Intent to break the law is not required for a [Stark law] violation, & the law pertains only to physician referrals under Medicare.
“Culture trumps strategy,” Mr. Dahl said. “If you don’t get together and agree, you’ll lose your strategy because your culture does not support it.”
Analyze Your Practice’s Habits & Financials
Real-time analytics—using data collected in an ongoing fashion to make improvements or changes—is an important tool to use when analyzing your practice’s habits and how they fit into your plan.
The analytics of your rheumatology practice are more than just financial numbers, Mr. Dahl said. Consider the time spent with patients, the percentage of cancellations recovered, your number of no-shows. These data are indispensable and will assist you in making smart business decisions.
“If you don’t measure it, you can’t change it,” Mr. Dahl said. “If you don’t value it, you won’t change it.”
An important metric is takt time—a way of measuring the maximum acceptable time to meet a customer’s needs. In a medical practice, it’s used to measure such factors as the amount of time in the day allotted for each patient, after all else is accounted for, including lunch and other breaks.
Cycle time is another important metric. It’s the total time a patient spends in the office—perhaps from door to door, perhaps from sign-in to check-out, but a practice has to measure it consistently in all clinics, Mr. Dahl stressed. Determining your cycle time could be as simple as tracking each patient at the top of each hour for a week—if you see patients for three hours in the morning and three in the afternoon, you’ve got data on 30 patients. That’s enough to start to evaluate what’s happening.
Tracking these kinds of data doesn’t require attending advanced courses or statistical expertise, Mr. Dahl said—just reviewing the information with an eye on trends and a certain amount of intuition.
A practice should also know how much it costs to provide a service.
“If you don’t know how much it costs you to provide a service how do you know that a managed care contract is [appropriate]?” Mr. Dahl asked. How do you know that you will be adequately compensated under a capitated, episodic or bundled agreement?
Practices can get a sense of changes that need to be made by defining cost categories, Mr. Dahl said. Determine your practice’s fixed costs, which are the same no matter your patient volume; variable costs, which change with volume; direct costs, which are specific to the patient care mission; and indirect costs, which support related activities.
He suggested keeping a score card, with four categories to evaluate performance. The financial category includes such items as net profit, cost of goods and operating expenses. The customer category includes visits, new and return patients. Internal operations includes such items as productivity and cycle time. And the learning and growth category includes an employee satisfaction index, internal promotions and education level.
Make sure sample data are representative of the population. Mr. Dahl also said practices need to ask: “Are there any outliers in [the] data distribution? How do they affect the results? What assumptions are behind [the] analysis?”