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Another finding was that some ANMCs in this project did not adequately track patient no-show rates nor had an understanding of the determinants of unkept appointments.
Decreases in unearned income were expected as the ANMCs generated more revenue.
A limitation of using RVUs to assess performance of APNs and ANMCs is that CPT codes do not capture all of services delivered by APNs (Sullivan-Marx et al., 2000).
At the time of data collection, ANMCs in this study were not able to link financial data with patient characteristics to control for variations in population characteristics.
Lastly, rather than traditional physician practices which served a median of 7% self-pay and 0.1% charity care and professional courtesy care patients in 2001 (MGMA, 2002a), federal Community Health Centers (CHCs) have a more similar patient mix (Forrest & Whelan, 2000; McAlearney, 2002) and would be a better comparison group for ANMC. The more similar patient mix reflects that CHCs and ANMCs are more likely to have a similar mission of serving vulnerable populations.
Administrators and practitioners must possess business acumen to ensure that ANMCs fulfill their mission, often of serving under and uninsured populations and providing education sites, while remaining financially solvent.
This perspective was employed to determine the prospects for self-sustainability of the ANMCs, so all relevant funding and costs were included.
National performance measures using the median per patient for FPPs provide initial reference points for comparative analysis until benchmarks specific to ANMCs are developed.
The top-ranked center's service revenue was approximately 400% to 600% higher than other ANMCs and 200% higher than FPPs.
In a time of rising health care costs and limited resources, ANMCs need to understand their practice's financial information to make informed business decisions.
These profitable ANMCs were consistently better performers across multiple performance measures compared to other ANMCs.
Findings from this study and benchmark data suggest that ANMCs should develop a staffing model that uses fewer staff more efficiently: clinical support staff should optimize the productivity of APNs and administrative staff should streamline processes including billing and collections.
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