NWRPCA Staffing Ratio Presentation 05-19-09

1 SSRRSSTAFFINGTAFFINGRRATIOSATIOSPPLANNIN GLANNING FORFORPPRODUCTIVITYRODUCTIVITY& C& CEE& C& COSTOSTEEFFECTIVENESSFFECTIVENESSG uidian healthcare ConsultingGuidian healthcare ConsultingGuidian healthcare ConsultingGuidian works with Community Health Centers to Guidian works with Community Health Centers to plan financially sustainable operations that meet the plan financially sustainable operations that meet the py ppy pneeds of the organization and its of the organization and its idian pro ides operations planning strategic planningGuidian provides operations planning, strategic planning, facility planning & pre-development services that include:Market Analysis Market Analysis Financial Projections Space Planningpg Functional Floor Plan Layout Operations Analysis and Patient Flow Guidian healthcare Consulting 2009 Guidian healthcare Consulting 2009 Grant WritingPage 2 Page 2 Staffing RatiosStaffing ratios -- OverviewOverviewSSTAFFINGTAFFINGRRATIOSA TIOS TTHEHEBBIGIGPPICTUREICTURESSTAFFINGTAFFI NGRRATIOSATIOS TTHEHEBBIGIGPPICTUREICTURES taffing ratios & Operations ManagementStaffing ratios & Operations ManagementCalculating Staffing RatiosCalculating Staffing RatiosBenchmarkingBenchmarkingWrap-up & QuestionsWrap-up & Questions Guidian healthcare Consulting 2009 Page 3 Page 3 Staffing ratios Staffing ratios The

2 Big PictureThe Big PictureStaffing ratios define the relationshipStaffing ratios define the relationship between your revenue producing employees and the staff needed to support them. ppStaffing ratios are a tool to evaluate the impact of your Staffing strategy on operational effectiveness & service delivery. Guidian healthcare Consulting 2009 Page 4 Page 4 Staffing ratios Staffing ratios The Big PictureThe Big PictureMeasuring Staffing ratios is Important Staffing expense is generally the largest fhlthtexpense for a health center Staffing decisions impact quality of gpqypatient care Staffing levels & functional allocation Staffing levels & functional allocation drive operating efficiency Guidian healthcare Consulting 2009 Page 5 Page 5 Staffing ratios Staffing ratios The Big PictureThe Big PictureStaffing ratios are used in Operations Management Determine optimal levels of staff overall D titil llf t ff b fti Determine optimal levels of staff by function Evaluate

3 Productivity and efficiency Guidian healthcare Consulting 2009 Page 6 Page 6 Staffing ratios Staffing ratios The Big PictureThe Big PictureNational Staffing Ratio Benchmark DataUDS Staffing BenchmarksUDS Staffing Benchmarks Health center specific data Gross Staffing ratios onlyMGMA Annual Cost SurveyStaffing ratios by specialty & region Staffing ratios by specialty & region Staffing ratios by functional area Guidian healthcare Consulting 2009 Page 7 Page 7 Staffing ratios Staffing ratios The Big PictureThe Big PictureExample MGMA Staffing RatiosClinical Support Staff per ProviderClinical Support Staff per Provider Number of RN, LPN, MA per Physician provider Number of RN, LPN, MA per Physician provider Number of Lab, Xray, Enabling staff Number of Lab, Xray, Enabling staffAncillary Support per ProviderAncillary Support per ProviderFront Office Staff per ProviderFront Office Staff per Provider Number of Reception, Med Rec.

4 , Scheduling, Transcript Number of Reception, Med Rec., Scheduling, TranscriptBusiness Operations Staff per ProviderBusiness Operations Staff per Provider Number of Pt Acct, Admin, IT, Maintenance staff Number of Pt Acct, Admin, IT, Maintenance staff Guidian healthcare Consulting 2009 Page 8 Page 8ppStaffing ratios Staffing ratios The Big PictureThe Big PictureGetting StartedWhat does CHC want to measure Provider productivity as a function of direct clinical pysupport levels Optimal number of billing staff Define appropriate Staffing ratiog Medical Asst per Provider Pt Acct Staff per Provider Guidian healthcare Consulting 2009 Page 9 Page 9 Staffing ratios Staffing ratios The Big PictureThe Big PictureGetting StartedMeasure data points over time Use historical data for provider productivity & staffingUse historical data for provider productivity & Staffing Calculate Staffing ratiosChart over time Chart

5 Over timeCithBhkhilblCompare with Benchmarks where available Guidian healthcare Consulting 2009 Page 10 Page 10 Staffing RatiosStaffing ratios -- OverviewOverviewStaffing ratios The Big PictureStaffing ratios The Big PictureSSTAFFINGTAFFINGRRATIOSATIOS& O& OPERATIONSPERATIONSMMANAGEMENTANAGEMENTS STAFFINGTAFFINGRRATIOSATIOS& O& OPERATIONSPERATIONSMMANAGEMENTANAGEMENTC alculating Staffing RatiosCalculating Staffing RatiosBenchmarkingBenchmarkingWrap-up & QuestionsWrap-up & Questions Guidian healthcare Consulting 2009 Staffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management Understands How Staffing Effects Overall OperationsStaffing AffectsStaffing Affects Provide Productivity & Revenues Provide Productivity & RevenuesStaffing AffectsStaffing Affectsy Quality of Patient Care Billing and Collectiony Quality of Patient Care Billing and Collection Recruitment and Retention BudgetingPti tFl Recruitment and Retention BudgetingPti tFl Patient Flow Patient Satisfaction Staff Satisfaction Patient Flow Patient Satisfaction Staff Satisfaction Guidian healthcare Consulting 2009 Page 12 Page 12 Staff Satisfaction Staff SatisfactionStaffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management Analyzes Staffing in Relation to Operational Measures Operations Operations

6 Evaluate productivity as a function of t ffillti Evaluate productivity as a function of t ffilltiAnalysisAnalysisstaffing levels over time Identify functional area inefficiency duestaffing levels over time Identify functional area inefficiency due Identify functional area inefficiency due to misallocation of staff Identify functional area inefficiency due to misallocation of staff Identify operational improvements by benchmarking internally & externally Identify operational improvements by benchmarking internally & externally Guidian healthcare Consulting 2009 Page 13 Page 13 Staffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management UsesStaffing Analysis to Plan for the Future Operations Operations Effective allocation of staff Effective allocation of staffpPlanningpPlanningEffective allocation of staff Recruitment planningEffective allocation of staff Recruitment planningpg Budgetingpg Budgeting Guidian healthcare Consulting 2009 Page 14 Page 14 Staffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management UsesStaffing ratios as a Tool Measure operating efficiency (process) & productivity (staff)& productivity (staff)

7 Measurement Measurement Measurement Measurement Guidian healthcare Consulting 2009 Page 15 Page 15 Staffing ratios & Operations EfficiencyStaffing ratios & Operations EfficiencyCStdCase Study:A small CHC felt it could increase the number of patients it treated by hiring more clinical support staff but wereMedical Assistant to Provider Ratioit treated by hiring more clinical support staff, but were reluctant to spend the resources to hire additional : 1 Ratio2 : 1 RatioVariancePRODUCTIVITYP atients per Assistant to Provider RatiopPatients per Visits3,0593,864805 Average NPSR$351,785$444,360$92,575 Cost of FTE MACost of lost NPSR $35 880$92 575 Guidian healthcare Consulting 2009 Guidian healthcare Consulting 2009 Page 16 Page 16$35,880$92.

8 575 Staffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management UsesStaffing ratios as a Tool Identify process bottlenecks by benchmarking Staffing ratiosggIdentification of Operational IssuesIdentification of Operational IssuesIdentification of Operational IssuesIdentification of Operational Issues Guidian healthcare Consulting 2009 Page 17 Page 17 Staffing ratios & BottlenecksStaffing ratios & BottlenecksCStdCase Study:A growing CHC noticed that its cycle times were increasing. Management was unsure of the cause because it hadManagement was unsure of the cause because it had increased the number of clinical staff with increased CHCMGMAV ariancePRODUCTIVITYP atients per Time per Patient85 minutes 46 minutes39 minutesFront Office Support per.

9 Guidian healthcare Consulting 2009 Guidian healthcare Consulting 2009 Page 18 Page 18 Staffing ratios & Operations MgmtStaffing ratios & Operations MgmtEffective Operations Management UsesStaffing ratios as a Tool Maximize revenue and minimize cost by optimize Staffing allocationypgOptimize Staff AllocationsOptimize Staff AllocationsOptimize Staff AllocationsOptimize Staff Allocations Guidian healthcare Consulting 2009 Page 19 Page 19 Staffing ratios & Misaligned StaffingStaffing ratios & Misaligned StaffingCStdCase Study:A busy CHC determined that its AR and bad debt were too high and were actually growing month over month Afterhigh and were actually growing month over month.

10 After evaluating the billing process they determined that although they had sufficient patient accounting staff, the allocation of staff was misaligned. They had an insufficient number of billers and could not complete timely Staff per per ( )Charge Entry/Coding per Mgmt per Provider03502501 Guidian healthcare Consulting 2009 Guidian healthcare Consulting 2009 Page 20 Page 20 Posting/Cash Mgmt per RatiosStaffing ratios -- OverviewOverviewStaffing ratios The Big PictureStaffing ratios The Big PictureStaffing ratios & Operations ManagementStaffing ratios & Operations ManagementCCALCULATINGALCULATINGSSTAFFIN GTAFFINGRRATIOSATIOSCCALCULATINGALCULATI NGSSTAFFINGTAFFINGRRATIOSATIOSB enchmarkingBenchmarkingWrap-up & QuestionsWrap-up & Questions Guidian healthcare Consulting 2009 Calculating Staffing RatiosCalculating Staffing RatiosStaff Staff Specific RatioSpecific RatioFunctional Functional