访问 is a strategic priority for medical group leaders, but they often lack the ability to measure their performance. 领导者要处理各种各样的静态报告,比如预约时间或第三个可用时间, but this information is rarely actionable and often inaccurate.
Instead, access should be evaluated through the lens of supply and demand. 在这种情况下, demand represents unique patients seeking new patient appointments, 供应表明实践的能力,以适应预约在病人期望的时间框架. By consistently evaluating a practice’s journey to equilibrium between supply and demand, 它可以实现更大的访问, 这就导致了增长, financial sustainability and patient satisfaction.
在这个供需方程中, 医疗集团对供应有更大的控制权, 根据提供商容量来衡量. 因此, 实践应该通过适当地评估和评估其提供者为病人看病的能力来开始他们的访问之旅. 以下概述了评估和改善推动准入战略的能力的三个关键策略:
- 分析云顶集团40011官网的临床时间
- Examine the relationship between clinical time and productivity
- 优化关键容量驱动因素.
分析云顶集团40011官网的临床时间
Medical groups tend to focus on benchmarking provider compensation and productivity; however, 要了解提供者是否在充分发挥其能力是一项挑战. 这对于在各种环境下进行临床工作的专家尤其重要. Analyzing provider capacity is the crucial step to ensuring access is available. Prior to considering the recruitment of additional providers, assess whether supply can be increased using existing resources.
了解当前提供商的能力, 使用以下步骤将每个供应商的实际工作时间与合同或预期工作时间进行比较:
1. If not already written into provider contracts, 为全职临床云顶集团人员应该工作的病人时数设定一个标准期望, 根据每个提供者的临床努力进行调整. 例如, 你的机构可能会决定每周32小时的全职云顶集团, allowing for one hour of administrative time per half-day block of patient-facing time. Establish a standard number of workweeks per year, 比如47, which allows for five weeks of time off annually.
这些指标使您能够计算出应该安排全职临床提供者工作1,504 hours per year (32 hours per week x 47 weeks per year). 同样,0.90 clinical FTEs (CFTEs) would be expected to work 1,354 hours per year (1,504 hours x 0.90立方英尺).
2. Quantify the actual hours worked by each provider. 根据专业和工作类型的不同,计算这个值所需的努力也会有所不同. 包括在诊所的时间, 执行程序或手术, reading imaging studies and providing inpatient coverage. 专门在诊所工作的初级保健提供者可以直接量化, 如图1A所示. 在多个临床地点花费时间的程序专科云顶集团40011官网可能更难以量化, 如图1B所示. 在计算这些小时的时候, it is important to account for all actual hours worked, 而不是“计划好的”时间, which may be skewed by underutilization or inaccurate templates.
一旦计算出实际工作时间, compare it to the hours each provider is expected to work; this is referred to as a worked-to-expected (W:E) analysis. W:E分析为管理员提供了一个快速指南,帮助他们了解在个人或项目级别上提高能力的机会领域. 它也是一个有用的工具,在开始讨论关于云顶集团40011官网的时间花费在临床设置, 包括随时间变化的趋势. 例行地运行这些分析(例如.g., monthly or quarterly) to adjust for changes in capacity, demand or schedules.
Examine the relationship between clinical time and productivity
一旦W:E分析完成, 将其与提供者的生产力进行比较, 如图2所示.
Comparing an analysis of hours to an analysis of productivity (e.g., wrv(占行业中位数的百分比)可以揭示提高提供商能力的机会, 因此, 病人的访问. In comparing these data points, one of four scenarios will emerge, as depicted in Figure 3:
- W:E和生产力的一致性通常,医疗云顶集团提供者的生产力表现与他或她的临床工作时数有关, 如下所述.
- W:E hours are low and so is productivity (scenario 1):在这个场景中, a provider’s work hours should be increased to align with his or her CFTE, and the assumption is that productivity would also increase.
- W:E hours are high and so is productivity (scenario 2): This is likely the ideal scenario and may not involve any action; however, 领导和提供者应该意识到倦怠的风险,并在适当的时候主动干预.
- W:E和生产力的错位虽然合理的假设,一个提供者工作足够的临床时间将有适当对齐的生产力指标, 情况并非总是如此, 如下所述.
- W:E hours are low but productivity is high (scenario 3): Providers in this situation may be highly efficient, or they may be performing more high-yield activities than their cohort, 内部或外部组织. 在他们的同事的背景下检查这些提供者,以了解是否有任何实践的细微差别可以解释这种工作时间和生产力的不一致. 例如, 专门从事睡眠医学的肺科云顶集团40011官网可能需要修改生产率基准.
这种情况可能需要重新调整基准或在专业成员之间更平均地分配工作. 如果提供者的临床时数低于预期目标,则应增加临床时间. 在大多数医疗团体中, 高生产率不应该给供应商提供比合同规定工作时间更短的自由通行证. - W:E hours are high but productivity is low (scenario 4): Examine in further detail how the provider’s clinical time is being spent, and ensure proper capture of clinical activities, 包括计费. 一些常见的不对齐区域包括:
- The provider is scheduled for clinic but blocks time as unavailable.
- There is low demand, and the provider has unfilled slots.
- The provider’s visit durations are too long for their complexity.
- The provider’s time is not being billed properly (e.g., undercoding, open charts, unbilled encounters).
- An aspect of the provider’s time is not being counted (e.g., imaging reads are performed but not billed).
- W:E hours are low but productivity is high (scenario 3): Providers in this situation may be highly efficient, or they may be performing more high-yield activities than their cohort, 内部或外部组织. 在他们的同事的背景下检查这些提供者,以了解是否有任何实践的细微差别可以解释这种工作时间和生产力的不一致. 例如, 专门从事睡眠医学的肺科云顶集团40011官网可能需要修改生产率基准.
优化关键容量驱动
即使是工作效率高、工作时间充足的提供者也应该关注影响实践整体访问策略的驱动因素. 可以帮助提供者了解实践能力和获取的关键组成部分包括新患者比例, 访问时长和转化率.
新增患者比例
Productivity and access metrics are not always in alignment, 有时,高生产力的提供者可能会把时间花在不支持实践访问任务的活动上. 例如, 如果医疗云顶集团提供者倾向于通过在相同时间内治疗两名已确诊患者而不是一名新患者来获得wrvu,那么就没有优先考虑获得. Provider schedules should be designed with the proper new patient ratios in mind, with dedicated appointment times for new patients. 新访与复诊的比例将有所不同:外科和程序实践应看到高达50%的新患者比例, 而医学实践将看到更少, 初级保健将接近10%到20%与他们提供的纵向护理相一致.
访问的长度
预约的持续时间也会对访问和提供者的生产力产生重大影响,但不会影响提供者的工作时间. 平均就诊时间因专科和护士提供的支持数量而异, residents or advanced practice providers working alongside the provider; however, decreasing visit times will have a direct and positive impact on access. 例如, if a provider typically schedules new patient visits for 60 minutes, reducing each visit to 40 minutes will allow for 50% more visits to be added.
转化率
除了新的病人比例, the ratio of new patients to key procedures or surgeries is an important access metric. 例如, 心脏外科云顶集团40011官网预计每年要做200例心脏直视手术,他们将从了解新患者和手术之间的转换率中受益. If two new patients are seen in the clinic on average for every one surgery, 这位外科云顶集团40011官网每年需要为至少400名新患者提供及时的手术,以达到预期的手术量.
The duration of visit types is often a contested issue, 但是云顶集团提供者必须明白,持续时间是云顶集团提供者在访问期间需要在场的平均时间. 实践经常会犯错误,包括病人预约所需的任何前或后工作.g., 病史和体格, 结帐过程), but this reserves too much of the provider’s time and lowers capacity. Visit durations are often designed as a “worst-case scenario,” with providers and managers trying to account for the longest possible patient visit, 不是平均花费的时间.
增强改善获取的能力
Improving 病人的访问 is a financial, strategic and operational imperative. When considering access as a balance between supply and demand, medical groups can focus on what is most in their control: the supply, 或者提供商能力. Because providers are a medical group’s most valuable asset, 对他们时代的彻底分析, productivity and efficiency should be conducted routinely. 通过评估能力, managers are able to determine whether current provider time is being maximized. 只有在优化后,才应该雇用额外的提供者作为进一步扩展的手段. 现在比以往任何时候都重要, practices must focus on their financial sustainability, and thoughtful management of 病人的访问 is a critical piece of this puzzle.
萨拉·特利, 工商管理硕士, 参谋长, Rush University Medical Center; Michelle Hirschman, 工商管理硕士, 云顶集团线路管理员, Rush University Medical Center; and 史蒂夫·麦克米伦, 尼古拉斯, 高级经理, 心电管理顾问
2020年9月1日发布