Top 10 Metrics You Should Track

 In chiropractic billing, chiropractic patient experience, chiropractic software, ICD-10 for Chiropractic
(Last Updated On: July 31, 2017)

metrics for chiropractorsWhat Metrics Should You Track in Your Practice?

Are metrics important to you?

Our clients have determined that these are the most important metrics to track in your practice: Collections, Patients Visits, Charges, New Patients, No Shows, No Future Appointments, Accounts Receivable, Unbilled Visits, Unsigned Notes and Claims needing to be corrected by the Practice. They’re related to each other and they affect each other.

How do you track them? Do you have a tool to monitor them with a simple glance at a chart? Do you have a radar chart or a histogram that you can understand with a quick look on the home screen?  The tools to track these metrics are built into our software and your Practice Success Coach will help you to understand the numbers and their relationships to the others. These Key Performance Indicators (KPIs) must be measured to know the health of your Practice. You’ll be able to see if you’re reaching your goals instantly because two time ranges compared show your improvements.

Learn more with the free webinar that can be viewed right on this page.

Read the transcript:

This week’s webinar, the topic for this week is How to Measure the Success of Your Practice. Really what to measure? What things as a practice owner should you be looking at? What things should you have in place as weekly, monthly, yearly things that should be measured and then managed?

So today is going to be which metrics you should look at, and we can talk about frequency, but that frequency is only recommended. You as a practice owner will be able to choose whatever frequency you’re looking at there. and we’ll actually get into how to find information within our system so practice owners can have this happen a little bit more easily should they be concerned about something, so the key indicators are going to be discussed today.

And aside from that though, we’re going to…well, first I’ll start by introducing myself. My name is Jason Barnes, I’m the Chief Operations Officer here, and I may have been sitting here for about six and a half now helping practice owners figure out what to measure, and how to measure it in their practices.

So what things should be measured, first of all? And why do you need to do it? And how it is going to begin? When you talk about the success of your practice, I have differing opinions from one practice owner to another. Some practice owners want to measure it on the amount of money that we’ve brought in. Others, the number of visits. Both of those numbers are very important, I would recommend that they both be looked at. But at the end of the day, you’re going to have to figure out which one is more important to you because there can be only one top number that will drive your practice and typically that number is dollars. A lot of practice owners prefer to look at visits but visits can be viewed in a number of different ways.

So looking at this moving forward, we’re gonna take it down to the ones that we talk about the most, the ones that we’re going to utilize while actually making recommendations to practice. Collections. Now, collections can be viewed in a couple of different ways. The amount of money in your bank account, the amount of money posted in your system. If they’re the same amount of money, you’re doing really well, but if they’re not the same amount of money you’ve got a problem, and we need to figure out why there could be an issue there.

But where do collections come from? And if they’re low, what can be done about them? So the first thing to show you is a diagram. You have a practice here…and I’ll make this slightly larger. You have a practice here with three different numbers on it, right? The blue line is their total collected, their green line is their cash collected, and their red line is their insurance collected. As trends would go, it looks like they’re trending down as they went in from the end of the year to the beginning of this year. It’s pretty typical for the end of the year where you’re having less [ inaudible 00:03:16] visits due to the holidays than in the beginning of the year where you see deductibles kick in.

However, if you were to contrast that over patient visits, this is the same exact timeframe right now, you would know that visits dictate your collections. But there’s a big trend of going down from 2,088 ending at a much, much lower number here in the 1,400 range. So for this particular example, I brought up and put together a few diagrams. If you’re looking to increase collections, if the collections are indicating that they’re going down, there are a few obvious places to look, like going to visits. You would have to increase patient visits or you would have to fight underpayments.

So if your visits weren’t going down, it means that the amount of money you were getting paid was going down. So there’s really only two ways that you could look at the metric of collections, two possible things that could be bringing it down. Either my visits went down or the amount I’m getting paid per visit went down. Either way, you have to know what to do next and which metric to look at next. So visits are fairly easy. You know, if you check somebody in, that’s a visit, and underpayment is a much more challenging thing. And I’d like for you guys to see a separate webinar we did on fighting underpayments and you can find it in any of our websites to go over how we do that.

But then what? What is it that you’re gonna change? How is it you’re gonna manage your practice if you have a metrics issue like low collections? So if you analyze that your visits have gone down, what is it that you do next? Am I not getting patient referrals? Am I not rescheduling no-shows? Am I allowing people to leave here without resigns or a future appointment set up? There’s got to be something that I can do next.

So we put this diagram together with most of our practice owners. These are the next logical steps: remind my patients, get new patients, make sure that I’m retaining the patients that I have. If I have underpayments, well, you have to have tools to fight this. And we do provide those tools and we can go over those tools in great length and detail other places, but these are the next steps. And these are fairly large and I wanna use this as an example right now because increasing patient visits sounds easy enough. Any practice owner listening to this, that’s the hard thing to do in business. The hardest thing to do in business is increase patient visits.

So what we’ll focus on is we don’t know how to coach you to go out and get new patients. We do however have tools to help you to track and retain your current ones. And we’re well equipped to help you fight underpayments, all right? And the getting every single claim paid, making sure you have good follow-up procedures in place, those are the things that we can help you with as well, but increasing charges for visits is another quadrant that we would struggle as an organization to help you with. Making sure that you’re billing out every line item, making sure that, you know, you’re billing the right level of code or the number of units per code.

These are things that you’re gonna have to look at in depth to make sure that the metric of collections is correct. Did your payer mix change? Did he at one point…with this example that we had right here where we brought up the total billed, and the insurance collected and cash collected. If we bring out insurance collected and then we bring it down and select our cash collected, the cash for this particular practice far, far outweighs your insurance collections. So if you’re seeing a dip in insurance patients, it really won’t make that big of a difference. If you’re seeing a dip in cash patients for this particular practice, you’re gonna have a major fall.

So the first one that we’re looking at, and this white paper is available on any one of our websites, you can go check it out, is collections and payments. The second one is charges. Charges sometimes are thought to be right in line with visits. If I had all the visits, I’m doing fine. But if you’re a heavy insurance shop and all of a sudden the particular CPT codes start getting covered you’re in a world hurt, you’re seeing a big reduction. If you start seeing all of a sudden a big increase in the number of Medicare patients that you’re seeing, and they’re only gonna pay certain codes, you’re gonna see charges drop like a stone. This is a big picture metric.

Moving down to patient visits, patient visits are a lot trickier than any other ones that we’ve seen up to this point because now you’re dealing with relationships. You have somebody that comes and agrees to see you and you have the visit scheduled for them. There’s only one or two things that happen, right? They showed up or they didn’t show up. If they showed up, did you make sure they had another visit set up? And if they didn’t show up, what is the mechanism of tracking them and making sure that you’re gonna follow up? How did you ensure that they’re going to get there?

So we look at different metrics as operational versus performance metrics. We have to be able in practice to say our performance metrics are our charges, collections, patient visits. Our operational metrics are many, but the operational metrics such as making sure that all the reminders went out lead to all of your financial or your big picture metrics. If you don’t have a good method or a process in place to support your operational metrics, your big picture or financial metrics never reach the potential that you’re looking for.

That being the case, there are additional metrics that you can take into consideration and we’ll keep going over those now. New patients. I was recently at a conference where I got up and they applauded that somebody was able to average 50 new patients a month for an entire year. It’s quite the accomplishment but a lot of the people who were attending the conference found it to be lackluster in comparison to their own numbers of 10 to 15 patients a month. Why on earth would that comparison exist? If you’re comparing 50 new patients verses 10 to 15, it’s a huge difference. However, the practice that’s seeing 10 to 15 new patients a month and retaining 100% of them versus somebody who’s getting 50 new patients a month and is onlyretaining 10% of them, you know which practice you’d rather be.

Focusing on patient retention has to be just as important as getting new patients through the door. So these particular metrics I bolded because they’re going to make up your big picture [inaudible 00:10:34]. You have to know how these affect your financials. So new patients are only great if you keep them.

No shows. The bottom line is that when you have a no show, you don’t just lose the money that you’re going to get from that visit. No shows must be tracked fiercely, they must be tracked every single month. And if you have a downward trend, then you have to make a decision as the practice owner, what am I going to do to reverse that? If somebody’s not showing up there is either a real conflict that existed or they didn’t find the value in the service that you provide. The assumption that has to be made by any reasonable practice owner is that in the absence of any other real tragedy that is keeping somebody from getting there, that there’s a value question. This value question can’t be ignored and we have to make sure that they’re reminded of it, and we have tools to help one do that. But how are you gonna do this? We’ll go over that in just one moment.

Accounts receivable. We’ll go back to our system here. So if you’re gonna look at accounts receivable, and I’ll underline it here, we have a couple of different ways of using this dashboard up here to help you keep your finger on the pulse of the financial performance of your practice. First, looking at the amount of dollars that you’ve collected month to date is helpful, but this next number of $15,000 is the amount of charges in total that are outstanding. That is your account receivable for this practice, it’s $15,000. But we wanna make sure that that $15,000 gets collected as quickly as humanly possible. Here, you’re gonna see there’s a $5,000 amount that’s sitting out there beyond 30 days waiting in age, $1,700 waiting beyond 50 days, and only $378 dollars waiting beyond 120 days.

Amounts in accounts receivable over 120 days is the indication of a poor performing practice. I will say that again. If this number is high, it means that your practice is performing poorly. How poorly you ask? We measure that in percentages. Here, this $378 only indicates that it’s 3% of the total outstanding receivables. According to national averages, that’s actually very good. If you’re in the double digits, even 10%, you’re still performing well above the national average of 18%. But if you get any higher than that, you’re risking a lot of money.

What causes things to not get paid for four months? I suspect for a myriad of reasons that we can go into. But if you’re not paying attention to this, it means that there are dollars that are going to become less and less likely that you’ll be able to collect because the longer you wait, the harder it to collect if we don’t get a process change. And it doesn’t matter if you’re doing the billing, follow-up, and the posting in your shop or whether or not we’re actually handling it on the back end in our shop, this number needs to be paid attention to by all practice owners.

Unbilled visits. In this particular case, I’ll bring up for an additional report here and send this out. We put this under compliance. Unbilled visits for a practice. Well, in this particular case I’ll head over to my demo provider. It’s going to give you a breakdown of unbilled visits in buckets, your 30-day bucket, your 30 to 60-day bucket, and different buckets, and it will kind of give you your total. If you have any unbilled visits, this represents three different types of problems that you can run into. Number one is a compliance problem. You have to bill out every visit for insurance, and you have to sign off on every note. Typically, an unbilled visit also represents an unsigned note but it doesn’t happen necessarily.

The second could be also a compliance problem because if you have a co-payment that you needed to take from a patient, you have to know what is that co-payment is. If you’re out of network, you’re gonna have co-insurance associated with you if your out of network and have to know what to be able to charge the patients.

In this particular case, the third thing is a care plan. I don’t care if it’s insurance or a cash portion of your care plan. If you’re not billing out in real time, you’re not gonna be able to adequately give a patient a snapshot of what it is that they owe and what their future commitment is. We need to make sure that these unbilled visits stay in check so that your practice is able to have conversations with patients and stay compliant all at the same time.

Then moving on to unsigned notes, this is solely a compliance problem. The way it can keep you from getting paid is if you have any personal injury or if anyone ever requests notes and you’re not able to produce them, you’re not going to get paid on those visits. But if the law states this, we’ll see that you’re gonna have to sign off in your note at some point and make sure that you’re going to reduce your exposure to any sort of audit. And if you were to receive one, you go and pass it with flying colors.

The last metric is claims that needs something done on them. How does one identify when a claim needs something done? If you’re using our system or not using our system, that can be a big difference. Within our system, we’re going to automatically identify those claims. When a claim is submitted there are only three things that could possibly happen to it. First is it gets paid. Second is it gets rejected, and in that case, we have to know which claims need to have something done on them. And then third is that claim can have no response whatsoever on it, no one got back to you.

So in those instances, both the second and third option, we have to be able to identify where a claim is gonna go. And in our case, those claims are gonna go to workbenches. The workbench that it goes to is gonna identify the problem or the reason why a claim is identified and it will stay there indefinitely until a proper action is taken on it to get it through a paid state. If it doesn’t get to a paid state, the only other way to get rid of the claim is to write it off. So those are the only two options that anyone will have in order to stop a claim from appearing on a workbench.

So in this particular list of 10 things that you have to go over in a monthly health check, knowing how to count them is also super important. Collections and payments can be run a number of different ways. How is it you wanna look at it? If you wanna look at it based on how much you collected in a month versus how much did I collect per dates of service in a month, you’re going to have to run two separate reports in our system. Those are two different numbers.

And to demonstrate and run a report based on data service, and we’ll simply do this by payer. This is our billing statistics report. You go to the reports menu, choose billing analytics, and then choose the billing statistics and it gives you a number of options for you to choose, and I’m gonna choose primary insurance only in this particular case, but here you’re gonna look at a date range of January 1st through January 31st. And if you run this date range, you’ll see very different results than what you collected for that particular month.

So I’m right in this date range right now. You’ll see that there were $160,000 billed out, and only $66,000 actually collected so far, leaving a balance of $8,300. If you were to run the report based on what was actually collected this month, you’ll see a very, very different number because these particular dates of service for the month of January are only associated with services rendered within that date range. So you have to be very specific with how you wanna look at the collections that you’re looking for. If you want every single date of service to get paid, but you wanna make sure that you’re collecting enough in any given month to cover your overhead as well.

The next one, I won’t go over all of them today, is your charges. You’re gonna use the same exact reports. Your billing statistical report will tell you the total billed charges of $160,000 dollars were billed out for that month. You can see charges based on clinician, location, payer, and in this particular case, this is a big private pay practice. So you’re able to see that $135,000 was billed out for that particular practice.

Patient visits. There are two ways of measuring patient visits as well, and I keep talking to practice owners about the differences here. They’ll tell me they had 2,000 visits and I’ll tell them, “Nope, you had 1,671.” The difference between your billed out visits and your check-in visits are your unbilled visits. You have to be able to make sure that you’re looking at the right number, and you will never get patient balances correct if you’re not going to bill out all of your visits.

And one that I’ll leave you with, and we’ll conclude this particular one before we go into a few other reports that are unrelated to a metric but more to support new patients This is an argument that seems as old as I’ve been here, “How do you account new patients?” Is it when a patient account is created? Is it when a first visit is put on there? Or is it when the first visit is billed out? There are three different schools on this. The best practice and recommended practice for everyone that we talk to is don’t count a new patient until you’ve billed them out.

Just going through a screening and creating a patient account didn’t create a patient for life. Putting somebody on the schedule who called in, doesn’t make them a patient yet. They’re a patient when they come in and you first treat them. We even have some practices that take it a little bit further and don’t call a new patient a new patient until they actually have them on a care plan. So it’s up to you how you wanna do this, but there are three different reports to come up with those numbers. So the report that we’re gonna recommend is always going to be your billing statistics report for new patients, but we have a lot of other ways to go and actually look at these.

So if you head over to patients, you’ll see a new patients report. This new patient report will bring up all of those people who had a patient account created in the system. It does not mean that they had a first visit.

The other way of doing this is to go over to reports, patients or even scheduling, and go to your appointment detail. A lot of people have day ones listed in there. And for a timeframe, you can choose the appointment detail type or they appointment type that you put in there and account your number of day ones. So we’ll do that, fill on this for a timeframe, search it out. We have 107 total appointments here. You can filter or sort anyway you want to. And this is our demo account so you’ll see adjustments, re-exams, X-rays. For this particular case, I’ll just count re-exams.

I can see that I had 14 re-exams in this particular month. This is just another way of actually counting visits, but it’s never black and white. For all those people listening, you can’t assume that your practice metrics are black and white because they mean something to every one else, a little bit different than they do to you. So if you get off of a phone call with a colleague who’s saying that they have 50 new patients a month, I would always ask them a follow up question, “Well, how many of them did you see?” And if that number is 15, you’re doing okay.

So you have to account things the right way, the metrics that you need to pay attention to on a regular basis are clear. You can pay attention to a lot of other metrics, but without these, I don’t see any practices that get to flourish.

And so I’ll open it up right now for any questions. Anybody who emailed us, we will email them three things. We will send them the metrics paper that we wrote, we’ll send them the operational versus performance metrics, and we’ll send them our MHDE book which goes over each metric and how you can plan for success for them. So if you have any questions, please type them in and if a minute or two goes by and there are no additional questions, what we’ll do is we’ll open it up for any other questions that we could possibly answer on today’s call.

And I recommend that when you do have a monthly health check and especially with patient retention, if you’re having any issues, we’ve got 14 options that we can offer with how to address patient attention from different reminder services, to notifications, to sending notes, letters, emails, text messages, after-the-fact identifying patients, emailing them reminders of the exercises that they need to be doing, you know, for home, their goals. So for patient retention in a big way, make sure you reach out to us if you’re having a problem with that key performance indicator.

So remember, these key performance indicators, these metrics that we’re talking about are supposed to either make you feel really good about the things that you’re doing in your practice right now, or they’re supposed to move you to action. And if you don’t know what that next action is, that’s the biggest problem. Just having a metric is not enough. So if you don’t have a clear idea of what to do with a metric you don’t like going in the right direction, talk to us about it. Get us involved we’d be absolutely thrilled to help you out, especially in areas with the big picture financial ones.

One thing we’re really not able to help anybody do is figure out how to talk to a patient or go get new patients, that’s not part of our expertise. But tracking, making sure we know when we cite our arms-length plan patients is something [inaudible 00:26:28]. All right, if there are no other questions, I will hang out for another minute and then we’ll end for this week.

All right, thanks everybody. Have a great rest of your week.

Read how Genesis Chiropractic Software helps you track your metrics.

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