The Medical Group Management Association (MGMA) is a professional association representing medical practice administrators and executives in the United States. One of the keyways MGMA helps medical practices succeed is through developing practice performance standards and metrics. MGMA’s practice performance standards outline operational and financial data points that well-managed practices should aim to achieve. These standards allow practices to benchmark their performance against industry norms, identifying opportunities for improvement. Practices that meet MGMA standards demonstrate to patients, payers, and the healthcare industry that they are operating at a high level of efficiency and care quality.
Background on MGMA
MGMA was founded in 1926 as the National Association of Clinic Managers. Today, MGMA represents more than 15,000 medical practice administrators, executives, and leaders across the United States. As the leading association for medical practice professionals since 1926, MGMA strives to improve the performance of healthcare practices to ensure that patients receive exceptional healthcare. They offer industry-leading medical practice education, advocacy, benchmarking data, consulting, networking, and solutions to support medical practices in providing excellent patient care.
MGMA has over 40,000 members that range from small private medical practices to large medical groups and integrated health systems. Their membership reflects the full spectrum of practice settings, including physician practices, hospitals and integrated delivery systems, billing companies, and medical product/service organizations.
Overview of the MGMA Standards
The MGMA standards encompass many areas of medical practice operations and performance. The standards provide benchmarks and best practices across key categories like:
- Financial performance
- Use of technology
- Patient care processes
The metrics were developed by MGMA researchers leveraging industry data sources, surveys, expert consensus panels, and analysis of high-performing practices. They evolve to reflect industry changes. The standards go beyond high-level benchmarks to provide prescriptive guidance on best practices for patient engagement, care team roles, payer contract evaluation, and more. They aim to help practices optimize operations, financial health, quality of care, and compliance.
Benefits of MGMA Compliance
Meeting MGMA’s practice performance standards can significantly benefit your medical practice in multiple ways:
Your practice can streamline workflows and operations by implementing policies and procedures aligned with MGMA standards. This allows staff to operate with increased efficiency and productivity. Compliance encourages the use of technology and best practices that save time and reduce redundancies. Your team is enabled to operate with greater efficiency rather than putting in extra effort.
An efficient practice tends to be a more profitable one. Compliance helps eliminate wasted time and resources on tasks that don’t drive revenue or patient care. It steers focus toward profit-generating activities. Your revenues can be optimized, and costs controlled when following MGMA guidelines. This enables your practice to operate in a lean yet effective manner.
Higher Quality of Care
Compliance leads to improved care coordination, access to care, and service levels. Patients are more satisfied and likely to stay loyal to your practice. By meeting quality metrics and benchmarks, you deliver superior health outcomes. Your practice gained a reputation for providing safe, effective, timely, efficient, equitable, and patient-centered care. This is the core of MGMA standards.
How Compliance is Measured
Compliance with MGMA’s practice performance standards is measured through regular data submissions and benchmarking against key metrics. Practices that choose to comply with the standards must submit timely data on factors like:
- Revenue and costs
- Staff productivity
- Patient volumes
- Days in Accounts receivable
- Overhead expenses
This data allows MGMA to benchmark each practice against industry averages and identify any areas where they may be lagging their peers. Compliance is determined by how closely a practice matches or exceeds the median benchmark values across the measured metrics.
Consequences of Non-Compliance
Failure to comply with MGMA’s practice performance standards can have serious consequences for medical practice. The most significant risks include:
- Practices that don’t follow MGMA standards will likely fall behind industry benchmarks for cost, revenue, productivity, accounts receivable, etc. Staying competitive becomes challenging under these circumstances.
- Suppose a practice lacks the latest technologies, administrative processes, staff training, and other aspects dictated by MGMA. In that case, patients may be frustrated by long wait times, billing issues, and inadequate communication channels. This might prompt them to consider changing service providers.
- In some cases, lack of compliance can result in direct penalties. For example, failure to meet security and privacy standards could result in HIPAA violations and fines. Likewise, practices that don’t follow evolving payer requirements around documentation, coding, and claims could face penalties in reimbursement rates or have claims denied. This directly impacts revenue.
Overall, failure to adhere to MGMA’s recommended performance standards can put a practice at a significant competitive disadvantage. It can lead to loss of patients, lower profitability, and lack of leverage in negotiations with payers. Doing so helps them keep up with industry norms and demonstrate commitment to patients and payers.
Implementing the MGMA Practice Performance Standards
Successfully implementing MGMA’s practice performance standards requires thoughtful planning and execution. Explore the following recommended strategies:
- Audit your current processes and workflows. Identify areas that need improvement to meet MGMA standards.
- Collect relevant data on clinical quality, patient satisfaction, financial performance, staff productivity, etc. This data will be crucial for measuring improvement.
- Analyze the data to pinpoint priorities and opportunities. Look for trends and insights.
- Form a dedicated team to analyze the data and brainstorm solutions. Include staff from different departments for cross-functional input.
- Research best practices from top-performing practices in each priority area. Don’t reinvent the wheel.
- Set specific, measurable goals for improving performance aligned with MGMA standards.
- Document improved workflows, protocols, and guidelines to support change.
- Pilot changes on a small scale first to work out any issues.
- Train staff thoroughly on process changes before full implementation. Education is key.
- Monitor results closely and tweak as needed to optimize compliance and performance.
- Standardize successful changes across the practice to hardwire improvements.
Assessing your current practice’s compliance with MGMA’s performance standards is the critical first step. This allows you to identify any gaps where you may be falling short of the standards. Consider creating a spreadsheet or checklist to track compliance in each area. Examine both quantitative metrics and qualitative aspects of patient care and practice management.
Some key questions to ask:
- How do our patient wait times and appointment availability stack up against the standards?
- Is our staff trained adequately on clinical guidelines and utilization of EHR systems?
- Are we sufficiently monitoring the quality of care and patient satisfaction?
- Do we have protocols in place to maximize insurance pre-authorizations?
- Are our finances, billing, and collections meeting benchmarks?
Identify any weak points where you see a disconnect between MGMA’s standards and your current practice. These are the areas you’ll want to focus on improving. Once gaps are identified, develop a plan to achieve full compliance. This may involve updating procedures, investing in technology, hiring additional staff, implementing training programs, or other solutions. Getting a baseline measurement of how your practice compares to MGMA’s performance standards is the crucial first move. This allows you to pinpoint opportunities for improvement and build an effective strategy. With diligent work, your practice can successfully meet industry benchmarks.
Compliance with MGMA’s practice performance standards is crucial for medical practices looking to operate efficiently and provide quality care. While transitioning to meet the standards requires time and resources, the long-term benefits make the effort worthwhile. Compliant practices operate more profitably and sustainably. They are better equipped to withstand industry and regulatory changes. Most importantly, they are positioned to provide exceptional service to patients.
The next step for practice leaders is to review MGMA’s requirements, audit their current operations, and develop an action plan. Incremental changes to align with the standards will lead to progressive improvements. MGMA provides the tools and guidance to make this process manageable. Their standards serve as the definitive model for operational excellence. Don’t wait to begin your compliance journey – implement the standards now to maximize your practice’s potential. By meeting patients’ rising expectations, you will establish your group as the provider of choice in your community.