Key Performance Indicators

Matt Gilchrist of Healthy Business for Doctors outlines the Key Performance Indicators for the modern general practice.

KPIs are things that your accountant probably speaks about. KPI stands for Key Performance Indicator. The following is a list of KPIs that are useful in a General Practice setting.

KPIs for Doctors

One of the large corporates refers to their doctors (to their face) as IGUs or Income Generating Units. Needless to say that this company takes their KPIs pretty seriously and they make significant amounts of money doing that. My list of KPIs for doctors includes:-

Number of results in inbox – This is the number of results that remain unchecked. I see many doctors who keep results in their ‘Inbox’ because they are waiting for more information or are trying to decide how to manage the patient. The problem with this is the rest of the practice does not know what is happening and are unable to assist the patient.
Patient waiting (minutes) – This is something that patients truly hate, but doctors generally do not understand. In most practices there are some doctors who always run late and others who always stick to their schedule. Those that frequently run late should review either their scheduling or consider the reasons this happens to them but not to other doctors.
Starting time – a significant component of minimising waiting time is to start on time. If your first patient is at 8:00 am, then be at work with enough time to get a coffee and check your results / mail and be seated at your desk ready to start at 8:00 am. If you cannot be ready at 8:00 am then schedule your first patient for 8:15 am instead.
Dollars per hour of patient appointment time – This is one of the financial type PKIs that accountants love. It is a way of measuring efficiency. Of course it does not consider patient outcomes.
Dollars per day per room – Same as above.
Treatment room expenses per doctor – In a perfect (accounting) world all use of the treatment room would be costed, including nurse time. In practice this is very hard to monitor and manage, but some practices do this to charge different associates different percentages.
Diversity of items billed – compare what item numbers are billed with your colleagues. You may just lean about an item number that you could be charging that you did not know about.
Patient Adverse Outcomes – It is really hard to track patient outcomes in an Australian settings, but collecting data about near misses or actual adverse outcomes is achievable and a requirement of accreditation. Collating this by doctor is not a significant challenge for most doctors.

KPIs for Reception

Uncompleted appointments – Ensuring that all appointments are marked as either Did Not Attend (DNA), or show completed billing. Your billing software can probably produce a report that details this information.
Scanning – Check the number of items that have been scanned but not allocated to patients / doctors, and also the amount of scanning left at end of day (none hopefully!)
1. Ensure that scanning settings are correct. (Namely black and white, 150 dots per inch (DPI)).
Online Claim Batching and all banking completed each day.
Patient contact are details updated at each visit as per RACGP accreditation requirements. This is important but often not done. However, monitoring this is difficult.
Number of billing errors. Often billing errors only become apparent when an issue has arisen. You can also check the number of reversed or amended invoices and payments via software reports on a regular basis.

KPIs for Administration / Management

Debtors – Check status of ‘held’ accounts, and monitor the aging of debtors. Ensure that all accounts are paid, especially Workcover, solicitor and insurance company accounts.
Check billing reports for reversed accounts, cancelled payments, and Medicare Patient Claiming. Administrators need to be sure that no one is rorting Medicare, or stealing from their employer by cancelling payments and invoices and simply pocketing money received.
Check cancellation of appointments – confirm with the patient that the appointment was actually cancelled if required.
Count and chart DNAs. Regular DNA offenders should be marked as such in the software with notes for reception staff to confirm on the day. If the issue still continues discuss with the patient that alternative care will need to be arranged.
Follow-up actions from Inbox – Failure to follow up recalls can be a significant risk for the practice. This needs to be regularly monitored by administration staff.
Unallocated Results and Incoming Letters – Practices must ensure that all incoming results and correspondence are seen by the appropriate person.
Online Claiming batches requiring follow up – Resubmissions need to be dealt with in a timely manner.

KPIs for Nurses

Recalls and reminders – Are these up to date?
Care Plan and Health Assessments completed – Set targets for, and compare numbers of, care plans, reviews and Health Assessments completed. Targets will be different for each practice depending on patient demographics.
Comparison of counts of billed GPMPs vs billed TCAs and a comparison of the total of billed (GPMP + TCA) vs billed Reviews. A review can occur for each of a TCA and GPMP.
CVC Program – Monitor the percentage of DVA patients on CVC (Co-ordinated Veterans Care). This program is well remunerated!
PIP IHI CTG registration – Monitor percentage of enrolments for eligible patients.
Number of Item 10997 billed – Compare billings with targets set and ALSO to the number of patients with care plans.
Infection rate – Monitor the number of infections per hundred or thousand procedures. If this is not very low, then an audit of the clinical processes should be undertaken.

About the Author

Matt Gilchrist is a very experienced Practice Manager with an interest in IT systems. Matt was a successful manager long before he joined healthcare. Matt has been a Rural GP Practice Manager since 2003. Matt is:-