访问 is a strategic priority for medical group leaders, but they often lack the ability to measure their performance. Leaders juggle a variety of static reports about time to appointment or third next available, but this information is rarely actionable and often inaccurate.
Instead, access should be evaluated through the lens of supply and demand. 在这种情况下, demand represents unique patients seeking new patient appointments, and supply indicates the practice’s capacity to accommodate appointments within a patient’s desired time frame. By consistently evaluating a practice’s journey to equilibrium between supply and demand, 它可以实现更大的访问, 这就导致了增长, financial sustainability and patient satisfaction.
在这个供需方程中, 医疗集团对供应有更大的控制权, 根据提供商容量来衡量. 因此, practices should begin their access journey by properly assessing and evaluating their providers’ capacity to see patients. Outlined below are three key tactics for evaluating and improving capacity to drive an access strategy:
- 分析云顶集团40011官网的临床时间
- Examine the relationship between clinical time and productivity
- 优化关键容量驱动因素.
分析云顶集团40011官网的临床时间
Medical groups tend to focus on benchmarking provider compensation and productivity; however, it can be challenging to understand whether a provider is working to his or her full capacity. This is particularly relevant for specialists whose clinical work occurs in a variety of settings. Analyzing provider capacity is the crucial step to ensuring access is available. Prior to considering the recruitment of additional providers, assess whether supply can be increased using existing resources.
了解当前提供商的能力, compare each provider’s actual worked hours to contracted or expected number of hours using the following steps:
1. If not already written into provider contracts, set a standard expectation for the number of patient-facing hours a full-time clinical provider should work, 根据每个提供者的临床努力进行调整. 例如, your institution may determine that 32 hours per week is consistent with a full-time provider, allowing for one hour of administrative time per half-day block of patient-facing time. Establish a standard number of workweeks per year, 比如47, which allows for five weeks of time off annually.
These metrics enable you to calculate that a full-time clinical provider should be scheduled to work 1,504 hours per year (32 hours per week x 47 weeks per year). 同样,0.90 clinical FTEs (CFTEs) would be expected to work 1,354 hours per year (1,504 hours x 0.90立方英尺).
2. Quantify the actual hours worked by each provider. Depending on the specialty and type of work, the effort required to calculate this will vary. 包括在诊所的时间, 执行程序或手术, reading imaging studies and providing inpatient coverage. A primary care provider who works exclusively in a clinic setting would be straightforward to quantify, 如图1A所示. A procedural subspecialist who spends time at multiple clinical locations may be more complex to quantify, 如图1B所示. 在计算这些小时的时候, it is important to account for all actual hours worked, 而不是“计划好的”时间, which may be skewed by underutilization or inaccurate templates.
一旦计算出实际工作时间, compare it to the hours each provider is expected to work; this is referred to as a worked-to-expected (W:E) analysis. The W:E analysis serves as a quick guide for administrators to understand opportunity areas to improve capacity at the individual or programmatic level. It is also a useful tool in beginning discussions regarding provider time spent in clinical settings, 包括随时间变化的趋势. 例行地运行这些分析(例如.g., monthly or quarterly) to adjust for changes in capacity, demand or schedules.
Examine the relationship between clinical time and productivity
一旦W:E分析完成, 将其与提供者的生产力进行比较, 如图2所示.
Comparing an analysis of hours to an analysis of productivity (e.g., wRVUs as a percentage of industry median) can reveal opportunities to improve provider capacity, 因此, 病人的访问. In comparing these data points, one of four scenarios will emerge, as depicted in Figure 3:
- W:E和生产力的一致性: Often a provider’s productivity performance is related to the number of clinical hours he or she works, 如下所述.
- W:E hours are low and so is productivity (scenario 1):在这个场景中, a provider’s work hours should be increased to align with his or her CFTE, and the assumption is that productivity would also increase.
- W:E hours are high and so is productivity (scenario 2): This is likely the ideal scenario and may not involve any action; however, leadership and the provider should be aware of risk of burnout and proactively intervene as appropriate.
- W:E和生产力的错位: While it is reasonable to assume that a provider working sufficient clinical hours will have appropriately aligned productivity metrics, 情况并非总是如此, 如下所述.
- W:E hours are low but productivity is high (scenario 3): Providers in this situation may be highly efficient, or they may be performing more high-yield activities than their cohort, 内部或外部组织. Examine these providers in the context of their colleagues to understand whether any practice nuances account for this misalignment of work hours and productivity. 例如, a pulmonary provider who subspecializes in sleep medicine may require a modified productivity benchmark.
This scenario may call for realigning benchmarks or spreading work more evenly among members of the specialty. If a provider’s clinical hours are below the expected target, clinical time should be increased. 在大多数医疗团体中, high productivity should not give providers a free pass to work fewer hours than what they are contracted. - W:E hours are high but productivity is low (scenario 4): Examine in further detail how the provider’s clinical time is being spent, and ensure proper capture of clinical activities, 包括计费. 一些常见的不对齐区域包括:
- The provider is scheduled for clinic but blocks time as unavailable.
- There is low demand, and the provider has unfilled slots.
- The provider’s visit durations are too long for their complexity.
- The provider’s time is not being billed properly (e.g., undercoding, open charts, unbilled encounters).
- An aspect of the provider’s time is not being counted (e.g., imaging reads are performed but not billed).
- W:E hours are low but productivity is high (scenario 3): Providers in this situation may be highly efficient, or they may be performing more high-yield activities than their cohort, 内部或外部组织. Examine these providers in the context of their colleagues to understand whether any practice nuances account for this misalignment of work hours and productivity. 例如, a pulmonary provider who subspecializes in sleep medicine may require a modified productivity benchmark.
优化关键容量驱动
Even providers who are productive and working sufficient hours should focus on drivers that affect the practice’s overall access strategy. Key components that can help providers understand practice capacity and access include new patient ratio, 访问时长和转化率.
新增患者比例
Productivity and access metrics are not always in alignment, and sometimes highly productive providers may be spending time on activities that don’t support the practice’s access mission. 例如, a provider who prefers to obtain wRVUs by treating two established patients instead of one new patient in the same amount of time is not prioritizing access. Provider schedules should be designed with the proper new patient ratios in mind, with dedicated appointment times for new patients. The ratio of new to return visits will vary: surgical and procedural practices should see up to a 50% new patient ratio, 而医学实践将看到更少, and primary care will see closer to 10% to 20% to align with the longitudinal care they provide.
访问的长度
The duration of appointments also has a significant impact on access and provider productivity without affecting the hours a provider works. The average visit length will vary by specialty and the amount of support provided by nurses, residents or advanced practice providers working alongside the provider; however, decreasing visit times will have a direct and positive impact on access. 例如, if a provider typically schedules new patient visits for 60 minutes, reducing each visit to 40 minutes will allow for 50% more visits to be added.
转化率
除了新的病人比例, the ratio of new patients to key procedures or surgeries is an important access metric. 例如, heart surgeons who are expected to perform 200 open-heart surgeries per year will benefit from knowing their conversion rates between new patients and surgeries. If two new patients are seen in the clinic on average for every one surgery, this surgeon would need to provide timely access for at least 400 new patients per year to yield the desired surgical volume.
The duration of visit types is often a contested issue, but providers must understand that the duration is intended to be the average amount of time the provider needs to be present for the visit. Practices often make the mistake of including any pre- or post-work required for the patient’s appointment (e.g., 病史和体格, 结帐过程), but this reserves too much of the provider’s time and lowers capacity. Visit durations are often designed as a “worst-case scenario,” with providers and managers trying to account for the longest possible patient visit, 不是平均花费的时间.
增强改善获取的能力
Improving 病人的访问 is a financial, strategic and operational imperative. When considering access as a balance between supply and demand, medical groups can focus on what is most in their control: the supply, 或者提供商能力. Because providers are a medical group’s most valuable asset, 对他们时代的彻底分析, productivity and efficiency should be conducted routinely. 通过评估能力, managers are able to determine whether current provider time is being maximized. Only when it is optimized should additional providers be hired as a means of further expansion. 现在比以往任何时候都重要, practices must focus on their financial sustainability, and thoughtful management of 病人的访问 is a critical piece of this puzzle.
萨拉·特利, 工商管理硕士, 参谋长, Rush University Medical Center; Michelle Hirschman, 工商管理硕士, 云顶集团线路管理员, Rush University Medical Center; and 史蒂夫·麦克米伦, 尼古拉斯, 高级经理, 心电管理顾问
2020年9月1日发布