In many communities, it is not uncommon to see billboards touting lightning-fast wait times for emergency care at this hospital or that health system. The high-profile advertising, unseen a generation ago, highlights today’s super-competitive healthcare environment and underscores the growing importance of emergency room operations.

No longer are emergency departments (ED) viewed by hospitals as costly but necessary loss-leaders for providing a full spectrum of critical care. Instead, administrators understand that the emergency room is the true front door of the hospital. Not only is it responsible for originating the majority of inpatient admissions, but the ED also is where many people form long-lasting opinions about the hospital’s brand: Its personnel, level of service and overall quality of care.

That’s why emergency groups should be working constantly to strengthen their operations and enhance their hospital relationships, not just with administrators, but with fellow clinicians and staff. By improving the service and value delivered in the ED, groups can boost the hospital’s overall competitive position. Just as important, they can enhance their standing within the organization and reduce the likelihood that they’ll be replaced by another emergency practice.

Measuring to improve

Measuring and tracking a range of operational and financial metrics is one of the keys to improving performance in the emergency department and proving your overall value to the hospital and to payers. Here are some essential variables that can illuminate ED operations:

  1. Average Patient Flow by Hour:
    Enables groups to see peak volume times across different days and shifts. Tracking average arrivals and discharges by hour helps emergency departments determine the most appropriate staffing levels for both physicians and physician extenders. Nursing leaders can also use the information to optimize nursing support staff.
  2. Average Length of Stay:
    Shows how long patients are within the department, from initiation of care to discharge or hospital admission. This metric can be reviewed by month, day-of-the-week or specific shift, and is valuable for identifying bottlenecks that may delay service. For example, if length of stay for some patients seems inordinately long, ED managers should determine if the individuals received lab work or had x-rays taken. Reoccurring problems with radiology or lab throughput should be shared with hospital and ancillary staff to mitigate delays and improve customer service.
  3. Time-to-RVU:
    A provider efficiency metric that practices can use to determine which clinicians are working most effectively and which ones may be struggling. By assessing the number of minutes each clinician takes to produce a single relative value unit (RVU), production variance caused by different levels of patient volume is eliminated and apples-to-apples comparisons are possible. Chris Edmonson, McKesson Business Performance Service vice president of client reporting for emergency medicine, says that tracking Time-to-RVU is akin to lining all up physicians for a 40-yard dash. This measurement eliminates the guesswork when it comes to productivity assessments and consequently is extremely helpful when establishing productivity-driven compensation plans.
  4. Provider Report Cards:
    Combine a number of different metrics to create additional insight into clinician performance. Along with Time-to-RVU, a report card may include the following elements for assessing overall physician productivity:
    • Total Patients Seen
    • Total RVUs Produced
    • Total CPTs Performed
    • Average Evaluation and Management Distribution Percentage
    • Total Number of Deficient Charts (broken out by reason)
Knowledge is power

Now more than ever, emergency medicine groups need to harness data to fully understand and optimize their businesses, to help improve patient satisfaction and to demonstrate their value to hospitals. Fortunately, McKesson Business Performance Services for Emergency Medicine has long been the leader in physician business analytics and reporting. Our systems mine information from claims data to provide unprecedented insight into ED group financial and operational performance, including group and individual provider productivity.

Not only does this reporting help the practice achieve and sustain high levels of operational excellence, but it also allows the group to contribute in meaningful ways to improving the hospital overall. This benefits not just the facility but patients, fellow providers, payers and, equally important, the group itself.

Dave Berry

About the author

Dave Berry
Senior Vice President of Sales - Emergency Medicine
McKesson Business Performance Services