Journal of Healthcare Management - May/June 2013 - (Page 182)

Journal of H ealt H care M anage Ment 58:3 M ay /J une 2013 study provide a benchmark for organizations seeking information on APP productivity as they shed light on return on investment (ROI) factors and the causes of SVA variance in medical and surgical subspecialties. impact on roi We found that the time spent on RGSs provided by APPs at our facility was between 60 and 65 percent and the time spent on SVAs was about 30 to 35 percent. In essence, two thirds of APP daily work was spent conducting services that have direct revenue-generating opportunities through RVU allocation, while one third of that time was spent on SVAs, most of which were either nonRVU generating or difficult to quantify. The implications of these finding are far reaching. The quantifiable financial ROI on the utilization of an APP is only about two thirds of the total productivity of that provider, which implies that about one third of the productivity of each provider is lost when productivity is considered on the basis of current reimbursement and practice standards. The findings also indicate that, using current RVU standards, only 60 to 65 percent of the providers’ productivity is accurately assessed, whereas 30 to 35 percent of the time spent on valuable patient care services is lost, missed, or poorly accounted for. As indicated earlier, pre- and postservice activities were defined as valued services lumped into current reimbursement calculations. These services have evolved over the past 20 years to include additional technology-based services and increasingly complex communication strategies, such as online medicine and electronic health records, subsequently altering methods of care delivery. Newer tools for service delivery, such as electronic health records, while aimed at improving efficiency and care, require the healthcare provider to have advanced education and training with very little improvement in reimbursement. Variance in Medicine and Surgical Subspecialties The results indicate that a statistically significant variance exists when comparing APP productivity (RGSs vs. SVAs) in medicine and surgical subspecialties (see Figure 4). Medicine subspecialties were noted to have statistically significant differences in percentage of time spent on RGSs (c2 = 13.382, p < .05) versus SVAs, while the surgical subspecialties did not demonstrate similar significance (c2 = 5.925, p = .205). These findings suggest that a narrower variance of productivity and services delivered could be expected in medicine subspecialties than in surgical subspecialties when staffing the medicine services with a PA or an NP. In contrast to medicine services, APPs in surgical services, who demonstrate the cross-coverage competencies, might provide healthcare organizations an opportunity to explore innovative deployment and coverage strategies that yield maximum productivity without compromising quality and patient safety. ModEl dEVEloPMENt This time and motion study is a prelude to the development of a supplemental model of productivity assessment intended to complement the existing 182

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2013

Journal of Healthcare Management - May/June 2013
Contents
Interview with Thomas C. Dolan, PhD, FACHE, CAE, President and CEO, American College of Healthcare Executives
Equity in Care: Picking Up the Pace
How Might a Reforming U.S. Healthcare Marketplace Threaten Balance Sheet Liquidity for Community Health Systems?
Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study
A Positive Deviance Perspective on Hospital Knowledge Management: Analysis of Baldrige Award Recipients 2002–2008
How to Improve Breast Cancer Care Measurement and Reporting: Suggestions from a Complex Urban Hospital
The Fear Factor in Healthcare: Employee Information Sharing

Journal of Healthcare Management - May/June 2013