business of pediatrics

How to Manage Your Medical Practice with Data Analytics

What impact did COVID have on your vaccination rate? How many of your teenagers are overdue for depression screening? Are your visit rates picking up post-COVID? What payors are keeping you from paying your staff more? The answer to all of these pressing questions lies in data analytics, the consistent tracking of your practice’s performance and goals. If you depend on reports from last quarter or last year, your pediatric practice could be missing out on enormously helpful information to improve your practice operations and revenue, patient care, and impact key business decisions. Here’s how to use data analytics to improve the way that every facet of your practice operates.

Key Metrics to Use for Primary Care Physicians

Just as you would track the wellbeing of a patient with a chronic condition, your practice needs informed and consistent monitoring; the best sources of data you can look at to improve your practice is your EHR, and your practice management system, along with the input of physician-owners, your office manager, practice administrator, and your accountant.

Data analytics takes the pulse of your practice and allows you to form a care plan for the business and clinical tasks you do every day. By following data and trends, you will discover how the practice can improve and where your strengths and weaknesses are. Some key metrics your pediatric practice should monitor to stay in top health are:

  • Well visit coverage rates
  • Immunization rates
  • Revenue per visit, with and without immunizations
  • Pricing (relative to Medicare)
  • E&M Distribution
  • Sick-to-Well Visit Ratio

With more than 30% of the nation’s children overdue for well-child visits, tracking your well visit coverage and immunization rates will keep your patients proactively healthy and your practice’s revenue protected, too. By studying these metrics you’ll also learn quickly if any key areas -- such as developmental screening or HPV immunizations -- need attention.

These metrics are the baseline for a healthy practice. Your EHR or tracking software should also allow you to track your performance and metrics over time. Let’s dive into analytics for clinical and financial performance to see what the data says when you dig deeper.

Clinical Health = Population Health

Data will help you understand how well your practice is providing each patient the preventive care they need, but there is insightful information between the lines, because each patient is a representative of a larger population. This population information can make you ask interesting questions, such as: How good is your practice at recall? Are your 7-to-11-year-olds missing out on care? 

Answering these questions will help your practice see the forest for the trees, discovering successes and potential issues in your patient population as a whole.

Well Visit Coverage Rates

Preventive care is the distinctive competency of pediatricians and the most important work that they do. It’s also the most important piece of the revenue puzzle. Tracking your well visit coverage rates can help you understand the effectiveness of your patient recall campaign, for example, or which patient ages or sexes need more focus. 

Helpful software like PCC’s EHR can help you not only track data over time so you can measure your performance 5 months or 5 years ago, but also compare yourself specifically to your peers on a state, regional, and national level. 

Immunization Rates

Immunization rates, like well visits, are the backbone of a pediatric practice’s clinical and financial success. How effective was that push for HPV vaccines last quarter? How are your MMRs? If you’re not doing as well as you’d like, maybe it’s time for a vaccination campaign.

Context is also crucial for this metric. If your immunizations and other metrics are where you’d like them to be, you can move on to other priorities. PCC’s Dashboard offers this context as a 100-point scale grade with color coded ratings, so you can focus on where your energy is needed most. The Dashboard also provides context with HEDIS scores, which are important in pursuing PCMH qualification. With a report card in hand, you can study for the areas you’re most concerned about, like MMR rates for example, and know that you’ve got the rest already covered.

Sick-to-Well Visit Ratio

Why does a sick-to-well visit ratio matter for your practice? In short, it helps practices focus on preventive care and chronic disease management, which is better for clinical performance and for practice financial success. A lower ratio shows that a practice is focusing on visits for immunizations, well visits, and disease management visits like controlled substance visits. Learn how PCC practices have been lowering their sick-to-well visit ratio over the years in this post from Chip’s blog.

There are plenty of areas in clinical data to explore, depending on your practice’s needs. You could investigate the rate at which adolescent visits might decline after a certain age and place measures to get families back to the office. You might notice a spike in mental healthcare needs and use the data to support hiring a social worker or attending a training. You can see how many newborn visits your practice provided last year to see the pace at which your practice is growing. You can even use your clinical metrics to celebrate milestones, call out physicians who have improved or performed well, and boost your practice’s morale. Correct interpretation of data can inform and justify business decisions that improve patient care.

Financial Health

Revenue per Visit

What does your practice earn per visit? This metric represents how much your practice makes in revenue divided by the number of visits in a given period of time. Taken with the context of the other metrics such as sick-to-well visit ratio and immunization rates, revenue-per-visit can demonstrate the performance of your visits on average.

This metric is affected by more than the type of visit -- it depends on practice operations, your focus on preventive care, your billing, and your relationship with payors. While discovering problems in these areas can be difficult, they’re much easier to face when they’re discovered early through careful tracking. For example, if your billing department has fallen behind your personal collections or if a particular payor has stopped covering a particular procedure.

Your software should adjust revenue-per-visit calculation for you by clinician, visit type, location, and whether to include or exclude immunizations to get an even clearer picture of your financial health. 

To Exclude or Include Immunizations

Why is isolating immunizations from the revenue-per-visit metric important? Because immunizations have become such a large part of the business of pediatrics that they can hide many of other usual suspects. According to a recent look at PCC clients, immunizations have grown to become 25-30% of most practices’ revenue. Removing vaccines from the revenue-per-visit metric levels out the playing field among other practices, so you can compare how you’re doing with the rest of the work you deliver.

Pricing relative to Medicare

On the financial side, while proper E&M coding can help you determine that you’re billing for the best return on claims, your pricing relative to Medicare and Medicaid can help you understand if you’re pricing adequately for the revenue you deserve. 

Learn more from our previous post on RVUs and pricing to discover what level of pricing is appropriate for your practice.  

Data for Business Strategy

Using data to help your practice’s decision makers take action is not only smart business sense, it puts a clear why to each project or decision. Say that you know that vaccination promotion is difficult for your team, so you want to recruit your staff to attend training so that they can speak more comfortably. Without a why, there could be resistance from staff in taking on more work or initiating difficult conversations. 

If, however, you can show that your immunization volume is down and your practice needs to have a plan to increase vaccinations, you can have a more nuanced discussion about how to accomplish this -- whether your team takes on the training or suggests an alternative strategy.

Data-Driven Strategy

Pediatricians are fantastic at acting upon data like vital signs or a lab result. Try to apply the same reasoning for your business, as the results are vital to your practice’s health. When your practice has gathered the data that clearly indicates a clinical or business need, it’s time to act, or according to the Harvard Business Review, it’s time to choose offense or defense.

According to HBR: “Data offense focuses on supporting business objectives such as increasing revenue, profitability, and customer satisfaction… Offensive activities are often more real-time than is defensive work, with its concentration on legal, financial, compliance, and IT concerns.”

Translated to pediatric concerns, you might consider an offensive strategy, for example with a patient engagement campaign by promoting messages in the patient portal, in response to data that indicates you’re missing out on well visit revenue.

Defensive strategy, on the other hand, allows you to put data to use for you to defend your negotiations, plans, and ideas and protect your practice from potential legal or financial problems. Some examples include an annual negotiation with your payors to get paid appropriately for your services. 

For example, with data demonstrating that your after-hours care is important for your patients’ health, and reduces the number of trips to the ER, you can deliver a convincing and confident negotiation to be paid for after-hours care. Another defensive example might be annually updating your practice’s policies. Say HIPAA has been updated effective next year. Educating staff on compliance regulations and protecting patient data ahead of time ensures your practice remains in compliance with new laws and can defend its preparation if there is a need for a HIPAA report later.

Benefits of Data Analytics

If getting the pulse of your practice’s performance isn’t enough cause to celebrate, data offers many other positives for pediatrician-owners and administrators. Using data effectively, business leaders can make a plan as outlined above to defend their ideas for practice change or growth, protect their employees and practice, deliver the clinical care patients need, and be paid appropriately so that all of these plans can continue in the years ahead.

These kinds of actionable, measurable goals are also invaluable for the success of your goals, because setting a clear purpose can help get your practice’s staff on board with change, a key part of any goal’s success. 

Of course, perhaps the best benefit to using data analytics is clarity of purpose. When you have data, problems can be solved and strengths celebrated, but only when you take action. 

Would you like to learn more about how your practice’s metrics measure up? Take a look at our Performance Calculator to see where your performance data measures against other PCC practices. See something you want to improve upon? Let us know, and PCC will help you get to your goals.


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Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.