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EstablishingProductivity BenchmarksPractical Tools for Seminar Learning Copyright 2006 American Health Information Management Association. All rights reserved.

DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.How to earn one (1) CEU for participationTo earn one (1) continuing education unit, each participant must do the following:Step 1:Listen to the seminar, via Webcast link, audio CD, or MP3.Step 2:Complete the assessment quiz contained in this resource book.Use the included answer key. Do not return the quiz to AHIMA.Save it for your records.Step 3:Fax or mail us the completed sign-in form from this resource book.The fax number and address are located at the bottom of the form.Step 4:Print the certificate of attendance for each listener. The certificate must beretained by each participant as a record of their participation, along with a copyof their completed quiz.After listening to the seminar, please let us know what you think, by completing our onlineevaluation survey at tmi

FacultySusan M. Hull, MPH, RHIA, CCS, CCS-PSusan M. Hull, MPH, RHIA, CCS, CCS-P is a professional practice resources managerfor the American Health Information Management Association (AHIMA). In her role asmanager, Susan provides professional expertise to AHIMA members, the media, andoutside organizations on coding practice issues, and develops written products aimedat furthering the art and science of coding.Susan has over 20 years experience in the HIM field. Before joining AHIMA in 2002,she served as Senior Executive Director for HMI Corporation where she oversawcoding reviews; chargemaster maintenance and development; and presented seminarsin outpatient, inpatient, and physician documentation and coding. Prior to this, sheworked in numerous HIM roles, including consultant, HIM department director, andHIM software developer and manager.In addition to AHIMA, Susan is actively involved as a volunteer in the HIM profession.She has presented on timely HIM topics to the Health Information ManagementAssociations of California, Tennessee, and Southern Illinois, as well as the SouthernIllinois Healthcare Financial Management Association.Susan received a bachelor of arts degree and a master of public health in HealthServices and Hospital Administration from the University of California, Los Angeles.ii

Table of ContentsDisclaimer . iHow to earn one (1) CEU for participation . iFaculty .iiDo you need productivity standards? . 1Sources for benchmarks . 1-2Criteria for benchmarking . 2MGMA guidelines. 3Job specific guidelines—examples. 4Calculating staff levels . 4Steps to benchmarking . 5-6Questions to ask . 6Issues that increase staffing needs . 7Solutions for low productivity . 8AHIMA Audio Seminars . 8Thank you for attending (with link for evaluation survey) . 9Appendix.10Assessment QuizContinuing Education Credit and Compliance Sign-in FormCertificate of Attendance and Quiz CompletionQuiz Answer Key

Establishing Productivity BenchmarksNotes/CommentsDo you need productivity standards? Are staff keeping up with patient flow? Are staff keeping up with paper flow? Are claims going out timely? Are claims going out clean? Are you performing adequatefollow-up of all rejected orreduced claims? Are you current with fulfillingrequests for information?1Sources for benchmarks Medical Group Management Association(MGMA) (www.mgma.org) Practice Support Resources (PSR)(www.practicesupport.com) American Medical Association (AMA)(www.ama-assn.org) American Medical Group Association(AMGA) (www.amga.org)21

Establishing Productivity BenchmarksSources for benchmarksNotes/Comments(Continued) American Health Information ManagementAssociation (AHIMA) (www.ahima.org) National Association of HealthcareConsultants (www.healthcon.org) University Health System Consortium(www.uhc.edu) Medical Economics magazine(www.memag.com)3Criteria for benchmarkingTwo basic criteria The number ofsupport staff perfull-time-equivalent(FTE) physician (3-5) The percentage ofgross revenue spenton support staff salaries (25-27%)42

Establishing Productivity BenchmarksNotes/CommentsMGMA guidelinesStaff per full-time physician — administrative General administrative 0.24 Business office 0.80 Managed care administrative 0.16 Housekeeping, maintenance, security 0.14 Medical receptionists 1.0 Medical secretaries, transcriptionists 0.34 Medical records 0.43 Other administrative support 0.135MGMA guidelines(Continued)Staff per full-time physician – clinical RNs 0.44 LPN/LVNs 0.40 MAs, nurse aides 0.76 Clinical laboratory 0.34 Radiology and imaging 0.21 Contracted support staff 0.2363

Establishing Productivity BenchmarksNotes/CommentsJob specific guidelines — examples Schedulers — 180-200appointments per day Check out personnel – 70-90patients per day7Calculating staff levelsAdd up all staff’s weekly hours (includingmidlevel practitioners if non-revenueproducing) Divide by 40 to get number of FTEs Divide by number of full-time physicians(including midlevel practitioners if revenueproducing) to get staff per physician Compare to local (ideal, if available) ornational standard benchmarks 84

Establishing Productivity BenchmarksNotes/CommentsSteps to benchmarking Understand the process Steps involved Source of needed information Problems encountered during the processAnalyze the time involved andidentify nonproductive time Physical observation Recording by performer9Steps to benchmarking (Continued)Develop recommendations Elimination of redundant steps in process Simplification of process Reassignment of work steps Reduction in number of individualshandling paper Reduction in number of individuals involved inprocess by combining tasks Reassignment of responsibility105

Establishing Productivity BenchmarksSteps to benchmarking Notes/Comments(Continued)Review recommendations with staff The most critical stepSolicit recommendations for changes to planOnce modifications are made and buy-infrom staff is obtained, assign the newstandards Review again with staff Start the program Monitor results 11Questions to ask Are the right people doing the right things? Each task should be performed by the least trainedperson able to perform it adequately and safely. Are staff scheduled appropriately? Are the right people being rewarded fordoing a good job? Are under performers receiving overtime whileefficient staff are not? Are efficient staff taking on work of underperformerswithout reward?126

Establishing Productivity BenchmarksNotes/CommentsIssues that increase staffing needs Presence of mid-level practitioners(PAs, RNPs, other advance practice nurses) Satellite locations Large numbers of procedures Large numbers ofhospitalized patients High turn-over of staff,perpetual training mode Large numbers of disparatecontracts13Issues that increase staffing needs (Continued)The physician’s style How organized How independent How involved withpatients and staffon a personal basis147

Establishing Productivity BenchmarksNotes/CommentsSolutions for low productivity Staff education New employee orientation All staff orientation to newprocedures, computer applications, etc. Regular (at least annual) reorientation to officepolicies and proceduresIncentive programs Profit sharing Other financial rewards(bonuses, clothing allowances,World Series tickets, etc.)15AHIMA Audio SeminarsVisit our Web sitehttp://campus.AHIMA.orgfor updated information on thecurrent seminar schedule.While online, you can also register forlive seminars or order CDs andWebcasts of seminars. 2006 American Health Information Management Association8

Establishing Productivity BenchmarksNotes/CommentsThank you for attending!Please visit the AHIMA Audio SeminarsWeb site to complete your evaluationform online s.html9

AppendixAssessment QuizContinuing Education Credit and Compliance Sign-in FormCertificate of Attendance and Quiz CompletionQuiz Answer Key

Assessment Quiz – Establishing Productivity BenchmarksTo earn continuing education credit of one (1) AHIMA CEU, Fast Facts Audio Seminar listeners must also completethis 10-question quiz. This CE credit is for attending the audio seminar AND completing this quiz. Please keep acopy of the completed quiz with your certificate of attendance. Do not send a copy to AHIMA.1.True or false? Every practice should establishproductivity benchmarks.6.a. Trueb. False2.a. TrueCriteria for benchmarking staff can be based on:a. Number of support staff per full-timephysicianb. False7.b. Percentage of gross revenue spent on supportstaff salariesc. Number of support staff per patient3.a. TrueThe number of mid-level practitioner has whateffect on staffing levels?b. False8.b. Usually decreases staffing levelsMidlevel practitioners who do not producerevenue are treated as forpurposes of calculating productivity?c. Has no effect on staffing levelsa. support staffb. physician staffThe most critical step in establishing staffingbenchmarks is:c. either support or physician staff, whicheverproduces the best numbersa. Correctly estimating time spent in activitiesd. They are not counted at all if they do notproduce revenue.b. Reviewing any recommendations with staffc. Developing recommendationsd. Monitoring results5.True or false? A practice in which a largenumber of procedures are performed in theoffice will probably have higher staffing needsthan one where most visits are evaluation andmanagement only.d. Either a or ba. Usually increases staffing levels4.True or false? The two main ways to analyzetime involved in a process are by directobservation and by having an outside personrecord time spent in each task.Among the recommendations frequentlydeveloped as a result of process analyis arewhich of the following?a. Elimination of redundant steps in the processb. Simplification of the processc. Reassignment of responsibilityd. All of the above9.True or false? The least trained person who cansafely and effectively perform a given task is theperson who should be performing that task.a. Trueb. False10. True or false? A physician who is highlyindependent and organized will need fewersupport staff than one who is dependent anddisorganized.a. Trueb. FalseDo not send a copy of completed quizzes to AHIMA. Please keep them with your certificate of attendance, for yourrecords. Be sure to complete and send the seminar sign-in sheet found on the next page of this resource book.ANSWERS to this quiz are found on the last page of theseminar resource book, Practical Tools for Seminar Learning.