The Numbers Game: Barriers to Transparency

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By Jenni Love

When asked to write an article about key performance indicators (KPIs) and benchmarks, my initial thought was “no problem, I look at data and talk numbers all day, every day.”

But when I sat down to compose an outline, I realized that the true barrier to financial success in the physical therapy space today is not related to understanding the data points themselves; rather, the barrier is related to the fear and resentment that’s embedded in the profession when it comes to “talking numbers.” That fear and resentment often hold owners and professionals back from truly understanding and advancing their practice.

Only in the past few years have conferences and webinars become saturated with educational content on what the KPIs should be in our industry. Technology advancements also allow us to accurately measure those KPIs. It is now time to go further. We must develop a strategy and have clear, transparent conversations with every employee around what the KPIs and benchmarks are for a practice, how to achieve them, and why they matter, in order to affect positive change and drive business forward. The following are some of the most common barriers to these transparent conversations practice owners may cite.

IF I TALK ABOUT NUMBERS, I DON’T VALUE PATIENT CARE AND EMPLOYEE EXPERIENCE

Very rarely will you find a physical therapist who entered the profession with business objectives and the financial bottom line at the forefront of their career goals. More often, helping people and serving the community inspire physical therapists’ career choices. However, without also focusing on maximizing financial potential, physical therapist private practice owners risk being undervalued by the public and payers. To provide great patient care you need exceptional staff, and to have exceptional staff you need to be able to pay them what they deserve, which many owners struggle to do. Think of some of your favorite restaurants that are no longer around. You might think, “How could they have closed? They had the BEST food!” While this may be true, unfortunately we live in a time where no matter how good the product or service may be, if the business owners aren’t tuned in to what it takes to keep the lights on, they will ultimately fail or be forced to change.

IF I DISGUISE KPIS AS “EFFICIENCY” OR DEVELOP COMPETITIONS AROUND ACHIEVING BENCHMARKS, MY STAFF WILL UNDERSTAND AND PERFORM BETTER

Guilty as charged. Rewards or incentives are given out to employees or clinics for lowest cancellation rates or biggest improvement in payment per visit. Or, maybe you have changed what you call a KPI so it is better received by your team. This does work, but only in the short term. Why are we still so afraid to talk clearly and openly about what our business needs to do to be successful? Your staff should understand that achieving benchmarks isn’t a bonus for the company, it’s a necessity to be sustainable.

I SHOULDN’T TALK ABOUT KPIS, ESPECIALLY WITH CLINICAL STAFF, BECAUSE I DON’T HAVE CREDENTIALS AFTER MY NAME

If you find yourself in a leadership role without credentials like I did – or if you are reluctant to place leaders in your company based on this fear – this is one of the things that may be subconsciously holding you back. Some of the greatest sports coaches and managers in history never played the game themselves. It’s time to take that knowledge from the sports world and apply it to health care. While it’s true that I will never discuss a plan of care or correct a physical therapist on how they are progressing a post-op patient, why can’t I help clinical staff realize that some of their interactions and habits may be contributing to a high cancellation rate or a low plan of care completion? I will always argue that a clinic’s success in some of the critical KPIs relies on human connection far more than how the injury or condition itself is treated.

I DON’T WANT TO FOCUS ON THE CURRENT KPIS BECAUSE WE ARE GOING TO BE PAID FOR OUTCOMES/VALUE SOON

While we all see the light at the end of the tunnel, and there are amazing activists for the profession fighting to make changes, the majority of us are still working in the fee-for-service model where we have to scratch and claw to get what we deserve from insurance companies. Delaying discussions surrounding relevant KPIs today will do nothing but delay your potential. Even in a new payment model, there will be new measurable data points that can project success, so it is beneficial to get comfortable in those uncomfortable conversations now.

SO, HOW DO WE CHANGE?

Transparency

When making the conscious decision to be transparent about data, ensure it’s communicated to everyone, not just clinic leadership. Be transparent with the WHY behind each KPI, how it is calculated, how each KPI impacts the profession and patient experience (not just the financials), and how each role in the company can impact each KPI. If your company has historically not shared information, then also remember to be transparent with your reasons for starting.

Strive for Balance

Be creative in setting your KPIs to what is most important and clear to your team. My company has never had a one-size-fits-all model and has always allowed for flexibility to adapt to clinical specialties, as well as patient needs. This variation did not allow us to accurately view all clinics or clinicians the same when benchmarking certain KPIs. It wasn’t until we combined two of the standard KPIs (Visits Per Hour + Units Per Visit) that we were able to have a level playing field. We set a benchmark of 5, and it allowed for our clinics that thrive on volume to continue operating in that capacity, but also ensured that our clinics providing hour long appointments of one-on-one care were billing appropriately for their time.

Know Your Audience

What matters to your team? It is important to find that out so you can better tailor your conversations around achieving benchmarks to what is important to them. For example, a physical therapist on our team always felt guilty for billing appropriately; after a dedicated conversation helped them see that consistently under billing allows insurance companies to under value the profession, the employee’s behavior changed.

Start Somewhere

How can we talk numbers and share data without freaking people out? A decade ago, the answer to that question was, we don’t. The philosophy was always to keep the numbers and financial data locked up with the belief that, with great service and experience, business will continue to flourish. Until we find ourselves in the promised land where enough of the general public values the magic of the profession enough OR insurance companies fairly reimburse, we have to be strategic and remember that financial success and providing great patient and employee experiences should not be mutually exclusive. That starts with transparent conversations with employees about the KPIs that are important to our businesses and what role they play in helping us achieve the best results possible. 

References:

1Dwight D. Eisenhower Quotes. Brainyquote. https://www.brainyquote.com/quotes/dwight_d_eisenhower_149102. Accessed May 7, 2021.


Jenni Love

Jenni Love is a PPS Certified Administrator and the Chief Operating Officer at IRG Physical & Hand Therapy serving the Pacific Northwest. She can be reached at jennifer.love@irgpt.com or on LinkedIn at www.linkedin.com/in/jennilove.

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