A Case Study of the Financial Benefits of CHIME

  • June 1, 2020

A comparison of the pre-CHIME and the post-CHIME outcome of a primary care clinic in downtown Toronto helps illustrate the net financial benefit of CHIME.

Summary

The numbers at a glance

  Before adopting CHIME After adopting CHIME Percentage Change
Total MDs 7 full-time equivalents 14 full-time equivalents +100%
Cost per Appointment $17.67 $8.14 -54%
Annual Savings - $342,000 -

Seeing the Change over Time

The following illustrates:

  1. The monthly appointments in the clinic before and after CHIME; and 
  2. The effective cost of on-site support staff and facilities before and after CHIME

Before CHIME, the clinic averaged approximately 1500 appointments a month for a total cost of approximately $17.67 per appointment.

After adopting CHIME, the clinic doubled their monthly appointments over the course of the next 18 months to reach a new plateau of approximately 3000 appointments a month for a new total cost of approximately $8.14 per appointment, or savings of 54% per appointment.

Effect of CHIME Installation on Monthly Clinic Volumes and Costs per Appointment
Effect of CHIME installation on monthly clinic volumes and costs per appointment.

Let’s unpack this data.

Before CHIME

This clinic had 11 largely identical exam rooms and was paying approximately $158,000 per year for 2600sf of clinic space, inclusive of rent and TMI ($95,000), utilities ($18,000), and amortization of leaseholds and equipment over the ten year lease ($45,000).

7 hours of patient visits (9AM to 5PM, excluding lunch) were scheduled each business day to accommodate a single shift of full-time support staff for the clinic with appropriate breaks. Each shift involved:

  • 1 receptionist;
  • 2 medical assistants escorting patients to rooms and preparing and measuring them (e.g. wbv, adult physicians, intake forms); and
  • 1 nurse assisting with appointments (e.g. delivering shots, ear syringing, etc.).

Collectively, these 4 full-time staff (excluding managerial and other administrative support staff), had a total payroll of approximately $160,000, including a 10% gross-up to account for vacation, statutory holidays, and sick days. These staff were focused on facilitating the “day to day” needs of the clinic and already felt extremely busy, and were asking for additional day to day support. 

At any given time, up to 5 physicians could simultaneously see patients at the clinic. This means the clinic supported a physician complement of 7 full-time equivalents, each in-clinic an average of 3.5 days a week (and either off or working from home 1.5 days a week).

If fully booked and attended, 3.5 in-clinic days a week works out to 98 weekly appointments, or approximately 5000 appointments a year. In practice, the actual number of conducted appointments was approximately half, or 2500 appointments a year, per full-time family physician in-clinic an average of 3.5 days a week. 

Reasons include:

  • Physician breaks and lunches;
  • Physician vacation and statutory holidays;
  • Physician meetings and other engagements;
  • Physician illness and sick days; and
  • Patient no-shows, cancellations, and otherwise unbooked appointment slots

Altogether, the clinic had approximately 90 appointments a day, 1500 appointments a month, or 18,000 appointments a year, where for each appointment, the effective total cost of the facilities was $8.78 per appointment, and the on-site support staff was $8.89 per appointment, for a total cost of $17.67 per appointment.

After adopting CHIME

As illustrated above, the benefits of CHIME accrue over a number of months. This is because it takes time to adapt the in-clinic processes to take advantage of CHIME. It also takes time to recruit additional patients and physicians.

Let’s examine the new plateau that this clinic reached after approximately 18 months (i.e. CHIME was installed fall 2016 and a new plateau was reached early 2018).

From a physical space perspective, the clinic continued to have 11 largely identical exam rooms. Actual rent costs had increased due to an escalating rent structure, but let’s assume it maintained steady: approximately $158,000 per year for 2600sf of clinic space, inclusive of rent and TMI ($95,000), utilities ($18,000), and amortization of leaseholds and equipment over the ten year lease ($45,000).

Instead of 7 hours of patient visits a day, this clinic expanded to 10 hours a day, from 7AM – 5PM daily continuously. The staffing complement and staff schedules were also adjusted to:

  • 2 medical assistants, one working 7AM - 3PM and the other working 9AM – 5PM; and
  • 1 nurse working 8AM – 4PM

This approach meant during most times of the day, there were 3 support staff on duty, but this would drop down to 1 during “low” times such as the early morning (e.g. 7AM – 8AM) and the late afternoon (e.g. 4PM – 5PM).  Staff had staggered breaks and lunches so that at all times between 7AM and 5PM, there was at least 1 staff on duty.

CHIME features that made this possible included our check-in kiosk, our patient wayfinding, our automated room assignment, our dashboards, and our mobile tablets. By automating rote tasks and improving communication, staff on duty could focus on prepping and measuring patients, or answering questions, while simultaneously keeping a watchful eye over the clinic. During low volume periods, a single staff member could readily support a clinic having multiple physicians seeing patients.

The total yearly payroll was therefore reduced to $135,000, from $160,000.

At the same time, the average number of patients seen each day approximately doubled. Notably, this was accomplished without shortening patient visits or increasing patient or physician wait times. Instead, this increase was accomplished by:

  • Expanding the daily number of hours patients could be seen in clinic from 7 to 10;
  • Increasing the number of physicians simultaneously seeing patients out of 11 exam rooms to 7 (or even 8 for short periods); and
  • Allowing physicians to schedule themselves into the clinic in a much more flexible way.

How the increase in hours was accomplished while reducing staff costs was explained above.

Increasing the number of physicians simultaneously seeing patients was accomplished with the CHIME feature of room sharing, where CHIME intelligently enables physicians to share a pool of rooms, instead of assigning 2 rooms per physician.

Allowing physicians to schedule themselves into the clinic in a more flexible way is worth explaining. Assume for example a physician is sick on a Monday and cancels a clinic. In a clinic with a highly structured schedule, it’s not necessarily possible for that physician to “make up” that time on Tuesday because there are not enough rooms available. In a flexibly scheduled clinic, the physician can easily look at the schedule and add some hours during the low volume times, knowing that their additional volume will just get “absorbed”. This flexibility helps deliver higher volumes, on average, over time, together with better patient and physician satisfaction.

Altogether, the clinic had approximately 180 appointments a day, 3000 appointments a month, or 36,000 appointments a year after the installation of CHIME, where for each appointment, the effective total cost of the facilities was $4.39 per appointment, and the on-site support staff was $3.75 per appointment, for a total cost of $8.14 per appointment.

Looked at another way, without CHIME, the clinic would have needed to spend $635,000 to support 36,000 annual appointments. With CHIME, the clinic only spent $293,000, for savings of $342,000 annually.