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The Benchmark Email
...benchmarks, strategies and ideas for improving
your agency
A service of Fazzi Associates, Inc.
June 4, 2004
Comparing
High Nursing Productivity
With Low Nursing Productivity
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.
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