KPIs are things that your accountant probably speaks about. KPI stands for Key Performance Indicator. Follows is a list of KPIs that I think are useful in a General Practice Setting.
KPIs for Doctors
One of the large corporates refers to 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:-
1. 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 and their health. What keeping results / letters in the inbox achieves is that the rest of the practice doesn’t know what is happening, and are unable to assist the patient.
2. Patient waiting (minutes) – This is something that patients truly hate, but doctors generally don’t understand. In practices there are usually 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 the reasons as to why this happens to them but not to others.
3. 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 can’t be ready to start by 8:00 am then schedule your first patient for 8:15 am instead.
4. 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 doesn’t look at patient outcomes.
5. Dollars per day per room – As above.
6. 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 very hard to monitor and manage, but some practices do this to charge different associates different percentages.
7. 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 didn’t know about.
8. Patient Adverse Outcomes – 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 impost for most doctors.
KPIs for Reception
1. Uncompleted appointments – Ensuring that all appointments are marked as DNA, or are completed including billing. Your billing software can probably produce a report that details this information.
2. Scanning – Checking both the quantity 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!)
a. Ensuring that protocols have been followed (ie B&W 150 DPI)
3. Online Claim Batching and all banking completed each day.
4. Patient contact details updated each visit as per RACGP accreditation requirements. This in my observation is the thing that the staff don’t do, that they are required to do. Determining whether or not this was completed is often hard to determine.
5. 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
1. Debtors – Check status of ‘held’ accounts, and monitor the aging of debtors. We need to ensure that all accounts get paid, especially Workcover, solicitor and insurance company accounts.
2. 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.
3. Check cancellation of appointments – confirm with the patient that the appointment was actually cancelled if required.
4. Count and chart DNAs. Regular DNA (Did Not Attend) offenders should be marked as such in the software with notes for reception staff to confirm on the day, or plan to exit the patient if necessary.
5. Follow-up actions from Inbox – This is recalls, and can be a significant medical risk if not managed properly. Sorting recalls is a whole of practice process, but someone needs to lead.
6. Unallocated Results and Incoming Letters – Practices need a way to ensure that all incoming results and correspondence are seen by the appropriate person.
7. Online Claiming batches requiring follow up – Resubmissions need to be dealt with in a timely manner.
KPIs for Nurses
1. Recalls and reminders – Are these all up to date?
2. 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 based on the patient demographics.
3. 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.
4. CVC Program – Some comparison to the numbers of DVA patients on CVC , and those eligible. This program is easy money (relatively speaking).
5. PIP IHI CTG registration – Comparison of enrolments to eligible patients.
6. Number of Item 10997 billed – comparison with targets set and ALSO comparison to number of patients with care plan.
7. Infection rate – number of infections per hundred or thousand procedures. If this is not very low, then some audit of clinical processes should occur