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This also applies to association webinars. These are only available to members and non-paying members and shouldn't be captured by AI bots. Association staff will remove bots from the meetings. Our speakers for today are John Brady, CEO of Fox Valley Orthopedics, Beverly Cook, Director of Finance, Midwest Orthopedics at Rush, and Joe Larkin, Chief Business Development Officer, Bale Summit Orthopedics and Neurosurgery. And now I'll turn it over to our speakers to get us started. Hi, my name is Beverly Cook. I work for Midwest Orthopedics at Rush. I'm Director of Finance. Benchmarking is something that we use all the time. We use it for physician compensation and many different things. We've been using this ever since I've been with the company, but I'm sure before that. And I've been with the company 15 years, so we've been using it this for a long time. John? I'm John Brady. I'm the CEO of Fox Valley Orthopedics in the far western suburbs of Chicago, Geneva, St. Charles, Elgin area. I'm a huge believer in benchmarking. I don't think you can improve if you don't know where you've been or where the market is. So I don't think statistics mean much without a benchmark. So I'm a big believer in benchmarking and throughout my career I've always tried to incorporate benchmarking into into my decision making. Joe? I'm Joe Larkin, Bale Summit Orthopedics and Neurosurgery, and I agree with Beverly and John. The information that we get from benchmarking helps us provide context for our business's performance and understand where maybe we're performing well and where we have opportunity. We've incorporated benchmarking into our regular weekly and monthly and annual KPIs. We use it as we budget our business for the coming year. So we've gained quite a lot of value from participating in the benchmarking program. All right, so how have you used benchmarking data in compensation discussions with your physicians? I actually love using benchmarking data in this conversation because compensation discussions can get very emotional and very personal, and I like to keep it away from that. I like to keep it more factual and grounded. And when you get, especially when you get some older physicians who are decreasing productivity a little bit, who think they should still be making 75th percentile dollars compensation, but they're only performing at the 25th percentile in productivity, using benchmark data really, and it's not just, you know, benchmarking against the peers in the practice, but it's also benchmarking against the marketplace, that really makes the conversation just that much easier, that much more concrete, and it takes a lot of the emotion out of it. Definitely. And, you know, one thing I love about the AAOE dashboards is that you can drill down by location, you know, and by practice size. It makes it very, very easy to compare yourself against other practices. Yeah, the what-ifs, you know, but I'm different. Well, are you? Let's look. Right. Yeah, I love that. Yeah. Joe, how do you use benchmarking in compensation discussions? You know, we had a meeting, a business planning meeting with one of our physicians yesterday, and I think that's a great example. We, and I think we'll get to this later in our conversation, but we do a productivity evaluation for each of our doctors in reviewing their visits and procedures and work, our views, et cetera. We also review, like John said, where their compensation lands versus their productivity levels, and we use that to inform our conversations as we plan the coming year and support for their business, et cetera. And it really, I think, to John's point, it kind of helps level set for the business and for each physician in particular, and it works in both directions. So, you know, we have physicians that relative to where they land maybe in productivity, they're on the higher end of compensation, and we have physicians on the other side where their productivity level is a bit higher than their compensation. And it gives us the opportunity to kind of dig into those metrics and understand the factors and adjust the dials a little bit as we look ahead. Yeah. Recognizing the correlation that exists is really important. And a lot of times, you know, the docs have been around for 20, 30 years who, you know, people my age who think, oh, you know, I've been through the wars, I should be making more, but I don't want to work as much. And it's like, well, okay, it is an equally treated environment. We need to be, especially in the independent practice world. So, we need to make sure we have things to connect people to reality. And I think also it leads us to deeper insights. You know, in a discussion, in fact, yesterday, you know, we honed in on conversion to surgery from new patient visits to surgery, for example. We looked at paramics, you know, for this provider versus the rest of our practice. So, this kind of information really helps us, you know, that idea of following the data right, kind of dig deeper with, I think, good information. Well, the other thing, too, is, you know, we sit right next door to a large academic medical system and right across the street from another large community health system that have medical groups, internal employed medical groups and physicians. And, you know, they have much greater resources to pay, especially at the early levels, the entry levels, you know, when people are new to the practice. And to show compensation benchmarks, especially over time, you know, yeah, you're one to three, this is where you're at. But when you start looking at it and tying productivity to it, they can start to see the value of independent practice and they can start to see the value of, you know, how our model works compared to, yeah, you know, first year out of fellowship, you're going to make $800,000 across the street and you're only going to make, you know, half that here. But three years from now, that guy's making $900,000 and you're making $1.2 million, you know. So, you know, those type of conversations and this gives validation. It's not just me blowing smoke, it gives validation to those type of things. So, I find that to be, again, keeps the emotion out of it, keeps it factual and it just makes it that much easier to have the conversation. Right. You can't argue with this data. I mean, it's factual. All right. This is a spreadsheet that I put together of six of the metrics that we look at. It's collections, new patients, and visits. It's the first three. So, we use three different benchmarks internally. We use OrthoForum, the MGMA, and AAOE. And you can see there's some similarities among them all and some that MGMA doesn't have, like new patients. So, the AAOE benchmarks are great because, you know, they come in where MGMA does not have data for it, you know, and MGMA also doesn't benchmark shoulder. And then here are the other three we look at, which is WorkRVU, Surgical Cases, and Total Compensation. And I know that Joe and John use similar metrics in their practices and, you know, look at them year over year. And these are very helpful when looking at comparing your physicians against the benchmarks. Yeah, I actually, this year in our scorecard that we're using, we finally have good data to compare against. We were part of a merger a couple years ago, and we had different systems across some different offices. And in 2023, we merged into one EMR and one system, which created common workflows. And one of the things that I have found very effective in justifying and validating and encouraging the use of those workflows has been benchmark tools like this to show that how much more efficient we are now compared to what we were before. And it's a really important change management tool when you can show people what others are doing and, you know, and compare yourself to them. Now, we may be crushing it in one area and not doing so great in another. And it's, you know, people tend to focus on the good news and not necessarily the middling or bad news. And I like the constructive feedback that external benchmarks give. It is a nice reality check. Definitely. All right. So, how have you used benchmarking data to evaluate provider productivity and volume? Joe, do you want to go first? Yeah. So, Vicki, what's on our next slide? Is that? Yeah. So, this is an example of something that we use internally. This is a mock-up. So, this is not our practices real data, but it is a benchmark data. And for example, this is a worksheet we used in a meeting we had with the physician yesterday as we're doing some business planning. And for example, this is a worksheet we used in a meeting we had with the physician yesterday as we're doing some business planning. So, we use it, you know, I think consistent with what Beverly and John had to say. You know, one, to gauge overall performance. So, in this case, the mock-up I used is a provider that performs, you know, generally around the median. I wanted to show some low and high performers. So, I plugged in, for example, a low injection rate and a high. In this case, I think I bumped real estate. So, I could bump comp just to kind of show what the visual cues look like. And throughout our practice, you know, we have people that perform at different levels. You know, if we have a physician slow down mode, they may be below the 25th percentile. If we have a really high performer, you know, we'll see this right shifted a bit. You know, I would say generally, we tend to see good correlation. So, if people are, you know, if their productivity is, you know, again, using this example in the kind of median, we generally see compensation in that area as well. But sometimes, we see outliers. I think I mentioned earlier that in a meeting yesterday, we, you know, focused on conversion to surgery as an example, right? This was an easy way to see that all the metrics weren't lining up and it gave us a visual cue of an area to kind of dig into and understand that that physicians practice a bit better and have some strategic discussion about their business. We use these metrics at least monthly when I think about all categories. We produce some weekly reporting on KPIs, so around office visits, surgeries, work RVUs, and collections, and then we look at compensation on a monthly basis. So, we're, you know, we're very focused on these metrics and we use the AOE benchmarking to inform our decisions and we'll see that a little bit later in our discussion on a different report we use. Yeah. Internally here, we look at work RVUs, collections, and new patients when evaluating our employed physicians, you know, and they like to see that, you know, where they are. Are they at the median or between median and 75th? They're very competitive and they always want to do better. So, they like to see those metrics and we provide that to them quarterly. That's an interesting point, Beverly, because, you know, these individuals that go through, you know, give up 25 years or 30 years of their life, you know, to study a discipline, they are very scientific and evidence-based. I mean, that's what they're trained to be. So, you can use evidence to end their natural competitiveness to engage and encourage productivity. There's a thing in statistics called Pearson's Law, which says that, you know, improvement that is measured or activity that is measured improves and activity that is measured and reported improves at a faster level. And that's very true. It's the basis of most weight loss programs. Weight Watchers makes you weigh yourself in front of a group of peers and you don't want to be the person that didn't lose weight that week. Well, the same thing with these physicians. You don't want to be the person that's not converting surgeries or not capitalizing on ancillaries because of that natural competitiveness. A lot of these folks were athletes, so they've got that kind of built into them. And I like to take advantage of that, knowing that psychology is, you know, a big part of what motivates individuals in this specialty, in particular. I think that that's a great thing. Any kind of surgical specialty, you see that kind of competitiveness and that eager, they want to see themselves, you know, on the podium, so to speak. And I think that benchmarking is a great way to encourage provider productivity. It also, at the latter part of their career, at the end of their career, gives them a sense of, you know, do I need to be working this hard? And, you know, what would it, you know, and then show them the impact. You know what? You want to take that Friday off and play golf every day, every week in the summer. This is what it's going to do to you from a comp standpoint. If you're comfortable with that, then, you know, you know, hit them straight. If not, don't complain about your comp if you do it. And it's a really nice way to inform decision making. All right. Can you provide an example of a new program or improvement that you've made in your practice based on benchmarking results? Go ahead, John. I like to, any time we put something new in, for example, we put a new MRI into a facility two years ago and the old was like a 0.3 or 0.4 Tesla. It was kind of a crappy old open machine. And then we put in this new wide board. It's got AI technology that makes it look like it's a better read than what you normally get. And we used the benchmarking. I took the historical volumes of that old machine. And I said, look, I just did a business case with it. And I said, look, if we do what people should be doing and what these things can do. And I found some benchmarks for ancillaries around. I said, if we just met what the 50th percentile is or the 25th percentile is, this is how much additional revenue we'd have with this new machine. And it really helped build the business case. And it did it in not this wishful thinking way, but in a way that points to this is something that happens in the real world. This is what other people expect with it. And we don't even need to set the world on fire. We just need to be in the middle and we can do very well. So when I do new acquisitions or new equipment acquisitions, I'm a big business case. I come from a strategy background. So I'm a big business case believer. And I think benchmarks are critical in helping to do that, to put into any kind of innovation or new program development. The benchmarking data helped us understand. And actually, let's see here. So if you want to jump ahead, I think two slides. One more. Yeah, here we go. So this is an example. And this is a mock-up again as well. And this mock-up, by the way, in each of these slides are similar. So we run a weekly KPI report and we report on our APPs, our physicians, and then team. And in our case, our PAs are attached to their doctors. We have two cases, I think, where the docs share PAs and we split their productivity to those doctors proportionally. In this view, the gray bar is last year's performance. The blue bar is this year's performance. And then the red dot is a target. The left half of the worksheet is the most recent month and the right half of the worksheet is a year-to-date value. Again, these are all kind of mocked up data. So you'll see, for example, that the left side and the right side match each other directionally. But with benchmarking data, one of the things that we identified is that our average PA productivity was on the low side. And from that, we initiated a PA incentive plan for 2025. We just rolled it out in January. And so far, there was a lot of enthusiasm for it. We'll see how it plays out over time. But the goal is to incent our PAs to an increased productivity. That was born directly from benchmarking comparison data that made it really clear that we have some opportunity there. So that was an example of a program we've put in place that was really influenced by what we learned through benchmarking. Great. How have you worked to make participation in the benchmarking survey more efficient? I delegated it. That works. No, we build it and we, you know, the first time you do this, it's painful. And the fact now that some of the surveys are starting to come into alignment a little bit across the multiple opportunities to use these things has been helpful. But I think just knowing what is in it and knowing that it doesn't change all that much allows us to create the reports that we need so that it really is more of a data dump than it is having to go chase things. The first year you do it, you gotta build the reports and you gotta go chase stuff. But now, I mean, two, three years ago, when we really started getting involved in these things, it was like pulling teeth. It was so painful. But we were using multiple systems too. Now we just build reports into our EMR and we can run those relatively quickly. And, you know, we have two or three people that are responsible for putting it in. And then another, you know, two of us look at it and validate it and make sure that it passes the sniff test. So it's a much easier process today than it was when we first started doing it. And it gets easier every year. I actually asked this question to the person who is responsible for the data aggregation. And she goes, oh yeah, I've already pulled all that stuff. When's it due? I'm like, oh, okay, because I just got the email. So she was already ready for it. So it just, practice makes things better. I mean, it's like anything, you know, you do something, the more you do it, the better you get at it. And that's what I found to be the case with this. Agreed. You know, one thing that I did when I first did the survey is I mapped our income statement. And it wasn't in our system. It was externally in Excel. So I mapped all of the GL accounts to what it's supposed to be in the survey. And then I pivoted based on that. And it makes it so much easier year after year. I only have to add in any new accounts that we've created in our system. But that is just, I mean, it saves me hours of time now that I've created that template. That's exactly what we did. We've done the same, John. I think, you know, we took your approach with reporting and, you know, we refined over time. But yeah, we've got these reports built into our EMR now so we don't have to create them when we get to this time of year. I think we just opened up the survey. And then Beverly, as you mentioned, we also, we actually worked with our accounting firm to overhaul our chart of accounts because we weren't particularly well-aligned with the benchmarking data. And we saw that as an opportunity. And it improves visibility into our business. It also makes it easier or more efficient using this language to complete the benchmarking data. But it really has helped provide better insight into our business. Yeah, and I will comment here also that if you're a member of the OrthoForum or OrthoConnect, that AAOE will take your survey. You just have to message them and there's a portal. You can upload it right there. So you don't have to do both of the surveys. You only have to do the one and AAOE will take it. Which is phenomenal. And I'm thrilled that AAOE did that because it's made everyone's lives that much easier. And it also kind of helps when you're showing multiple surveys to doctors. It's like, look, I can cut data any way you want it and I can torture it to say whatever you want it to say. But when we all start looking at things the same way across industry, across associations, things like that, it just makes the practice better. And it makes, we're all singing from the same hymnal. Because if I know that Joe is looking at something the same way I'm looking at it, it makes his data that much more valuable to me. And what other benefits do you experience from participating in benchmarking? I'm a data geek. I'm an academic data geek. So I love, like I just said, torturing data and playing with it and seeing what I can do with it. Joe's description of the PA example. I mean, that stuff, I get giddy about that stuff. My wife is an operations leader at a hospital and she's also a clinical researcher. We sit around and play with data all the time and it's just people, must be fun being you. But I love this stuff because it just makes me understand my business that much better. And I can have conversations that are more meaningful with shareholders and other physicians where I can say, look, here's the data. And if I can speak to it intelligently and confidently, it makes messaging that much easier. And if I've got something to back me up instead of this anecdotal, I'm seeing all kinds of patients that aren't able to do this and like, well, let me show you the data. Let's talk about that. So I think that it's just, it just, it takes a lot of emotion. I've said that a couple of times. It takes a lot of emotion out of conversations and it really allows you to get down to kind of, okay, we're done with the bluster. Now let's talk about what the reality is. And those are the big benefits I get out of it. Yeah, and when you actually complete the survey yourself internally, you know what numbers are going into all of these. So you don't have to question, for instance, what's a new patient visit? What codes are included or what types of visits are included? You know what's in a new patient visit. You know what is included and what is not. So you know how your data fits in that metric. Yeah. Yeah, you know, for quite a long time now, right? We've heard this phrase, data-driven decision-making. And when we look at our own business, I think oftentimes we may think there is an area that we're strong in or an area that we're not doing so well in. And the benchmarking data gives us some context to either prove that or disprove it potentially, right? And then, you know, with good information, then we really can follow the data. You know, if we have areas that we're performing really well in, we can keep our foot on the gas. If we have areas we're underperforming in, we can investigate those as opportunities. But I think, you know, this information helps us understand, well, I back up to, I think what Beverly said, just going through the process, we learn a lot about our own business, getting the benchmarking data from our colleagues around the country really helps provide some context. And I think, you know, when I think about our business, you know, we think strategically on a longer term basis and we can identify kind of these bigger opportunities. And then going back to some of the reporting I shared earlier, you know, we're paying attention to those things every week. And I think it really helps us, you know, identify what the key areas of opportunities are and then stay focused on them. And progress over time. I think the data-driven decision-making is an important one, informed decision-making. Because I mean, even small practices are really, really complex organizations anymore with the way payers work, the way that, you know, the reporting requirements we have, the patient demands that we have, you know, the need to create patient accessible experiences, the need to, you know, try to maintain physician compensation to where it's been in the past as best we can. So if you don't have data, you're just, you're making it up as you go along. And even, you know, it doesn't matter the size of your practice. Like, I can't tell you how many times I've told physicians here, it's like, you're not a small practice anymore. You know, it's not a mom and pop practice anymore. And even mom and pop practices aren't mom and pop practices anymore because of the technology and, you know, the innovation and things like that. We have to be efficient. And the way we know whether we're achieving those goals is benchmarking. You know, how do I know something's working? Well, I look at where I sit in the market or I look to see how the benchmarks shift. You know, if I see that I'm, you know, I'm doing all this improvement, but I'm still at the 50th percentile. But if I look back at last year and I see the 50th percentile was less than it is today, I can show that, yeah, my percentile is not changing, but my actual number is, in that area, is going up or down however I want it to go. And that's, you know, because we all, everyone is trying to improve. So as everyone tries to improve, the mean is going to change. And, you know, we want to stay, we want to understand the mean and we don't want to get lost. We want to make sure that we know where we live in that area. Well, and John, I think you said this earlier, you know, paraphrasing, but what gets measured improves, right? And, you know, I think it's true broadly, but certainly we see this with positions. Start getting this kind of information in front of them regularly, you know, and we use the phrase scoreboard here. I think it's used broadly. You know, when everybody's looking at the scoreboard every week, you know, I think they're more tuned into their business. I think they're more likely to keep up. So I think, you know, they benefit individually. Of course, as an organization, we benefit greatly. Well, and it's funny, you know, 25 years ago, almost 30 years ago, I was working in a hospital in a marketing strategy role. And there was this cardiovascular surgery scorecard that was being put out in some, in something. And we posted it outside of the ORs at the hospital, but we didn't put the physician's names. And so, you know, we didn't put the physician's name next to it. And we were wondering why we didn't see much movement. And it's because they all thought they were the person in the upper right quadrant. No one believed they could be in the lower left quadrant. And so we didn't see much change. You know, here we put their names next to it. And when they see their name, it's a great motivator. You know, I don't want to be that guy or that gal that is not performing or not at at least the median. And it makes a big difference. It really, really does. Yeah, that graph we showed earlier, we do the same thing. We designed that purposely. It prints on a one-page report. And we shared our monthly meetings. And with our new PA programming, we posted it in our lunchrooms, in our clinics. So all the PAs know exactly how they're doing. And it does, it changes behavior, right? Yep. All right, so if anyone has any questions, here are all of our emails. We are happy to take emails, you know, and I use Athena in our practice here. And if any of you have questions about how to pull certain reports from Athena, you can certainly feel free to email me. I'm happy to help in any way. Yeah, we do as well. And it makes this process very easy. We use eClinicalWorks. So similarly, I'd make the same offer, reach out if there's something we can help with. Thank you. I do not see any questions coming through. So I will say thank you so much to our speakers for hosting this wonderful presentation today. And thank you to all of our attendees for joining us. Thanks again, and have a great rest of your day. Thank you. Thanks. Thanks, everyone.

benchmarking

physician compensation

productivity

strategic planning

data-driven decision-making

orthopedic groups

incentive plans