1-800-477-5175 jcastagno@cehcc.com

Revenue cycle managers are constantly forced to justify their resource counts and expenditures. RCM (revenue cycle management) is a cost center and under continuous pressure to hold the line somewhere in the two to four percent range. How is an RCM vice president or director supposed to build a staff model that fits? – Bring on the industry KPIs! Let’s build a manpower to volume ratio matrix.

Unfortunately this reflexive move appears to be a sound strategy on the surface, but doesn’t address a number of contributing factors that must be incorporated into any resource planning process. “I don’t know what I don’t know” is the challenge most organizations don’t see coming. Whose data should I use… MGMA, HFMA, my colleague in Dayton that runs a multi-specialty clinic? Unfortunately, all of these sources may provide what seems like a valid data point in your calculations, but they lack context – and this is the trap.

Context… for this discussion simply means the accuracy of the variables that impact the validity of our model. In our experience the minimum variables that must be considered are as follows:

  • Deployed technology
    • AR Management system
    • Integrated EHR – with or without coding assistance
    • Integrated automated eligibility verification
    • Integrated clearing house services – claims, e-remittance, denial management
    • Auto payment posting functionality
    • Fully functional collection system with auto tickler / follow-up tracking
  • Staff experience
  • Payor mix
  • Specialty / facility vs provider services
  • Outsourced services – coding

This is a starting point to begin understanding the variables that impact staff productivity. Each of these must be considered when developing team level workflows and the associated environment specific productivity metrics (KPI) for each of your disciplines – this is your specific context.

Now that you know what variables impact your metrics, you can begin to evaluate your teams based on each of their disciplines (responsibility). If you are not already tracking individual productivity now is the time to start, a fair starting point is the average between your high achievers and those in the middle range. We do not consider the lowest performers in establishing our baseline as experience has shown that most organizations have approximately one third of their resources underperforming – you do not want to build negative performance levels into your metrics.

A baseline performance metric based on an understanding of our environment provides the basis for building our manpower to volume ratios allowing you to forecast resource needs based on projected growth or acquisition. Remember to consider the impact changing any of your identified variables may have on overall productivity. If you add upgraded technology or integrate an EHR system that interfaces demographics and/or changes the workflow, the productivity of your teams can be dramatically altered. Recast your baseline metrics whenever a significant technology or workflow change is encountered to avoid the manpower to volume ratio trap.