Productivity Stats

Question

Answer

Measuring productivity is easier when a facility has software in place to manage clinic operations. However, smaller clinic operations might be able to accomplish the same thing manually. There are several basic elements necessary to the calculation:

*Number of procedures by provider
*Time associated with each procedure
*On duty hours

The first element requires that you have a complete list of procedures performed by each provider. These data can come from encounter forms used for billing, but it is important to recognize that a significant portion of an audiologist's time involves professional services and treatment services that may or may not be billed, depending on the insurance carrier. Professional services include such things as histories, decision making, counseling, coordination of care, chart review, data analysis, treatment planning, consultation, and documentation. These services occur before, during and after the encounter. Physicians are able to bill for these services using Evaluation and Management (E&M) Services, but in general audiologists cannot bill for E&M services. Medicare and most Medi-gap type insurance will not cover these services, but some managed care organizations will cover them. Check with your insurance carrier or HMO. The same is true for treatment services (e.g. cerumen management, vestibular rehab, auditory rehabilitation, and hearing aid services). If you extract productivity data from billing, it is important to understand that productivity is quite different from billable time. In most cases, billable time will be less than total time spent providing patient care. Software that links reimbursement and workload complicate productivity calculations since any code entered to capture ''work'' gets added to the bill. Ideally, software should separate these two functions.

Each procedure requires a certain amount of time to complete. The time spent varies with the complexity of the patient. If you are fortunate to have software that accumulates time spent, then calculating productivity is easy. However, one can assign generic or typical values to procedures. It is important to note here that almost all Audiology CPT codes are complexity-based. In other words, such codes are based on a ''typical'' patient. Complexity-based CPT codes are entered once no matter how many times procedures are done. Time-based codes, on the other hand, have specific time factors and are coded once for each time unit. For example, a 15-minute CPT code is coded once for each 15 minutes of direct care. Complexity codes should never be entered more than once, unless accompanied by a modifier to explain why procedures were repeated. It is quite common to see clinics billing by unit (e.g. 30 minutes). For Medicare and carriers that follow Medicare rules, this practice is expressly forbidden.

The easiest way to set times associated with procedures is to do a time study. A time study requires clinicians to record how much time they spent on each procedure during a reporting period. One then calculates the mean or median time for each procedure and uses this as the typical time value for the code.

If one has a count of procedures and a typical time value for each procedure, one is then able to calculate the total time spent for each procedure and the total time in direct patient care by provider. The last element is the total on duty or total paid hours. On duty productivity corrects paid hours for leave (annual leave, sick leave, authorized absence). This is the most accurate method since a manger does not expect an employee to be ''productive'' during authorized time away from the clinic. The productivity or efficiency ratio of the total patient care time to the total on-duty time. Generally, this ratio should be 70-110%. Anything below 70% suggests one of two things:

*The clinician is not as productive as he/she should be.
*The time values associated with each procedure are incorrect.

Any value above 100% is also suspect. Normal down time, no-shows, etc. will decrease productivity. Even the most productive audiologist will not be 100% efficient because CPT code do not exist to capture some services. Again, values greater than 100% suggest that the time values are incorrect.

Finally, one needs to define direct patient care time. Typically, code values for reimbursement involve direct (i.e. face-to-face) time. In productivity calculations, the time spent includes indirect time as well as direct time. Indirect time is that time before and after the service period when the audiologist performs services related to the care of the patient. This work includes, but is not limited to, consultation with the referring source, preparation, data analysis (post service), consultation with patient and family (e.g. by telephone), coordinating care with other clinicians, planning, and documentation. For productivity purposes, the time spent should include both direct and indirect clinical time.

Productivity data can be used for more advanced applications such as staffing models. Staffing models allow a manager to estimate how many patients for which a clinician is responsible (panel size). These models are typically used in primary care physician settings. There use in consultation-type clinics is controversial. However, Audiology is in a sense both ''primary care'' and consultative. In other words, audiologists not only respond to consults but also manage their own patients for treatment and follow-up. The basic elements for staffing models are:

*Number of available work weeks/year (corrected for leave, holidays, etc.)
*Number of available work hours/week (corrected for non-clinic responsibilities)
*Typical appointment length

From these basic data elements, one can calculate the number of patients (or panel size) per provider. The panel size can be adjusted for different variables such as no-show rates, new patient demand, typical number of visits per year, supervisory responsibilities, assistants, and clerical support. For example, let's say we have a clinic that meets 44 weeks/year. The provider is available 32 hours per week. The typical appointment is 60 minutes. The clinic capacity is 1408. If we allow for a 4% no-show rate (which reduces effective capacity), reserve capacity (for contingencies), a 2% new patient demand (new patients that require more time), a re-visit rate of twice a year (the clinic must plan for total patients, not unique patients), then the adjusted panel size is 596 unique patients. Clearly, this panel size would have to be adjusted if the clinician supervised students (supervises cannot be as productive as non-supervisors) or had an assistant (increase productivity 25-30%). The panel size must also be adjusted for the type of clinic (assessments may take longer than follow-ups) and the maturity of the clinic (new clinics fill up with new patients that may need more time but quickly begin to fill up with established patients that may need less time).

Panel Size Models



Kyle C. Dennis, Ph.D.
Deputy Director
Audiology and Speech Pathology Service
(117A) VA Central Office
50 Irving Street NW
Washington DC 20422
(202) 745-8379
kyle.dennis@med.va.gov