “Reliability is the number one thing PTS has been able to deliver to us that none of the other benchmarks can do.” - Les Mitchell, Corporate Director of Physician Affiliations, Mercy Health
  • 30. 30 Reliable. Measurable. Actionable. PTS OVERVIEW3 Our Roadmap for ROI is your Pathway to Success Value Realization Continuum
  • 31. 31 Reliable. Measurable. Actionable. PTS OVERVIEW3 Our Roadmap for ROI is your Pathway to Success PTS Process
  • 32. 32 Targeted and Collaborative PTS OVERVIEW3 Our Roadmap for ROI is your Pathway to Success Results Client Study NE Ohio Hospital $1.5M annual ongoing savings 47% reduction in total practice investment ROI in excess of 25:1 Developed a culture of partnership with the physicians. “This element may have been the most beneficial.” (client sponsor)
  • 33. 33 Not only analytics, but a roadmap. • PTS Delivers a Workable, Collaborative Roadmap • We help healthcare executives understand the complete ROI from their employed physicians and provide a roadmap to significantly improve their economic performance. Our Roadmap for ROI is your Pathway to Success PTS OVERVIEW3 “PTS improves our return on investment.” - Thomas Stover, MD, CEO, Akron General
  • 34. 34 Table of Contents • PTS DataPath Screenshots • PTS Patient Care OptimizerÂŽ Screenshots Our Roadmap for ROI is your Pathway to Success 1 2
  • 35. 35 PTS DATAPATH Our Roadmap for ROI is your Pathway to Success 1
  • 36. 36 PTS DataPath Scorecard for 16 Metrics Provides the specialty specific benchmark for 16 key performance metrics across compensation, productivity and expense. It allows you to compare your practice’s performance to one another (peer comparison) as well as to the benchmark median. Our Roadmap for ROI is your Pathway to Success PTS DataPath1
  • 37. 37 PTS DataPath Physician Scorecard Provides 7 key Physician level metrics (not inclusive of physician extenders) Our Roadmap for ROI is your Pathway to Success PTS DataPath1
  • 38. 38 PTS DataPath Practice Trend Analysis Provides trend analysis for all performance metrics available in the Scorecard for 16 Metrics. Our Roadmap for ROI is your Pathway to Success PTS DataPath1
  • 39. 39 PTS DataPath CPT Code Analysis Compares individual practices or physicians to database average for CPT code billing Our Roadmap for ROI is your Pathway to Success PTS DataPath1
  • 40. 40 PTS DataPath Financial Impact Scorecard Allows you to calculate the potential financial impact of shifting selected performance metrics along the scale from low, average to high performance for each of your practices based on current actual performance and your future goals. Our Roadmap for ROI is your Pathway to Success PTS DataPath1
  • 41. 41 Overall Comparison to Benchmarks An index is computed to be 100 at the median. Your index is the average of your practices’ actual performance relative to that benchmark. In other words, your index is a percentage of the median. Our Roadmap for ROI is your Pathway to Success PTS DataPath1 *Compensation = Physician Compensation / # of Physician FTEs **Productivity = Work RVUs generated by physicians / # of Physician FTEs Practice Specialty Group *Compensation Compensation Index **Productivity Productivity Index Pegasus Cardiology Cardiology $539,701 92.81 10,643 109.88 Orion Neurosurgery Neurosurgery $819,634 80.47 11,672 86.12 Dorado Specialists Neurosurgery $1,259,039 121.47 17,692 133.07 Leo Surgery Associates General Surgery $659,916 158.40 10,799 139.52 Carina Internal Medicine Internal Medicine $211,413 102.11 4,417 94.20 Apus Family Medicine Family Medicine $251,202 121.04 5,367 107.01 Pleiades Surgeons General Surgery $384,137 93.75 5,919 78.16 Andromeda Neurosurgeons Neurosurgery $1,473,512 142.71 15,549 116.13 Family Medicine of Saturn Family Medicine $224,967 113.58 4,240 86.09 Overall Compensation Index = 112.96 Overall Productivity Index = 95.78 PTS DataPath Compensation vs. Productivity This report allows you to identify practices that do not align in terms of compensation and productivity (work RVUs), when compared to the benchmark median.
  • 42. 42Our Roadmap for ROI is your Pathway to Success PTS DataPath1 PTS DataPath Opportunity Analysis: Apus FM The analysis below highlights opportunities for a selected practice. These observations are presented to each client during our face-to-face performance review. Scorecard for 16 Metrics • The practice ranked in the worst quartile in terms of net loss/physician FTE in 2013 • Patient volume, work RVU production, and net revenue compared favorably to the PTS median • Work RVUs/patient visit ranked well below the median (0.97 vs. 1.23) • Are the physicians performing different types of procedures, or is there a coding issue? • Physician compensation was above the median, but practice overhead seemed to be the main contributor to net losses • “Physician Practice Overhead” accounted for 48% of total expenses – what is included in this item? What opportunities for office consolidation or more cost effective operations? CPT Code Analysis • The practice billed fewer 99214’s and more 99213’s than the PTS dataset • High frequency of zero work RVU procedures (lab tests, blood draws, injections, etc.) Financial Impact Scorecard • The practice ranked in the 3rd percentile in work RVUs/patient visit (0.97) • Improving 20 percentile points to 1.13 would result in $550K of additional revenue
  • 43. 43 PTS PATIENT CARE OPTIMIZERÂŽ Our Roadmap for ROI is your Pathway to Success 2
  • 44. 44 PCO Revenue Stream Tracking Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Demonstrates the net revenue impact of employed Physician Practices across their entire revenue stream - their own patient encounters as well as revenue from referrals across the system (to specialties and to facilities).
  • 45. 45 PCO Revenue Stream Tracking – Practice Detail Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Break out detail analysis calculates the Net Gain/Loss after physician compensation and practice expenses. At physician group Level, by specialty, by practice including the specific categories of referral revenue and expense. Allows drill down on the referrals to see specific Service Lines and Specialties for the referred services. From there, you can drill down to individual patient encounters.
  • 46. 46 PCO Referral Tracking Dashboard Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Near real time views of referrals from Primary Care to Specialties, to facilities within your health system.
  • 47. 47 PCO Provider Referrals by Specialty Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Observe changes in referral patterns quickly providing an opportunity to engage. Referrals can be tracked down to the Physician level showing referrals in both “From” and “To” perspectives.
  • 48. 48 Follow up Visits for Patients with Critical Conditions Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Demonstrates the impact of follow up visits after discharge. Calculates differences in readmission rates in followed-up and non-followed-up cases. Calculates the financial implications in terms of total case charges when expected follow up visits occur or not.
  • 49. 49 Readmissions Dashboard Our Roadmap for ROI is your Pathway to Success Patient Care OptimizerÂŽ2 Our Readmissions Dashboard highlights key metrics as well as presents your readmit trend over time. We include readmission rates for the CMS Critical Conditions as well as client-selected conditions of interest
  • 50. 50 In Summary • Committed Partner • Experienced People • Superior Solutions Our Roadmap for ROI is your Pathway to Success SUMMARY

Hinweis der Redaktion

  1. The last presenter on a Friday afternoon, brevity is the soul of wit, so I will be concise Be about 20-25 minutes, so plenty of time to ask questions as we go through
  2. Road less traveled CHS The 2014 Global Action Challenge awarded a $1M investment to Treatspace, a health innovation technology company. Been to HFMA meetings when on the provider side, first time as a speaker * Why joined PTS – survey-based story “we are different” Don’t’ claim to be an expert on all the aspects of hospital owned-practices Have a perspective from the provider and IT company in different roles, in healthcare quite a while Any questions I can’t answer, will get back to you
  3. - Year long due diligence and setting up the strategic alliance-
  4. - Who said this. Perhaps one of you. I feel fortunate to have the opportunity to serve and have a career in healthcare, but I must say have felt like this a number of times during my career
  5. Interesting to be reminded periodically that challenges have been around a while
  6. I have followed ACHE a long time, and the list hasn’t changed that much Healthcare reform was DRGs when first started CEO and mentor, his focus on a clean hospital, good food, and happy doctors I guess things have gotten more complex
  7. In response to the CEO top concerns on finances, physicians, and reform came the strategy of hospital-owned physician practices Bill Sonn quote in Becker’s hospital Review says the big two short-term financial drivers of the employee relationship are downstream revenue and readmissions Quite frankly, the relationship with employed physicians don’t seem to be much different that private practice often times - These can have an immediate impact as value-based is being phased in
  8. Employing physicians has been in place a long time, but is now over 50% Increase in the number and the loss/physician has the total losses in the millions, and getting the attention of executives and Boards We do have some clients actually with profits on some practices, but it is rare – often it is primary care which has adopted a walk-in clinic model Anyone here have a profitable practice?
  9. Opinion piece in Becker’s Hospital Review (Bill Sonn) In-depth research project on one hospital presented in Becker’s Hospital Review Of those tracking downstream revenue, is it accurate, does it measure indirect and outpatient accurately Who is doing this currently? Indirect is dependent on tracking the referrals accurately, not usually the case combination of technology and staff data entry issues Corroborates findings in our research from our database, varies by specialty and hospital *Conversations regarding comp and revenue
  10. - There isn’t a way to benchmark contribution margin because hospitals do it differently, but we are starting to work on it in our database
  11. These also tend to be the specialties often employed, except for hematology/oncology We do see some of these losing money Not much done with benchmarking this yet, but we are working on it
  12. - How many attended the breakout session on readmissions? - I will just give a quick overview - There is good reason to have a focus on leveraging the relationship with employed physicians to improve readmission rates - Only measure with penalaties at this point - May have seen all this, but probably worth repeating
  13. - $162,000 per hospital
  14. It is generally believed that follow up visits have a positive impact on avoiding readmission. As of yet, there is not one defined optimal protocol. It varies by a number of factors such as condition, and nature of admit (medical versus surgical). A number of studies have shown that patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission. Green line demonstrates reduction of readmissions after discharge with intervention versus usual care (blue) Measuring the actual readmission rates when follow up does and does not occur, by condition, and even by provider allows focus at an actionable level with an ability to see results of programs and physician engagement.
  15. As the importance of outcomes measures increase, so has the physician compensation structure We recently added a comp modeler to measure what happens physician salaries based on adding other measures and their impact when different goals are achieved
  16. - The reason for not achieving targets was identified as lack of accountability and measuring the important drivers of under-performance
  17. - Can technology help with improving financial performance, aside from the meaningful use incentives
  18. - We are in the big data/analytics space, and this is what we hear from hospitals
  19. We have six analytical pathways for measuring physician practice performance A couple of the analytical pathways in our solutions focused on the top drivers of financial performance for employed physicians - Priorities will change as reimbursement reform continues
  20. The BenchmarkerTM solution was commercialized in 2009 by our Founders with experience in healthcare management and IT A PTS Cofounder is Dr Rao Unnava is a professor at OSU. Based his research, PTS set up a new approach to physician practice benchmarking by taking data directly from IT systems, and from a complete set of data sources Our team has developed specialized expertise and strong client relationships over the past five years. Our references will tell you that customer service is a strength of our company
  21. Database includes Physicians, Physician Assistants and Nurse Practitioner which is summarized here as Provider Full time equivalents Over 80% of the database is physicians The source of the data is PTS clients At the end of 2014, we project the database to be close to 4,000 providers Clients range from some of the largest health systems in the country such Mercy Health (formerly CHP been the 15th largest hospital system) to community hospitals such as Akron General Just started roll-out to mid-atlantic region in conjunction with VHA and Cardinal Did two webinars sponsored by VHA, anyone see it or participate? - Expect to have good representation by the end of the year
  22. PTS DataPath is the first practice analytics solution in the nation using transaction-level raw data from three sources - billing, FTE, and financial statements DataPath offers financial comparisons for hospital employed physicians from our database We take data already being captured from disparate IT systems which do not talk to each other Cleanse and normalize it Turn it into actionable information Did anyone attend the breakout session on managing physician practices? We focus on the analytics and provide direction, not consulting, so we aren’t incentivized to upsell
  23. PTS Patient Care OptimizerTM (PCO) provides visibility across the care continuum to optimize patient outcomes and profitability PCO deliver insight into: Total direct and indirect revenue from individual physicians to the entire hospital system Physician Referral Patterns Readmissions Follow up visit analysis Emergency Room Usage High Cost Patients
  24. Our analytics are precise because data comes directly from the IT systems for thousands of physicians and comparable health systems Whether you want reports monthly, quarterly or semi-annually, we get you the right information at the right time There has never been a question about the accuracy of our data. Our clients trust the information. Important to be able to trust the data when decisions potentially affect clinical care. Can avoid the unproductive discussions with the practices about the accuracy of data and reliability
  25. We deliver not only software, but a process based on: Cleansed and complete data Metrics all the way to the individual physician level Progress measured consistently over time IT, finance and other professionals can spend their time on priorities other than collecting and reporting data. *QUOTE _____________________________________________________________ PTS Delivers a Proven Process: Highly cleansed and complete data to provide accurate and precise benchmarks An extensive selection of customizable reports using metrics at the specialty, practice and individual physician level Deeper insights into performance drivers and isolating the most impactful opportunities Flexible and tailored reporting periods Progress measured over time with consistent data Healthcare professionals can spend their time taking action on improvement rather than collecting and categorizing data.
  26. PTS moves you down the continuum towards results We organize, standardize and refine your data to present clear, and understandable information PTS benchmarks provide context. To interpret performance metrics, it’s essential to have a point of comparison. PTS analytics allow you to compare to benchmarks and peers To meet goals, you need to move to action. Quantifying opportunities allows you to consider where to pursue the “biggest bang for the buck”. The bottom line is to achieve measureable results. PTS is part of a Success Plan that Health Systems can deploy SUCCESS PLAN: Enable our customers to reduce expenses, improve productivity, create capacity and then fill that new capacity with growth in demand or market share and then……..Do it all over again over and over. Start with benchmarking to know where you are Compare your performance with the best in your market Make improvements Figure out referral patterns and market share and increase top line revenue Extensive set of metrics at the specialty, practice, and physician FTE level providing deeper insights into drivers of performance and identifying more refined areas for opportunity and action  Recognizes each client’s unique structure to tailor data and recommendations to how executives and managers run their business
  27. Intake detailed data: Billing Data Can aggregate from multiple source systems Practice P&L Statements Compensation and Expense Provider FTE information Ensure accurate representation of true provider hours worked in the practice Carefully, hand match the data “Connect the dots” between physician productivity, compensation, and expense Allowing us to roll it up to a Practice including staff and overhead Conform the data to standard definitions and categorizations Drives precision into the benchmarks, increasing accuracy and reliability over self-reported data Accounts for differences in practice and system structures while enabling high “comparability”. “Apples to apples basis” Produce benchmarks and performance metrics across Productivity, Compensation and Expense A large array of metrics At system level By Specialty By Practice By Physician Deliver information in the most useful way for stakeholder BI Tool for interactive access to detailed data Tailored, customized reports aligned to system structure, business goals, or other needs
  28. We leverage benchmark comparisons to highlight opportunities CASE STUDY: NE Ohio Hospital with 15 Physician Practices Bottom Line Impact: Approx. $1.5M annual ongoing savings 47% reduction in total practice investment ROI in excess of 25:1 CS -PROCESS: Initially benchmarking our practice performance vs. the PTS comparative data set, and prioritizing opportunities for improvement Collaborative sessions between PTS, hospital admin., and providers allowed everyone to fully engage in the process. Physicians then took ownership of the plan, helping achieve significant progress toward performance improvement goals PTS providing reliable, accurate measurement and monitoring of progress over time CS -OUTCOMES: New performance targets for physicians and practices performing below median Increased Orthopedic Physicians surgeries and new patients Evaluated OB/GYN physicians, and determined need to reallocate time New provider scheduling protocols resulted in increasing number of new patients Developed a culture of partnerships with the physicians. “This element may have been the most beneficial.”
  29. We deliver not just analytics, but a collaborative roadmap so that you Understand where you are relative to other health systems Can have informed dialogue with physicians and staff Identify reachable targets Quantify the financial impact of those targets Track progress *QUOTE ________________________________________________ PTS Delivers a Workable, Collaborative Roadmap: Precise understanding of physician practice performance relative to benchmarks Informed, meaningful dialogue with practice leadership and physicians Identify reachable targets for improvement Quantify financial impact and prioritize opportunities Track progress and help with course correction PTS works with you to develop a customized roadmap that navigates a clear pathway to success for achieving your goals
  30. Go through some screenshots  You probably won’t be able to read everything, so I will give you an overview of information provided
  31. Export perform calculations  - Caugth an error on this slide since corrected from when sent this deck last week
  32. Does not pull in claims based data to look at referrals to other providers Hopitals don’t seem satisfied, assumptions and lag in the data Anyone use this? Can get that from CMS for government payors much cheaper