Methodology to Analyze Most Valuable Diagnoses to a Hand Surgery Practice

Orrin I. Franko, MD – East Bay Hand Medical Center in San Leandro, CA

Hypothesis: The purpose of this study was to develop a reproducible protocol used to determine the most valuable diagnoses to a hand surgery practice. Recognizing the relative value of various diagnoses can help guide practice management, scheduling, and growth strategies for success.
Methods: Two years of professional fee billing and collection data was generated from a single practice management software. Using Microsoft Excel formulas, tools, and pivot tables a reproducible protocol was developed to analyze the value of common patient diagnoses defined as greater than 20 patients. The specific workflow began by isolating patients with a single diagnosis limited to the first 5 characters of the ICD-10 standard (exclusive of digit or laterality). Next, total charges and total collections were calculated for each diagnosis, and further sub-divided by insurance status (Medicare, Medicaid, Private-PPO, Private-HMO, Work Comp, or None/Cash Pay). Results were then divided by adjusted time per visit to calculate revenue per minute for each diagnosis. Values were normalized for easier interpretation.

Results: A total of 21 isolated ICD10 diagnoses were included the analysis ranging from 21 to 217 patients by category (Table 1). We selected ICD10 M65.3 (Trigger Finger) to serve as the control based on it being the most common diagnosis, as well as it’s overall average collection within the list (ranked 12 of 21). Other diagnoses ranged in total collections from 61% to 190% relative to Trigger Finger, and when adjusted for office time from 60% to 140%, representing 3.1x and 2.3x differences in total revenue and revenue/minute, respectively. The most valuable diagnoses were Distal Radius Fractures (S52.5), Carpal Tunnel Syndrome (G56.0) and Swelling/Masses (R22.3/D36.9). The least valuable diagnoses were Contusions (S60.2), Finger Sprains (S63.6) and Open Wounds/Cellulitis (S61.4/L03.1).

Summary Points:

  • Reproducible protocols can be developed for analyzing overall revenue and revenue per minute in the practice setting
  • Understanding the value of different diagnoses can help focus marketing and growth strategies, scheduling, and practice management protocols for higher efficiency
  • This analysis did not account for differences between payors nor ancillary revenue from imaging, therapy, or surgical facility fees that would likely have a measurable but unknown impact on these results.