Healthcare Issues & Trends

Advice & Insights for Healthcare's Leaders & HR Professionals

Staffing Ratio: Clinical Support Staff & Provider FTE Outside the 25th-75th Percentile

Posted on August 22, 2014 by INTEGRATED

What is impacting your clinical staffing ratios? Are those impacts within benchmark range? 

Many physician practices do not take the time nor make the effort to "right-size" their clinical support staff in the face of either external or internal changes in the practice. Recently-trained physicians joining the private practice may feel the need for the level or type of clinical support staff they had in their training program. The costs of that support, however, may not have been justified by the activity level or revenue received per visit. Additionally, senior physicians in practice may not feel comfortable in the office without their regular nurse, despite spending little time in an office setting.

Conversely, the lack of a balanced clinical support staff can lead to poor patient service and inhibit patients from accessing proper care. The key in both cases is to revisit the rationale for the type of clinical support staff to ensure both financial and clinical issues are considered and that any "right-sizing" takes place in a thoughtful manner.

Recently, INTEGRATED performed an Operations Assessment for a client that revealed their overall nursing support staff to be at or above the benchmark media. Their staff, however, felt overwhelmed by the workload and couldn't keep the pace with the increasing demand from patients along with returning phone calls. Their preferred solution was to hire an additional staff member to take care of the additional workload. INTEGRATED was able to identify process changes that led to more efficient use of the nursing staff's time. The practice's physicians and staff supported the changes and the organization was successful in avoiding the added cost of hiring. 

At INTEGRATED Healthcare Strategies, we have a team dedicated to Physician Practice Operations. Their entire focus is on measuring, benchmarking, and improving operational performance. If your practice struggles with optimizing operations with the right staff, invite one of our senior consultants to give you a call--no obligation. They're well-equipped to spend time assessing the situation and give you their initial impression. 

Benchmarking Without Benchmarks?

Posted on July 28, 2014 by INTEGRATED

“We are unique, so finding a benchmark for us is impossible!” If you’ve heard this once, you probably have heard it a thousand times! Even worse, if you’ve said this once, it was probably one too many times!

In the healthcare industry, the concept of individualized patient care is natural. But that doesn’t mean we don’t do diagnostic tests and compare the results to what is considered “normal” ranges for similar patients? Healthcare providers benchmark patient care all of the time – yet still create an individualized care plan for each patient’s specific needs. Why would we approach the health of the practice any differently?

It isn’t uncommon that we encounter a client program where benchmark data truly doesn’t exist. In these cases we don’t stop trying to help the client improve. After all, we know what “better” looks like without a benchmark. So, driving improvements in the absence of benchmark data, starts with an assessment of the “current state” of the program with common metrics. The next step is to envision what the “future state” will look like, quantified in terms of those metrics and allowing for the gaps to be identified. Then, through rapid cycle improvements targeted at those gaps, we make changes and re-measure to determine impact.

The concept isn’t new. It is the scientific method, the same methodology that drives medical advancements.

We have often seen a practice with performance that benchmarks well ahead of its peers, sustain a false sense of accomplishment, resulting in performance below potential. Conversely, we have seen practices with performance well below benchmark, lose enthusiasm for improvement because they see how far they are behind, how far they have to go. So even when benchmark data is available, measuring impact of change relative to previous performance will never lead you astray in your quest for optimizing your practice’s potential.

Benchmarking with out benchmarks? Sure! You should do it all the time!

Increasing Organizational Risks | The Challenges and Opportunities for Hospitals and Physicians to Embrace

Posted on July 8, 2014 by INTEGRATED

In today’s healthcare environment, two things are driving an increase in organizational risks: a reduction in payments and a transition to a value-driven system. The real challenge today is how to best move forward.


Accountable Care Organizations (ACOs), provider organizations that assume some financial responsibility for maintaining the health of a population, present an important challenge. The most widely used ACO is Medicare, which has a financial arrangement for sharing risks and rewards.

Recent medical school graduates with large amounts of debt also present a challenge associated with an increase in risk. Many are not willing to accept risk themselves, but are willing to work for an organization that will assume and help mitigate risk. 


Undoubtedly, each organization and market poses different opportunities and challenges associated with managing the declining reimbursement and increasing risk paradigm. It’s important, however, to take a step back and envision the desired state of the organization or market in five to ten years, realistically think about the external world’s impact, and confront the facts internally. Some recommended internal steps include:

  • Performance improvement
  • Lead with quality
  • Physician extenders

Watch the three-part video series, “Raising the Bar,” featuring Don Seymour and Dr. William Jessee, to further learn how to thrive in today’s evolving healthcare environment. 

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Work RVU Production below the 25th Percentile – Work Harder!?

Posted on June 30, 2014 by INTEGRATED

The internal medicine department of a hospital-owned multi-specialty group was due to have their contracts renewed. In keeping with their corporate physician compensation plan, the Physician Practice Executive Council commissioned a Fair Market Value analysis, which included a review of historical compensation and production. As a group, the five internists’ compensation and production levels hover at the median, per FTE. However, individual review shows there to be a significant deviation among the providers. At the low end, Dr. Lowe’s compensation and production levels fell below the 25th percentile.

An E&M coding analysis for Dr. Lowe led to the discovery that her coding practices varied greatly from the national coding practices of her peers. Theoretically, Dr. Lowe would not have to increase patient volumes in order to be more productive. If her work effort is documented to support the coding pattern of her peers, by accurately coding her work she would experience a 57% increase in productivity!

The same analysis was completed for the other internists. Only one of the physicians was found to have a coding pattern that resembled that of the national benchmark. The other three also showed potential for increased productivity between 18%-23%. For this small group of five internists, the total revenue opportunity that was identified exceeded $250,000.

The total Work RVU Production of a provider or group of providers is an indicator of their operational effectiveness. Groups of providers averaged together may hide the lower performance of individual providers, so it is important to fully understand the data on an individual provider basis. When normalized for a 1.0 FTE effort, individual providers whose performance is below the 25th percentile should have a clear understanding of what is impacting this performance. A review of the provider’s E&M Coding pattern as compared to CMS benchmark data may reveal helpful insight.

If your practice struggles with physician productivity below the 25th percentile, the answer may not be to get them to work HARDER, they may need to work SMARTER. INTEGRATED Healthcare Strategies not only has the expertise to help identify if working SMARTER is the right strategy, we offer solutions to help build systems and processes that educate and support them working smarter.

A Decrease in Healthcare Payments Brings Challenges and Opportunities for Healthcare Providers

Posted on June 24, 2014 by INTEGRATED

A volume to value transition has begun as hospitals and physicians face decreasing healthcare payments. As a result, they will begin to receive less pay per increment of service, which leads to the potential to force some out of the market. On the upside, payment deduction compels quality to move to the forefront. However, quality-focused healthcare produces some major challenges for a value-based system.


With this shift from volume to value, a traditional acute-care fee-per-service system will be the primary model. This will lead to certain challenges:

• More performance-based fee-per-service contracts

• Pressure to keep costs down

• Hurdles to get performance bonuses

• Difficult transition time


The key to undertaking these challenges is chronic disease management. In fact, 75-80% of healthcare costs are related to one of six chronic diseases—diabetes, congestive heart failure, coronary heart disease, asthma, depression and obesity. Acute care providers, such as hospitals and physicians, weren’t trained to address wellness and prevention health management issues that chronic disease patients need. Thus, public policy shifts must follow in order to address the needs of chronic patients and payment support.

An additional opportunity is technology. In order to successfully manage the health of the population, a good information system is vital to tracking patients over time. Some examples include:

• Information technology: provides electronic health records for providers and consumers; helps consumers to become better educated

• Clinical technology: inventing new tools to enhance patient care

• Telemedicine: changes venue from bricks and mortar to digital

• Big data: has the capability to make improve diagnostics and treatment

Watch the three-part video series, “Raising the Bar,” featuring Don Seymour and Dr. William Jessee, to further learn how to thrive in today’s evolving healthcare environment:

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