Healthcare KPIs and how and what a mid-size medical clinic should track can be a mystery. National organizations, such as the Medical Group Management Association (MGMA), are dedicated to the analytics questions that administrators have. Numerous consultants, software vendors, and online resources can be purchased, each touting access to comparative metrics or assistance with applying metrics to your business scenario. But in the end, the question remains: which KPIs are important to your medical clinic, and how can you use the data in a meaningful way that reduces expenses, increases quality, and improves profitability?
KPIs will generally monitor, track and compare volume, revenue, labor, productivity, and expenses across the business. For medical billing services, the key performance indicators are directly related to each of these: 
- Volume: How are the clinic support staff and providers performing? Is there an adequate volume of patients? Is there adequate ability to service the patient’s needs? Are operations appropriately scaled to handle the volume without bottlenecks?
- Revenue: Is cash flow sufficient to run monthly business expenses? Can the practice plan for surges and declines from provider vacations, seasonal healthcare changes, or a period of heavy infrastructure or staff investment?
- Labor Expense: What is the staff ratio per provider on payroll, and how does this compare to other operations? Is the clinic able to retain staff, or is there fierce competition for quality staff?
- Payer Mix: What are the reimbursement levels for services, and is the profitability understood across the various payers? Is the clinic in-network for all major payers and able to accept patients from a broad range?
- Productivity: Are internal staff performing? Is there quality management holding staff accountable to day-to-day outcomes, or do a few carry the load? What are the quality and training metrics and goals for employees?
Optimally, medical clinics access comparative metrics to see where they fall in the spectrum, however, being high on the indicators but failing financially cheapens the value. The right mix of KPIs that truly matter to the clinic’s market segment and specialty are what is important. Outsource Receivables believes the key performance indicators for revenue cycle management are:
- Having access to financial benchmarks from local, regional, and national organizations like the Medical Group Management Association (MGMA)
- What are the metrics around rejections and denied claims, and do your analytics help you improve in these areas?
- What are the accounts receivables dynamic for collecting from patients, and are you being successful?
- Are your staff workflows and software efficient, or are they struggling with productivity and losing revenue for the practice due to inadequate and timely tracking of claims processing?
Some of these areas may have been considered optional just a few years ago, but with the massive changes from the Covid-19 pandemic, administrators now have staff working from home, and the challenge of measuring staff performance is more complex than stopping by their desks. Healthcare providers that traditionally relied on in-person interaction with staff must use remote technology and systems. This does not end with staff. Patients also need the same tools and conveniences online technologies offer for scheduling, payments, and clinic contacts. Will you know if your patient is not pleased with the service before or after the review on google?
Administrators need quick and uncomplicated access to metrics to see how their customer service performs on calls, how their billing department manages accounts receivables, and whether patients are paying online or still mailing checks. Moreover, they need this data to tell them which strategy and changes are working so they can focus their efforts. By comparing data to industry KPIs, clinic leaders can determine which services and areas of the clinic drive revenue and which services offer opportunities for performance enhancement.
Relevant KPIs will increase the visibility of gaps for managers, create employee buy-in, and help narrow down areas that need improvement. Most importantly, good KPIs will help prioritize and drive the decision-making process and evaluate progress when it occurs. This data must be timely, easy to access, and trustworthy for busy clinic administrators. Moreover, data cannot require hours and hours of work to compile, so software needs to assist in this process. Relative comparative data is available to set goals and drive strategy. The MGMA DataDive Survey is one tool that collects and distributes relevant medical practice data. MGMA collaborates with healthcare professionals through surveys in Operations, Profitability, Productivity, and Value.
Outsource Receivables is a full-service medical billing company that tracks and manages client financial data. ORI uses daily, weekly and monthly benchmarks to track staff and clinic performance across various areas. ORI also provides feedback on rejections and denials through a process called Exceptions Management. The Exceptions educate the clinic on specific claim examples of clinic processes that produced claim denials and provide aggregate data to help focus efforts on which area costs the most in revenue delay or revenue loss for the practice. Contact ORI to learn more about the proprietary processes that can contribute meaningful KPIs to your clinic operations.