What you measure is what you create. The money will follow …

Many practices have a unique character that was built in a unique way where a founder established a vision (yes, pun intended). It is so specific it cannot be measured or even easily reproduced. It is like a grandma making a recipe without measuring cups, but rather using just enough of each ingredient. It just works.

But more and more, everything is being measured. We must feed data to the monster. If there was a 10% drop in revenue an hour ago, your software can text you an alert! Mix this in with an economic downturn where inflation is still rising, the market of potential employees remains thin, and reimbursements are declining. You pick the reason or excuse. It doesn’t matter if you are an owner, board member or employee … all this instantaneous information at our fingertips can call us out or elicit a conference call to problem solve.

The information often forces us to take a hard look at factors impacting profit. From partner meetings to board rooms, the spreadsheets and pro formas tell the story. Numbers don’t lie. Or do they? These numbers are the measurable outcomes that all businesses revere. However, health care is not a rule follower; it is on the streets (well, in the exam room) that we find the unique drivers of growth.

THE DANGER OF ‘TEACHING TO THE TEST’

If we are only measuring revenue, productivity and time, then our practices will adapt to try to improve these numbers and these numbers only. All decisions will focus on improving metrics. In high school, if the teacher told me the math test was on a specific topic, I only studied outlined material to pass the test. If a subject knows what a study is measuring, then the behavior will be tailored to optimize the outcome. But make sure your measuring stick measures up.

Measuring the money can lead to exponential losses with missed opportunity cost. Recently, our surgical center was told by the contracting anesthesia group that we will be charged if a minimum collection was not achieved for that day. Since this could lead to less measured revenue for the center, our initial instinct was to have this anesthesia group bill the outside providers bringing patients to our center. The surgeons would be told that if they did not bring enough cases to cover this cost of the anesthesia provider for the day, they would need to cover the difference. The charges to doctors using our center could range from $200 to more than $2,000 a day, depending on volume.

The center was “measuring” revenue and deliberating how to minimize the impact from this new policy. However, after further discussions, we determined that focusing on the value of our long relationship with the outside surgeons and measuring their satisfaction with use of our center was a more meaningful metric compared to revenue alone. With our new focus on what to measure, we turned the discussion to how to resolve this issue without threatening our surgeons with fees to use our center or stress them with needing to bring more cases each day to avoid being billed.

After all, there were other surgical centers nearby they could use without being concerned about anesthesia bills. If we lost a surgeon who does 20 cases a month, the surgical center is out more than $150,000 revenue in one year. This pales in comparison to the risk of anesthesia fees of a few hundred dollars paid occasionally by the center to our anesthesia group.

CRISIS AVERTED, TEAMWORK ENHANCED

All decisions were formulated with the goal of increased surgeon satisfaction in mind. First, we communicated our problem about anesthesia providers to our visiting surgeons. We wanted to allow these doctors to become part of the solution — without sending them a bill. They contributed some great ideas. For example, our Monday surgeons decided to have only one anesthesia provider for both rooms instead of the typical two providers. If each surgeon has seven cases in each of our two rooms, then the total is 14 cases for this anesthesia provider and covers our minimal cost while only delaying each surgeon 5 minutes each case.

MEASURE THE LESS TANGIBLE TOO

Spending strategic money on something that will not make money or save you time … is exactly an investment you can’t afford to not make in order to increase revenue!

At my request, my group purchased a heads-up 3D display for cataract surgery for each of my two ORs. Now, I had a perfectly functioning microscope already. If the “measuring stick” was this device’s ability to generate revenue, save time or create efficiencies, admittedly the purchase would get a big fat zero for each category.

But, if you are measuring outcomes such as physician longevity and job satisfaction along with surgical staff engagement, then you are getting to the root of what drives growth. I asked my group to invest in me. The heads-up 3D display, with its superior ergonomics, would foster my longevity in a subspecialty with well-known risks to neck and back health. The large monitor is great for teaching and offers 4k video recording that has allowed me to share 3D content online.

The practice benefits from this expenditure include a professionally enriched, satisfied surgeon, a strong recruitment tool to hire providers with live surgery resident courses each year (Figure) and a staff who can finally see what is happening during a surgery. It’s a clear win when adjusting to measure for the “why” rather than the “now” or the fiscal outcome.

IDENTIFY THE WHY

My Grandma Sallye always said “love don’t pay the bills” when her grandchildren introduced her to whoever they were dating at the time. To this end, I am not suggesting abandoning every fiscal metric. Yes, plan and keep those spreadsheets coming. But, in health care, don’t just start or end with measuring typical boardroom data. Health care is different. Each practice, each provider has its own special unique identity that is the reason for growth and revenue. It takes an effort from the top management to decide what to measure. That begins with identifying why a particular practice thrives and grows. Then measure success. OM

Scott LaBorwit, MD, is founder of Select Eye Care in Maryland, chairperson of the Medical Advisory Board for Vision Innovation Partners and assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.