Productivity Metrics
Health care administrators balance costs and revenue for streamlined and predictable business operations. Capturing productivity data is one approach to monitoring efficiency of service delivery. Administrators may consider the time needed to generate clinical procedures, related charges and reimbursement rates, and staff hours using different metrics. Understanding your organization’s metric may help you navigate your clinical practice and professional advocacy.
ASHA encourages employers who monitor productivity or who establish a productivity standard for clinicians to include any activity required for patient care—such as completing documentation, analyzing test results, coordinating care, and attending team meetings—not only billable time. Productivity standards should also reflect reasonable labor practices, such as time for meal breaks.
Volume- and Time-Based Productivity
There are several productivity strategies that use time and the number of available appointments. They do not capture efficiency of services or the complexity of the procedure or patient.
Volume-Based
- This metric counts the number of billable patient contacts over a period of time (e.g., an 8-hour workday).
- It is typically seen in salaried models of employment based on the number of visits (e.g., in home health); procedures (e.g., in acute care hospitals); encounters (e.g., in outpatient clinics); or patients (e.g., in skilled nursing facilities).
Time-Based
- This metric counts the number of patients seen within a unit of time. For example, SLP 1 sees four patients in an hour, and SLP 2 sees two patients in the same time period . SLP 1 is more productive than SLP 2.
- It is typically seen in hourly or per-visit models of employment, or employment of PRN staff.
Capacity-Based
- This metric counts the number of encounters that the facility needs to maintain consistent revenue.
- It allows a practice to examine the impact of staffing and session length for the typical procedures encountered in the practice.
- This prospective model is influenced by the number of scheduled work hours, clinician vacation time, cancellation rate, and other planned down time.
Because these metrics use time and the number of appointments as key factors, employers may decrease the length of individual appointments to create more units of potential productivity. There are many potential negative consequences when patient care time is driven by administrative mandates rather than by clinical judgment. For the patient, these negative consequences can include poor quality of care and outcomes, errors, and low satisfaction ratings. For clinicians, negative consequences can include low morale, moral distress, burnout, and higher rates of staff turnover.
Relative Value Unit (RVU) Productivity
The relative value unit (RVU) productivity methods factor in the complexity—or relative amount of work, resources, and required expertise—for the services provided. They do not represent exact times or specific monetary values.
There are two ways to establish RVUs:
Time study
- This metric develops a relative unit by capturing data on actual time spent by staff, or consensus of an expert panel to determine time per procedure.
- These RVUs are subjective and specific to the clinic or department, so they cannot be standardized across health care facilities or used to benchmark against national averages.
Resource-Based Relative Value System (RBRVS)
- This metric weighs Current Procedural Terminology (CPT®) procedure
- It was developed by the Centers for Medicare and Medicaid Services (CMS), with substantial input from the American Medical Association (AMA). The AMA, with input from specialty societies such as ASHA, recommends a relative value for each CPT® CMS ultimately assigns the final RVUs for each CPT code and publishes them annually as part of the Medicare Physician Fee Schedule.
In RBRVS, the total RVUs consist of three components:
- professional work: the amount of time, skill, training, and intensity necessary to perform a given procedure
- practice expense: costs associated with the procedure—such as rent, equipment and supplies, consulting and professional services, and staff salaries
- malpractice expense: liability expenditures borne by or on behalf of the provider
Each CPT® code uses an average of the weighted percentage for each of the three components. Speech-language pathology codes tend to have the most value in the professional work category as opposed to the other two categories. From year to year, the professional work area tends to be the most stable— with more fluctuation in CMS calculations seen in the practice expense and malpractice expense categories than in other categories.
RVUs and Payment
An RVU reflects the value of a code, which determines how much that code gets paid. The actual dollar amount of payment for services is generated when a conversion factor—in this case, dollar per RVU—is applied to the total number of RVUs accrued. The value of the conversion factor varies from year to year based on federal spending requirements.
Medicare establishes a fee schedule for CPT® codes annually. Each component of the RVU is multiplied by the Geographic Practice Cost Index (GPCI) to account for variations in living costs and business costs across the country. Then, the three elements are added together, and the sum is multiplied by the conversion factor. Because the Medicare Physician Fee Schedule changes each year, members who would like a breakdown of current RVUs are encouraged to contact reimbursement@asha.org.
RVUs and Productivity
RVUs from CMS are based on outpatient service delivery, so they are not reflective of typical time or resource use in inpatient settings.
When used to assess productivity, RVUs reflect the revenue generated by a clinician while considering the complexity of the service provided. The inherent assumption is that more complex procedures take more time and have a higher RVU attached to them. The greater the value of the code, the more revenue that is generated. This view of productivity may more accurately reflect the clinician’s workload (i.e., a data point that considers complexity of service and not just number of patients served) as opposed to their caseload (i.e., the number of patients served regardless of their medical complexity).
CPT® codes include pre-service time (before you see the patient), intra-service time (while you see the patient), and post-service time (after you complete your intervention with the patient) service to the patient). This helps reflect time spent engaging in activities such as medical records review, documentation, and care coordination. To obtain a detailed explanation of activities included in varying CPT® codes, members can contact reimbursement@asha.org.
