Measure Your Success, One Metric at a Time

The Company Scorecard — using a balanced approach to improve your clinic success.

By Mickey Shah, PT

Consider your clinic’s last month’s performance: What if the results you achieved weren’t the ones you expected?

Would you just keep going without making any changes? Or would you want to evaluate both what went right and where to improve? How would you do this? Would you look at your approach to see where you veered off course? Would you scrutinize it on your own or ask your team for feedback? Do you know which numbers to look at to create an action plan? Gathering the right data allows you to easily analyze the details, so you can optimize the value and effectiveness of your practice and support your team.

Recently, my company acquired two additional practices, adding 15 employees along with $1.5 million in revenue and $1.75 million in expenses. That’s right: We acquired clinics that were underperforming. We needed systems in place, and with multiple locations I couldn’t know everything anymore. I needed to evaluate the business from afar, and I suddenly turned from a clinician–physical therapist to a clinician–business owner. Any business owner will tell you that you need key performance indicators (KPIs) to evaluate business performance in order to drive your business decisions. The saying comes to mind, “What can be measured can be changed.” I came across the “scorecard” concept from my wife, who has her MBA with a specialty in business strategy and data analytics.

But with statistics, the devil’s in the details. Analyzing too many variables can muddy the waters with an abundance of information while obscuring the useful details. Analyzing too few won’t give you the clarity you need. Evaluating strategy execution is important, but it shouldn’t be overwhelming. Start with a simple set of numbers and add more as you use empirical assessments to get the insights you need—without getting lost in the minutiae.

Using a Balanced Approach with Your Data

The Balanced Scorecard (BSC) was originally developed by Dr. Robert Kaplan of Harvard University and Dr. David Norton as a framework for measuring organizational performance using a more balanced set of performance measures.¹ Traditionally, companies used only short-term financial performance as a measure of success. The best insights can be gleaned from analyzing the right mix of numbers. Considering measurement after the fact will make your job much more difficult. Instead, by planning for it up front, you can determine what you would like to measure based on the goals of your clinic.

The BSC can be separated into three categories:

1. Hard data, such as the number of new patients obtained or the dollar amount of revenue generated, lets you objectively measure specific results. Nowadays practice management software makes this information easily accessible.
2. Marketing metrics, such as customer satisfaction and brand awareness and perception. You can gather these soft metrics via surveys, social media monitoring, or even staff observation.
3. Patient outcomes tracking allows us to gain insight into happy patients, which leads to happy referral sources and in turn leads to more patients.

You can use this information strategically to improve key areas in your practice, giving you a well-rounded clinic performance evaluation, proving the return on investment (ROI) of marketing dollars, staffing expense, new programming or equipment, and so on. These numbers should provide the foundation for planning for the future.

Clinics Metrics Scorecard: What to Measure?

I often get asked: What do you measure, and more importantly what do you do with this information? Let me walk through our company’s balanced scorecard, our targets along with our action plan for improving areas not achieved within our target (Table 1). We have a pretty lengthy list of things to measure, but they can be categorized into: (1) productivity, (2) billing, (3) referral and marketing, and (4) patient outcome metrics.²

Productivity Metrics

These are the key business metrics that can distinguish a healthy clinic from one that is critically ill. Some refer to these metrics as the “make or break metrics.” We look at these metrics both as combined clinic performance and as individual clinics and therapists.

1. Total Number of New Patient Cases: Tracking patients over time allows us to see fluctuations in specific months. For example, every January we see our new patient numbers decline over 40 percent. Now that we know this we can determine a particular marketing or sales campaign to improve numbers in January.
2. Total Number of Patient Visits: When combined with average charges and number of new patients, this can help you forecast and budget. Every clinic and therapist understands their weekly and monthly target.
3. Arrival Rate: This determines the efficacy of your patient reminder efforts.
4. Average Visits per Case: This allows insight into your patient experience process and patient diagnosis demographic. At one clinic we noticed our average number of visits per case was 5.4, while at our other clinic it was 18.2. What we found was that the clinic that had 5.4 visits did not have a single postoperative patient in six months, whereas the clinic with 18.2 visits had 90 percent of its caseload as postoperative care (POC).
5. Discharged Patients: Completed POC versus Dropouts: Perhaps the most undertracked but most important data point is the number of patients who complete a POC plan to discharge. Generally, this happens when appropriate care is provided (regardless of number of treatment sessions), goals are met, and functional limitations are eliminated. A high percentage in this metric indicates that the clinician provides quality care and communicates well with their patients.
6. Vacancy Rate: Number of hours of nonscheduled patients per therapist. This number will track over- or underutilization of your staff.

Billing Metrics

1. Monthly Billed Charges: This shows how much your clinic is billing, which allows for forecasting. For instance, if billed charges are less, you can expect a decreased revenue. Every clinic should know their healthy range, including their expected payment after insurance adjustments.
2. Average Units per Visit: Another metric that is highly variable depending on the patient population and insurance type is units per visit. Tracking units/visit at the provider and company level is beneficial; this serves to make sure therapists are not underbilling, which is all too common in physical therapy practice. It also allows therapists to make sure they are not overbilling, which may make you more susceptible to audits. This metric also allows for more accurate clinic budgeting and forecasting income.
3. Collected Payments: This completes the billing cycle. This is how you pay your expenses.
4. Expenses: This number is needed so that you can plan where every other number needs to be. The higher the expenses, the more patients you need to see, the greater the charges, etc.

Referral and Marketing Metrics

1. Referral Sources: Even with direct access, referrals make up your business, especially in private practice. You need to know where your patients are coming from. You depend on your referral sources; thus you need to track this data. You can determine how to allocate your future marketing based on these trends. We track referral categories of physicians, website and social media, patient or past patient, and community events.
2. Newsletter Subscribers: I like this number, because it tells me how much our brand is growing and how many like hearing from us.
3. Facebook Followers: This is similar to a newsletter; however, we all know that social media has a great reach.
4. Website Visitors and New Patients from Search: Are people finding us on the web and when they do, how many choose us? This is a detailed and intricate process that we have outsourced to a website company.

Measuring Success, One Metric at a Time

What gets measured and tracked gets done. Properly developing, executing, and evaluating practice analytics can help you quantify and prove the value of your clinic. There is an art and a science to this, and it is one that is constantly changing, thanks to advances in technology, EMR and data collection. But just as important, measuring your results lets you hone your strategic and tactical planning processes for the future. With the right approach, you’ll be able to transform flat numbers on paper into actionable insights that will empower you and your team to make more informed strategic decisions, enhance your patient and staff experiences, and improve your future marketing programs.

See Table 1 for an example of our company scorecard.

When it comes to measurement tracking, one size does not fit all. Different clinics have different goals; different patients have different expectations. These questions—and the answers you uncover—will be key to improving your practice and helping you achieve your goals.

References

¹ Chapman C, Hopwood A, and Shields MD (eds.), Handbook of Management Accounting Research: Volume 3. Oxford, UK: Elsevier; 2009.

² Wickman G. Traction: Get a Grip on Your Business. Dallas, TX: BenBella Books; 2011.

Mickey Shah, PT, is a PPS member and owner of Goodlife Physical Therapy in Orland Park, Illinois. He can be reached at mshah@goodlifrehab.com.