Beanchmark

Module 07 - Benchmarks and Productivity

Productivity Standards

The HIM Director is responsible to establish productivity standards for functions within the HIM department. Productivity standards can be defined as reasonably achievable quantitative and qualitative expectations based on relevant data, benchmarks, industry metrics, or a combination of those indicators. These standards are important as they help the HIM Director evaluate whether the staff are meeting the standards as they will be used to evaluate the employees performance during evaluation time. An efficient way to measure these standards should be developed on a daily, weekly, or monthly basis so that you will be able to determine ways to improve productivity.

Creating Effective Productivity Standards

The following criteria is considered the basics for developing effective productivity standards:

How To Establish Productivity Standards

The best way to establish productivity standards is to get a baseline of current practice from other sources such as your colleagues and publications and to review the Joint Commissions information management standards and Centers for Medicare and Medicaid Services requirements. Often the State Board of Health and the health care facilities By-Laws and Rules and Regulations for the Medical Staff have health information standards as well so these should also be checked. Many of these requirements are based upon timely documentation in the medical record such as a time requirement for a history and physical to be on a patient's chart within 24 hours of admission.

Work with a team or staff who perform a particular process to chart the process and create realistic standards. Understand the number of charts that can be coded in an hour for example but also keep in mind the accuracy or quality you find acceptable. Standards should be fair, achievable, objective, and easily measurable.

Evaluating productivity standards:

Productivity Standard Examples:

Scanning

Quality Indicator

Prepping: 98% accuracy expected. Prepping includes removing staples and paperclips, verifying patient identifiers are on each page (front and back when necessary) including barcodes, rips and tears are repaired, and all pages are in the appropriate format (size and color).

Scanning: 98% accuracy expected. All pages are fed through the scanner in an appropriate manner.

Quality Control and Indexing: 98% accuracy expected. Indexing is the process of associating a patient encounter and document name or type to each document. During the indexing images are compared to the paper document to assure a quality image. Poor quality images are marked for rescan.

Quantity Indicator Number per hour	Low	Medium	High
Prepping #inches per hour	3	5	8
Scanning #pages per hour	2400	3000	3600
Indexing #pages per hour	600	780	960

Quantity Indicator Based on minutes	Low	Medium	High
Prepping (minutes per inch)	20	12	7. 5
Scanning (pages per minute)	40	50	60
Indexing (pages per minute)	10	13	16

New employees are expected to achieve the Low standard within 60 days of hire. When employed for 6 months or greater are required to maintain the Medium standard. If not meeting this standard, a Performance Improvement Plan is recommended. Any employee achieving the High standards should receive acknowledgement through the annual performance review process.

Standards

An employee working in prepping will measure the number of inches prepped during their shift and document inches prepped on their productivity sheets. Productivity sheets will be submitted to their supervisor at the end of each week.

All charts are scanned within 1 working day of receipt. Scanning schedules should reflect enough coverage so this can be done.

Release of Information

Quality Indicator: 100% accuracy is expected.

Quality Indicator # / hour	Low	Medium	High
Process written requests which includes verification of authorization, logging, record retrieval if needed, photocopying and printing and logging completion	4	4	8
Prepares written requests for copy service to complete (includes logging, verification of authorization and record retrieval if needed)	10	12	14
Completes in person requests (authorization vertification, loging, record retrieval, photocopying or printing, invoicing and logging completion)	2	3	4
Prepares subpoenas or court orders (includes certification)	2	3	4
Processes telephone requests for verification of date of service	30	40	45

New employees are expected to achieve the low recommendation within 60 days of hire. Any employee processing release of information requests for 6 months or more are required to maintain the medium number of requests and if not, a performance improvement plan needs to be initiated. Any employee achieving and maintaining the high recommendation should receive recognition through the annual performance review process.

Management Standards

Verified completeness and accuracy of authorizations. Calculates payments for copies requested and follows HIPAA policies and facility specific guidelines regarding release of information. If any problems arise, Risk Management needs to be notified.

Coordinates with the billing department to ensure the timely release of information for payment of claims. Completes the logging of requests received and the date requests are processed in order to track and trend the release of information turnaround times. Follows state and federal regulations regarding release of information.

Turnaround times are calculated each month. Requests for release of information will be completed within 2 working days of chart availability. Monthly turnaround time reports for request processing should indicate less than 5 days.

Consistently prioritizes requests for release of information following hospital specific guidelines. Maintains and monitors pending request log and informs the Director, HIM of any requests that are greater than 15 days.

Key Indicators

Key indicators are current statistics of the work processes in the department. By developing key indicators a Director of HIM can keep their pulse on the processed and productivity of the department. A goal has been established and this key indicator can be measured against the goal by monitoring the service standard to see if extra staffing or a change in the process needs to be done in order to accomplish the goal. In hospital systems that are part of Corporation, key indicators are often established by a Corporate HIM Director and all of the hospitals in the corporation need to be report these numbers on a monthly basis. If the key indicators do not meet the goals, then an action plan would need to be done in order to get the standard in line with the goal. Often these key indicators are part of the hospitals performance evaluation system so much attention should be given to this area. Areas in HIM that may have monitoring are:

· Transcription turn around time

· Days outstanding in accounts receivable

· Release of Information turn around time

· Percentage of incomplete records

· Days that paper charts need to be scanned

Example of Key Indicators for a HIM Department:

Key Indicator	Goal
Delinquent Medical Records	>25% of monthly discharges
Quality Audit on transcribed reports	98%
Scanning of medical records completed each day	100%
History and Physical on inpatient medical records 24 hours after admission	100%
Operative Report on chart within 24 hours of procedure	100%
Coding completed within 2 days of discharge for inpatient records	98%
Release of Information completed within 5 days of received	98%