2. Revenue
When participating in their voluntary survey, practices can get a copy of revenue metric data annually from the Medical Group Management Association (MGMA). It collects the number of FTEs, gross revenue, net revenue, and collection rate and is broken down by specialties so your practice can benchmark against others. Total revenue, including oncologists’ salaries per FTE from the ASCO survey, was $7,323,900, but comparisons are difficult since practices differ in services.
Revenue metrics can consist of total revenue (cash collections), net medical excluding radiation services, drug revenue for infusion services, cash expenses including salaries, net accounts receivable, and gross accounts receivable minus contractual allowances and bad debt. Practices can differ on bad debt collection because of the emotional nature of cancer treatment. However, some use revenue cycle management companies with debt collection services; others find charity foundation funds for patients who can’t pay.
Pontchartrain also tracks when its clinic gets paid. Ms. Oubre said the best practice is that your claims receive payment within 21 days. They send claims out every 24 hours. “For example, most of that money is in drugs we’ve administered to patients we’ve likely already paid for.” Since there is a gap between paying their wholesaler for drugs and receiving reimbursement, they closely track claims and payment metrics.
Any claims that get sent back are refiled and sent out again within 24 hours. When claims hit 31 days without a response, the practice reaches out to learn the problem. “We’re proactive rather than waiting for the denial to come,” Ms. Oubre told this news organization. Dr. Brieva said for every revenue metric a practice tracks in which they’re not performing well, the practice has to find a solution. Are too many claims being denied? Do claim forms contain errors? Are most claims being paid in the 21-day window? Is the problem a user error, an issue with the clearinghouse, or an intake error on the other end? The key to successful metric use is to drill down for answers to these questions.
3. Patient satisfaction
Patient satisfaction may be one of the more straightforward metrics practices can track, though not specific to oncology. Dr. Brieva said most metric programs include patient satisfaction surveys against which you can benchmark your practice. You can also create your own emailed patient surveys. The metric can show how satisfied your patients are and how you compare against other practices.
Ms. Oubre said Pontchartrain also tracks metrics around participating in advanced care planning, survivorship care, and transitional care management. Even though most insurers require copays for these services, they’ve found patients who participate in them have an overall better experience.
“The Biden administration also has a Cancer Moon Shot initiative, which intends to reduce cancer deaths by 50% by 2047,” said Dr. Brieva. “They want to reduce deaths and improve the experience of patients. So, tracking survival rates will also be key for this program.”
4. Referrals
Oncology is typically a referral business. So, keeping track of the top referring physicians every quarter is the best way to ensure your referring clinicians are happy with your practice’s service. A best practice is that all new oncology referrals are seen within 48 hours. If your referral metric drops off, especially for top referrers, a physician from your practice should check in with the referrer.
Ms. Oubre runs reports out of the EMR and scrubs for referring providers, so she’s alerted to any issues. “It can be as simple as a front office staff who was rude on the phone,” she said. “We had an issue years ago with one of our schedulers who didn’t want to risk staying after 5:00 p.m., so she wouldn’t put anyone on the schedule after 3:00. But if I hadn’t called and identified that from the referring practitioner, I wouldn’t have known that they couldn’t get late-afternoon appointments at our clinic.”
5. No-show appointments
Practices track no-shows per week to determine which patients did not show up for their visits vs. those who rescheduled. If a patient on active treatment starts no-showing, practices must find out why. Is it a social or a transportation issue, or do they want to discontinue treatment? Often, you can help with the problem if you know what it is.
“Sometimes we can help from a social determinants of health perspective, helping to provide services like transportation, financial assistance, or other things, and patients appreciate that we would care enough to reach out to see if we can help,” said Ms. Oubre.
For recurring no-shows, practices should notify the referring provider. Letting the referring clinician know that the patient stopped coming is a professional courtesy that helps strengthen your referral relationships. You wouldn’t want the referring physician to think the patient is being treated for cancer only to find out later that they discontinued treatment.
6. Injections and infusions
By tracking the number of injections and infusions per location per week, clinics can assess how busy their chemo chairs are and how many injections they give. Benchmarks include the number of initial intravenous infusions/injections and the total number of drug administration services per patient per chair. Similar metrics in radiation oncology are helpful.
7. Pharmacy prescriptions
For practices with an in-house pharmacy, tracking how many prescriptions are written per week by each provider and whether they could fill them in-house or had to send them out to a specialty pharmacy because of an insurance issue tells you the volume of drugs your pharmacy is fulfilling. Point-of-care dispensing pharmacy revenue averaged $1,843,342 in the ASCO survey.
Dr. Brieva mentioned many other trackable metrics, such as the time to start treatment, adherence to treatment guidelines, rates of side effects and complications, patient retention rates, treatment completion rates, and coordination of care with other providers, which may be additional metrics your practice wants to track.
Dr. Touloukian said that practices must be careful how they measure some metrics because if you’re extracting data from the EMR and someone hasn’t entered it correctly, you won’t get accurate information. “I like programs like QOPI because while it’s a little labor intensive, my staff actually goes in and extracts the data from the charts and shows the proof.
“Comparing yourself to other [oncology] practices across the nation helps to ensure you’re achieving a certain level of success on some of these traditional metrics,” said Dr. Touloukian.
A version of this article first appeared on Medscape.com.