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Moderator:
(Bill Finerfrock) Operator: Hello everyone. Thank you for holding and welcome to the Rural Health Clinic Technical Assistance call sponsored by the Office of Rural Health Policy. We are recording today's conference. And at this time, I'd like to turn the call over to your moderator, Bill Finerfrock. Please go ahead, sir. Bill Finerfrock: Thank you. I'd like to welcome everybody to today's presentation entitled "Benchmarking - Keeping it Simple." I'm Bill Finerfrock, executive director of the National Association of Rural Health Clinics. Our speaker today is Linda Goldsmith, president and principal associate in Goldsmith & Associates, which is a rural health clinic-consulting firm. She provides a variety of services designed to optimize administrative performance of rural physician groups and hospitals. Today's call will be followed up by a call later on using your benchmarking data to establish a budget for your RAC. Today's program is schedule for one hour. The first 45 minutes will be Linda's presentation and then we will open up the lines for questions and answers. This series is sponsored by the Health Resources and Services Administration's Federal Office of Rural Health Policy in conjunction with the National Association of Rural Health Clinics. The purpose of the series is to provide rural health clinic staff with technical assistance and RHC-specific information. This is the eleventh call in the series, which began in 2005. As you all know, there is no charge for participation. This is fully funded by the Office of Rural Health Policy. Individuals can sign up and receive announcements regarding call dates, topics and speaker presentations - www.ruralhealth.hrsa.gov/rhc. A transcript of today's call, as well as the slides - the slides are already available and a transcript will be available in a few weeks on the ORHP site at that location. We will request that callers during the Q&A provide their name and location before their question. Linda, we're looking forward to your presentation and the line is yours. Linda Goldsmith: Thank you very much, Bill. And, I'd like to say good afternoon to everybody. I hope wherever you are located that's its cool and not too hot today. Today's presentation is about benchmarking and it's intended to serve as an introductory-level course to this topic. I would like to suggest that if you are interested in a more advanced discussion about the topic to let Bill know and maybe he can schedule a follow up session in the future. Please go to my PowerPoint presentation, starting with Slide #3 where the course objectives are referenced. As stated it is hoped that at the conclusion of this session (l) you will be able to understand what is meant by the term "benchmarking,"; (2) understand the benefits of benchmarking, (3) be able to develop a plan to benchmark, using key indicators for your own clinic and, finally, (4) understand the limitations of benchmarking. On slide #5, I have the Webster's Dictionary definition for benchmark and that is, "benchmark is a standard by which something can be measured or judged." Therefore, benchmarking for a rural health clinic owner or manager is the process of comparing the performance of selected indicators from your clinic to the performance of other clinics. As a practice management consultant, I get requests
from clinic managers and owners to assist them with a specific problem.
For example: On slide #6, I would like to provide a little history about benchmarking. In his book, In Search of Excellence, Tom Peters wrote, "you cannot manage what you do not measure." As you know, there is a lot of truth to that. The process of benchmarking helps a manager measure. Therefore, benchmarking is used by most if not all industries and has been around for a long, long time. For example, automobile manufacturers benchmark their EPA miles per gallon to industry standards. Chip makers, such as Intel, want to know how many defects they have per million chips manufactured. To measure this critical aspect of their operation they benchmark the number of defects that they have to their own data base as well as other chipmakers. Hotels also use benchmarking to compare their occupancy rate and guest satisfaction to a national database. And finally, hospitals use benchmarking by comparing their number of falls out of the bed, medication errors and infection rates to a national database. Benchmarking is even used to measure sporting indicators such as earned run averages for baseball and par scores for golf. In summary, benchmarking is used very broadly in both corporate and non corporate environments. Benchmarking for medical practices did not really begin to develop until the 1980s, at which time clinics began to computerize their accounts payable systems and accounts receivable systems. This made it easier to gather specific data, and as a result, for organizations such as Medication Group Management Association (MGMA), to develop sell a dataset as benchmark information. Benchmarking for RHCs is still very much in its infancy and unless an effort is made on a national basis, RHCs will have to continue to benchmarks to non RHCs. On slide #7, you may be wondering "Why start benchmarking now? My response is "When is there a better time?" Specifically, many rural health clinics are struggling with increased overhead, capped rural health clinic all-inclusive rates, discounted fees, increased indigent population, shortage of qualified and motivated staff, and to complicate these problems our patients are becoming more demanding. In addition to a changing financial environment, years of routine can institutionalize effectiveness and prove costly to a rural health clinic. How many times have you gone to work somewhere and asked, "why do you do something this way," and the answer is, "I don't know, it's just the way it's always been done." Benchmarking can open the eyes of the practice by showing you how well you are functioning and why it is important to question why and how you are performing selected tasks. On slide #8, "What can benchmarking do for your clinic?" The reason I like to benchmark is because the process will identify missed opportunities and create an environment to work smarter. Another way to say the same thing is that benchmarking will give you, the office manager or owner, a much better sense of the clinic's weak and strong areas of performance. Slide #9: Before we review the steps to begin
the process of benchmarking, I want to review the following benefits:
Keeping all the benefits in mind, let's get started. Slide #11: "Identify Clinic Indicators You
Want to Benchmark". So, with our first area, let's talk about CHARGES: Percentage of various payers. Another indicator that I like to benchmark is a percentage of various payers. This could be very important to a rural health clinic because, obviously, our revenue is enhanced the most by having a larger percentage of Medicaid and Medicare. But, more important, we need to know what percentage of our clinic is commercial and PPO, because it is in this area that we have to pay special attention to charges due to heavy discounting. Also, by benchmarking the percentage of various payers, you will be able to answer the question pertaining to financial advantages of continued participation in the RHC program. My experience is the primary financial benefit of operating as an RHC is in regards to the volume of Medicaid encounters. If many of your Medicaid patients have defected to a CHC which just opened a block from your RHC, you will want to monitor the impact of this new competition in order to evaluate the cost benefits of continued participation in the RHC program. Adjustments Percentage. The amount not collected on fees for services due to contractual write-offs, charitable adjustments, free services and other discounts divided by gross charges. This measures the percentage amount of what a practice bills which is not actually collected. A lower figure is better. It also will identify the amount of charitable care you provide and how much the charitable care costs you in addition to zero collections. Now, let's talk about COLLECTIONS. Annual Collections. The total receipts (collections) for patient services per FTE provider. Does not include other practice come received. I like to benchmark Annual Collections because it directly relates to Annual Charges and my budget process. Gross Collection Percentage. Annual collections (receipts minus refunds) on fees for services divided by annual gross charges. Net Collection Percentage. Total collections (receipts minus refunds) on fees for services divided by adjusted charges (total gross charges minus contractual, professional, charity & other discounts for which payment is not expected). This benchmark tells you if your cash flow is good or bad. The net collection benchmark for a family practice clinic, in the southern region of the United States, is roughly 98 percent. Most of my rural health clinics in the same region have a net collection percentage in the range of 105 to 115 percent. This ratio runs higher for RHCs because of the AIR (all inclusive rate) we receive for Medicare and Medicaid encounters. Therefore, if your RHC is below 105%, and for sure, below the 98 percent benchmark for non RHCs, you know you have a problem with your billing and collection systems. Accounts Receivable Ratio. Total accounts receivable divided by average monthly gross fee or service charges; also referred to as number of months of receivables outstanding. This particular benchmark is going to let you know how well your people are working unpaid accounts. A/R Percentage 0-30 days. Percent of total accounts receivable that are 30 days or less. This is determined from a practice's accounts receivable aging report. Because of the high number of citizens living below the poverty rate, low median family income, and high uninsured population in most rural areas of American, for RHCs, this percentage should be a minimum of 50% of your A/R. However, even with the poor economic conditions of rural areas, if (l) you transmit claims daily, (2) assertively work old accounts, and (3) are fairly disciplined about writing off uncollectible balances on a routine basis, your percentage should be between 60% - 65%. Days Gross Charges inA/R. This is the number of
days of charges that are in A/R. The formula to determine this benchmark
is: Total Account Receivable In a perfect world, RHCs can have 50 to 55 days of charges in your A/R. In summary, benchmarks pertaining to charges and collections will tell you how well you are managing the revenue components of your clinic's finances. There are also key performance indicators related to expenses. For example: Total Practice Expenses. Operating costs of a practice excluding physician and paraprofessional compensation. Total practice expenses are all expenses excluding physician compensation, physician benefits, paraprofessional compensation and benefits divided by total collections. These benchmarks tell you how well you are doing, with regards to profitability and cost management. Expenses to Charges Ratio. Total operating expenses divided by total charges. This measures productivity in terms of what it costs to produce the fees charged by the clinic. If percentage goes up (over 65%) or down (30%) you will need to determine the cause. There are other very important indicators, in addition to expenses and in addition to collections. Staffing Ratio - Total Employees. This is the number of full time equivalent employees per physician, excluding APN, PA-C., etc. To determine your ratio, total the number of hours all employees worked during a 12 month period of time and divide by 2,080 hours. If you have more than 1 FTE provider, divide the FTE staffing ratio by the number of FTE providers. For example, the employees of a FTE family physician and FTE PA-c, worked a grand total of 17,350 hours (includes office manager, medical assistants, LPNs & RNs, X-Ray & Lab techs, receptionist, insurance clerks, and billing clerks). 17,350 divided by 2,080 = 8.34 FTE. Divide 8.34 by 2 FTE providers = 4.17 staffing ratio per provider. The benchmark for a family physician is 4.9. One could conclude that you are understaffed since your ratio is 4.17, but by much. Visits Per Week. This indicator is important because it speaks directly to the productivity of a provider and overall demand for patient services, which is necessary in determining what the staffing ratio should be. I have clients that like to benchmark their hospital inpatient visits per week, nursing home visits per week, and new patients per week. I like new patients per week because it helps me evaluate the demand for services which determines if it is necessary to recruit additional providers. I have just identified some basic performance indicators that from my perspective will be useful for a rural health clinic to benchmark. There are many more indicators, but due to time I had to omit from the presentation, but you can identify additional indicators when you purchase your dataset. Slide #14. Step 2: Identify Appropriate Dataset. This probably is the hardest step in the process, but getting easier as more and more commercial resources are getting into the business of collecting data to create a larger dataset. By dataset I mean a set of national, regional, or local norms for you to use to engage in the process of benchmarking, because benchmarking is comparing. Remember, you are going to compare your clinic's performance to a similar clinic's performance, so the dataset you purchase contains the norms most similar to your clinic. In order to select a dataset, you will need to find a source that best matches your clinic's profile. Therefore, you have to go shopping for a dataset. You are going to first start with a data source that is the same specialty (or most similar) as your clinic. For example, if the scope of services for your clinic is general in nature or resembles the services provided by a family physician's office, then find a dataset that is representative of family physicians. Do not use a database that reflects a surgery clinic or cardiology clinic. To select a non family practice dataset is the same as comparing apples to oranges. To digress for a moment. I don't know if this happens to you, but I often talk to owners who will read in a journal, perhaps "Medical Economics", where the staffing ratio of a medical office is 3.5. He/She wants to know why their ratio is 4.17. When an article does not identify the specialty of the medical office, I explain to the owner that the ratio is useless. Once you have decided on a specialty, select a dataset that is most representative to the size of your clinic. For example, is your clinic owned by one provider or owned by a group? A small group versus a large group is going to have different outcomes. For smaller clinics, I almost always use benchmarks for a solo or small family practice group, even if the primary provider is a physician assistant or a nurse practitioner, assuming, of course, that they are providing the same scope of services a family physician provides. I have a couple of pediatric clinics and we use the pediatric benchmarks for them. So, now that you have identified your specialty and the size of your clinic, try to find a dataset that provides a similar geographical background. Again, matching your clinic to a similar clinic will give you a truer database to use as benchmarks. By geographical, I mean a dataset that provides benchmarks specific to your region or better yet, state. You can imagine that the cost to operate a rural health clinic in Hawaii, where everything is very, very expensive, is going to be much higher than operating a clinic in McGehee, Arkansas where we think overhead tends to run lower than many other regions in the country. So, in order for your benchmarking process to be of value, you need to find a dataset that representative of as many clinics as possible in your specific geographical area. Some resources that I'm going to talk about later on also will provide benchmarks broken down to rural versus urban settings. Let's say your RHC is located in Iowa and has one FTE board certified FP, one FTE GP, and one FTE APN specializing in adolescent medicine. You have decided you are in the market for a dataset representative of a small group practice of family physicians operating in the Midwest. Given that information, let's go to slide number 17, because you have several resources where you can obtain your dataset. Slides 17- 21. I have listed six different resources that provide datasets matching the profile above. The first is Practice Support Resources. You will see that I have provided the telephone number. I think PSR is a very good source and one that I frequently use because it provides benchmarks by geographical regions, it has surveyed a large number of clinics (the recent dataset for family physicians is representative of 1,600 family physicians working in small groups. Also, it is fairly inexpensive. The second resource is MGMA. You will see that I have provided the telephone number for MGMA. MGMA's dataset is especially good if you have a large group (six or more full-time providers). It's even better for specialty groups, or multi-specialty groups. It's also does a very good job of explaining the definition for each indicator. And, with that in mind, I need to make sure that I emphasize the importance in selecting a dataset that is the most current (most datasets available for purchase represent data collected two years prior to the printing of the results) and provides excellent definitions pertaining to each indicator. Without a clear definition of the indicators you will not be able to benchmark your performance with accuracy. Another benefit of using MGMA is that they have benchmarks for the general population of clinics surveyed as well as selected "best practice" benchmarks. This is important because one must always remember that benchmarks are equal to status quo. By that I mean, they are the average - some clinics are doing better and others are doing worse. I like to set the "bar" regarding performance for my clinics higher than the benchmark (unless it is labeled "best practice") which should be representative of the better practices. The third resource is the National Association of Healthcare Consultants and that's on slide 19. I have provided their telephone number. I have never used them before, but I've seen them referenced in credible reports and journals. In reviewing their dataset products, they do have benchmarks for regional areas. They are a little expensive, but not as expensive as MGMA. The fourth resource is The American Academy of Family Physicians - if you are working for a family physician or a mid-level provider specializing in family practice - the AAFP's web site is excellent with regards to the productivity of a family physician. The dataset is titled "Facts About Family Physicians." I use their facts as a benchmark and I really like it because the number of family physicians surveyed (their membership which is over 100,000 FPs) is significantly higher than the other resources. They also present the dataset by geographical areas as well as urban and rural. It's very, very good with regards to productivity, number of average patients per week, number of weeks per year, number of hospital admits, etc. Perhaps the best feature is that it is free if your owner is a member of the AAFP. The website is www.aafp.orgquery.html. Search: Facts About Family Physicians. The fifth resource is the National Association of Rural Health Clinics. At the Summer Institute in Reno, Ron Nelson presented cost report benchmarking data for rural health clinics. His presentation is going to be available on the National Association of Rural Health Clinics web site soon. I missed his presentation in Reno, but if I understand the handout that I got, he benchmarked rural health clinics using Medicaid data in Michigan. And, it is a fairly large database that compares RHCs to FQHC and Independent RHCs to Provider-based RHCs. Because it contains cost report information from Michigan clinics it is for sure representative of Michigan RHCs as well as neighboring states. This is a very, very useful benchmark source for the clinics in that area. And, with the exception of a dataset published a couple of years ago by the Washington State Association of Rural Health Clinics (representative of RHCs located in Washington), it is the only other dataset to my knowledge that is exclusive to RHCs. The sixth resource which could be RHC specific may be the individual that prepares your cost report. For the first time this year, I have developed a dataset representative of all my clients that is available only to my clients. So, perhaps your consultant has a dataset as well. Slide #22. Step 3: Gather Data to Analyze. Once you have purchased your dataset, you need to carefully read the definitions provided for each indicator that you wish to benchmark. And that is especially important because you want to make certain the data you collect from your clinic is derived in the same manner as reflected in the benchmarks. The second thing you need to do is develop a strategy to collect your data. That means you want to make certain you're A/R and A/P systems are able to give you the results you need in the format that works with your benchmarks. If the A/R system does not provide the exact data, develop a spreadsheet that will do the necessary calculations to reach your objective. Making the extra effort to perform this task will really provide you a more reliable comparison. At this point, you know the indicators that you
want to benchmark. You have identified the resource to purchase
a dataset and subsequently have purchased the dataset. And, now,
for step four, you're ready to begin to analyze it. Now that you have your spreadsheet developed and have compared your performance to the benchmarks, you can identify the indicators where you are out performing the benchmark and those where you are lagging. Take each area that indicates a lag or underperformance and proceed to undergo a good old-fashioned problem solving exercise to identify a set of strategies to implement in order to improve your clinic's performance in the specific area. The best way to brainstorm is to gather various employees to suggest things that can be done to improve the problem without thinking about barriers. Once you have all the strategies listed, one by one evaluate them to determine which ones will work and which ones won't. At the end of this exercise, you should have one or more strategies that you can implement to improve the performance of the lagging indicator. Write-up the policy and procedures for implementation then meet with the key people associated with implementing the strategy to review the process. I strongly recommend that you re-evaluate the effectiveness of the new strategies at least every three months to determine if there is an improvement. If you initial strategy(s) did not work then find out why and try something else. We cannot continue to lag behind the benchmarks representing similar clinics. Slide #25 references the limitations in the benchmarking process. The first limitation is to remember that one benchmark will not tell the whole story. Just because you find an indicator that appears to be lagging, you may have a reasonable explanation and therefore, you won't need to start a quality improvement project to correct it. For example, as a result of benchmarking, you have realized that your net collection ratio seriously lags behind the benchmark. However, you also know that your front office was understaffed by one FTE employee for two months and to make things worse, your insurance clerk was out seriously ill for three weeks. As a result, the many essential detailed tasks associated with a higher collection ratio were not being implemented as routinely as they should. However, now that you are fully staffed (you have hired a replacement for the empty position and your insurance clerk is back 100%) the percentage should improve. However, before you dismiss the potential problem, you want to continue to monitor the indicator over the next several months to make certain your problem was a one time situation. If you continue to lag in that area, you may have a problem that needs addressing. Another limitation to benchmarks, as I mentioned previously, is that benchmarks represent status quo. And operating at status quo will not get you where you want to be if you truly aspire to be a better performing RHC. Therefore, if the benchmark for Gross Collection Percentage is 77% and your percentage is 77, don't get too happy. Your 77 percent means you are average and there is room to improve your performance. In conclusion, it is easy to say there is no perfect benchmark and as a clinic manager, one should not rely on just one way of looking at things. However, benchmarking will provide you the opportunity to open the eyes of the practice and help you gain success in those areas that are lagging by helping you identify issues, set targets, take action and measure your success. Finally, it provides you with a very effective process to be successful. And, with that I'd like to thank you very much. This is a difficult topic to address via telephone conference, but I've tried to lay out the basics for you to get started and try to have fun with. Hopefully, you will get more good news than bad news if you choose to undergo the process of benchmarking. Bill Finerfrock: Thank you, Linda. We appreciate it. Before we open it up, I had a couple of things I wanted to ask you about. In terms of the database that you select, you gave several options and talked about, you know, national database, regional, state. Do you have to be concerned about the size of the database? In other words that you're refining your request for information to such a small number. When you say, well, I want information on a family practice, in a rural community, in the southeastern United States, you know, that the number - the amount of information or the number of participants in that database gets so small as to question the reliability of it? Linda Goldsmith: Yes, and thank you for bringing that up. You do have to question the size of the dataset and also the age of it. That is why I frequently use the dataset provided by Practice Support Resources. Their most recent data set for family practice is the results of the findings of a survey of over 1,600 family physicians in the southern region alone and it's also representative of urban as well as rural clinics. And that for me, when I'm working with clients in the southern region, that's about the best I can do. And, also, I think I mentioned on the MGMA slide, I believe the MGMA dataset is best suited for large practices and subspecialty groups versus small primary care groups. The last cost production report I reviewed (several years ago) had an N of 12 for family practice clinics in the whole United States. So, from my perspective, MGMA is not my choice for as dataset to use in a RHC in McGehee, Arkansas. So, your point is well taken. When you are in the process of purchasing your dataset, questions regarding size, geographical reakdown, and age are good ones to ask. Bill Finerfrock: ((inaudible)) what is your (end)? Linda Goldsmith: Pardon? Bill Finerfrock: What is the (end), the number of ((inaudible)) ... Linda Goldsmith: Well, you know, you want it to be as big as possible but because there has been no major effort on a national basis to develop a dataset for RHCs we have to use what we can find that is most appropriate. The N for Practice Support Resources re FP in the southern region is 1,600. The N for MGMA the year I considered their dataset was 12 for family practice. Obviously, Practice Support Resources has a large dataset than MGMA. The N for the dataset I have developed for my clients based on cost reports is 18. I feel comfortable with 1,600 FPs and I feel comfortable with 18 RHCs of similar size and in the same geographical area. So, its variable, Bill. Bill Finerfrock: OK. There was a question that came in via an e-mail prior to the call. I'd like to answer it, or see if you could at least provide some direction. It says, "in RHCs are RVUs traditionally lower than national averages? If so, why? Is it due to covering hospital inpatients, since rural areas may not have hospitals, or is it due to increased numbers of patients with co-morbidity and increased (psyche) issues among lower-income patients, which are frequently addressed in primary care offices?" Linda Goldsmith: In answer, I don't know if it's true that RVUs are traditionally lower than national averages. I have not seen any studies to tell me one way or the other. But, let's look at the indicator regarding FP salaries earned by rural family physicians versus urban family physicians. My experience has shown that rural family physician salaries are equal to, and in many cases greater than, most urban family practice salaries, so given that comparison, it's hard to see where rural is lower than national.. But, I do not use RVUs in a rural health clinic setting because they represent work units, and because the majority of a rural health clinic reimbursement is not based on work units, but instead on our all-inclusive rate, I kind of see no relevance. So, I'd have to say to the person that submitted the question, I'm just unfamiliar with what he's talking about. I have not seen any specific studies addressing the issue and I think that the RVU methodology is more appropriate for large multi-specialty clinics. Bill Finerfrock: OK. All right, Operator, do you want to open it up to the audience? Operator: Absolutely. If anybody has any questions at this time, simply press star one on your telephone keypad please. Again that's star one. Please release your mute function before your signal and you will hear an automated voice prompt on your line to indicate when the line is open. So once again, it's star one for questions. We have our first question. Go ahead, please. Again, your line is open. Go ahead, please. (Christy): My question is ... Bill Finerfrock: Identify yourself and where you're from please. (Christy): Oh, sorry about that. My name is (Christy) and I'm with (Horn) in Nashville, Tennessee. And, my question is regarding the resources. What would you say is the best resource for rural health clinic benchmarks? Linda Goldsmith: Well, I have no vested interest in which resource you use, but the one I use most frequently is Practice Support Resources, and I use it for many reasons. Number one, it's reasonably affordable. Number two, they have a large N. For example, for the southern portion of the United States they surveyed 1,600 family practice physicians in 12 states. Number three, the profile of practices includes suburban, urban, rural, solo, group and a variety of years in practice. They also caution that the majority are established practices at least 2 years or more. The only problem I have with them is that they use a range rather than an absolute. But, I can live with the range because it's the closest in terms of me being able to really know that I'm comparing similar clinics to similar clinics. (Christy): OK, thank you very much. Linda Goldsmith: You're welcome. Bill Finerfrock: Linda, in terms of the - you'd made some reference to PAs and nurse practitioners. A lot of the databases only look at physicians. Is that correct? Linda Goldsmith: It does, but ... Bill Finerfrock: Is there anything special because of the use of PAs and NPs? Linda Goldsmith: I benchmark PAs and NPs the same way I benchmark physicians. Basically, I do not cut them any slacks "just because" they are not a physician because in many cases, I have PAs and NPs that see more patients in the clinic than the physician does while working the same number of hours. With regards to salary benchmarks, I believe that all the sources I have referenced in this presentation have benchmarks regarding PA and NP salaries but they do not have benchmarks for productivity. Bill Finerfrock: OK. All right. Operator, the next call. Operator: No questions holding at the moment. Again, it's star one if you'd like to ask any questions, please. Linda Goldsmith: I'd also like to add, Bill, that on the PA issue, a couple of years ago I was trying to benchmark a physician assistant's productivity and I was told the Physician Assistant Association had some benchmarks, but I was never able to get a response to my request. I think you have to be a member to get their data, but they had average number of patients that a PA sees a year, the average going salary, and I think it was even regional. Bill Finerfrock: Yes Linda Goldsmith: I don't think it could be purchased. I think you just have to be a member and hopefully they'll provide that information to you, should you want it. Bill Finerfrock: OK. Operator, any questions? Operator: We do have some questions holding. We'll move to the next question. Go ahead, please. (Maria Parabello): Hello, my name is (Maria Parabello) and I'm in mid Michigan. I wonder if you would be kind enough to give us the web site that you were mentioning earlier in your presentation. Linda Goldsmith: I mentioned two web sites. One was the AAFP and the other one is the National Association of Rural Health Clinics. Which one did you want? (Maria Parabello): Well, I went to the - see, I got notified about the presentation, but I was not able to get the PowerPoint presentation, so therefore I really couldn't follow you that well. Linda Goldsmith: I'm sorry. Bill, maybe you can address that. Bill Finerfrock: Yes, there you need the - it's www.ruralhealth - one word - r-u-r-a-l-h-e-a-l-t-h - dot hrsa dot gov forward slash rhc, and it'll be there by date and topic. (Maria Parabello): Oh, OK. OK, great. Linda Goldsmith: And, we will have a written transcript, so if you can get the PowerPoint presentation and compare it to the written transcript then hopefully it will make more sense to you. Benchmarking can get very confusing and we are doing our best to try to keep it simple. (Maria Parabello): Right. I wanted to be able to access those free databases or that free benchmarking information that you were talking about. Linda Goldsmith: Well, now, the free is - what type of a doctor are you working with or for, or are you a ((inaudible))? (Maria Parabello): ((inaudible)) practice. Linda Goldsmith: Pardon? (Maria Parabello): A family practice. Linda Goldsmith: All right. Is the family physician - is he a member or she a member of the AAFP ... (Maria Parabello): No, I don't think so. We're ... Linda Goldsmith: ... the American Academy of Family Physicians? (Maria Parabello): American - I don't think so. Linda Goldsmith: OK. I don't know if you have to be a member or not, because I've just been on their web site so much. But ... (Maria Parabello): Right. Linda Goldsmith: ... if you go to my PowerPoint presentation, I have the web site there for you. And, actually, let me get it right now. Bill Finerfrock: I have it here. I'll give it, Linda. Linda Goldsmith: OK. Bill Finerfrock: It's "www dot aafp dot org forward slash - the work query - q-u-e-r-y - dot html ... (Maria Parabello): OK, got it. Bill Finerfrock: ... and then you look for facts about family physicians. (Maria Parabello): Very good. Thank you. Linda Goldsmith: You're welcome. Bill Finerfrock: Operator, next question. (Laura Black): Yes, this is (Laura Black). I'm the manager at the Las Molinas Family Health Center in Las Molinas, California. And, our practice situation is we have two nurse practitioners who see the patients primarily, and we have a physician who comes every other week for a few hours, and so we are primarily a nurse practitioner based clinic. So, I just wanted to perhaps add a little information there. The American College of Nurse Practitioners has a lot of really good data about nurse practitioner practice and numbers of patients they're seeing and productivity and that sort of thing, so ... Linda Goldsmith: Exactly, just like the PAs. But, also as I said previously, I benchmark them right to family physician benchmarks. I mean they are - they're capable of being as productive. (Laura Black): They're doing the job. Linda Goldsmith: They're doing the job, absolutely, and I have seen where they are holding their own with a family physician. You know, obviously, they're going to lag in the hospital area, but regarding issues pertaining to productivity, such as charging, the are right there with the physicians if not doing better, so I do not cut them any slack and they seem to hold up to it. Bill Finerfrock: The ACNP - is that publicly available data? (Laura Black): yes. Bill Finerfrock: And do you know their web site offhand? (Laura Black): I do not know it. I know they're the American College of Nurse Practitioners. They're out of Washington, D.C. Linda Goldsmith: Do you have to be a member? (Laura Black): No. Linda Goldsmith: OK, because I remember I tried to get some of that data years ago and ... (Laura Black): I don't think so. I think you can go on their web site and they have a lot of that data right there ((inaudible)). Bill Finerfrock: We'll look into providing a link to that data, as part of the transcript of the presentation. (Laura Black): OK. Linda Goldsmith: Thank you very much. (Laura Black): Not a problem. Thank you. (Les Propaul): Hi, this is (Les Propaul). I'm at Mammoth Hospital in Mammoth Lakes, California. My question is in regard to the transcript and when that becomes available and how you go about getting that. Bill Finerfrock: Well, what we'll do is in about three or four days we'll get the transcript from the service. We send that out to the speaker. The speaker then goes through it. Because it's a transcript of an audio they - you know, sometimes words get jumbled up and there needs to be some clarifications, so it takes a little bit of time for the speaker to go through. Once that's cleaned up and the speaker releases it, it's then posted on the Web site, and it'll be the same place where you get the slides, where you got the PowerPoint slides. Then added to that will be the transcript. (Les Propaul): OK. And, Linda made mention that some formulas and things will be in there for the ratios? Linda Goldsmith: Yes. Yes, I'm going to give you the basic formulas for indicators. (Les Propaul): Great. Thank you. Linda Goldsmith: You're welcome. Thank you. (Phyllis Burke): Yes, this is (Phyllis Burke) from Sioux Valley in South Dakota, and just a couple of general questions in regard to these databases. And, I might have missed part of your presentation here, but it looks like a lot of them refer to the region. As far as the size of the practice, between a rural and an urban, is there ones that are more specific ((inaudible))? Linda Goldsmith: No - unfortunately, as much as I wish we could find something specific to rural, at this time, other than Ron Nelson's cost report benchmarks, the benchmarks developed by the Washington State Association of Rural Health Clinics, and any benchmarks the consultant that prepares your cost report may have, the only other resource is the American Academy of Family Physicians which does break down some of data by rural versus urban, but even that breakdown is not regional. It's just rural versus urban. Again, I tend to - and trust me, I have nothing gained by promoting Practice Support Resources. I think that theirs is more rural compared to other datasets. (Phyllis Burke): OK. Once of the comments I've gotten from some of the facilities is "well, benchmarking is good, but we're ((inaudible))." Linda Goldsmith: I know. Our patients are sicker. (Phyllis Burke): Yes, it's always ... Linda Goldsmith: I know. And I promise, you are going to hear that until the day you die. But, that's why I always explain that the benchmarking process provides an objective basis for discussion operations improvement and through the benchmarking process; they may find areas where they perform better than the benchmarks. Also, I remind them that one benchmark will not tell the whole story, but we still need to benchmark. I try my best to put the positive spin on it. You know, we're looking for the things we do well, but, you know, we may come across some things that we're not doing so well. Remember, through benchmarking you can do some exciting motivational things including developing an incentive program (bonus payments) based on benchmarks. (Phyllis Burke): OK. Linda Goldsmith: Good luck. (Phyllis Burke): OK. Bill Finerfrock: If there's one more question, we'll take it, otherwise we're going to have to start closing it down. But, if we have one more question ... Operator: There are no other questions holding. Bill Finerfrock: Well then it works out well. I want to thank all of the participants and particularly our speaker, Linda Goldsmith, and I also want to thank the Office of Rural Health Policy for sponsoring this teleconference series. As has been mentioned, the transcript of today's presentation will be available in the very near future. I want to remind participants that the call will be followed up with a call later on using your benchmarking data to establish a budget for your RHC, and I want to encourage others, who may be interested, to register for the technical assistance call series, and if you go to the Web site we've mentioned already, there's a link there on how to register. That will allow you to get into the database, so make sure that you get all of the information on these calls as they occur in the future and any notice we want to put up about it. The next call we will send out an announcement when that has been formally scheduled. And, just in the future, we suggest that you begin dialing in a few minutes before the call, so that we can begin promptly at three o'clock. Again, thank you to Linda Goldsmith, our speaker today, and the Office of Rural Health Policy for their support for this project. Linda Goldsmith: Thank you. Operator: Thanks again, ladies and gentlemen. That concludes today's call. Have a good day. END
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