I’m driving again. I thought I would drop a message and share something. Since I’m in the car and I’ve got a little bit of productivity windshield time, I thought I would share something that we dealt with quite a bit when we were running a billing company, and we’ve had people ask us, “How to deal with this?” and “How to address this?”

Part of the analytics that we’ve helped people with is to get their data out of the system or to be able to calculate productivity for their revenue cycle management team, whether it’s a billing company or whether it is an in-house billing group. It doesn’t make a lot of difference.

What are Productivity Measures?

Productivity measures are somewhat complicated. You would think they would be quite simple. I think once upon a time; they probably were simple because there was mostly data entry business. You could count how many words or how many lines people entered, and life was simple.

Even now, I think there are some aspects that you can have simpler measures. Some parts of this are a little easier. You can measure how many patient eligibility inquiries were there or how many patients were registered, and so on.

Even once you get to payment posting, it’s a little bit more complicated. Of course, you can measure how many claims were posted, but they’re not all the same. We certainly saw wide variance, mainly depending upon the type of provider where some typically had one CPT code or one encounter line. Maybe, it was an E&M or something like that. Others had 2, 3, 5 on average. Others had 15 or 20, and it was radically different.

Within a single specialty, you might see fewer variants of this. But even within something like orthopedic practices, you would see an extraordinary amount of errands because you might have MRI, X-ray, and so on within one part of the practice, whereas you’ve got surgery, E&Ms in another part, and then you’ve got DME. There might be a significant amount of variation if one is posting predominantly patient encounters in a clinic that’s one line in E&M, maybe 2 lines. Again, it depends on what it is. Maybe, 2 or 3, if you’re doing injections and pain management stuff. If you were in another part of the business, it might be 3 or 4 or 5. It might be radically different.

Charges to enter Productivity

The PT part of the business is also different. Even charge entry can be complicated when it comes to those types of things where something like anesthesia requires some calculation, depending upon the system. We mentioned PT. Taking back to that example, you have to calculate time, and it makes it more complicated.

Again, within an orthopedic practice, you might think, “Ah, charge entries are all the same.” They’re not the same.

Your team will let you know, and you can ask them for input in terms of how to create measures. Working AR is much more complex to measure. Track that and incentives.

We found it to be extraordinarily complex when we were trying to not only measure it but were trying to put in place incentives. Even before we get to the incentives, just putting up on the board how successful people would be, you know, sort of the leaders, we quickly found people were gaming the system fast. The ones that they could do quicker, they just started cranking through those real fast to get like a thousand or something in a day where somebody else had done some much smaller measurements. Some employees looked incredibly good, the ones who were motivated to game the system and also knew how to game the system, whereas others were not as effective in doing that.

Measuring collectors and accounts receivable

It can be a real challenge to measure collectors and accounts receivable. The incentives, of course, amplify that significantly. If you have incentives in place with loopholes or other channels, you will find people just driving trucks through them.

Claim status is different than doing a write-off. It’s different than doing appeals. All of those require very different amounts of time. You want to consider measuring those things differently.

Beyond gross productivity, we get into the concept of net productivity and quality control. Do you want a ton of errors? Do you want people to crank out volume where there’s a ton of mistakes? Again, mistakes could be something as simple as fat fingering something, where there’s a data entry error or more complex problems.

Let’s take patient registration. Do you want somebody who did 100 patient registrations, and 50 of them were garbage? They made a lot of mistakes. Or do you want somebody who did 80, and all 80 of them were correct? We’ll come back to what correct means a little later. You’ll prefer somebody who’s doing the 80 rather than 100, even though 100 looks much better on paper initially.

How do you find those errors? How do you figure out which one is doing better or worse? Because at first blush, if you look at straight-up productivity, it seems like 100 is better than the 80. What most organizations do, is do audits. They sample, they say, “Okay, we’re going to pull 30 records or something like that and figure out how many of those had errors in them.” They go through and check, “Okay, name, patient ID, blah, blah, blah match all that.” They have somebody QA that manually and go through them.

Problems to look out for

Problems with that include the fact that it is a ton of work, so you must maintain another whole separate QA department. It’s often not very accurate. They’re going in and checking all of those things, but they can make mistakes themselves pretty quickly.

It also misses an important factor: errors matter, and relatively speaking, which are essential or not important. So if somebody fat fingers. Wow! I’m having a hard time. Maybe, I need some caffeine. It’s not that early. It’s 11:00 AM. I should be able to talk by this point.

Okay! If you want to look at, for example, “Did somebody fat finger or just mistyped, have a data entry error: a patient name versus something else?”, a lot of times, if somebody inputs the patient name wrong, it’s still going to get paid, so it doesn’t matter. Do you want to focus on making sure somebody spells every name correctly if that doesn’t result in nonpayment? As opposed to, say, a patient ID If it’s entered incorrectly, likely, it’s not going to get paid.

Some areas matter much more than others. Some are deal-killers: they completely kill the claim. Others don’t matter, and some are in-between: sometimes it matters, sometimes it doesn’t. How do you figure out which ones of those matters?

Those are some things to consider when looking at productivity measures. We will do a follow-up episode on some of the suggestions and some of the things we dealt with and measure some of these and productivity and even incentives in the next episode.