Clinic Volume & Revenue: Breaking Down the Numbers

  I am the director of a hospital-based outpatient clinic for wound management and hyperbaric medicine that has been in operation for 10 years. Over those years I have gathered and looked at statistics in many ways. I look at total numbers—number of patients, number of visits or number of wounds. I also look at relative numbers—percentage of wound types, visits per patient, breakdown of demographics such as age or gender, payer mix. All of these can serve a purpose in managing a wound clinic. As a director you need to know what each category tells you and take an active role in determining the ones that are used to evaluate the performance of your clinic.

  I tend to use total numbers in budgeting and predicting workload. Each individual patient represents a certain amount of management work. For each patient a medical record is created, a plan of care generated, a referrer to be communicated with, the payer source has to be verified and billed.

Understand The Resources

  There are also resources that need to be provided for each visit whether it is a new patient or a returning patient. A treatment room must be available. Licensed and support staff are needed to prep, assess, and provide care to the patient. Each visit requires documentation and charge capture.

  There are other resources, which are more related to the number of wounds. The amount of labor and supplies utilized can vary greatly from patient to patient and visit-to-visit based on the number of wounds an individual patient has on a particular visit.

Sorting Statistics

  Gathering and trending each of these statistics can be useful in planning and defending a budget. For me they have been invaluable in justifying staff needs and maintaining a stable workforce.

  Relative numbers have more clinical and marketing implications. These types of statistics reflect the needs, issues and potentials that are specific to your own clinic.

  Probably the most important statistic in this category is the breakdown of wound types seen most frequently in your clinic. This information is essential in determining the best utilization of resources such as funding for education or purchasing dollars. Valuable information can be gained at both a conference on leg ulcers and a course on diabetic foot issues. If you can’t afford to send someone to each course, knowing the types of wounds your clinic sees most frequently will be helpful in making the best choice. Certainly any decision to purchase equipment—both capital and minor equipment—must take into account the types of wounds that are treated most frequently.

Knowing Your Clinic

  The relative volume of wounds of each type that your clinic treats is also very important in gathering and utilizing outcome data. Any good-benchmarking program will breakdown outcome reports by wound type. When you look at your own outcomes for each wound type you need to evaluate if your volume in a particular category is high enough to have a valid measurement. Do you want to base your marketing program on an outcome measure that you rank in the top 10% if you only had 5 patients that comprised that outcome? If you are in the bottom 25% for time to healing in a category that only represents 5% of your workload should you expend a lot of resources to improve that particular outcome?

  Demographic statistics as well as wound type data play a significant role in operational aspects such as customer service and marketing. Age and gender demographics may affect basic decisions such as waiting room amenities and décor. In today’s clinic good customer service is just as important as quality healthcare. Do you see enough pediatric patients to a have a ‘kid friendly’ treatment room? Will your mostly geriatric population be put off by your staff wearing cartoon scrubs?

Collecting and Evaluating

  Collecting and evaluating revenue statistics is essential in managing a wound clinic. Although most clinicians prefer not to dwell on the business aspects of the care they deliver, revenue and expense cannot be ignored if you want to continue providing quality care. Wound centers should exist for the clinical outcomes we can achieve. However, even in a non-profit organization we must generate enough revenue to cover our operating expenses as well as allow for future growth.

  In most businesses greater volume of work is directly correlated with greater volume of revenue. Unfortunately, in our world that is not always the case. In healthcare, to effectively evaluate revenue, you must know your payer mix. In general we receive the best reimbursement from commercial insurances and the least from the uninsured. Medicare and Medicaid fall somewhere in between. Also in consideration is the fact that the percentage breakdown of payers­­­ is likely to vary somewhat by wound type.

  If I want to evaluate the potential revenue generated from the use of Dermagraft (produced by Advanced BioHealing, www.dermagraft.com) I need to know the payer mix specifically for my patients with diabetic foot ulcers. I may be looking to expand my services and note that pressure ulcers and traumatic wounds may both make up a small percentage of my clinic business. While my trauma population may be likely to have a higher percentage of patients with commercial insurance and workman’s comp than in my pressure ulcer population does it also have a higher percentage of uninsured?

  Both volume and revenue statistics are important in the management of a wound clinic. They tell us where we have been and help us determine where we are going.

Tere Sigler has worked as a Physical Therapist for 25 years in a range of settings including acute care, outpatient, long-term care and home health. She has been focused on wound care since 1991. In 1999 Tere established the Archbold Center for Wound Management at Archbold Memorial Hospital in Thomasville, GA and is still the clinical director. This past year the center has expanded to include Hyperbaric Medicine.

Tere is an active member of APTA and AAWC. She earned her CWS through AAWM in 2000. She has served on advisory boards and participated in focus groups for several companies in the wound care industries.

Tere also began lymphedema management in 1996 after completing training in Manual Lymph Drainage through the Vodder School in Walschee Austria. In 2002 she passed the Board Exam to become Certified as a Lymphedema Therapist through the Lymphology Association of North America.