Key performance indicators (KPIs) measure the success and solvency of an organization. As a healthcare business, you should know what KPIs to watch in your urgent care as a baseline of financial and operational well-being.
Similar to a patient exam, KPIs are the vital signs of your clinic, and tell the story of your clinic’s financial health. Poor KPIs serve as warning signs of business issues that need to be addressed. With this data, owners are empowered to make wiser decisions regarding staffing, services offered, and process improvements.
Here are some of the most important KPIs to watch in your urgent care center.
1. Average Revenue Per Visit
What it is and why it’s important: The average revenue per visit is the total amount received per visit from both the patient and the payer. Average revenue shows actual payments received per visit. It also helps determine projected cash amounts.
What can affect it: This number can be difficult to calculate accurately because it needs to be averaged over a set period of time, usually six months to one year (rolling average). Incomplete visits in A/R should be removed from this metric, along with bad debt write-offs.
Occupational medicine and workers’ compensation visits should be segmented and averaged on their own, to avoid skewing the average revenue per visit for general urgent care visits. Variety of payer types and contracted rates affect this number.
How to calculate it: Total payments collected – total reversals/total visits
(Should be calculated over a set period of time.)
2. E/M Code Distribution
What it is and why it’s important: E/M code distribution shows the use of code levels by staff and is an important KPI to watch in your urgent care. E/M code selection directly affects reimbursement amounts based on chosen code level. Code levels 1 through 5 tell payers the level of visit complexity and charges rendered.
What can affect it: Documentation supports E/M code selection, so it’s essential for providers to enter all correct information for the appropriate code selection. Upcoding and under-coding can explain unnatural variations in E/M codes, leading to wider clinic revenue fluctuations. Chart audits (on a per provider basis) can pinpoint coding and documentation performance needs.
The percentage of new versus established patient visits should be evaluated when reviewing E/M code distribution, as reimbursement per visit varies per patient type. Established patients traditionally have a higher code level, due to past documentation records.
How to calculate it: Each E/M code level/total visits with an E/M code
(Separate new and established visit types to create two E/M code distribution charts. A weighted average of E/M code level can help you determine if your levels are trending in a certain direction over time for new and established visits.)
3. Ancillary Revenue Per Visit
What it is and why it’s important: Ancillary revenue per visit is how much revenue you receive per visit for procedures and services. Urgent cares often have a contracted amount for an office visit E/M code with payers—so ancillaries are in addition to that amount. Ancillary charges can be labs, injections, x-rays, or medical equipment.
What can affect it: Not properly documenting procedures causes an industry average loss of $25 per visit. Providers can forget to include procedure documentation and codes when tied to an ancillary service (such as a rapid strep test + the charge for processing the lab result). Only visits with an E/M code should be considered, as these visits have procedures tied to the visit type.
How to calculate it: Total collections of CPT code range/total visits with CPT code
4. Front Desk Collection Rate
What it is and why it’s important: Front desk collection rate is the percentage of collections gathered by the front desk from the patient before they leave the clinic. A larger percentage captured at the front desk is typically represented by a higher percentage collected per visit.
What can affect it: Front desk procedures and personnel impact this metric. Enforcing the correct collection of copays at patient intake ensures higher percentage of patient payments in full. Traditionally in urgent care, the policy is to collect as possible at the time of service since the patient may not be a repeat customer—or may not be insured.
Having real-time insurance verification in your software helps staff collect the correct amount. If a patient is cash-pay, personnel should gather 100 percent of their charges at time of service.
How to calculate it: Front desk collection dollar amount/total visits
5. Days in Accounts Receivable (A/R)
What it is and why it’s important: Days in A/R is the amount of time your charges are sitting in accounts receivable. It’s an important KPI to watch in your urgent care to measure your revenue cycle success. Days in A/R is revenue you have yet to get paid for, divided by the average daily charges at your clinic. The lower your days in A/R, the quicker the turnaround with realized revenue.
What can affect it: Payers and patient responsibility both impact this number. Submitting clean claims results in faster acceptance and reimbursement. Fluctuations in days in A/R means payer or claim issues are likely.
The goal for days in A/R is to keep day distribution steady and not to let more A/R slide to higher aging. Days to bill (how long it takes to get your bills out) and days to pay (how long it takes a payer to pay) also affect this metric. Typical days in A/R for urgent care range from 20 to 40+ days.
How to calculate it: Total outstanding A/R/average daily charges*
*Average daily charges = total gross charges/total Visits
(Use 90 to 120 days of charges as an average to remove seasonal fluctuations. Also review total days in A/R versus insurance-only days in A/R.)
6. Percentage of A/R Over 120 Days
What it is and why it’s important: This metric is the percentage of A/R being held for over 120 days. The longer it takes to collect on A/R (90 to 120+ days) the more likely it is you have serious collection issues—and lower overall reimbursement rates.
The goal is to have the smallest percentage possible fall into this older aging bucket. Split your A/R into categories of insurance, patient, and employer—and set goals for how much A/R you’d like in each aging segment.
What can affect it: Insurance delays can result from payer contracts, provider credentialing, front desk procedures, or not completing A/R fast enough. You can keep your patient A/R from aging into 120+ days by sending unpaid balances to collections at the 90-day mark.
How to calculate it: Total A/R aged over 120 days/total A/R
7. Days to Bill
What it is and why it’s important: Days to bill is how long it takes your billing team to get claims submitted. Faster days to bill means fewer days in A/R and faster reimbursement from insurance and patients. However, faster days to bill shouldn’t be sacrificed for accuracy and quality of your claims. You risk an increase in claim rejections and therefore, more days in A/R.
What can affect it: Several items can slow days to bill. They include providers not locking patient charts, front desk errors, slow coding teams, EMR system not set-up to have claims prepared daily, or bad processes for following up on unsent claims.
How to calculate it: Number of days between visit date and claim date to the first payer
(Calculate only visits with insurance claims.)
8. Days to Pay
What it is and why it’s important: Days to pay is the amount of time it takes a payer to pay a claim. Quicker reimbursement means fewer days in A/R and faster revenue realized.
What can affect it: This number will vary based on payer types and be affected by how clean your claims are. Contracts with payers generally define days to pay—and appeals for claims can be submitted by billing teams if the claim is rejected or not submitted on time. Ranges for days to pay depend on payer and claim practices, but typically fall between seven and 30 days.
How to calculate it: Number of days between the date when claim is sent and date of first payment received from insurance.
(Calculate only visits with insurance claims. Break down days to pay by payer. This can identify payers who take longer to pay, so you can pinpoint delays and inquire for reasons why.)
9. Visits Per Clinic Per Day
What it is and why it’s important: Even with the best payer contract rates, it doesn’t matter if you don’t have any patients coming through the door. You won’t reach a profit without adequate patient volume. An urgent care business plan should designate breakeven and profit points tied to visits per day.
What can affect it: The age and location of the clinic affects this number. Newer clinics slowly build a patient base, while established clinics have a solid base with repeat customers and a reputation of service to rely on. Marketing and community partnerships can also increase this metric. Seasonality will often affect visit volume.
How to calculate it: Total patient visits/total number of business days
(Calculate over a set time period—generally a week or month. Segment numbers by clinic if you have multiple locations.)
10. Door-to-door Time
What it is and why it’s important: This is the amount of time it takes from the moment a patient enters your clinic to when they leave. In urgent care, lower door-to-door times increase the number of patients you can see. The more efficient the visit time, the more revenue opportunities.
What can affect it: Complexity of visit, staff response within the clinic, and poor workflows can impact this number. Typical door-to-door times in urgent care range from 20 to 70 minutes, well under national emergency room averages.
How to calculate it: Total door-to-door time for all visits/total visits
(Calculate over a set time period. You can break down door-to-door time further to see where in the patient visit you can increase efficiencies—such as door-to-provider, exam room, or discharge times.)
Use KPIs to understand your organization’s health.
Goals around each KPI you should watch for your urgent care clinic are essential for success. Combined with an establishing a baseline or benchmark of data for comparison, you’ll be able to identify your strengths, and where your clinic needs improvement. Examining data over specific periods of time gives your clinic a well-rounded picture of performance.
Consistent data review keeps you aware of trends and potential issues. An invaluable asset to your clinic is a reporting tool that lets you pull real-time reports, find clinic trends, and spot trouble areas quickly. Better yet is if this tool includes benchmarks that let you compare your results directly against other urgent cares, regionally and nationally.
Data interpretation requires looking at the entire scope of your clinic’s performance to find accurate cause and effect. Assumptions and incorrect comparisons can result in poor reactions and business decisions. KPIs empower better decision-making for urgent care owners—but only if you know how to calculate them, track them, and adjust processes to improve results.
Want all the KPIs we recommend you track? Download the white paper to stay on top of the ten KPIs to watch for in your urgent care today!