Determing The Right Staffing Levels Using Metrics

"Metrics" is a current term to describe the use of objective data to make decisions. Typically metrics equates to numerical data. Now that our mini MBA course is done lets look at how this may apply to the medical office environment.

It is no surprise that personnel cost is the largest component of medical practice operating expenses. Not only are good staff harder to find and retain, but their cost is increasing faster than their return on investment. It is imperative that, in order to stay successful, every practice, hospital-affiliated or private, find ways to keep these costs as low as possible.

Step one would be to see what staffing reductions might be possible from expanded use of technology. EMR, autoposting, automated appointment reminders, e-prescribing, and other applications can all have an impact on the number of folks needed to run the office.

Let's assume that the people you have are doing the jobs they need to do, but the question is how many FTEs are really necessary. Our experience is that most excess staff members are found in the billing office and front desk area. While some practices have extra clinical support staff, most offices have one FTE per FTE provider and that seems to work well.

An approach we have found that works well in evaluating front desk staffing is simply watching patients come and go. Assume that the practice has four providers and they have 15 minute appointments over a 7 hour day. Observation shows that it takes about 3 minutes for a patient to check in and have their demographics updated. That means four patients arrive every 15 minutes, 16 per hour. This results in 48 minutes of "work". If the front desk also makes appointments let's assume the phone rings 20 times per hour with an average of 2 minutes per call. Add another 40 minutes of "work". Each hour there is a total of 88 minutes of staff effort required, or about 1.3 FTEs. If we add in time lost to moving charts, making copies, and other minor tasks, we could easily get by with 2 staff at the desk.

One large primary care practice had a single individual assigned to charge entry. The practice had six FTE providers each day and each saw 24 patients. Charge entry averaged no more than 1.5 minutes per encounter. This volume generated 216 minutes of work or about 3.6 hours a day. They were paying someone full time to do less than a half day of work. Needless to say, they were quickly assigned other tasks.

If you are curious about staffing your business office, have your best employee perform the various tasks and time them. If you manually post charges, how long does it take your experienced payment poster to enter an EOB? Gather up a pile of payments, give her a quiet place to work, and see how many dollars get posted in a day (this will differ widely by specialty). A family practice without lots of lab will be about $24,000 per eight hour workday. Divide the average daily receipts by this and you get some idea about how much time is needed per day. You need to adjust for the fact that you measured your best worker, but this also means you don't have to tolerate your slowest.

Every member of the staff will remember that one day that everything went wrong and it took twice as long as normal. Staff for the average day, not the exception.

Collection calls? Have staff keep a log of their calls over a couple of days and periodically check to see they are actually on the phones.

Staff that are not cross trained become like fire extinguishers, when they are not needed they just hang around. Be sure that everyone has other assignments to keep them busy on those days that volumes are down. Check-in staff have little to do the last half hour of the day after the last patients have arrived, they can file charts. Checkout does nothing for the first 20-30 minutes of the day since the patients are all being seen; get filing.

We perform this analysis every time that we evaluate practice operations and are continually surprised at the number of excess staff that we find. Management often just doesn't have the time to devote to the observation and analysis. Make use of our practice management consulting to make your staff more cost-effective today. Contact us here to see how we can help you improve your practice.