Compiled by Rehab Management staff
Practice management software is designed to see the big picture and deal with the day-to-day details of running a practice so that therapists can concentrate on taking care of their patients. In this roundtable discussion, manufacturers of practice management software discuss the various clinic processes that their software is designed to handle for therapists. They also discuss the key metrics practice managers should keep in mind to operate optimally, and how their software has evolved over time to keep up with therapists’ expectations.
Participating in this Q&A are: Jerry Henderson, PT, vice president of clinical strategy, Clinicient; Sharif Zeid, business director, MWTherapy; Steven Presement, president, Practice Perfect EMR + Management Software; Terrence D. Sims, president, chief operating officer, Raintree Systems; Lori Collins, product manager, ReDoc by Net Health; Daniel Morrill, PT, DPT, CEO/president, TheraOffice; and Heidi Jannenga, PT, DPT, ATC/L, president/co-founder, WebPT.
Q. What are the top practice management headaches you hear about, and how should software help address them?
A. Jerry Henderson, Clinicient: The most common headaches we hear about are how to get from point A to point B – how to set goals and achieve them. It’s so difficult for practice owners to see the forest for the trees and get up and out of their day-to-day in order to develop some perspective and make a plan. We believe software should help get the busywork out of their way and help them focus on what’s truly important. Software should automate where it can, it should present them with the next most important thing they have to do that day, and it should provide them with clear clinical and financial reporting so that they can determine where they are and where they need to go to meet those goals.
A. Sharif Zeid, MWTherapy: Practices always strive to offer clinical excellence, keep staff happy, and stay profitable in an ever-increasing insurance payment and compliance environment. Achieving those three goals requires multiple steps, multiple people, and multiple processes. A good piece of software will bring these teams and steps together into one place, minimizing errors, things falling through the cracks, saving time, and eliminating duplicative tasks. There’s a lot of crossover between keeping staff happy and delivering clinical excellence. Happy therapists provide excellent care. Having an EMR that is highly customizable keeps therapists happy and producing, while improving the bottom line. Customization also leads to better quality and more defensible documentation.
A. Steven Presement, Practice Perfect: The thing we hear the most is that there is simply not enough time to get everything done, there are so many demands from insurers, government, etc, that the simplest tasks, the ones that generate easy revenue or collections, simply get pushed to the back burner. Good practice management software should automate these functions as much as possible. If you don’t have time to call patients and remind them about upcoming appointments, have your software do it. If you don’t have time to call all of those patients who’ve stopped attending, have your software do it. No time to call patients who cancelled and need to rebook? Again, software. This also extends to gathering information – rather than taking staff time to compile metrics for your clinic, let the software take care of this.
A. Terrence Sims, Raintree Systems: We usually hear about two headaches. The first is the lack of specialty-specific content for EMR templates and documentation. The second is the lack of advanced billing, AR, and RCM tools built into the software. Developing specialty-specific content requires an advanced understanding of medical specialties. This takes a deep commitment to that specialty and strong partnerships with providers and practitioners to help you create highly intuitive content that makes the provider’s job easier. It’s the same for developing advanced billing, AR, and RCM tools. Software developers need to engage deeply with customers and the market, have a firm understanding of needs, and be willing to build products that help practices simplify the complexities of their fields.
A. Lori Collins, ReDoc by Net Health: We consistently hear the same challenges: Practices struggle with managing therapist productivity, efficient and effective scheduling for both patients and providers, timely and actionable business reporting, and staying compliant with all the different regulations and payor rules. They need to manage and grow the business, but at the same time deal with budgetary constraints. Software should be able to quickly provide insight into important business metrics, enabling clinic managers to spend more time addressing any issues in those areas. Software should also accommodate those circumstances that can be unique to a rehab therapy practice, such as scheduling and workflows. When tools, such as software, don’t function in the manner needed, it can prove detrimental to productivity and employee satisfaction.
A. Daniel Morrill, TheraOffice: Simplification of complex business processes is where software should impact top practice management headaches. Start with insurance and patient billing, which are the most time-consuming and difficult tasks for typical practices. Great software will help users organize their day to make sure they are spending time on tasks that matter. Software should help identify and highlight issues before they become problems. Software should also solve some of the headaches of sourcing data for management and productivity reporting.
A. Heidi Jannenga, WebPT: Approximately 20% of physical therapy patients drop out of treatment within their first three visits – and 70% never complete their entire course of care. Lack of patient engagement and loyalty rank high among factors that influence early patient dropout, which is why a clinic’s ability to collect and act upon honest, relevant feedback from patients is paramount. That’s where patient relationship management (PRM) software – complete with automated Net Promoter Score (NPS) tracking – comes in. NPS is a simple metric that provides high-quality actionable data practices can use to make improvements to their operations and care delivery, thus improving patient engagement, loyalty, and outcomes.
Q. What are the key metrics a practice should look at?
A. Jerry Henderson, Clinicient: That really depend on the goals of that practice. However, no matter what your goals are — or what payment model you’re under – you have to know how many patients you’re seeing, what your therapist efficiency is in treating those patients, what you’re getting paid per patient visit, and how quickly you’re collecting that money. You also need to know how much it costs you to see those patients and if your average reimbursement, either per patient or per visit, is more than your cost. If you’re aware of just those things, you can keep your doors open.
With the growing importance of value-based payment models, practices should consider measuring and comparing clinical outcomes compared with cost. Measuring average improvement by using a patient-reported outcome score or performance-based clinical finding per visit would be a good start.
A. Sharif Zeid, MWTherapy: It’s less important which metrics are selected as it is to consistently look at the same metrics every week, month, and year. Practices should work through a three-step process. First, select three metrics to use (one financial-based, one visit-based, and one outcome-based) and stick to those three metrics, checking them at regular intervals. The metrics should be tracked long enough to establish a baseline (perhaps 3 months).
Second, once a baseline is established goals and a corresponding plan can be set. The goals should be clearly defined, and the plan that goes with it should define how the practice will get there. Third, practices can continually assess progress and goals against the baseline and adjust as necessary. From time to time, a practice may choose to change or alter the three metrics used.
A. Steven Presement, Practice Perfect: Some key metrics to keep the doors open involve a) patient flow – how many new patients are you seeing per week, b) patient retention – how long are patients staying and what are they spending, c) cash flow – how reliably is your money coming in, how old is your accounts receivable, d) productivity – are your therapists actually working, how much of their time is spent on producing revenue, e) cancellation/no-show rates, by provider, f) referrals – where is the business actually coming from. The vast majority of clinic owners just want to treat. They don’t know what their productivity should be, they don’t know what an unacceptable cancellation/no show rate is, and they aren’t aware of how much real revenue needs to flow through the doors to make it all worthwhile.
A. Terrence Sims, Raintree Systems: Revenue is one of the most important key performance indicators (KPIs), but others should incorporate multiple variables to a single number that is easily understood and communicated. A common metric/KPI is efficiency/productivity; often defined as how many patients a therapist treats per day/week/month. A metric like this allows a practice to estimate revenue, gauge patient backlog, understand practice growth, etc. Another important metric is revenue by therapist. This KPI measures how much revenue a therapist generates that actually comes back to the practice. A KPI like revenue by therapist can help the practice manager understand their AR situation, identify issues with the billing department, identify profitable treatments, etc.
A. Lori Collins, ReDoc by Net Health: Some key operational metrics include patient attendance, patient outcomes, therapist productivity, and referral source trends. While many clinics do recognize these as important, many don’t know what “good” looks like or how they compare to similar clinics. Knowing what their targets for those metrics should be is critical to effectively manage and grow the business. Establishing and communicating performance thresholds for those key metrics helps everyone in the clinic understand how they are performing. In addition to knowing performance targets, clinics should establish and consistently follow a regular review process. It’s equally important to investigate and act quickly if warranted, when a metric is found to be trending outside of acceptable limits.
A. Daniel Morrill, TheraOffice: Start with cash flow; it is the lifeline of any business, period. Cash flow tracking can be complicated because many times this data will come from different sources (PM system, patient AR, bank statements, deposit slips, accounting software, etc). Next, we like to look at patient volume and visit metrics. Simply put; are you getting enough new patients to support your practice’s financial goals, and are those patients staying for the prescribed time frames? Having good insight into cash and patient volume, and being able to trend this over time, is a great way to look at the health of a practice. Our best advice is don’t get lost in the weeds when it comes to reporting unless you have a specific reason. Necessary reports should paint a big picture. Start drilling down when the picture needs more detail to understand an issue.
A. Heidi Jannenga, WebPT: While there are many metrics a practice should consistently review, we’ve learned – through working with WebPT members – that these six metrics are key to determining organizational health from a productivity perspective:
Referral Conversion Rate: the percent of referrals who actually become patients, as tracked through patient cases and finalized initial evaluations. (Equation: converted referrals / total referrals x 100.)
Initial Evaluations: the total number of finalized initial evaluations with a date of service that falls within the selected date range; excludes no-charge visits.
Visits: the total number of finalized notes with a date of service that falls within the selected date range; excludes no charge visits.
Visits per Discharge: the average number of visits a patient has within his or her discharged episode of care, which WebPT Analytics derives from the total note count associated with the patient case. (Equation: total number of visits for all discharged cases / total number of discharged cases.)
Cancel/No-Show Rate: the number of cancel and no-show appointment types divided by the total number of created appointments. (Equation: (no-shows + cancellations) / total number of scheduled visits.)
Units per Visit: the average number of CPT codes billed for a visit, as documented in the SOAP note. (Equation: total number of billed units / total number of finalized billable notes. Excludes no-charge visits, G-codes, and L-codes.)
Because these are such important key performance indicators (KPIs), WebPT Members can easily view and track their progress on all of these on the WebPT Analytics dashboard.
Q. How have the expectations for practice management software changed over time, and what development in your company’s software products, service, or support has done the most to keep your company in the game?
A. Jerry Henderson, Clinicient: Over time, software has evolved from “a thing that we have” to more of a partnership relationship. It’s no longer acceptable for software to be a two-dimensional thing that people interact with because they have to in order to get through their day. Software should anticipate a workflow, and act intelligently to interact with that workflow. Software needs to be something that makes your life easier.
Clinicient understands how therapy practices work and remains focused on being a partner in all ways. We understand that people don’t want to be tied to a stationary computer, and we’re working on taking our application and our reporting packages mobile. In addition, we’re streamlining our processes so therapists spend less time looking at a screen, freeing them to focus on what matters most: improving the lives of their patients. Clinicient understands that each practice has their own individual workflows and goals, and we’re working on making our reporting and business intelligence suite more customizable so that people can spend less time combining spreadsheets and more time reaching their goals. We understand that people want support in various ways, so we’ve made our online support model more robust, and have expanded our hours of operation so that you can reach a human when you need to. We want to help you answer your questions and then get you back to treating patients as quickly as possible.
A. Sharif Zeid, MWTherapy: Technology is always an exciting place to be because the possibilities are endless, and with 100% cloud-based solutions, like MWTherapy, updates can be delivered at a fast pace. Today’s practice wants a complete and customizable EMR/Practice Management platform. We’ve continued to deliver on both fronts.
Our goal is to continue to deliver feature modules built in-house by the same team. Integrated systems have their place but today’s game is about built-in, not integrated. Integration means connecting different systems together over a bridge; built-in means having everything in the same system and in the same place. All of MWTherapy’s core modules, including Schedule, EMR, Billing, Reporting, Outcomes, and more, were all built by our teams.
Customizability is crucial. Cookie-cutter systems are destined for the technology grave. Today’s healthcare landscape is far more competitive and specialized than ever before. Customizability delivers enhanced efficiency by giving therapists the ability to document in a way that makes sense for a specific practice’s workflow. It gives a way to respect the equipment, training, and style that a practice’s clinicians have and use. It also gives a huge way to differentiate a practice and display professionalism that can help deliver patients from referral sources.
For over a decade, we’ve continued to deliver on the promises of EMR/Practice Management through innovation, service, and honesty, and will continue to do so.
A. Steven Presement, Practice Perfect: We are finding that there is more need for client access – clients being able to register online, fill out paperwork online, book their own appointments online, pay their bills online, get statements online, and in some cases even review their own case notes. Basically, we’re turning into a self-service world where the ability to access info may actually be more important than the actual care received. A patient would sometimes rather go somewhere just because they can book online and not because they offer better care.
A. Terrence Sims, Raintree Inc: The biggest change in expectations is simply with the quality of the software. For a long time, many practices were happy with a software product that worked but may have had shortcomings that could be worked around or could be overlooked. Users now demand products that not only look great and function well but that has increasing levels of sophistication and features that touch all aspects of the practice (Front Desk, Therapists, Back Office, Billing, AR, Reporting, etc) – essentially complete business management software. Users now require advanced reporting and administration tools, billing/AR/RCM tools, patient engagement and communication tools, payment processing abilities, web-enabled mobility features, etc.
Raintree is always looking to improve our products. We engage with our clients and look for new features and functionality that can be built into our products. We also partner with outside software companies to integrate their products and services directly into our software products to extend the capabilities of Raintree Practice Management/EMR software. Raintree has been making Practice Management/EMR software for over 35 years, and we will continue to develop and create highly functional and useful software and services that support the therapy market and the individuals providing service to their patients.
A. Lori Collins, ReDoc by Net Health: In addition to changes in the regulatory and reimbursement landscape, patients are becoming more and more involved in their own care. The proliferation of high-deductible insurance plans, along with an amazing amount of information now at our fingertips, have made us much more savvy healthcare consumers. Patients want to shop around and make sure they’re getting the best care they can afford. They rely heavily on the reviews of fellow patients and look for any information they can find regarding outcomes for their particular condition. Keeping patients engaged during their course of treatment is an important driver of satisfaction and ultimately, outcomes. We provide tools, such as appointment reminders and home exercise programs, that enable clinics to keep their patients engaged and involved. Outcomes prediction and monitoring capability is an important feature we offer that touches on some of those key metrics mentioned earlier. Consulting services is also an offering that our customers find to be very beneficial.
A. Daniel Morrill, TheraOffice: In our mind, software stakes are high in the rehabilitation industry when it comes to continuing to develop cost-effective software that helps clients save time and achieve their practice goals. We believe a few ways to do this is by first listening to the needs of our clients and the rehabilitation industry as a whole. Next, and most importantly, is to be there when clients need help with their practice through outstanding customer care. Driving new and alternative technology as we continue a path of interoperability and patient connections remains one of our main goals. Changing regulations is also part of the process as well, so we need to continue to be advocates for rehabilitation software in the bigger world of healthcare IT.
A. Heidi Jannenga, WebPT: When WebPT first launched in 2008, practices were primarily seeking intuitive cloud-based practice management (PM) software that enabled them to produce legible, defensible, compliant, and secure patient medical records. Today, the documentation component of cloud-based practice management software is much more standardized. So, with that as table-stakes, practices are now evaluating PM software based on its ability to help them improve operations and care delivery as well as better connect with prospective and current patients – all for a significant return on investment (ROI). In other words, they’re looking for software to help them achieve greatness in practice (which just so happens to be the WebPT mission statement).
In order to deliver on that, we’ve expanded our offerings beyond rehab-therapy-specific defensible and compliant documentation to include several notable, specialized products and features – all of which have garnered tremendous positive feedback from our community: intuitive scheduling functionality and automated appointment reminders that reduce cancellations and no-shows by as much as 30%; fully integrated outcomes tracking with a library of well-respected, risk-adjusted tests; enhanced multimedia home exercise programs; robust business intelligence analytics; comprehensive billing solutions that increase payments per visit by up to 10%; and advanced patient relationship and marketing tools. RM