Healthcare Management KPIs, Metrics & Benchmarks

KPIs & Metrics to Measure and Manage Healthcare Management Performance

Healthcare Facilities & Services

What are Healthcare KPIs?

Healthcare KPIs provide a data-driven view into both medical and administrative functions within a healthcare facility (hospitals, clinics, etc.). A typical healthcare facility operates, in many ways, like a normal business. They have customers to serve, bills to collect, and a staff of employees to manage. Healthcare metrics measure customer service (quality of care), administrative efficiency (billing, data management, IT, HR, etc.), staffing levels and other vital areas of operation within a healthcare facility.

Improve Patient Care and Facility Administration with the Right Healthcare Metrics

Healthcare facilities must effectively balance cost control, facility administration, technology optimization, and patient care – among other things. Healthcare KPIs should be designed to monitor all aspects of facility operations, applying the appropriate weight to each area. Profitable, well-run healthcare facilities control costs while diligently monitoring quality of care to ensure that they are not sacrificing quality for profitability. For example, healthcare metrics can be used to develop facility scorecards where the appropriate weight is applied to each category to produce an overall quality score.

KPI's & Data 

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Healthcare Management Benchmarking Report

This 18-page benchmarking report includes benchmarking data for 7 health insurance operations KPIs including Adjusted Expenses per Inpatient Day, Hospital Employees per Adjusted Occupied Bed...

Type : Benchmarking Report Bundle

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Benefit Accuracy Rate

The number of patient responsibilities for health insurance claims in which the payer returned the correct patient responsibility information (based on patient benefits eligibility) at the t...

KPI Type : Quality

Formula : (Number of Instances where Correct Patient Responsibility Amount was Communicated by Payer / Total Number of Patient Responsibility Amounts Communicated) * 100

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7 Important KPIs for Managing Hospitals and Healthcare Facilities

Balancing the individual needs of patients with the realities of managing a hospital can be a tenuous balancing act. There are many well-defined, industry-standard KPIs for monitoring quality of care, administrative efficiency and cost. Here are 5 examples:

  1. 1.Patient Days per Staffed Bed
  2. 2.Re-Admission Rate
  3. 3.Average Patient Length of Stay
  4. 4.Patient Days per Registered Nurse
  5. 5.Inpatient Mortality Rate

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KPI's & Data 

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Healthcare Management Benchmarking Report

This 18-page benchmarking report includes benchmarking data for 7 health insurance operations KPIs including Adjusted Expenses per Inpatient Day, Hospital Employees per Adjusted Occupied Bed...

Type : Benchmarking Report Bundle

KPI's & Data 

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Benefit Accuracy Rate

The number of patient responsibilities for health insurance claims in which the payer returned the correct patient responsibility information (based on patient benefits eligibility) at the t...

KPI Type : Quality

Formula : (Number of Instances where Correct Patient Responsibility Amount was Communicated by Payer / Total Number of Patient Responsibility Amounts Communicated) * 100

KPI Benchmark Range : Buy this instant download data-as-a-service product to find out now!

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Provider Enrollment Request Cycle Time

The average number of days required for a health insurance company, or payer, to process a request from a healthcare provider for enrollment into their provider network, from the time the re...

KPI Type : Service

Formula : (Sum of Provider Enrollment Request Cycle Times) / Total Number of Provider Enrollments Completed

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Patient Eligibility Accuracy Rate

The number of instances where the patient eligibility information initially returned by the health insurance company matched the final outcome of claim adjudication divided by the total numb...

KPI Type : Quality

Formula : (Number of Accurate Patient Eligibility Transactions / Total Number of Medical Claims Adjudicated) * 100

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ERA Transparency Rate

The total number of electronic remittance advice (ERA) claim denial or adjustment messages provided by the insurance company that include clear, actionable items and explanations divided by...

KPI Type : Quality

Formula : (Number of ERA Denial or Adjustment Messages Including Clear Reasons and Action Items / Total Number of ERA Denial or Adjustment Messages Sent) * 100

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Uncompensated Care Expense as a Percentage of Gross Patient Revenue

The dollar amount of charity and bad debt-related expense incurred by the healthcare facility divided by the total dollar amount of revenue generated by the healthcare facility over the same...

KPI Type : Cost

Formula : (Amount of Charity and Bad Debt-Related Expense Incurred / Total Amount of Revenue Generated) * 100

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Percentage of Claim Lines Paid $0

The total number of claims that were filed by healthcare providers, but for which the payer paid $0 due to disclosed and/or undisclosed claim edits (i.e., changes to claims reimbursement rul...

KPI Type : Quality

Formula : (Number of Medical Claims Lines Paid $0 / Total Number of Medical Claims Lines Submitted) * 100

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ERA Accuracy Rate

The total number of initial electronic remittance advice (ERA) claim denial or adjustment messages provided by the insurance company that include accurate adjustment messages and/or denial r...

KPI Type : Quality

Formula : (Number of Accurate Initial ERA Messages Sent / Total Number of Initial ERA Messages Sent) * 100

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Adjusted Expenses per Inpatient Day

The total cost of providing inpatient and outpatient care divided by the number of adjusted inpatient days managed by the hospital over a certain period of time. Time spent on outpatient ser...

KPI Type : Cost

Formula : Total Cost of Inpatient And Outpatient Care / Number of Adjusted Inpatient Days

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Hospital Employees per Adjusted Occupied Bed

The number of employees working within a hospital divided by the total number of adjusted occupied beds for that hospital.

KPI Type : Organizational

Formula : Number of Hospital Employees / Number of Adjusted Occupied Beds

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Patient Days per Registered Nurse

The total number of patient days managed by a healthcare facility divided by the number of registered nurses working for the facility at the same point in time.

KPI Type : Productivity

Formula : Total Number of Patient Days Managed / Number of Registered Nurses

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Patient Days per Staffed Bed

The total number of patient days managed by a healthcare facility divided by the number of staffed beds operated by the facility at the same point in time.

KPI Type : Productivity

Formula : Total Number of Patient Days Managed / Number of Staffed Beds

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Percentage of Charges Transferred

The dollar amount of healthcare expenses (e.g., co-insurance, deductibles, or other non-covered medical services) that are transferred from the primary insurer to the next responsible party...

KPI Type : Service

Formula : (Dollar Amount of Healthcare Costs Transferred to Next Responsible Party / Total Dollar Amount of Claims Submitted for Adjudication) * 100

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KPI's & Data 

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Healthcare Management KPI Encyclopedia

This document defines over 100 Healthcare Management industry KPIs, including metric definitions for Care Management, Patient Relations, Pharmaceutical Distribution Services and more. These...

Type : KPI Encyclopedia

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Prior Authorization Rate

The number of medical services rendered by in-network providers that require prior authorization (i.e., explicit approval from the insurance payer prior to the initiation of the service; or...

KPI Type : Service

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Technology Support Expense per Bed

The total expense incurred by the hospital's or healthcare facility's technology support function (i.e., service desk) over a certain period of time divided by the number of beds operated by...

KPI Type : Cost

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Average Charge per Discharge

The total adjusted patient charges (for all patients - from admission to discharge) divided by the total number of discharges over the same period of time.

KPI Type : Revenue

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Technology Support Expense per Hospital Employee

The total expense incurred by the hospital's or healthcare facility's technology support function (i.e., service desk) over a certain period of time divided by the total number of employees...

KPI Type : Cost

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Technology Support Expense per Physician

The total expense incurred by the hospital's or healthcare facility's technology support function (i.e., service desk) over a certain period of time divided by the total number of physicians...

KPI Type : Cost

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Staffed Bed Occupancy Rate

The quotient of the total number of days in which inpatient care is provided to patients in the healthcare facility and the number of days the facility is open for patient admission divided...

KPI Type : Quality

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Percentage of Patients with Documented Care Plan

The number of patients under management with chronic or terminal illnesses or disabilities who have met with a case manager and developed and implemented a long-term care plan divided by the...

KPI Type : Quality

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Average Emergency Room (ER) Wait Time

The average number of minutes required for a patient to see a physician, or physician's assistant (PA) within a hospital's Emergency Room, from the time the patient checks in with the hospit...

KPI Type : Quality

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Inpatient Mortality Rate

The number of patients admitted to the hospital who succumb to death before they are discharged divided by the total number of patients admitted to the hospital over the same period of time,...

KPI Type : Quality

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Percentage of Hospital Managers Holding Clinical Degrees

The number of healthcare facility managers (hospital administration and management staff) who hold a clinical degree (M.D., Healthcare Management, or similar) of some kind divided by the tot...

KPI Type : Quality

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Change in Cost of Care (post-plan vs. pre-plan)

The dollar amount of care-related expense incurred over a certain period of time after transitioning to a documented, long-term care plan that was developed with the assistance of a case man...

KPI Type : Quality

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Percentage of Duplicate Medical Records

The number of records (and related entries) within the patient medical record database that are duplicated and/or redundant divided by the total number of records entered into the patient me...

KPI Type : Quality

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Percentage of Patients Requiring Prior Authorization

The number of patients managed by the healthcare facility that require prior authorization from their health insurance provider for certain prescription medications or procedures divided by...

KPI Type : Quality

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Patient Days

The number of patients managed by a healthcare facility at the end of the day (typically measured at or just before midnight) multiplied by the number of days each patient has been admitted...

KPI Type : Volume

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Risk-Adjusted Mortality Index

A measurement developed to indicate whether a hospital's inpatient mortality rate is higher or lower than expected for specific diagnoses and procedures given the risk factors of the patient...

KPI Type : Quality

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Risk Adjusted Complications Ratio

The number of actual inpatients who experience postsurgery or postobstetrical (procedures concentrated on pregnancy or childbirth) complications divided by the number of postsurgical or post...

KPI Type : Quality

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