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Productivity in the Healthcare Workplace
Tom Hajny
I have a theory about human behavior and productivity in the work place -- specifically concerning health care business offices. This theory -- my theory -- if rendered true (or even half-true) is troubling. Here it is:
Sixty percent of all resources expended in health care business offices have nothing to do with optimum cash flow, cost, or customer service.
The thesis rests on the assertion that business offices resources need to be expended in support of the three C's of the revenue cycle: Cash, Cost and Customer Service.
If activities (behaviors) do not lead back in support of one of these raisons d'etre, then they should be abandoned -- or, at least prioritized below those who do.
The wasted productive time is not the time spent hanging around the water fountain, or personal phone calls, or just plain cussedness--rather it comes from disorganization and lack of prioritization of critical activities. It is due to a lack of an understanding of success indicators, and non-assertive management of problem employees.
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(Tom Hajny, Mon, Jun 13, 2005)
To All,
Paul Krugman - NY Times columnist/Princeton Prof. had interesting column on healthcare costs and single payer system.
http://www.nytimes.com/2005/06/13/opinion/13krugman.html?th&emc=th
TGH
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(Tom Hajny, Wed, May 25, 2005)
You've hit the nail on the head... the physician is the only revenue producer in the practice. As their time is dragged away from the patient and the real practice of medicine. Practice revenue, physician productivity, and time spent with the patient all suffer.
So the game is how to ensure the physician is only engaged in activities that only a physician must be engaged. Also, how to fill in all the other critical activities by staff.
A Question: Do you feel you are engaged in activities which would (and could) be better left to your staff and which pull you away from your patients? Could you list the Big 5?
Tom
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(rlamberts, Wed, May 25, 2005)
I agree - I think that the business skill required to run a practice is underestimated (something I have learned the hard way). My main point was that at the heart of the system remains a contradiction - that clinical outcomes often run squarely against good business practice. I have to run a good business despite the fact that I am practicing good medicine. To accomplish both is a major task and is a great part of the reason why physician job satisfaction is so low. We feel guilty if we overemphasize the business at the expense of medical quality, yet we need to pay our staff and would like a good income.
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(Tom Hajny, Tue, May 24, 2005)
rlamberts - Did I mention there are actually four C's of a physician practice - Cash, Cost, Customer Service & Clinical Outcomes? Being an accountant by education and a revenue cycle guy by vocation and a so-so tennis player by avocation, I keep my thoughts to myself on the subject of clinical Outcomes. However, the business office staff (as well as all other staff) are there to support the patient-physician relationship. For the business office staff there focus needs to be the support of the physician/patient through getting the patient to the physician as-quickly-as-possible, capturing and communicating information for billing, collection, the financial expectations of the practice.
We fail to run practice's efficiently and effectively because we many times do not understand the best practices of the revenue cycle, critical control points, or the prioritization of critical activities. We also fail our staffs through lack of clear practice principles and practices (i.e Credit policy), training, inefficient patient flow, and just a lack of good, sound communication with the patient on the financial expectations of the practice.
Healthcare is highly regulated and highly confusing. Some days it seems we are making the best of a bad situation - but for the business office staff, there are right ways to address the challenge - and again it comes back to how they (and systems and processes) support Cash, Cost, and Customer Service.
Tom
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(rlamberts, Mon, May 23, 2005)
Productivity in primary care is a tension of opposites. In one sense, productive time is that of generation of revenue. I am "nonproductive" as a physician if I spend time doing things for which I am not paid. Unfortunately, those things include prevention, disease management, and discouraging unnecessary care. So to be financially productive means I am medically nonproductive (if "productivity" means I render the service well). Our office quality numbers are high, but they do not result in higher financial success - in fact they tend to work against it.
Until the reimbursment structure changes from one where the unit for reimbursement is an "episode of care" to one where the quality of that care is factored in, living in this dichotomy will cause offices to struggle. We have done what we can to achieve the high quality without spending a lot of time (through computerized automation), but it is very frustrating that this has yet to get us paid any more. We have to be efficient DESPITE giving high quality. It is a connundrum we just should not have to face.
Overall I agree with the post - but I do not think that the medical marketplace is as simple as other market situations. Hopefully some of the "pay for performance" initiatives will address this inequity.
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