Measure data to boost transcription bottom line
Analysis pinpoints where help is needed
Despite advances in technology, efficiently deciphering physician notes remains a challenge for medical transcription departments. Adding to the quandary is that the department often is seen as a variable expense or a cost center in today’s cost-conscious health care environment.
By putting systems in place to capture detailed, accurate data, medical transcription departments can improve costs and productivity, says Kathy Cameron, ART, CMT, director of education for Health Professions Institute in Modesto, CA.
Although Cameron says cost saving opportunities vary because hospitals track costs in so many different ways, "the difference in just 10% more productive [transcription] time is phenomenal in terms of costs."
Improvements instituted in the word processing and medical transcription department at Geisinger Medical Center in Danville, PA, resulted in an 11.8% increase in turnaround time for projects and $495,000 in cost savings in one year, says department manager Cynthia Taylor. (See related story on Geisinger, p. 13.)
Obviously, such improvements don’t happen overnight. So where do you start? Cameron, who has 20 years experience in the health information management field, offers these tips:
1. Measure the cost and productivity of each report produced by the medical transcription area.
The standard measurement: number of lines produced per minute of dictation, sorted by hospital department, by physician, by report type, and/or by transcriptionist.
2. Analyze by dollars.
This includes analyzing:
• Total cost per unit. This involves all direct and indirect costs for the department everything from wages to equipment to resources required outside the department such as mailroom staff and postage.
• Cost per unit broken down by medical transcription labor costs (including taxes and benefits), fixed expenses (such as office space and equipment), and variable expenses (office supplies, utilities, etc).
• Cost per patient admission or encounter (output per admission or encounter multiplied by cost per unit).
3. Share this information with department heads and, if appropriate, individual physicians or transcriptionists.
Once the measurement system is in place, you can compute overall averages and look for outliers. For example, does an admission history and physical report for Dr. Smith average 200 lines at a cost of $42 per report, compared to a department average of 90 lines at a cost of $18.90? You have the data you need to approach the physician or to investigate whether the physician is overdocumenting.
Data offer clout when approaching department heads or physicians, Cameron points out. You may consider instituting a peer comparison program for physicians. "If they’re in any type of globally capitated environment where they are impacted by performance, they have an incentive to help the hospital control costs," she adds.
4. Measure transcription staff productivity by department and by individual.
This can help identify opportunities for improvement and, by preparing monthly or quarterly reports, show if improvement programs you institute have resulted in productivity increases.
For example, you might find that an evening shift transcriptionist has an average productivity of 122 lines per hour at a cost of 11.6 cents per line (factoring wages and benefit costs into the transcriptionist’s productivity). This compares with a department average of 160 lines per hour at 8.5 cents per line. But you may also find that this transcriptionist works alone and is routinely assigned to operative reports an area she has little experience in. You might change the type of reports assigned to this transcriptionist or offer more training in operative report transcription during a time when another staff member can monitor the progress.
Instituting other improvements
A good transcription department productivity goal is 80% of hours worked devoted to actually transcribing notes, excluding lunch breaks and department meetings, Cameron says.
"A more realistic rate is probably 75%," she adds. "Some hospitals are there now, while others may only have 50% productivity, especially if they are spending time answering phones or performing other duties."
One way to measure productivity is through a graph analyzing monthly input, capacity, and output to identify areas where department output, measured by the number of lines produced, did not meet worked capacity (actual hours worked) or keep up with work coming into the department. Or, worked capacity could be less than regularly scheduled capacity, which possibly means staffing levels were not high enough to handle the amount of work coming into the department. (See sample of an output graph on p. 12.)
The reasons could be explored through departmental team meetings or meetings with individual staff members. The solution could be as simple as providing reference materials on certain specialties so the transcriptionist can spell the medical terms correctly, or identifying the need for clerical help to allow medical transcriptionists to spend more time on actual transcription and less time on administrative duties.
As with any program, buy-in from hospital administration and physicians is critical to success. One way to achieve this, Cameron recommends, is to put together an interdepartmental team for best practice sharing. This could include health information managers, a few key physicians (either department heads or those considered leaders by their peers), nurses, and officials involved with hospital bylaws, in case changes need to be effected. This gives all groups affected by changes in the medical transcription process a say in these decisions.
Generating regular reports to show how department costs and productivity have improved also show the impact improvements have on the bottom line and on the current industry buzzword: quality.
"It can become a wonderful TQI [total quality improvement] project when you start to get this data," Cameron says. "You can begin to see where and discover why [problems exist]" and move on to demonstrating results.
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