Financial and Operational Benchmarking
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1 Financial and Operational Benchmarking Jonathan Chapman Director of Community Health Center Advisory Services October 24,
2 Capital Link - Overview Launched in 1995, nonprofit, HRSA national cooperative agreement partner Offices in CA, CO, MA, ME, MO, SC and WV Over $1.1 billion in financing for over 225 health center capital projects In addition to the direct assistance towards planning for and financing operational growth and capital needs, we have developed metrics and analytical services for measuring, evaluating, and promoting performance improvement With HRSA s support and assistance we have gathered audited financial information for at least 80 percent of health centers and almost 100 percent of UDS reports Enabled the development of the National Trends Report 2
3 Benchmarking - Origin Originates from the chiseled horizontal marks that surveyors made in stone structures, into which an angle-iron could be placed to form a "bench" for a leveling rod 3
4 Benchmarking 1. A surveyor's mark cut in a wall, pillar, or building and used as a reference point in measuring altitudes. 2. A standard or point of reference against which things may be compared or assessed. 4
5 Think Thrice, Measure Twice, Cut Once 5
6 What Does Success Look Like? Time, Info, Resources to Plan Productive Teams Improved and Stable Operations Staff and Patient Satisfaction Improved Patient Outcomes Financial Sustainability 6
7 Goal: Financial Sustainability and Access to High Quality Care Staffing Financial Operations Productivity Improved Access & Financial Sustainability Patient Satisfaction Utilization Clinical Outcomes 7
8 Performance Benchmarking Benchmarking/Best Practices WHAT do I want to track? WHERE do I find this data? WHICH metrics do I need? HOW do I analyze it? WHO needs to know? 8
9 Growth and Expansion 9
10 Patients & Visits in Millions Five-Year Grantee Trends ,500 1, , Grantees Patients Visits Grantees 0 10
11 Millions Payer Mix: Number of Patients by Payer Source Private Insurance Public Insurance Medicare Medicaid Uninsured
12 Payer Mix: Percentages of Patients by Payer Source 100% 90% 80% 14% 14% 16% 17% 17% 2% 2% 1% 1% 1% 8% 8% 9% 9% 9% 70% 60% 50% 40% 40% 41% 47% 49% 49% Private Insurance Public Insurance Medicare Medicaid 30% Uninsured 20% 36% 35% 10% 28% 24% 23% 0%
13 Billions Total Revenues by Source $25 $20 $15 $10 $5 $3.2 $3.1 $2.5 $2.3 $0.4 $0.6 $9.0 $9.8 $3.3 $2.9 $0.3 $11.4 $3.6 $3.5 $0.2 $13.7 $3.9 $4.3 $0.1 $15.5 Other HRSA Operating Grants Capital Grants Net Patient Service Revenue (Collections) $
14 Percentage Revenues by Source 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 21% 20% 18% 17% 16% 16% 16% 16% 17% 18% 4% 2% 2% 1% 0% 60% 62% 63% 65% 65% Other HRSA Operating Grants Capital Grants Net Patient Service Revenue (Collections) 14
15 Financial 15
16 Financial Health: Some Key Metrics Metric 1 Operating Margin 2 Bottom Line Margin 3 Personnel-Related Expense 4 Days Net Patient A/R 5 Days Cash on Hand Why This Is Important Measuring stick of your business model; margins typically small but need to be positive Is performance dependent upon large capital grants and/or other sources of non-operating revenue? Consumes 70-75% of budget; key driver of financial performance Financial management starts with collecting your money efficiently Is there enough liquidity to keep operations running smoothly? 6 Physician Productivity (visits) Productivity is the basis for revenue generation 7 Mid-Level Productivity (visits) Productivity is the basis for revenue generation 8 Dental Provider Productivity (visits) *Capital Link Performance Benchmarking Toolkit Productivity is the basis for revenue generation 16
17 Financial Health: Some Key Metrics Operating Margin = Change in Net Operating Assets / Total Operating Revenue Personnel-Related Expenses = Salaries & Related Expenses + Fringes & Payroll Taxes + Professional/Contracted/Consultant Fees Total Operating Revenues Days Cash on Hand = Unrestricted Cash (Total Operating Expenses Depreciation) / 360 days) 17
18 Operating Margin by Quartile 12.0% 10.0% 9.1% 9.8% Preliminary % 6.0% 4.0% 2.0% 0.0% -2.0% -4.0% 6.9% 6.9% 5.9% 4.5% 3.6% 2.0% 1.3% 1.9% 0.8% -0.2% -1.8% -2.0% -2.6% 75th Percentile 50th Percentile 25th Percentile Benchmark Minimum 18
19 Bottom Line Margin by Quartile 12.0% 11.5% 10.4% 10.6% 10.0% 10.0% 8.6% 8.0% Preliminary % 4.0% 3.8% 3.2% 3.4% 5.1% 5.6% 2.0% 0.9% 1.5% 0.0% -2.0% -0.1% -0.6% -0.2% 75th Percentile 50th Percentile 25th Percentile Benchmark Minimum 19
20 80% 70% 60% 50% 40% 30% 20% 10% Personnel-Related Expenses as a Percent of Operating Revenue Preliminary % 75th percentile 50th percentile 25th percentile Benchmark 20
21 Days in Patient Accounts Receivables (Medians) 65 Preliminary Median Benchmark Maximum 21
22 Days Cash on Hand by Quartile Preliminary th Percentile 50th Percentile 25th Percentile Benchmark Minimum 22
23 Operational 23
24 10,000 Provider Productivity Visits per FTE 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, , ,810 2,739 2,703 2,632 2,611 3,394 3,316 3,241 3,152 3,095 1,128 1,090 1, Total Mental Health Visits Per Mental Health FTE Total Dental Visits Per Dental FTE Total Other Provider Visits Per Mid-Level FTE Total Physician Visits Per Physician Total Medical Visits Per Medical FTE 24
25 Percentage Change in Productivity, 2012 to % -2% 1 Total Medical Visits Per Medical FTE -4% Total Physician Visits Per Physician -6% -8% -10% -12% -9% -7% -7% -8% Total Other Provider Visits Per Mid-Level FTE Total Dental Visits Per Dental FTE Total Mental Health Visits Per Mental Health FTE -14% -13% 25
26 18% 16% 14% 12% 10% 8% 6% 4% 2% Annual Percent Growth in Visits by Service 0% -2% Medical Dental Mental Health Enabling Services 26
27 Visits Per Patient Per Year th Percentile 50th Percentile 25th Percentile 27
28 Cost Per Patient and Visit $900 $800 $700 $680 $716 $764 $793 $836 $600 $500 $400 $300 $200 $179 $189 $202 $210 $218 $100 $0 Operating Expense per Patient Visit Operating Expense per Patient 28
29 How Does Your Health Center Compare? 29
30 Capital Link Benchmarking Toolkit 30
31 Benchmarking within Managing 31
32 Creating Performance Dashboards Building Performance Dashboards Dashboards should be customized Identify your target audience Board members vs. executive management vs clinic managers Choose your financial and operational metrics Limit what you are tracking (5-10 metrics) Stay consistent with your ratio definitions & calculations Match your reporting objectives to your available data sources Annual data often most reliable: Audits, UDS, OSHPD, etc Monthly/quarterly data better support real-time decision making: PMS systems, interim financials, etc. Look to Excel as a simple tool for charting performance Explore your available reporting tools Time intensive to set up, then efficient for routine reporting 32
33 Enhanced Performance Evaluation Profile 33
34 34
35 35
36 36
37 37
38 38
39 Evolving Business Models 39
40 Transition from FFS to Value-Based Reimbursement 40
41 Value Transition Based from Transition FFS to Value-Based Reimbursement 41
42 Transition from FFS to Value-Based Reimbursement Fee for Service Volume Individual Health Quality is a concern Stand-alone systems can thrive Little financial risk Manage revenues Value-Based Outcomes Population Health Quality is financial driver Collaboration is essential Increased financial risk Manage costs 42
43 Transition from FFS to Value-Based Reimbursement Redesigned Incentives 43
44 Transition from FFS to Value-Based Reimbursement Metric Why This Is Important 9 Medical Provider Productivity (patients) Becomes more important in transition to team-based care 10 Medical Team Productivity Who are your teams? How do they perform? 11 Cost (Revenue) Per Visit How are your visit costs changing over time? 12 Cost (Revenue) per Patient With the move to PCMH, how are patient costs changing? 13 Medical Support Staff Ratio How strategic is the staffing the medical teams? 14 Non-Clinical Staff Ratio Non-clinical employees are not revenue drivers 15 Visit/Patient Growth Rates Are visits growing faster than patients? Is demand growing? *Capital Link Performance Benchmarking Toolkit 44
45 Thousands Medical Staffing (FTEs) Medical Provider FTES Medical Support Staff FTEs 45
46 Medical Services Productivity Medical Support Staff Ratio (Total Medical FTEs - Midlevel FTEs - Physician FTEs) (Midlevel FTEs + Physician FTEs)
47 Medical Services Productivity 1000 Medical Provider Productivity Medical Patients / Medical Provider FTEs
48 Transition from FFS to Value-Based Reimbursement 48
49 What Does Success Look Like? Time, Info, Resources to Plan Productive Teams Improved and Stable Operations Staff and Patient Satisfaction Improved Patient Outcomes Financial Sustainability 49
50 Jonathan Chapman Tel:
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