Get to know your practice

Making business decisions based on how you think your practice is doing, is different than making those decisions based on how you know your practice is doing.

Performance metrics are one way to take the guesswork out of physician group practice planning and decision making, according to Kenneth H. Katz, M.D., who presented on the topic in March at the 2017 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Fla.

Dr. Katz, a dermatologist, Mohs surgeon and founder and president of Forefront Dermatology, which has a network of dermatology practices throughout the United States, says performance metrics also gauge where individual providers stand among other providers in regard to quality indicators and compliance.

Performance metrics measure behavior, activities and performance daily, weekly or even minute by minute, he says.

“… every week, you see if you’re meeting the set goal that you needed to meet in order to afford to buy that laser, or afford to hire that nurse practitioner or aesthetician, to repaint the office or whatever it might be,” Dr. Katz says. “Obviously, as non-employed dermatologists, we’re subject to profit margins, just like any small business. So, you need to know what that’s going to be in advance, and it’s very easy to do with budget format.”

Know where you stand

Performance metrics tell dermatologists how they’re performing compared to others in the group, from day to day or week to week-however often doctors want to look. And these can be very visual comparisons, where everyone in the group knows where he or she stands, according to Dr. Katz.

These types of performance measures tend to apply more to groups of six or more dermatologists, he says. Although solo and small groups of dermatologists can engage in performance measures with other practices in a community, according to Dr. Katz.

Performance measures can look at such indicators as whether dermatologists are getting their charts signed on time. By looking daily or weekly at the measure, dermatologists can see if they’re doing a good or bad job at getting charts signed on time, compared to their colleagues or partners in practice.

Dr. Katz says his practice applies performance metrics to Mohs Appropriate Use Criteria.

“One of our goals at Forefront Dermatology is we want to give every patient a 99 percent chance of cure for whatever skin cancer they have,” he says.

The performance metric for that measure gauges how often dermatologists treat skin cancer patients according to the Mohs Acceptable Use Criteria, which helps determine when physicians need to do an excision, Mohs, cryotherapy and more to get to that 99 percent. The goal, according to Dr. Katz, is to ensure that every skin cancer patient who walks through the practice’s door has an exceedingly high rate of success.

Simple visual tells the performance metrics story

Forefront Dermatology uses a speed dial image to gauge how individual dermatologists are doing compared to others in the practice (see example, page 82).

“It’s like a speedometer. We’re all pretty competitive. And nobody wants to find themselves in the red of the speed dial. Everybody wants to be in the green or top portion of the speed dial. It’s a visual way to know whether or not you’ve done the right thing,” he says.

They use a visual in which the bottom third is red, the middle third is yellow and the top third is green. One can adjust the speed dial to a higher performance level than thirds, Dr. Katz says.

He cites the example of the measure that monitors how dermatologists are at getting their charts signed within 48 hours. The performance metrics speed dial at Dr. Katz’s practice is automated into the practice’s electronic health record, so it measures seven doctors in real time. On Mondays, every doctor gets a PDF of the cover page, on which they can see where they are in the speed dial. They know whether they’re signing charts at a good clip or need to go faster. They can click on the document to drill down into the results, to see where they stand among their peers.

“I call that a little bit of shaming people into compliance,” Dr. Katz says. “If you have eight dermatologists, pretty much by definition, four of them will be in the bottom 50% and four will be in the top. So, if those four in the bottom start working harder, it just changes the number. The speed dial is the average of everybody. So, it motivates everybody to work harder and do better and the more everybody does better, the more pressure there is to do even better, yet.”

Using performance metrics has made Forefront Dermatology more profitable, according to Dr. Katz.

“You have these doctors that were in the red on speed dial, and they see their name at the top of the list for underperforming and they work harder. You don’t have to tell them to work harder; they just will,” he says.

Dermatologists can measure anything, according to Dr. Katz. The most important thing, however, is to define your budget, measure what you can to stay on budget and make adjustments when needed.

He told the dermatologists attending his AAD presentation that they should go home, set a budget and measure one thing. Before you know it, he says, dermatologists will be measuring much more and have a better understanding of their practices.