5 metrics for managing physician revenue

Texas medical group offers tips to strengthen bottom line

In a competitive healthcare marketplace like Dallas-Ft. Worth, it’s essential that a physician practice tightly manage its revenue cycle. Texas Health Physicians Group is doing that by tracking five key financial metrics.

Sam Civello, vice president at THPG, told attendees at the 2013 HFMA ANI conference Tuesday that the challenges of attracting and keeping physicians in an employed relationship with a health system require both strong economics and communication.

“Physicians want to join a group with a broad vision and they want strong operational performance,” Civello said. “Is employment the long-term solution for setting up a strong health system/physician alignment? It is for some, but you must entrust physicians at every level with leadership.”

THPG is affiliated with Texas Health Resources, a 25-hospital health system in north Texas.

While employed physicians may be more focused on stable compensation or lifestyle issues, optimization of the revenue cycle is key to both of those, as the general health of a practice relies upon it. To adequately monitor the revenue cycle, Civello said THPG follows five metrics it considers critical to physician revenue performance. They are:

  1. Claim entry dates: Two days or less from the date of service;
  2. Un-reconciled visits: Maintain at 0.5 percent or less;
  3. Pre-bill rejection rates: Maintain at 4 percent or less;
  4. First pass denial rates: Keep them at less than 10 percent;
  5. Pass-through rates: Keep them below 3 percent.

“These metrics give us a real clue as to how our revenue cycle is working,” Civello said. “We track them and then share the information with the physicians.”

The Dallas-Ft. Worth healthcare marketplace is quite competitive, and Civello said tight revenue cycle observation helps his organization not just to maintain financial strength, but also to drive growth.

He noted that coding accuracy remains critical to revenue enhancement, which is why THPG performs regular coding assessments of physicians. “The biggest issue we’ve had was fear of overcoding by our providers,” he said. “As a result, they were undercoding, and not accurately capturing the encounter.”

Just as important as a focus on financial metrics, Civello said, is for the organization to function like a truly accountable care organization, to improve the patient experience and to identify current patients who have gaps in care and make sure the practice reaches out to them.

“Texas Health Resources is one of the Pioneer ACOs and we’re in discussions with many commercial payers to establish commercial ACOs,” Civello said. “We want our patients to stay with us, so we’ve created mechanisms and dedicated staff to directly improve the patient experience. We want our employees to develop their customer service skills, so that our patient experience remains high quality.”