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Metrics that Matter: Urgent Care KPIs Defined

Jul 25

Metrics that Matter: Urgent Care KPIs Defined

2018 | Filed in Posts

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Key performance indicators (KPIs) are the vital signs for your urgent care clinic. Measuring KPIs and using them to make adjustments to your business helps to keep your clinics healthy and performing at top capacity. Be sure you know your current KPIs so you can be on the lookout for where you can improve in certain areas for better performance.

If you’re not sure how to calculate these key performance indicators, download the equations and a free worksheet to help you keep track of your KPIs for reference.

Here’s our top 10 list:

1. Average Revenue per Visit

The average revenue per visit is the total amount received per visit from both the patient and the payer. This metric should reflect actual payments received per visit. It’s essential when evaluating your profitability and uncovering growth opportunities, as well as projecting cash flow.

What you should know:

  • Average six to 12 months of data for accuracy
  • Remove incomplete visits it AR
  • Remove bad debt write-offs
  • Calculate OccMed/workers’ comp separately
  • Payer mix and contracted rates affect this number

2. E/M Code Distribution

E/M code distribution shows the use of code levels by staff and directly affects reimbursement. The distribution can help you determine if providers are entering complete and accurate information in the EMR. Established patients traditionally have a higher code level, due to their medical history.

What you should know:

  • Average six to 12 months of data for accuracy
  • Up-coding and under-coding can explain unnatural fluctuations in code–and revenue
  • Separate new and established visit types and create two E/M distribution charts to identify trends

Special note: Looking at E/M levels by individual provider can tell you if there are outliers that skew your distribution, and may call for a quick review of coding practices for accuracy and compliance.

3. Ancillary Revenue per Visit

Ancillary revenue reflects how much revenue you receive for specific procedures and services such as labs, x-rays, or medical equipment. This revenue is additional to the contracted amount for urgent care office visits.

What you should know:

  • Only visits with an E/M code should be included (procedures tied to visit type)
  • Unfinished procedure documentation results in missed revenue
  • Incomplete procedure documentation can be common when tied to an ancillary service (such as a rapid strep test plus the charge for processing lab results)

4. Front Desk Collection Average

Front desk or point-of-service collection rate is the percent of total charges collected by the front desk before a patient leaves the clinic.

What you should know:

  • Average six to 12 months of data for accuracy
  • Collecting fees at the time of service can minimize statement costs and bad-debt write off
  • Real-time insurance verification (RTV) helps staff collect the right amount
  • Front desk should collect as much as possible at the time of the visit to increase the likelihood of full collection
  • For self-pay patients, aim for 100 percent collected at time of visit

5. Days in Accounts Receivable (AR)

Days in AR is the amount of time charges are sitting in accounts receivable. In general, the fewer days an account sits in AR, the quicker you get paid.

What you should know:

  • Average 90 to 120 days of data for accurate measurement
  • Clean claims speed up the reimbursement process
  • Fluctuations in days in AR can indicate payer, process, or claim issues
  • Days to bill and days to pay affect this metric
  • Typical total days in AR for urgent care range from 20 to 40+ days

6. Percentage of Receivables Over 120 Days

This metric tells you what percent of current total receivables (sum of all amounts owed to the practice by patients, third-party payers, etc.) is greater than 120-days old. This metric is a good indicator of a practice’s ability to collect timely payments.

What you should know:

  • Influenced by payer mix, provider credentialing, front desk procedures, and billing staff efficiency, especially in collecting claims that need attention/resubmission
  • Send accounts with no payment after 90 days to collection
  • Write off old, uncollectable debt
  • Calculate from the date of service, not claim date

7. Average Days to Bill

Days to bill reflects the length of time it takes your billing team to submit a claim. This metric is directly related to faster reimbursement.

What you should know:

  • Average 90 to 120 days of data for accurate measurement
  • Calculate only for visits with insurance
  • Front desk errors, slow coding teams, inefficient processes, and unlocked/unsigned patient charts all affect this metric
  • Decreased accuracy on the front end should not be sacrificed to speed up processes

8. Average Days to Pay

Days to pay is the number of days it takes a payer to pay a claim.

What you should know:

  • Average 90 to 120 days for accurate measurement
  • Calculate only for visits with insurance
  • Break down by payer to identify trends and respond to payers that take longer to pay
  • Averages for urgent care ranges from seven to 30 days

9. Visits per Clinic per Day

How many patients visit your clinic per day? Without patients, you can’t stay in business. Knowing visits per day helps you designate break-even and profit points.

What you should know:

  • Average 90 to 120 days of data for accurate measurement
  • Age and location of the clinic affect this metric
  • Seasonality can increase and decrease this metric
  • Segment numbers by clinic if you have multiple locations

10. Average Door-to-Door Times

Door-to-door time is the amount of time it takes from the moment a patient enters your clinic to when they leave. In urgent care, shorter door-to-door times increase the number of patients you can see and often increase patient satisfaction. Efficient visit times allow providers to see more patients, resulting in more potential revenue.

What you should know:

  • Average 90 to 120 days of data for accurate measurement
  • Complexity of visit, staff response in the clinic, and workflow efficiency can affect this number
  • Typical door-to-door times in urgent care range from around 55 to 70 minutes

Next Steps

After you’ve computed these key metrics, you’ll have the information you need to evaluate the opportunities for improvement offered by companies vying for your business.

If your results weren’t spectacular, don’t beat yourself up. Figure out how you got there, and find a partner that offers the tools to improve.

For simple equations to help you determine your performance against key KPIs and a free worksheet to keep track of your calculations, download part two of DocuTAP’s Switch Survival Toolkit. You’ll get resources to help you evaluate your software and get your team on board.