Internal benchmarking paves way for medical transcription improvements
Accurate data collection shaves costs, shortens cycles
To paraphrase W. Edwards Deming: What you would improve, you must first measure. Sound measurement is basic to benchmarking, but unfortunately, many of us fail to make good measurements where it’s easiest to gather the data: in our own facilities.
That’s especially true when it comes to measuring productivity in a medical transcription department. Despite advances in technology, efficiently deciphering physician notes remains a challenge for these departments. Adding to the quandary is that the department often is seen as a variable expense or cost center in today’s cost-conscious health care environment.
Nonetheless, by putting systems in place to capture detailed, accurate data, medical transcription departments can cut costs and increase 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 $494,000 in cost savings in one year, says department manager Cynthia Taylor.
Obviously, such improvements don’t happen overnight. So where do you start? Cameron, who has 20 years of 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. Establish some baseline benchmarks against which future measurements can be plotted. The standard measurement is the number of lines produced per minute of dictation, sorted by hospital department, physician, report type, and/or transcriptionist.
2. Analyze by dollars. This includes:
• total cost per unit, which 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 (such as office supplies and utilities);
• 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 with a department average of 90 lines at $18.90? You have the data you need to approach physicians or investigate whether they are overdocumenting.
Data offer clout when approaching physicians or department heads, 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 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 also may find that this transcriptionist works alone and is routinely assigned to operative reports an area she has little experience in. You might suggest changing 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.
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 output graph, above.)
Solutions may be easier than you think
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 so medical transcriptionists can spend more time on actual transcription and less 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 hos-pital bylaws, in case changes need to be effected. This gives all groups affected by changes in the medical transcription process a say in the decisions.
Generating regular reports that show how department costs and productivity have improved also illustrate the impact improvements have on the bottom line and on quality. "It can become a wonderful TQI [total quality improvement] project when you start to get these data," Cameron says. "You can begin to see where and discover why" problems exist and move on to demonstrating results.
After instituting a data reporting system in the spring of 1996, the medical transcription and word processing department at Geisinger Medical Center improved turnaround time 11.8% and cut annual operating costs by half a million dollars, Taylor reports.
The department also has experienced greater collaboration with other hospital departments and proved it could be cost-competitive with external medical transcription services, Taylor adds.
The environment at Geisinger is one familiar to many hospitals. Hospital leadership has been looking at ways to reduce costs without sacrificing quality. Staff cuts were instituted in the medical transcription department some as a result of cost-cutting efforts, and others through attrition after the data measurement program Taylor instituted identified ways to increase productivity. As a result, the department is operating with a 71-member staff, compared with 106 a year ago, yet turnaround time to generate reports has declined.
Taylor instituted the data reporting program shortly after returning from a workshop that Cameron conducted in March 1996. She admittedly had several factors working to her advantage. Geisinger had implemented a management document support system in January 1995 to run data on, so the systems already were in place to provide the data needed. In addition, Taylor had the full backing of hospital administrators to institute the program.
Eliminating extra tasks
Geisinger’s goals for the data measurement program included:
• Identifying how and where transcription staff time was being spent.
• Identifying tasks that were not value-added. Transcriptionists were key in identifying some of these tasks. Where possible, Taylor eliminated the task or transferred the work to another department. For example, the department calculated that transcriptionists were hand-addressing 400 interoffice envelopes a day to send out copies of reports. Taylor transferred the work to secretaries to free up the transcriptionists’ time.
• Working with divisional leadership to identify and institute improvements.
• Benchmarking productivity against industry standards to show Geisinger’s transcription unit was competitive with outside vendors.
Taylor began generating quarterly reports for each hospital department to measure utilization based on output of transcribed lines by department and report. Only one department wanted a physician-by-physician breakdown. She also instituted meetings with department heads every six months to discuss changes in productivity and output as well as opportunities for improvement.
Direct costs per line drop 13.8%
Taylor used the reports to identify ways to improve and encouraged transcriptionists to come up with their own ideas. Department meetings were held on an as-needed basis to discuss trends. Results to date have confirmed the program’s success. The department’s direct costs for the 1996 fiscal year decreased 20.9%, a $494,000 savings.
In addition, direct costs per line the department’s direct costs divided by the total number of transcription lines produced dropped 13.8% during the same period. Taylor recommends benchmarking transcription line production based on the national standard of 65 characters per line, as set by the American Association for Medical Transcription.
Other improvements included:
• Suggesting template changes for physicians to use on commonly used reports to cut down on transcription time.
• Identifying portions of reports that could be automated. This eliminated manual calculation of financial reports used in some documents.
• Holding frequent meetings with transcriptionists and asking them to identify ideas for improvement. Taylor gave individual transcriptionists recognition for ideas by inviting them to meetings with the appropriate department heads to present their ideas.
• Creating a benchmark cost per unit of service, then identifying what is needed to get there. For example, Geisinger’s average cost per line of transcription was .1655 cents for fiscal year 1994, compared with the current average of .129 cents per line.
[Editor’s note: For more details, contact Kathy Cameron, director of education, Health Professions Institute, Modesto, CA. Telephone: (209) 551-2112. Or contact Cynthia Taylor, word processing and medical transcription department manager, Geisinger Medical Center, Danville, PA. Telephone: (717) 271-6313.]