Practice management: doctors should not only know their billing figures, but also should know their practice management performance figures

Facts and Figures from the German Health Care System

What it’s all about

Billing figures are of particular importance for general practitioners and specialists, as they determine the economic output of their work. However, too little attention is paid to the fact that the performance figures of practice management, the key performance indicators (KPI), are just as important, because they indicate whether the conditions for billing are optimally designed. They provide this benefit by

  • condensing the complexity of practice management
  • making the circumstances and interactions of the areas of action manageable,
  • diagnosing the performance status,
  • identifying unused performance reserves and
  • control the management in a targeted way.

Only those who know the exact performance data of their practice management can work successfully in the long term, both medically and economically.

Example 1: The Teamwork KPI

The cooperation of the staff as a „real“ team decisively determines

  • how efficiently and productively the service is provided, and
  • what depth and breadth of service is possible.

For this, practice owners need knowledge – and not, as is widely the case, assumptions – about the following issues:

  • Team Experience Portfolio (TEP)

What is the current self-image of the team members, broken down into a description of strengths, weaknesses, threats and opportunities as a result of previous cooperation experiences?

  • Overall Team Satisfaction (OTS)

How do the employees generally rate their framework of action in comparison with their requirements?

  • Team Harmony Balance (THB)

How pronounced is the degree of agreement among team members in evaluating their working framework? The information can also be used as an

This information can also be used as an indicator of the potential for conflict within the team.

  • Teamwork Quality Score (TQS)

How far is the quality of cooperation in the sense of implementing „real“ teamwork developed? Often the members interact only as a community, group or alliance of purpose.

  • Return on Management (ROM)

What impact do team building measures have on teamwork quality?

  • Team Development Options (TDO)

What ideas and suggestions exist from the staff perspective that contribute to further improving teamwork.

The TQS shows for German GP and specialist practices that mainly groups, but no teams, work here. This form of collaboration is characterised by a low synergy of individual activities:

  • people work together, but only within the framework that is given,
  • Individual initiative or helping out with problems is rare,
  • Moreover, collaboration is often characterised by unresolved conflicts,
  • although every medical assistant strives to do her job well, there is no sustained commitment to continuous improvement.

Example 2: The Patient Care Quality Score (PCQS)

The quality of care determines the intensity of patient retention and acquisition, two other aspects that have a direct impact on billing. The appropriate score results from the combination of patient satisfaction and the requirements of the practice visitors. It provides the following assessment criteria:

  • PCQS > 80%: Best Practice Quality of Care.

This is the ideal state to strive for, but only few practices achieve it.

  • PCQS > 60% to <= 80%: Quality of care largely in line with requirements.

Patient criticism is kept within narrow limits. In most cases, it can be countered with a few corrective measures.

  • PCQS > 40% to <= 60%: Marginal quality of care.

In this constellation, patient dissatisfaction relates to a large number of different aspects. If no changes are made, a negative spiral develops which can lead to a further decline in the PCQS.

  • PCQS 0% to <= 40%: Inadequate quality of care

From the patient’s point of view, the care provided by these medical practices is out of the question and would have to be developed from scratch.

Example 3: The Best Practice Score (BPS)

This key performance indicator shows for the practice management as a whole, as well as by means of sub-scores for each individual area of action, whether all the instruments, regulations and behavioural patterns necessary for work to function smoothly even under changing loads are being used.

In German medical practices, its value is currently 53 % on average. This means that 47 % of the best practice standard is not used at all.

The value also explains why work overload, stress and demotivation at work are daily realities in many establishments and how this situation can be substantially improved. In addition, the quality of patient care is not as good as it could be.

Example 4: The Return on Management

However, KPIs are not only able to capture and map the nature, intensity and completeness of practice management, but also impact relationships. The Return on Management (ROM) with its various options provides information on this. It shows the impact success that is achieved with practice management.

In the form of the Total Return on Management (TROM) of a practice, it shows the effect of practice management on patient care. For this purpose, the Best Practice Score (BPS) is set in relation to the Patient Care Quality Score (PCQS):

  • a score of less than 1 indicates a below-average practice management effect, in which case there is an acute need for action,
  • a score greater than 1 indicates a disproportionate effect and it can be checked whether the commitment in sub-areas can be slightly reduced in order to free up resources for other uses,
  • if the score is 1, any intensification / weakening of practice management leads to linear reactions in the quality of care.

KPI easily determined

Similarly, ROM scores provide information on organisational or teamwork quality and offer practice owners targeted indications of necessary and possible changes. Moreover, they reveal risk factors.

GPs and specialists who want to carry out a practice analysis with KPI generation can use the Practice Management Comparison© for this purpose. The validated examination, which can be carried out without the need for an on-site consultant, requires only thirty minutes of medical working time and identifies an average of forty suggestions for improving practice work.