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Field Staff Productivity
After meeting all your agency’s revenue challenges (volume, payor mix, managed care rates, case mix index, etc., etc.), where do you look for more opportunities to improve your financial performance? Expenses would be your next logical step, and there is no bigger expense in homecare than labor.
Assuming that you are appropriately staffed in the office, keeping tight control of field staff salaries is key to your agency’s success. Measuring the productivity of field staff can be a time-consuming task, but an essential one. Remember the catchphrase: “You can’t manage what you don’t measure.”
Measurement of field staff productivity has two components: time and volume. You set expectations for your staff of how many visits they are expected to make, and how much time you expect them to take to make those visits. For example, if they are meeting your expectation of making 25 – 30 visits per week, but are taking 60 hours to do them, you have a time variance. And if they are spending 40 hours in a week but only doing 15 visits, you have a volume variance. Recognizing that some visits take more time than others, weight the admissions, resumes and recerts as two visits taking twice the time as a regular visit. Discharges would be measured as 1-1/2 visits.
An expectation of 1.25 hours per visit gives you 45 minutes of patient time, 15 minutes for documentation, and 15 minutes drive time. If your standard is 25 visits per week, this gives you 8.75 hours in a 40-hour week for case conferences, meetings, and inservices. (Calculate: 1.25 hours x 25 visits = 31.25 visit hours.) If you expect 30 visits per week, at 1.25 hours per visit, your “office” time goes down to 2.5 hours. Of course, visits per week is an average and can fluctuate according to the needs of the agency.
Investigation of variances by team or by individual staff should lead you to the root causes and direct your solutions. For example, are the staff calling patients ahead of time to be sure the visit time is understood? Are they scheduled to minimize the travel time between visits? Or, if yours is a rural agency, you may have to adjust your expectations to reflect the reality of the distance your staff has to cover.
Some ideas you may employ to maximize productivity:
• Set clear expectations for staff and hold them accountable.
• Engage staff and solicit their suggestions.
• Employ “per visit” staff. They are motivated by being paid by the number of visits they make and are not tied to a time standard. Caution: monitor the time they spend providing care in the home and the quality of care.
• Be sure your visits are scheduled to make the best use of staff time, and that they are not spending unnecessary time on the road.
• Publish productivity results and implement a reward and recognition program for the productivity “stars”
• Provide cell phones or reimburse for use of personal cell phones.
• Provide access to email to staff to improve communication.
• Use specific RN’s to specialize in admissions.
• Invest in telehealth.
• Use PT/INR monitors in the patients’ homes to eliminate lab drops and calls for lab results.
• Use of a case management model not only improves patient care and outcomes, but provides regular communication between disciplines and helps staff to schedule their visits.
Although managers are spread very thin in homecare, paying attention to this aspect of your agency’s performance is all-important, and you will be rewarded with improved financial results.
>> Go on to Simple Strategies for Effective Home Care Case Management
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