Integr8ting Productivity With Time and Facts

How many hours per day is the typical person really work and really is productive?

Well, you can start with an hourly employee.  They work, typically, an 8.5 hour day.  But of course, that .5 is for an unpaid lunch, so really it's just 8 hours even.

But they get breaks, two 15 minutes ones, and you can't really ask for production while they're on break, meaning now you're down to 7.5 hours.

End game: Production, true production that is, should be based on a 7.5 hour work day, but not an 8 hour work day.

As a side note, I tend to say that coders should work on a 7 hour work day so that they are given an extra 30 minutes per day for tough accounts or problem solving with their team lead/supervisor.


Next, how do you really know what their productivity is and what it should be.  Let's take the second part first.

There may be any number of ways to determine what the general production is.  Go on a list server or LinkedIn group and ask your peers.  Maybe read an article from a journal for your specialty.  But those tell you only what the general production for any given role is, without taking into account the nuances of your particular organization.  It's truly unfair to simply use the standard level for production.

What I recommend to Integr8tion partners is that they do two things to determine production:

1. Find out what the industry says their production should be
2. Time study your own employees to find out what it actually is

Next, I take the difference and add 5% (gotta aim high) and use that are our goal.

Now for the first part of the question, measuring production.  Here are my tips:

1: Automate: Humans are prone to error.  I know, big shocker, but that's why you need to automate as much of the process as possible.  Don't let staff manually track inches, pages, accounts, etc, since they could make an error either on purpose or mistake and throw off your calculations.  On the backend, who wants to waste the time manually adding up everything and also worrying about making mistakes.  Get the process online to save time and avoid confusion.

2. Set a policy and get HR's approval:  Always have a policy in place the explicitly explains what the production standard is, how it's calculated and what the consequences are for failing to meet it.  Work with your HR to ensure they believe in the policy and will help enforce it should that problem arise.

3. Be tough but fair:  Explain the policy and process to your staff, answer any questions they may have, but when push comes to shove, you need to be tough and enforce the standards.  Even if that means writing up "good" employees.  You need to administer the policy fairly and evenly, but let everyone know there are standards and they must be met.

ICD10 and Your Documentation Gap Analysis

With a project as large and potentially daunting as the looming ICD10 conversion (go-live date of October 1, 2013 for those of you living under a healthcare rock), one of ht major tasks you should have undertaken or need to, is a gap analysis on your documentation.

But, where do you being and where does it end?

First, believe in the mantra ALL CODES ARE NOT CREATED EQUAL.

There is only so much time you can devout to this analysis and any educational offerings thereafter to try and mitigate any large risks so you need to realize early that smaller specialties or codes aren't going to be able to get the kind attention that higher weighted codes may be.

For example, a hospital may not really focus on Podiatry patients as it may be low volume and possibly low weighted DRG payments, but a Podiatry practice would be the opposite.  So it all comes down to each individual facility.

So start with what you know...or better yet, what your coders know.  They should already be acutely aware of what DRGs or specialties have problems with documentation.

So start big, picks a few specialty or DRGs that you know your facility has a lot of and can be problematic.  Run some random reports to get patient lists and then try coding them using ICD10 (either through encoder or the book) and make notes as to where there are gaps that lead to a wide range of possible ICD10 codes.

This is great data to share with your doctors since it will help guide them on what they will need to do to expand the detail of their documentation (theirs an oxymoron for you).

Another piece to consider is contracting with a vendor to do the financial impacts.  While it may be possible to do this in house, the bottom line is that number of permutations and data that you'll be reviewing is so large that doing it in-house is probably use not feasible (also, consider the time constraints).

One great thing a third party can do is run the different variables on all your inpatient claims to see what possible DRGs they may roll up (or down) to in ICD10.  Since one I9 code will have many I10 code possibilities, these vendors can run all the permutations and different variables of those codes, so if you have a claims that has one code with 10 possible I10 codes, they can run it all 10 times and see how the final DRG plays out.

This isn't the end of your analysis...just the beginning.....

Form Design or Re-Design: Where Do We Start?

One of the most daunting undertakings for any organization, getting a true handle on forms can make even the strongest of managers feel like breaking down.

Whether it's developing, implementing and monitoring a process for new forms or working on re-designing them for an electronic world, it's very time consuming and thankless project, but one of the most important things you can do to ensure compliance, as well as it being a necessary first step.

Today, we'll talk about form design and re-design in the context of preparing for implementing a document imaging solution.  To achieve a successful outcome, you'll need the following 5 things.

1.  Time
That's right, the most important factor is the time necessary to complete the project.  At one of the hospitals I worked with, it took myself and my teammate almost a full business week to go through all the forms and create a document library of what forms the organization even had.  We did multiple 'asks' and meetings with all departments to obtain any and all forms they had.  Going one-by-one to enter them into a spreadsheet and capture the important information such as form name, department in use, etc was messy and long, but it was a key brick in the foundation for a successful go-live.

2.  Barcodes
The backbone of document imaging is barcodes.  Barcode the patient label, barcode the form, and let the system do it's work and take the guesswork and potential problems out of the human hands.  Barcoding forms is a fairly simple process, but there needs to be some logic behind it.  For example, on the off chance that the barcode is unreadable, or if you have to hand key in the form because it doesn't have a barcode, you want your most heavily used forms to have easy numbers so the staff can quickly ten-key them in.  For example, if you are using three digit barcodes, and your progress note form is very heavily used, you may want to make it 111 so that any staff could quickly key that in if need be.  If you have a detox form that is rarely used, making it 829 isn't as big of a deal because you don't see it enough.

3.  Fast Tracking Old Forms
Hopefully, you have some sort of forms committee or process in place, but as you do your forms library you may find that there are tons of forms that are old, outdated, pilots or home grown and are needed for continuity of services, however, you can't wait to send them through the monthly process of forms committee since they are already in use.  You need a way to ensure that you can quickly get these types of forms standardized and approved.

4.  Templates
Templates are key.  You need to ensure form standardization so that you can have better control over them.  This means not only that you should, to the best of your ability, have designated places on every form for where the barcode and patient label go, but also that the template for new forms is standard so that if the GI clinic wants to create a new form, they don't just try to make one out of Word, but instead have an organizational template that ensures the proper formatting.

5.  Patience
As I've said, all these steps take time.  Some take a lot of time and will require multiple reviews and reworks over days, weeks and months to ensure you have the right set.  For example, at one hospital, we started with over 800 forms after our initial pass, but by go-live we were down to only about 450.  Again, this is a thankless job, but incredibly important.

Welcome and Introductions

Welcome....to INTEGR8TION.

What is Integr8tion you ask?

Simply put, it's an idea, a concept, that the key to reaching our goals is through an integration of people, technology and resources.  Combing all these elements together creates a power greater than any that could be made by these parts alone.

A company may be founded by a driven, bright individual, but it succeeds because it has a great plan, it leverages the right technology, it hires the proper people and it remains focused on it's goals.

My goal for this venture?  To discuss HIM and healthcare IT related topics and how the integr8tion between these two concepts can maybe help drive you towards your goals and help focus our efforts on improving our great healthcare system.

I can't say I started out in this industry with this notion, but have grown into this way of thinking over my years of service.

Over time we'll discuss everything from implementing Document Imaging or organizational restructuring ideas to regulatory compliance issues like ICD10 and everything in between.  We'll talk about improving communication, placing people in roles and situations that allow them to succeed and how even the most daunting of challenges can be overcome with integr8tion.

Stay tuned my friends.....