2. 2
Agenda
⢠Bio - Penn Krause, FACHE
⢠ROI from Hospital-Owned Physician Practices
⢠PTS Overview
Our Roadmap for ROI is your Pathway to Success
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Speaker Bio
Penn Krause, FACHE
CEO, PTS Physicians
⢠Executive roles - CHS
⢠CEO - Pittsburgh Mercy Health System (Top 100 Most-Wired)
⢠Transitioned to IT â 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
7. 7
Who Said This?
âDespite 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 highâ
ROI2
8. 8
Who Said This?
Dr. Jack Masur
Assistant Surgeon General and Chief
Bureau of Medical services
1955
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
âIn 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 revenueâ
- Bill Sonn, SE2
ROI2
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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
âMost practice costs went up after a hospital system purchased a physician
group or practiceâ
- Member poll by American College of Physician Executives
ROI2
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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
âThe vaunted downstream revenueâŚturned out to be a fictionâ
- Bill Sonn, SE2
â42% of hospitals donât track downstream revenue from their physicians.
Most reported that this data was difficult to obtain or not available.â
- Kentucky Hospital Association
⢠How is indirect revenue captured?
ROI2
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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
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Specialties with Best Downstream Revenue
⢠Hematology/Oncology
⢠Cardiology (Invasive)
⢠Cardiac/Thoracic Surgery
⢠General Surgery
⢠Neurosurgery
⢠Orthopedics
âThe 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.â
- Dean Dorton Allen Ford
ROI2
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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 â Average bonus of $213,000, penalty of $1.2 million
⢠200-Beds â 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
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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
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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
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Physician Compensation: Key Metrics
⢠67% RVU productivity model
⢠64% physician-based quality indicators
⢠36% hospital and health system goals
Dean Dorton Allen Ford
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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
Beckerâs Hospital Review
ROI2
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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
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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
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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
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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:
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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
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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
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Analytics you can trust.
⢠Precise Data
⢠Timely Information
⢠Trustworthy Analysis
Our Roadmap for ROI is your Pathway to Success
PTS OVERVIEW3
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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
âReliability is the number one thing PTS has
been able to deliver to us that none of the
other benchmarks can do.â
- Les Mitchell, Corporate Director of Physician Affiliations, Mercy Health
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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.
âThis element may have been the most beneficial.â
(client sponsor)
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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
âPTS improves our return on investment.â
- Thomas Stover, MD, CEO, Akron General
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Table of Contents
⢠PTS DataPath Screenshots
⢠PTS Patient Care OptimizerŽ Screenshots
Our Roadmap for ROI is your Pathway to Success
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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 practiceâs performance to one another (peer comparison) as well as to the
benchmark median.
Our Roadmap for ROI is your Pathway to Success
PTS DataPath1
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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
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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
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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
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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
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Overall Comparison to Benchmarks
An index is computed to be 100 at the
median. Your index is the average of your
practicesâ 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
⢠âPhysician Practice Overheadâ accounted for 48% of total expenses â what is included in this
item? What opportunities for office consolidation or more cost effective operations?
CPT Code Analysis
⢠The practice billed fewer 99214âs and more 99213âs 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
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PTS PATIENT CARE OPTIMIZERÂŽ
Our Roadmap for ROI is your Pathway to Success
2
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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).
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PCO Revenue Stream Tracking â 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.
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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.
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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 âFromâ and âToâ perspectives.
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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.
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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
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In Summary
⢠Committed Partner
⢠Experienced People
⢠Superior Solutions
Our Roadmap for ROI is your Pathway to Success
SUMMARY
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
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 â survey-based story âwe are differentâ
Donâtâ 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 canât answer, will get back to you
- Year long due diligence and setting up the strategic alliance-
- 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
Interesting to be reminded periodically that challenges have been around a while
I have followed ACHE a long time, and the list hasnât 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
In response to the CEO top concerns on finances, physicians, and reform came the strategy of hospital-owned physician practices
Bill Sonn quote in Beckerâs 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 donât seem to be much different that private practice often times
- These can have an immediate impact as value-based is being phased in
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 â often it is primary care which has adopted a walk-in clinic model
Anyone here have a profitable practice?
Opinion piece in Beckerâs Hospital Review (Bill Sonn)
In-depth research project on one hospital presented in Beckerâs 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
- There isnât a way to benchmark contribution margin because hospitals do it differently, but we are starting to work on it in our database
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
- 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
- $162,000 per hospital
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.
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
- The reason for not achieving targets was identified as lack of accountability and measuring the important drivers of under-performance
- Can technology help with improving financial performance, aside from the meaningful use incentives
- We are in the big data/analytics space, and this is what we hear from hospitals
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
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
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
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 arenât incentivized to upsell
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
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
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
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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.
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, itâs 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 âbiggest bang for the buckâ.
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 thenâŚâŚ..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 actionÂ
Recognizes each clientâs unique structure to tailor data and recommendations to how executives and managers run their business
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
âConnect the dotsâ 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 âcomparabilityâ. âApples to apples basisâ
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
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. âThis element may have been the most beneficial.â
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
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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
Go through some screenshotsÂ
You probably wonât be able to read everything, so I will give you an overview of information provided
Export perform calculationsÂ
- Caugth an error on this slide since corrected from when sent this deck last week
Does not pull in claims based data to look at referrals to other providers
Hopitals donât seem satisfied, assumptions and lag in the data
Anyone use this?
Can get that from CMS for government payors much cheaper