Fazzi Associates, Inc.

Question: We are looking at our nursing daily visit productivity standard and thinking about increasing it. While we assume higher productivity might lead to better financial results (higher productivity = lower cost/visit) which would help us under Managed Care, we are concerned that it will have a negative effect on quality. Does higher productivity equate to lower quality?

Answer: The issue of clinical productivity is clearly becoming more and more important for agencies. With the threat of managed care growing in many parts of the country, many agencies are striving to find ways to lower their cost/visit. Higher productivity in most cases (not all) does mean lower cost/visit. But, does higher productivity mean lower quality and lower quality OBQI and Home Health Compare quality scores? Not necessarily!

Using comparative data generated from Fazzi Associates' BestWorks™ National Best Practice Management Service, it is clear that higher productivity does not mean lower quality. In fact, when comparing agencies with the highest nursing productivity to those with the lowest productivity, some interesting facts emerge. Note: Before dismissing the seemingly low productivity levels, read Note 1.

	Agencies With Low Nursing Productivity	Agencies With High Nursing Productivity
Nursing Visits/Day Based on Hours Worked (1)	3.07	5.38
OBQI Significant Difference - RAOI (2)	5.25	8.56
Home Health Compare Significant Difference - RAOI (2)	8.54	9.77
Profit/Episode Settled Claim	14.63	18.20

Note 1: Nurses visits/day are lower than what most agencies report but they are, in fact, accurate. We use the National Association for Home Care's formula for measuring productivity: hours worked by clinicians during a fixed period divided by visits made during that same period standardized for an 8 hour day. This calculation allows for "apples to apples" comparisons. Within this calculation, all visits including admission visits are counted as one and no credit is given for meetings, supervisory visits, etc.

Note 2: RAOI is an exclusive, copyrighted index developed by Fazzi Associates to measure the differences in agency quality. The Risk Adjusted Outcomes Index scores all agencies based on their OBQI scores or subscores such as Home Health Compare. Based on their OBQI scores, agencies are rated from -100 (bad) to 0 (national average) to + 100 (excellent).

What is clear is that higher productivity standards do not result in diminished quality scores. In fact, those agencies with higher productivity tend to have slightly better performance on their OBQI and Home Health Compare indicators. More importantly, they tend to have higher, significantly higher profit/episode. While there are clearly other issues that agencies need to look at to fully understand what impacts quality, simply suggesting that higher productivity will lead to lower scores is not true.

One final note. Because of the importance of productivity and the fact that many agencies are now moving to newer Outcome Management Systems for supervising and managing staff productivity, we will include an update on these types of systems in a future Benchmark Email.

Comparing High Nursing Productivity With Low Nursing Productivity

Comparing High Nursing Productivity
With Low Nursing Productivity