Premier Data: Gap Analysis of Annual Patient Contact Hours in Primary Care

COVID-19 has put added pressure on medical groups to appropriately staff providers to volumes that are still in recovery. Medical group alignment around providers’ work effort is critical to ensure high-quality care delivery at an affordable cost.

But how best to analyze a provider’s expected versus actual hours with patients, and whether there is quantifiable opportunity to improve access? Simple: clinician standards and clinical reconciliation.

Clinician standards define roles and responsibilities for providers within the organization. These include patient contact hours, provider time away, patient access standards and documentation standards, as well as balancing measures related to provider burnout.

Clinical reconciliation is the process by which organizations compare actual performance versus expectations. This enables primary care organizations to calculate the time providers spend with scheduled patients against the expectation. For example, industry leading practice is 36 patient contact hours per week and if providers only schedule 32 hours, on average, providers have the opportunity to open up four additional hours per week.

Premier Physician Enterprise experts recently leveraged our InflowHealth database, which consists of almost 40,000 ambulatory providers across more than 150 specialties nationwide, to analyze patient contact hours compared to clinical expectation for primary care providers (PCPs).

This analysis identified a significant gap in actual versus expected patient contact hours across nearly all primary care providers – and revealed that closing the patient access hours gap would lead to an average of over five additional patients per week, for providers below the 60th percentile in productivity.

On average, each provider included in the analysis had a gap of 123 annual patient contact hours which equated to 249 patients, 372 wRVUs and $30,943 in net patient revenue annually.

Premier utilized InflowHealth’s scheduling database to calculate each individual provider’s cumulative hours in session and compared this to their organization-specific clinical expectations based on clinical FTE. The data included more than 2,000 primary care providers from across the country and annualized the patient contact hours from July to December 2020 to remove the more prevalent scheduling anomalies from the height of COVID-19.

Providers above the 60th percentile in productivity were excluded from this analysis, as high-producing providers are less likely to need clinical activity action planning. It is important to note that the clinic hours calculation is based on available, schedulable time in clinic, not just time spent seeing patients. For example, no-shows and late cancellations were counted as schedulable time, but a provider-bumped appointment was not.

In this analysis, based on leading practice across medical groups Premier has worked with, a full-time equivalent provider equated to:

• Practicing 46 weeks a year,
• with nine, four-hour sessions per week,
• leading to 1,656 expected patient contact hours.

The Benefits of Clinical Reconciliation

Medical groups should undergo clinical reconciliation on an annual cadence. To do so, they must implement infrastructure and processes to regularly review the results, as this is an essential way to ensure clinic-based provider practices are aligned to organizational expectations.

Clinical reconciliation is crucial to the medical group’s success in a number of ways:

• Patient Access: Clinical reconciliation activities can drastically improve patient access by expanding templates and aligning clinic schedules to meet patient demand and practice service expectations. As noted above, Premier’s analysis found that closing the patient access hours gap would lead to an average of five additional patients per week, per provider, for those performing below the 60^th percentile of productivity.
• Physician Performance Expectations: Clinical reconciliation helps ensure providers and medical group leaders are in agreement about expected and actual work effort. In a time when financial performance is more pressing than ever before, medical groups have every incentive to conduct clinical reconciliation analytics on an annual basis.
  
  These insights identify providers who may need targeted action planning to achieve their expected patient contact time. Additionally, these analyses reveal rightsizing opportunities, which keeps compensation costs controlled and helps define true scheduling capacity versus perceived capacity. For many medical groups, these activities and reconciliation help open access without needing to recruit new providers.
• Patient Experience and Leakage: Expanding patient access improves patient satisfaction and reduces leakage. Opening up greater access – including via telehealth – allows patients to get in sooner, which is vitally important in a time when many medical groups are competing for patients against other health systems, consumerism and market disruptors.
• Revenue Enhancement: Across the more than 3,700 primary care providers included in the analysis, the average revenue growth potential per provider was over $30,000 in net collections annually when aligned with clinical expectations. Additionally, primary care is the front door for health systems and identifies patients who would benefit from additional, appropriate care.
  
  For example, a recent Premier analysis found that many medical groups’ utilization of the Medicare Annual Wellness Visit is low, despite a total revenue opportunity estimate of $2.4 million per clinic, on average. Download the white paper to learn four essential strategies to capitalize on Annual Wellness Visits.

Four Key Strategies for Medical Groups to Align Provider Expectations to Actual Performance

While the benefits of clinical reconciliation are clear, implementing systems of management and tracking for physician and advanced practice provider clinical practices can be challenging.

Premier’s Physician Enterprise team works closely with our members to implement several key strategies for medical groups to align provider expectations to actual performance.

1. Aligned Clinician Standards: Administrative and physician leaders should collaborate to develop provider expectations that apply across the organization. Practice standards typically define the clinical expectations of a full-time equivalent provider, organizational expectations around session length and the standards to which providers are held.
   
   For example, Premier’s Physician Enterprise team has found that national leading practice is for providers to work 46 weeks a year, with clinic-based providers having nine four-hour sessions per week, leading to 1,656 expected patient contact hours annually. Most primary care practices can track this through clinic schedules. For specialists, a deeper review of areas such as procedural time utilization or hospital service time would illuminate the proper alignment and opportunity.
2. Communication Plans: In order to effectively implement new provider standards, such as four-hour sessions, an organization needs to develop a thoughtful communication plan that includes physician champions to share the message.
   
   Collaborating with physician leaders is imperative to organization-wide adoption of practice standards. Check out our four methods to ensure physicians are engaged in transformation initiatives. Leaders should be sure to explain the organization’s rationale for prioritizing clinical reconciliation, including potential benefits to the organization and its patients.
3. Regular Benchmarking and Reconciliation: Frequent analysis and monitoring of provider effort in relation to defined clinician standards help to identify the gaps and allow for action planning. Reconciliation analytics also allow organizations a chance to measure the potential revenue pick-up from better aligned clinical activity and a higher standard for accountability for practicing providers.
   
   Leaders should consider using a business intelligence tool, like InflowHealth, with monthly tracking against key metrics (such as Average Available Hours per Provider cFTE, AM/PM Session counts, and Average Slots per Session and per Day), sophisticated office scheduling metrics and internal and external benchmarks by specialty.
4. Provider Productivity Incentives: Organizations with productivity-based incentives, either built into their compensation model or awarded by outcomes, may also clearly lay out the providers’ financial opportunity as they achieve increased productivity and patient contact hours. Including this benefit in both financial modeling and in communication with providers helps keep the providers aligned with system goals.

Clinical reconciliation and defined practice standards enable medical groups to improve care delivery and align internal resources to patient demand.

The development and implementation of practice standards must be a collaborative effort to ensure provider buy-in and an organizational culture focused on providing the highest level of care to its patients.

With these essential strategies, medical groups will be strongly poised to increase patient access as well as provider productivity.

Learn More

• Download our data-driven insights on how to optimize primary care staffing and model design to improve performance.
• Check out how to improve patient access and decrease lag times.
• Dig into InflowHealth, Premier’s business intelligence tool that compiles billing, scheduling, payroll, and general ledgers information to enable data-driven decisions across medical groups.