Is your medical staff office worth more than you know?
How to conduct a thorough cost/benefit analysis
Have you given much thought lately to the productivity and worth of your medical staff office? It’s generally considered a non-revenue-producing area, but a closer look could change that perception.
One of the major issues for a well-run medical staff office is the hours needed to handle the many aspects of the job and the personnel required to handle the tasks.
Linda Smith, CMSC, CPSC, manager of medical affairs at Our Lady of the Resurrection Medical Center in Chicago, recently put together a detailed benefit analysis of her office, its functions, and employee hours spent on each function.
Smith began by calculating productive hours of a full-time employee (FTE) using the following formula:
• 52 weeks x 40 hours a week = 2,080 hours
• minus 168 non-productive hours (holidays, vacation, sick time)
• = 1,812 yearly productive hours per FTE.
She then itemized the particular functions of her medical affairs office and determined the hours allocated for each task. A chart depicting this itemization in modified form accompanies this article. (See chart, below.)
| Time Spent on Medical Affairs Office Functions | ||||
| Function | Time Allocated | Total Annual Hours | ||
| Initial appointment | 90 applicants @17 hours each | 1,530 | ||
| Reappointment | 150 reappnts @ 8 hours each | 1,200 | ||
| Temporary privileges | 67 TPs @ 1.5 hours each | 100.5 | ||
| Provisional appointment | 90 prov. appts. @ 8 hours each | 720 | ||
| Data entry of CME & meeting attendance per member | 300 CME @.5 hours each | 150 | ||
| Total Hours | 3,700.5 | |||
| Source: Linda Smith, CMSC, CPSC, Our Lady of the Resurrection Medical Center, Chicago. | ||||
The chart accompanying this article is limited to Smith’s basic list of credentialing functions for her department. But the work doesn’t stop with credentialing. Her more extended list goes on to include:
• department and committee meetings;
• filling out reference questionnaires;
• data entry of CME and meeting attendance for each physician;
• peer review activities;
• new physician orientation;
• policies and procedures review and revision;
• preparation of new rosters;
• medical staff elections for officers and department chairs;
• committee appointments;
• calendar and meeting notices;
• social functions such as Doctors’ Day, golf outings, birthdays, physician/spouse outings, and group activities;
• travel arrangements;
• secretarial activities such as time spent on the phone, mail, filing, ordering supplies, and reading and responding to e-mail;
• Joint Commission survey preparation;
• professional affairs and board of directors reports on medical staff activities;
• preparing an annual budget;
• maintaining a medical staff bulletin board;
• special projects and other activities.
Smith’s complete list totals 6,368.5 hours requiring 3.06 total FTEs.
But the reality is that Smith’s office consists of herself and 1.5 FTE (a full-time credentialing person and a half-time physician relations employee). "We were very overburdened," she says, "bringing home work every night."
Was her administration impressed with her analysis? "Absolutely," she says. "The analysis was presented as part of a proposed four-facility centralized credentialing program. They were impressed with the development of the analysis, and they are ready to work with us to implement it."
Smith says she helped develop a similar analysis for a hospital she worked for previously. "It resulted in three more employees that I know of," she says.
She’s since shared her plan with two medical staff office managers at two other facilities who are currently using it to promote the case for their own medical staff offices.
It is the medical staff office, after all, that turns physicians into staff members, who in turn generate the major source of revenue for the hospital. It is the medical staff office that keeps track of CME activities, organizes peer review arrangements and hearings, handles dues and payments, provides orientation for new physicians, and handles many of the details for good physician relations such as social activities, travel arrangements, special requests, and secretarial functions for the office.
Part of the success of Smith’s plan lies in the specific descriptions she developed for each function on her chart. Listing more than 30 functions, she itemized the tasks involved with each individual function.
Verification imposes costs
Kim Gondzar, CMSC, CPCS, medical staff coordinator at Munson Medical Center in Traverse City, MI, also has some serious thoughts about the monetary value of her office’s work and sees it in terms of real earnings potential. "There are a lot of revenue areas I would like to embark on," says Gondzar, who also is the President of the Board of Directors for the National Association Medical Staff Services in Austin, TX.
In addition to the usual revenue item of staff dues, Gondzar cites the work of the central verification office (CVO) in health care systems. "Those services require hard work," she notes. "Should they be charged back to the institutions within the system? Does your CVO offer the verification service for other, smaller facilities in your area, such as nursing homes, and should this involve a small charge?"
Gondzar also notes the labor-intensive business of verifying physician presence at your facility as doctors apply for credentials elsewhere. "We’ve never charged in the past to verify that a doctor has been on our medical staff. But as more physicians and more facilities come into the picture, the paperwork is becoming staggering."
She says her office gets about 20 inquiries a week, "and we’re a relatively small health system. Some of these former staff members go back forever. They may have been on staff 20 years ago. For us, this means going through microfiche or going to the basement and digging through storage areas and old records to get the information."
And there’s the time invested in being a helpful colleague. "For instance, suppose your facility invests heavily in CME for your medical staff services professionals, and a smaller hospital nearby doesn’t have that benefit. It’s not unusual for the small hospital staff to call and ask for help with a problem. It’s nice to be able to answer their questions, but sometimes it involves time and research. Should we be charging for this kind of service? Where does networking end and consulting begin?"
There is much to be said for spelling out the costs and benefits of a well-run medical staff office. How to begin?
Success lies in specificity
It would be wise to take Linda Smith’s approach and calculate the actual number of employee hours that are expended each year. Then itemize your medical staff office functions. And don’t stop with credentialing services. Think hard about the additional functions that are inherent in a well-run office. Smith devoted much detail to the peer review process, estimating the hours spent on a basic peer review, the corrective action recommended, hearings, and appellate reviews.
Each step was broken down as a separate function. For instance, the initial peer review process noted everything from logging in the peer review request from quality management to coordinating each meeting required for the process, arranging for charts to be reviewed by each member of the peer review committee, time spent at the meetings, and documenting and reporting meeting findings.
Then, with similar attention to detail, she documented the steps for a corrective action, hearings, and appellate review.
Thoroughness is the most important thing to remember from Smith’s analysis of her medical staff office benefits. The big message here for hospitals is that those who handle medical staff services are responsible for a large portion of the hospital’s effective function, not to mention revenue produced by physicians. It could be bad business to undervalue those services, because a well-coordinated and satisfied medical staff is the backbone of the hospital’s mission and reputation.
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