Patient-days formula gauges staffing best
UCLA moves away from admissions staffing
(Editor’s note: The continuing cost consciousness among hospitals is making it increasingly difficult to determine and justify adequate staffing levels. In this issue, Hospital Access Management begins a series of articles on how admitting departments around the country determine what staffing levels they need.)
One thing quickly becomes evident when you look at how access departments determine their staffing levels: One size definitely does not fit all.
At UCLA Medical Center in Los Angeles, departmental staffing was based on the number of inpatient admissions until about eight months ago, says Cynthia Frizelle, RN, assistant director of admissions and registration. That’s when management took a look at productivity.
It became clear that although the staff was busy and was working efficiently, "We weren’t giving ourselves credit for the activity we were actually doing," she says.
Better reflections of workload
UCLA Medical Center decided that using adjusted patient days rather than the number of admissions in its staffing formula more accurately reflected the work involved. This formula, based on the premise that it takes 20 minutes to complete an uncomplicated admission, incorporates inpatient and outpatient transactions. The resulting figure is multiplied by total revenue and divided by inpatient revenue to get the proper staffing level.
The result, says Frizelle, is a better reflection of workload. Basing staffing on the number of admissions doesn’t take into consideration the maintenance of the account.
"You’re following through for accuracy, doing financial counseling, verification of insurance, working with the family and, if it’s an extended stay, verifying continuation of eligibility," she says. "[Using adjusted patient days] gives a better measurement of what we need to do to work a case."
A smaller facility without complex cases such as transplants might do fine using a formula based on admissions, Frizelle notes.
Different cost centers at the medical center have different staffing allocations. The Medical Plaza, for example, which handles inpatient admissions, outpatient registration, and screening for ambulatory surgery, is budgeted for 1,055 registrations a month. For each account, that includes preregistration, the actual admission, collection of demographic information, financial counseling, cash transactions, and insurance verification.
"We may do less, we may do more, but it averages out by the end of the year," Frizelle says. Four FTEs a manager and three financial counselors are allocated for that area, which only has a day shift. These employees also handle admissions from all specialty clinics.
Constant evaluation
Time management studies have determined that each employee takes 10 to 12 minutes to do a thorough preregistration over the telephone. That allows managers to calculate the number of FTEs needed to accommodate the volume at different times of day.
Skill levels also are taken into account. "You have to look at the mix of people, what level you want to hire in, and you’re constantly evaluating, changing your mix," she says. "For example, managed care accounts may have less financial counseling but more detail. You may not need as many senior financial counselors. Maybe an admitting worker could take care of those details."
[Hospital Access Management is interested in how staffing levels for your department are determined, as well as how you supplement them through volunteers, for example to do more with less. Please contact Editor Lila Moore at (404) 636-9264, Managing Editor Glen Harris at (404) 262-5461, or e-mail us at: [email protected]. We look forward to hearing from you.]
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