Beyond Coding & Documentation: The Impact of the 2021 E/M Changes, Part 3

Welcome to Part 3 of our ongoing series, 2021 E/M Changes: The Impact Beyond Coding & Documentation. In this series, we aim to cover the impact the 2021 E/M guidelines changes are having across organizations. In this, the third part of the series, we’re turning our focus to how Key Performance Indicators (KPIs) should be reevaluated based on the strange year we’ve all experienced. Let’s dive right in…

Key Performance Indicators / Benchmarks

It is unclear in the industry right now how the 2021 E/M guideline changes are going to affect benchmarks or key performance indicators (KPIs). What is clear, however, is that many organizations use national data published by other organizations to establish benchmarks. The inherent problem with this is that there is always a reporting lag, and therefore benchmarking surveys do not always reflect what is happening at the present moment. For instance, surveys being published now will typically reflect data from the previous year, or even two years past. And as we all know, the previous year was far from normal. So, is it fair to evaluate how well your organization is implementing new E/M guidelines based on data from a year with a public health emergency? And where does that leave us when evaluating our performance in 2021?

HFMA is recommending an alternative method of benchmarking. Rather than using outdated benchmarking data that is not relevant to the current situation, an alternative method is to look back at your own historical data, gauge where you have been, and analyze where you want to be for optimal performance.

If your organization is going to use benchmarking data, then geography must be acknowledged as a contributing factor. Different parts of the country were affected differently by COVID. When looking at national benchmarking data, there will not be a one-size-fits-all solution.

Benchmarks and KPIs are going to be affected by this huge shift that we all experienced over the last year-plus. We saw the landscape of healthcare shift significantly with the expansion of telehealth services, but also the transition of thousands of jobs to remote-working environments. Therefore, it is important that you analyze your KPIs more frequently.

I believe one of the keys to success is to get key performance indicators into the hands of front-line folks in your organization. Traditionally, we see benchmarking data and key performance indicators in the hands of gatekeepers. Getting data into the hands of providers, front and back-end managers, even front-line staff creates a direct tie from the work they are performing to the financial results of the organization. It creates a higher level of investment on behalf of the boots on the ground employees, and often, those are the folks that really translate the data into something meaningful.

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