Patient care is at the heart of every urgent care clinic. For many owners, it’s the reason you established your business. But it is a business, and successful urgent cares are run like one. This can be a challenge, especially when you don’t have someone on staff who has the time and expertise to properly analyze data to inform sound business decisions.
If you’re already using data to inform all your business decisions, good for you. But if you want to dive deeper and use even more actionable data to improve your decisions and your performance, you already have the building blocks to move forward toward your goals. If you cringe at the word “data,” fear not. We are going to make it simple so you can start using your data to help you take the actions you need to get the results you want. We’ll discuss four pillars of data and how to use them to make informed decisions that support a thriving business. You should be able to measure these metrics using data from your EMR/PM.
Getting comfortable tracking these metrics is an excellent step in the right direction. However, the most successful urgent cares go a bit deeper into their data with a Business Intelligence (BI) tool that does more of the complex work of data analysis than standard reports. So we’ll also explain how that makes a difference in decision-making.
Chapter One
Before we dive into metrics and how to use them, it’s important to note a few things. First, if you haven’t already, you need to establish your high-level goals. As a business, what do you want to achieve? Do you want to open more clinics? Sell your practice? Be highly reputable? Knowing this will help clarify where you want to take action — and what additional reports/KPIs/data you want to track down the road.
Second, we recommend running your reports to measure these metrics at the end of every month — ideally after closing the books as part of a broader month-end financial process. Build reporting into your schedule in whatever way ensures you can consistently take the time to review your numbers.
Third, we chose these four areas for two reasons.
Chapter Two
Here are four actionable metrics that provide RCM and CFO-level insights that successful practices measure to make impactful decisions.
A high average door-to-door time can prevent you from seeing more patients in a day and impact your NPS — you’ll have better patient satisfaction when they spend minimal time waiting — both in the lobby and alone in an exam room. This is a highly actionable metric when you have room for efficiencies and training in your processes and workflows, and it has a direct impact on revenue potential.
What BI does: There are a number of processes that factor into door-to-door time, some of which are volume-driven and some that are not. A flat report from your EMR/PM does not provide visibility that can help you address the specific areas that slow you down. BI can isolate waiting room time and time spent with individual providers for separate clinics. If you see some locations have longer waiting room times than others, it’s likely a volume-driven issue that can be addressed with preregistration and other tools that help reduce the amount of time needed to get a patient to an exam room. If data shows that certain providers are keeping patients in the exam room a lot longer than others, that’s a good opportunity to meet with individuals and see if they’re struggling with documentation in the system, using their tools optimally, or need other behind-the-scenes help.
How long does it take to turn a charge into dollars for your clinic? DSO is your total outstanding A/R divided by your average daily charges. The fewer days an account sits in A/R, the faster you get paid. In urgent care, your DSO should average 30 days. If it’s higher than that, you know to focus on the things that factor into claims and collections, like processes and data entry.
What BI does: Overall DSO is a great start but addressing it can potentially lead you on a wild goose chase, especially if data entry is not the reason it’s high. BI layers the information by clinic, primary payer, and provider. Say Blue Cross pays on an average in 24 days, but you have a high payer mix of Medicaid, which pays in 60 days. In this case, seeing the payer breakdown tells you that 30 days would not be a realistic goal for you no matter how tight your processes are. If the provider level of data reveals that one in particular has a high DSO, that may tell you that you forgot to credential a provider to a payer. These are two things that might not be considered in an action plan that lacks BI visibility.
It’s easy to see a capture of all the gross charges for your clinic(s,) but just because you bill $300 for a visit doesn’t mean you’ll receive $300. You’re more likely to net around $100-$120 in urgent care for an average visit. You want to be able to see exactly what you’re collecting — not only so you can look for areas to improve but also to plan and budget more realistically than you can by just looking at gross charges.
What BI does: This is another metric with a lot of factors at play. BI breaks down high-level data with layers of information per visit, including payer, provider, and code. If you know the value of your E/Ms, and you see one provider is getting more revenue per visit by coding 3.8 while another provider is coding 3.2, there’s an opportunity to coach providers who under-code their visits. By comparing payer amounts, you can see how different companies value visit types — which gives you ammo when it comes time to renegotiate your rates. If one payer pays significantly less than the majority of other payers for the same visit type, you can present clear data showing what you should be getting for those visits.
This is your “work smarter not harder” metric. Claim Denial Rate is more than just a gauge of your denied claims. This gives you a better picture of how hard you’re working to collect money. If your rate is ten percent (which is well above industry), you’re working your tail off to get paid on one of every ten claims. Consider what things your staff is doing that’s not only creating a denial for payment, but churn, rework, and other excess energy to collect. You can expect that some claims simply will not get paid. So if you think about hourly rates for staff, and how many claims they work, you start to see how much you’re spending to not get paid.
What BI does: Using the example above, if you should be closer to five percent, why are you at ten? This is hard to determine from a static report from your system. With BI, you can build a visualization layer of all the reason codes, history, invoice numbers, etc. This makes it easy to identify the root cause(s) of a high denial rate so you can build an action plan without using multiple reports or hiring an analyst.
What’s made me happiest about working with Experity is, confidence. Confidence that I know what should be happening is happening. I know that the accuracy is there. I know that if something is not going right, someone is going to catch and fix it before it becomes a problem.
Chapter Three
We know how complicated and time-consuming reporting is, so we don’t want to overwhelm you. But since we’re talking about decision-making and actionable data in urgent care, we just want to mention a few others that can be immediately beneficial.
If patients aren’t happy with their experience, not only are they unlikely to return, but they may also leave a bad review. Online reviews influence your overall rating and reputation — which potential new patients see when they’re trying to find a clinic. If patients don’t want to come to your clinic, you won’t have a business to run.
What’s the overhead that is required to turn a claim into dollars? Whether you use internal resources (which could be a designated person or someone with split responsibilities like front desk and collections,) an RCM provider, or other third-party products, you want to know administratively what your costs are and how much you’re collecting.
This is a specific part of your overall overhead ratio, and it’s important to separate because it can help you determine cost-reduction strategies. Changes to this bucket have significantly different financial implications than other pieces of your overhead.
We mention POS because this one isn’t just about getting paid faster, but also patient satisfaction. If you develop the right script and training to collect at the time of visit, there are no surprises for the patient. Expecting to pay one amount and getting charged something higher is immensely dissatisfying. Additionally, patients don’t want to deal with a bill in the mail. It’s actually easier for them to either pay when they’re face-to-face with you, or set up a payment plan that lets them feel like their bill is manageable.
Chapter Four
We’ve acknowledged that reporting can feel overwhelming. Which is why we want to stress that business intelligence tools decrease the complexity of your data by telling you the real story of what’s happening at your clinic(s.) Your research is accelerated through visual cues that let you identify outliers faster, evaluate your live workflow, and create an action plan around it. Plus, you can easily save any view to keep coming back to the specific metrics you’re monitoring. Learn more about the difference between reporting and BI in this blog.
Another factor in a successful reporting process is whether your systems are integrated. Integrated systems provide a clearer, more complete idea of what is happening in your clinic. When your EMR/PM, Patient Engagement, BI, and other operational tools talk to each other, you can make better decisions for your business as a whole and pivot as needed.
Interested in learning more about how an EMR/PM that goes beyond standard reporting can help your practice improve business and patient outcomes? Experity’s EMR/PM includes a full menu of traditional, export-friendly reports, plus a robust business intelligence module built on Tableau and designed to help urgent care operators make data-driven decisions. Click here to request a demo.
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