Why Productivity Matters
So, you know you need to be aware of your revenue-generating ability in your practice, but you want to make sure you are aware of the right numbers in the best way possible. And you’re smart for thinking that way. Not all revenue and data tracking strategies are the same! Knowing, without a doubt, your individual productivity matters.
But before you spend another day, week, or month avoiding the task of tracking your visits, billing codes, RVU and revenue and wander around on the internet googling “how do I know how much value I add to my practice?” and trying to put together a plan from scratch with yourself… I’ve created a super straightforward roadmap for you to follow to determine your productivity based on your practice setting.
Without getting too bogged down in the weeds here, you’ll be able to find the best strategy for you, your practice type, setting, and the way your practice bills on your behalf, and walk away from this episode with a concrete plan.
No more excuses when it comes to tracking your numbers and productivity and putting it on the to do list for next week or worse, next year. In case you’re still on the fence about why tracking your own revenue and understanding your value add matters, scroll on back and press play on episode 220 – it’s 5 reasons to know your numbers this year!
You need a few strategies to get you going and plan to enact in order to calculate your objective value-add and personal productivity. From there, you can tweak, adjust and make any changes that you need in order to have the system fit your specific situation.
But first, you’ve got to start tracking. Don’t overthink this starting phase.
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No Matter What Type of Practice Setting You’re In, You Need to Track Your Numbers
Let’s go over some foundational data mining rules that apply to everyone in clinical practice!
01) It’s not all about the numbers. Yes, we know we went into medicine, specifically clinical practice, in order to take care of patients. It’s important to strike a balance between focusing on your revenue and your relationships. You never want to become so focused on the numbers that you forsake practicing evidence-based medicine and start sacrificing the quality of your connection with your patients.
02) Remember the reason for tracking in the first place. Tracking data accurately and consistently can serve as evidence for your next negotiation. This information can help you to earn more money, to adjust your hours, to get extra help or to garner more admin time in your busy schedule.
03) No one, and I mean no one cares about your life, work-life balance, schedule and productivity as much as you do. You cannot rely on your practice administrator or billing team to track your data accurately on your behalf.
04) Maintain consistency. The longer you track and the more consistent you are with your data-gathering the more information you have at your disposal.
Now let’s dive back into your specific, strategic plan for tracking your productivity and extrapolating your value-add to the practice and your specific clinical setting.
Tracking for your Outpatient Practices:
When working in an outpatient setting in a practice that is medicine-based, whether primary care or specialty-based, tracking your numbers on a daily or weekly basis is a great place to start.
First, identify what your practice’s love language is. Data love language, that is. Figure out what your practice values. Is it RVUs, number of visits, new consults, patient access, wait time or straight dollars and revenue?
Keying in on what they value means that you will identify what is most important to track.
Once you’ve identified your practice’s revenue love-language, you can track that as your primary data endpoint. It doesn’t mean that you ignore patient access or number of visits per day if revenue is most important to the administrators in your practice, it simply means that the majority of your focus should be.
Here are a few detailed options of what to track:
- Money – RVUs, revenue
- Patient access – number of visits, consults, new patients, visits outside traditional office hours
- Time – shits, hours worked or potentially patients seen
Start small with tracking the number of visits per day. Then add what the billing codes are for those visits.
Create a system to track those on a daily basis at the end of the day. You can add for the week and track on a monthly rotation.
If you are tracking codes, then for every 99204 visit you have, you’ll need to convert to RVUs and then extrapolate to revenue. There are some calculators that you can use online to make that conversion.
So the conversion goes like this: billing code to RVUs and RVUs to revenue (dollars).
Using the CMS.gov website you can search the codes you are using to bill for each visit and these will generate a specific number of RVUs for Medicare.
Here’s the formula to get from RVUs to dollars. Each RVU is currently valued from Medicare with a conversion of around $38.
This can feel daunting at first and like it’s a lot of work to convert all of those units from one to another. It kind of reminds me of converting kilojoules to kilograms, and on and on in college chemistry. I don’t know about you, but I LOVED the amount of math that was involved in learning chemistry…
But once you get a system down, a spreadsheet or way to track the numbers, it doesn’t take as much effort once you’ve done the work on the front end.
You’ll see the same billing codes on repeat, have a conversion factor for those and see repetition which will make it easier.
A Note on Surgical Practices
Working in surgical practices includes a lot of duties that are considered non-revenue generating. This is things like preop H&Ps, preoperative medical clearances, postoperative visits, any inpatient care that happens before or after a scheduled surgery.
These visits don’t specifically generate revenue in that they don’t create a bill that is going to credit you specifically with RVUs or revenue, but they are a necessary part of patient care.
The other thing to consider in surgical practices is the time that is freed up for an operating surgeon due to the fact that you are doing these non-revenue generating tasks. Say you do 8-hours of clinic and 4 of those hours are taken up with non-revenue generating visits. This means that your surgeon or a surgeon on your team has 4-hours that they can be seeing consults or performing procedures, this should be tracked and noted when you consider the value you add to the practice.
For those primarily seeing patients in an inpatient service, you can track the number of patients, whether they were consults or follow ups, track the amount of discharges, and track their acuity.
Say you have a list to start the day with 20 and you recieve 4 additional consults, 6 patients in the ICU and you discharge 2 patients and 14 phone calls from the ER to triage admit vs. discharge for outpatient follow up. For that day you can track the amount of patients seen, then breakdown who was new, who was primary, who we were consulted on, the amount of patients in the ICU, the number of calls from anyone, the amount of time spent coordinating care.
You can get down in the weeds or track with more broad strokes.
Also – you can tailor what you are trying to prove with what you are tracking. I know that didn’t sound very scientific, so let me explain what I mean.
Say you feel your inpatient service has become too much work for the two inpatient rounders that you have present on any given day in the hospital. You’ve expressed this concern and received an answer “No” or maybe you haven’t asked yet and you want to get data to support your pitch for additional support of your service.
Tracking the number of calls and patients in this situation can share the need for increased support. You could also share what it was a year ago or 6 months ago and share that it’s continuing to trend upwards.
Inpatient data will be inherently less predictable and more erratic because there is no set schedule, but tracking matters in this situation all the more.
When it comes to first assisting there are also things that you can do to track your value, the cases you scrub, and even monitor the OR times.
For Medicare, assistant surgeons garner 16% of the fee schedule for the surgical procedure performed. PAs assisting instead of a surgeon can bill 80-85% of that 16% of the procedure performed fee structure.
Keeping track of the cases that you do on any given day in the OR will help you to figure out what your revenue numbers look like.
Alternatively, if you can generate data on operative times and show that the team is more efficient and spend less time under anesthesia or take up less time consistently for procedures with you in the OR, you can prove your value add using that data.
What To Do If You Don’t Have Access:
There are a lot of organizations where there is either a lack of transparency about numbers and productivity or a lack of communication. Either you don’t receive reports or the numbers you are being given don’t seem to accurately represent the work, the visits and the revenue that you are generating.
Here are three things to try if you don’t have access to a clear or accurate report for your volumes.
- Request a billing audit of recent charts, charges and your volumes. Typically this involves sitting down with a biller or coder who will review a sampling of recent charts. This can help you to identify if you are over, under, or accurately billing for visits and find areas for improvement.
- Track your visit volumes. You can take a representative week or month and extrapolate from that to see what your numbers look like on an annual basis.
- Run a report. Most EMRs will have an ability to generate a report, filtering for certain criteria like performing provider, for charges dropped within a certain time period. You can use this if you’re looking back several months or all year and you haven’t been tracking but want to get a handle on your data.
Beyond The Numbers – Create a Value Add List:
An option that can be done in addition to tracking your revenue-generating abilities is to create a value-add list.
Here’s a few questions to get the juices flowing on the value you add to your practice:
- In what ways do you add value to your employer and for your patients?
- What do you do that’s similar to (or above and beyond) what your collaborating physicians or colleagues do?
Spend some time looking at your outlook calendar to capture items outside of your clinical productivity that happen on a monthly or quarterly basis. Take note of any special projects, committees or involvement that you have in the practice outside of your clinical duties.
You can create your value-add list going forward, spending 2-4 weeks jotting down all the things that you do to add value to the practice. This can include creating a new process for clinical or clerical staff, orienting new providers, or anything you do that’s above and beyond the basics of your job.
Essentially, think of other duties as assigned and things that you do that would make you more valuable if you did them at another practice. It doesn’t have to be straight office visits or shifts that contribute to your productivity value.
These things often become a part of the regular rhythm of work so taking time to make a list of them has value, as well.
Yes, I realize that tracking your own productivity and revenue isn’t the sexiest or flashiest topic ever but it’s necessary. It’s effective.
It’s information that you can use to land a raise, pitch to grow your team, understand how to add more value or be more efficient in the building of your template for seeing patients.
This knowledge, specifically when you apply it strategically in your practice, is incredibly powerful. Do not sleep on this opportunity to consistently track the value you are adding to your practice!
If you’re looking for a way to apply this data, head to tracybingaman.com/ONE to download the PA Pay One Sheet. It will help you to craft your next negotiation pitch with confidence and leverage this data to see improvements in your compensation and schedule!