Matt Gilchrist’s KPI for practice personnel

KPIs for Doctors

One of the large corporates refers to doctors, to their face, as IGUs or Income Generating Units. Needless to say, that company takes KPIs seriously and makes significant amounts of money doing that. My list of KPIs for doctors includes:

1. Number of results in inbox. This is the number of results that remain unchecked. I see many doctors who keep results in their inbox because they are waiting for more information, or are trying to decide how to manage the patient and their health. What keeping results or letters in the inbox achieves is that the rest of the practice does not know what is happening, and are unable to assist the patient.
2. Patient waiting time, in minutes. This is something that patients truly hate, but doctors generally do not understand. In practices there are usually some doctors who always run late and others who generally stick to their schedule. Those who frequently run late should review their scheduling, or the reasons it happens to them but not to others.
3. Starting time. A significant component of minimising waiting time is to start on time. If your first patient is at 8:00 am, then be at work with enough time to get a coffee, check your results and mail, and be seated at your desk ready to start at 8:00 am. If you cannot be ready to start by 8:00 am, schedule your first patient for 8:15 am instead.
4. Dollars per hour of patient appointment time. This is one of the financial KPIs that accountants love. It is a way of measuring efficiency, although it does not look at patient outcomes.
5. Dollars per day per room. Useful as a room utilisation and business performance measure.
6. Treatment room expenses per doctor. In a perfect accounting world, all use of the treatment room would be costed, including nurse time. In practice this is very hard to monitor and manage, but some practices do this to charge different associates different percentages.
7. Diversity of items billed. Compare what item numbers are billed with your colleagues. You may learn about an item number that you could be charging but did not know about.
8. Patient adverse outcomes. Patient outcomes are hard to track in an Australian setting, but collecting data about near misses or actual adverse outcomes is achievable and is a requirement of accreditation. Collating this by doctor is not a significant impost for most practices.

KPIs for Reception

1. Uncompleted appointments. Ensure that all appointments are marked as DNA or are completed, including billing. Your billing software can probably produce a report that details this information.
2. Scanning. Check both the quantity of items that have been scanned but not allocated to patients or doctors, and the amount of scanning left at end of day. Ideally, none. Also check that protocols have been followed, for example black and white at 150 DPI.
3. Online claiming batching and banking. Online claiming batches and all banking should be completed each day.
4. Patient contact details updated each visit. This is required for accreditation, but in my observation is often the thing that staff do not do. Determining whether it was completed can also be hard.
5. Number of billing errors. Billing errors often only become apparent after an issue has arisen. You can also check the number of reversed or amended invoices and payments via software reports on a regular basis.

KPIs for Administration and Management

1. Debtors. Check the status of held accounts and monitor ageing of debtors. Ensure all accounts get paid, especially WorkCover, solicitor and insurance company accounts.
2. Billing controls. Check billing reports for reversed accounts, cancelled payments and Medicare Patient Claiming. Administrators need to be sure that no one is rorting Medicare or stealing from their employer by cancelling payments and invoices and pocketing money received.
3. Cancelled appointments. Check cancellation of appointments and confirm with the patient that the appointment was actually cancelled if required.
4. DNAs. Count and chart DNAs. Regular Did Not Attend offenders should be marked as such in the software, with notes for reception staff to confirm on the day or plan to exit the patient if necessary.
5. Follow-up actions from inbox. This is recalls, and can be a significant medical risk if not managed properly. Sorting recalls is a whole-of-practice process, but someone needs to lead.
6. Unallocated results and incoming letters. Practices need a way to ensure that all incoming results and correspondence are seen by the appropriate person.
7. Online claiming batches requiring follow-up. Resubmissions need to be dealt with in a timely manner.

KPIs for Nurses

1. Recalls and reminders. Are these all up to date?
2. Care plans and health assessments completed. Set targets and compare numbers of care plans, reviews and health assessments completed. Targets will be different for each practice based on patient demographics.
3. GPMPs, TCAs and reviews. Compare counts of billed GPMPs versus billed TCAs, and compare the total of billed GPMP plus TCA against billed reviews. A review can occur for each of a TCA and GPMP.
4. CVC Program. Compare the number of DVA patients on CVC with those eligible. This program is relatively easy money.
5. PIP IHI CTG registration. Compare enrolments to eligible patients.
6. Item 10997 billed. Compare the number of Item 10997 services billed with targets set, and also with the number of patients with a care plan.
7. Infection rate. Track the number of infections per hundred or thousand procedures. If this is not very low, some audit of clinical processes should occur.