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10 KPIs to Watch in Your Urgent Care

KPIs are the vital signs of your clinic. Similar to a patient exam, these metrics help tell the story of your urgent care’s overall financial health. Poor KPIs serve as warning signs of business issues that need to be addressed. While owners traditionally track KPIs in an urgent care, all staff should understand why and how the KPIs are measured, and what actions affect each metric. Here are ten of the most important KPIs to watch in your urgent care.

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Introduction

KPIs are the vital signs of your clinic. Similar to a patient exam, these metrics help tell the story of your urgent care’s overall 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.

While owners traditionally track KPIs in an urgent care, all staff should understand why and how the KPIs are measured, and what actions affect each metric. Here are ten of the most important KPIs to watch in your urgent care.

Incomplete visits in A/R should be removed from this metric, along with bad debt write-offs.

KPI #1: Average Revenue Per Visit

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 affects Average Revenue per Visit?

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 separately, so they don’t skew the average revenue per visit for general urgent care visits. The mix of payer types and contracted rates affect this number.

Average Revenue Per Visit - Chart

How to calculate Average Revenue Per Visit

Total Payments Collected – Total Refunds

Daily Visits

 

Recommended

Calculate this over a set period of time.

KPI #2: E/M Code Distribution

E/M code distribution shows the use of code levels by staff. E/M codes directly affect reimbursement amounts. Code levels 1 through 5 tell payers the level of visit complexity, and accordingly 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. Up-coding and undercoding can explain unnatural variations in E/M codes—leading to wider clinic revenue fluctuations. Chart audits (on a per provider basis) can pin-point 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 E/M Code Distribution

Each E/M Code Level

Total Visits with an E/M Code

 

Recommended

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.

Urgent cares often have a contracted amount for an office visit E/M code with payers—so ancillaries are in addition to that amount.

KPI #3: Ancillary Revenue Per Visit

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

Incomplete documentation of procedures cost an industry average 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 plus 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 Ancillary Revenue per Visit

Total Collections of CPT Code Range

Total Visits with CPT Code

The goal for days in A/R is to keep day distribution steady and not to let more A/R slide to higher aging.

KPI #4: Front Desk Collection Average

Front desk collection rate is the percentage of collections gathered by the front desk from patients before they leave the clinic. A larger the percentage captured at the front desk is typically reflected in a higher percentage of overall collections per visit.

What can affect it

Front desk procedures and personnel affect this metric. Enforcing the correct collection of co-pays at patient intake ensures higher percentage of patient payments in full. Traditionally in urgent care, the policy is to gather as much at time of service as possible, since the patient is not as likely to be a repeat customer—or may not be insured. Having real-time insurance verification in your software helps staff collect the correct amount. If patient is cash-pay, personnel should gather 100% at time of service.

How to calculate Front Desk Collection Average

Total Outstanding A/R

Average Daily Charges

 

Average Daily Charges = Total Gross Charges

Total Visits

 

The longer your A/R isn’t collected (in 90 to 120+ days) the more likely it is you have serious collection issues—and lower overall reimbursement rates.

KPI #5: Days in Accounts Receivable (A/R)

Days in A/R is the amount of time your charges are sitting in accounts receivable. This is the 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 affect this number. The cleanness of your claims during submission means a faster accepted claim and reimbursement. Fluctuations in days in A/R mean 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 Days in A/R

Total Outstanding A/R

Average Daily Charges

 

Recommended

Use last 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.

KPI #6: Percentage of Accounts Receivable Over 120 Days

This metric is the percentage of A/R being held for over 120 days. The longer your A/R isn’t collected (in 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

Offenders for insurance delays could be payer contracts, provider credentialing, front desk procedures, or not completing A/R fast enough. You can keep your patient A/R from aging to 120+ days by sending unpaid balances to collections at the 90-day mark.

How to calculate Percentage of Accounts Receivable over 120 Days

Total A/R Aged Over 120 Days

Total A/R

 

Recommendation

Use last 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.

An urgent care business plan should designate break-even and profit points tied to visits per day

KPI #7: Days to Bill

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 is not worth causing claim quality to suffer if you increase claim rejections and therefore, 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 Days to Bill

Number of days between visit date and claim date to the first payer

Recommendation

Calculate only for visits with insurance claims.

An urgent care business plan should designate break-even and profit points tied to visits per day

KPI #8: Days to Pay

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 will 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 in a 7 to 30 day range.

How to calculate Days to Pay

Number of days between the date when claim is sent and date of first payment received from insurance

Recommended

Calculate only for visits with insurance claims. Break days to pay down by payer. This can identify payers who take longer to pay—so you can pin-point delays and inquire about reasons why.

Newer clinics slowly build a patient base, while established clinics have a solid base with repeat customers and reputation of service to rely on

KPI #9: Visits Per Clinic Per Day

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 break-even 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 increase or decrease visits.

How to calculate Visits Per Clinic Per Day

Total Patient Visits

Total Number of Business Days

 

Recommended

Calculate over a set time period—generally a week or month. Segment numbers by clinic if you have multiple locations.

Typical door-to-door times in urgent care range from 20 to 70 minutes, well under national emergency room averages.

KPI #10: Door-to-door Time

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 made.

What can affect it

Complexity of visit, staff response within the clinic, and poor workflows can affect 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 Door-to-door Time

Total Door-to-door Time for All Visits

Total Visits

Conclusion

Use KPIs to understand your organization’s health. Having set goals for your clinic is essential for success, along with establishing a baseline of data for comparison. Examining data over 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 correct 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.

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