Healthcare KPIs every practice should track

What is a KPI in healthcare?

KPI stands for key performance indicator. A benchmark is someone else’s number for the same measure; the KPI is yours. MGMA’s Financials and Operations data set shows how many measures exist: it benchmarks over 4,300 organizations on denials, charge posting lag, no-show rate, call abandonment, staff turnover, work RVUs and dozens more. A practice needs far fewer.

What are the KPIs in healthcare? Formulas and the public numbers behind them

“None found” means no public figure from a named, dated source. “Count not published” means MGMA names the data set and year but not how many practices reported the measure. “Direction only” means the chart below shows just how many groups saw the measure rise or fall.

Sources: MGMA Stat, Jan 8, 2025, July 30 and Aug 11, 2026, citing MGMA DataDive; AMA, 2025 Prior Authorization Physician Survey.

Which revenue operations KPIs show where money is lost?

In MGMA’s January 6, 2026 poll (288 responses), 48% of leaders named denials and appeals their biggest revenue-cycle leak, ahead of front-end issues (23%), billing and collections (14%), coding (13%) and charge posting (2%). So the first-submission denial rate, by payer, goes first: each denied claim restarts the collection clock, and Medicare allows 120 calendar days from receipt of the initial determination to request a redetermination (42 CFR 405.942).

MGMA’s July 2026 analysis of days in A/R lists four checks. The first, aging the A/R by payer before contract talks, is on practice management. The other three:

• Time the path from visit to submitted claim. MGMA suggests clinicians close encounters within 72 hours and staff post charges within two days.
• Work denials daily, starting with high-dollar claims and the nearest appeal deadlines, and review the five most common denial codes for preventable causes.
• Collect before the patient leaves. Groups that improved patient balances most often cited clearer estimates, stronger collection at the visit and staff accountability (MGMA, October 21, 2025 poll).

What medical practice benchmarks are public, and which are members-only?

MGMA’s medians are for members. Its free Stat polls give only the share of groups whose measure rose, held or fell, and the responses. The chart compiles those where a measure moved the wrong way; each bar has its own sample, so read the order, not small gaps.

Which healthcare KPIs measure patient access?

MGMA advises counting cancellations and no-shows apart: a cancellation comes with notice and time to refill the slot, and a no-show usually doesn’t.

The Institute of Medicine defines third next available appointment as the average days between a request and the third open appointment, and uses the third because the first and second openings are often last-minute cancellations.

“Once the practice is able to offer same-day appointments, it should assess its effectiveness by measuring appointment availability on a daily basis (e.g., third next available appointment).”

Which healthcare productivity and quality KPIs move Medicare pay?

Work RVUs per clinical FTE (total work RVUs ÷ clinical FTE) changed meaning in 2026. CMS applied a −2.5% efficiency adjustment to the work RVUs of non-time-based services; time-based codes such as E/M, care management, behavioral health and Medicare telehealth-list services are exempt. Separately, MGMA’s 2026 compensation report (2025 data, more than 245,900 physicians and APPs) found physician work RVUs fell in 16 of 23 common specialties, while primary care NP and PA work RVUs rose about 8.8% and 8.7%.

MIPS turns a quality score into pay. A clinician’s final score is compared with a performance threshold of 75 points for the 2027 through 2030 payment years. The adjustment is 0% at the threshold, the applicable percent, 9%, at a score of 100 and −9% at any score up to a quarter of the threshold, with positive adjustments scalable by up to 3.0 for budget neutrality (42 CFR 414.1405).

What are the KPIs for home health, and how do they affect pay?

The expanded Home Health Value-Based Purchasing (HHVBP) model writes KPIs into payment. It applies to all Medicare-certified agencies nationwide (42 CFR 484.350). CMS scores each agency from 0 to 100: 35% from OASIS-based measures, 35% from claims-based measures and 30% from the HHCAHPS patient survey, when all three are reported. A measure counts only with at least 20 episodes of care a year (OASIS- and claims-based) or 40 completed surveys (HHCAHPS), and an agency needs at least five applicable measures to be scored.

The adjustment is a percentage of each final home health claim payment: the applicable percent (at most 5%, up or down) times the score ÷ 100 times a linear exchange function slope (42 CFR 484.370). CMS scores a full performance year, so track the same three measure groups monthly.

What is compliance benchmarking, and what should you measure?

Compliance benchmarking means measuring each part of your compliance program over time, against your own baseline. The HCCA-OIG roundtable’s resource guide (March 27, 2017) lists measurement ideas for the seven elements of a compliance program, from policies to investigations, and says it is not a “checklist”: using them all “is impractical and not recommended.” A practice can start with four:

• Training: completion rates for the high-risk roles, checked against sign-in sheets or tracking records (compliance training).
• Screening: who is accountable for exclusion screening, and the record of each check (OIG exclusion checks).
• Reporting: days from a report to the response and to the close, and days to open and close an overpayment matter against the 60-day timeframe (compliance program).
• Policies: the last review date of each policy.

What you can do today

1. Pick six to eight KPIs from the table (no rule sets a number), write each formula in one sentence, and give each an owner and a monthly review date.
2. From your billing system’s A/R aging and denial reports for the last 12 months, compute by payer the days in A/R, the first-submission denial rate and the share of copays and patient balances collected at the visit. Read MGMA’s figures as context, not targets.
3. Find your top Medicare Advantage plans’ posted prior authorization data (due on each plan’s website by March 31 each year) and start your own log: payer, submission and decision dates, standard or expedited, information requests, peer-to-peer reviews, denials, appeals and resolution date.
4. Count the third next available appointment for each provider and visit type once a week.
5. Pull the last six months of no-shows and cancellations from your scheduling system, sort them by visit type and lead time, and count how many of each were rebooked within 30 days and completed.
6. Re-base any work RVU target that includes non-time-based services for the 2026 efficiency adjustment, and compare your latest MIPS final score, in your Quality Payment Program account, with 75 points.

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