Why Your Healthcare Staffing Matters; Balancing Standards, Cost, & Care Quality
The right staffing balance is essential for an RHC because it contributes to the organization’s fiscal success and helps ensure that patients are always well cared for.
When optimizing and evaluating staff, your RHC should consider legal practice standards, cost, and patient satisfaction.
Healthcare Staff Legal Costs & Requirements
To meet CMS legal standards, clinics need to abide by and reach provider productivity standards.
Every certified RHC must have onsite:
- one physician,
- one mid-level provider,
- and one nurse practitioner or physician’s assistant.
The nurse practitioner or physician’s assistant must be onsite at least 50% of the clinic’s operating hours. Of that staff, according to CMS, a physician must be able to provide medical direction and oversight. He or she could be an owner, an employer, or a contracted service provider. This provider must be onsite at all times during business hours. Additionally, the physician provider is required to meet the productivity standards of 4,200 visits per year, while the mid-level provider is required to meet 2,100 in annual visits.
For many rural communities with smaller populations, meeting these standards can be difficult, particularly during the current SARS-Covid-19 pandemic. Some rural health clinics have found it especially difficult and have had to change the way they staff their clinics and bill for services. If your RHC finds itself in this situation and is unable to meet productivity standards, you may want to speak with your Medicare Administrative Contractor (MAC) about certain exceptions that can be granted during this Covid-19 pandemic.
How Much Should The Total Budget Be For Healthcare Staff?
In terms of cost, a good rule of thumb is that staff salary should be no more than 50% – 60% of your operating budget. Though, you can get more precise in your staffing estimates by adhering to certain industry benchmark data. Of course, the ultimate measure of cost will be the net impact staffing has on your bottom line.
How Does Your Staff Affect Patient Satisfaction?
Finally, getting your staffing right will have a direct impact on patient care and satisfaction. Care quality and patient satisfaction are core to a clinic’s performance.
While understaffing will most likely lead to a negative patient experience, overstaffing is not always a guarantee that the quality and experience will improve. In fact, overstaffing can lead to negative results. For example, loss in revenue and additional costs for your clinic.
How To Evaluate Your Clinic’s Staffing Needs
So, what are some easy ways to solve the issue of staffing? First, let us look at a few common business problems and misconceptions around staffing.
- “We need to staff as many people as it takes to perform safe and efficient operations”
At face value this seems like a logical response to a simple problem. Patient safety and quality are of the upmost importance, but this staffing response is an example of oversimplification. It assumes that all aspects of the clinic’s operations are operating efficiently, and it does not factor in financial performance. Take a step back and explore other options before hiring.
- “When work becomes backlogged and receivables decrease we need to hire more staff”
This may be true. However, first examine and investigate processes and procedures. Instead, ask yourself, is there is a way to increase efficiency elsewhere in the clinic? Are there better ways to organize or to help save time? What might be disrupting the workday? It might be simple fixes like scheduling issues or not using the online portal correctly. Are you making good use of treating patients through telehealth? Once you consider other factors like these, large or small, then you can return to the possibility of adding more staff.
- “Adding staff will only increase our overhead and operational cost”
It’s true, adding staff can put stress on a budget which in turn can lead to cutting staff in the end. That said, adding the right staff might be legally required or can lead to certain productivity gains, which in the end can improve your RHC’s financial performance.
Important Staffing Variables To Consider
Getting to the right staffing level requires multiple considerations. Every clinic is unique and so are your patients. Here is a list of other variables that you can consider when evaluating staffing.
Do you know how your RHC costs and productivity compare to state and national averages? You might want to consider other industry data.
The Practice Support Resources states that support staff per physician should be 3 to 1 and the support staff as a cost should be no more than 27% of your revenue. While the Medical Group Management Association, reports that support staff per physician should be 4.67 to 1, and support staff as a cost should be no more than 31.57% of your revenue.
Patient Volume/Types of Patients Seen
Does your RHC have the right staff to address your population’s unique health conditions?
Rural communities often have fewer resources to treat chronic ill patients but experience higher rates of chronic health problems and have higher comorbidity rates than non-rural areas. For example, people in rural areas have a 40% higher prevalence of heart disease. These types of patients require different services and more time needed to treat them.
Have you recently had to adjust your provider hours?
With the climbing rates of Covid-19 many providers are seeing a steep decline in patient visits. This could lead to your clinic open for less time. Have you spoken with your MAC about exceptions to CMS productivity guidelines that your RHC may qualify for?
Provider Practice Style
Has your RHC evaluated telehealth as an option? In general, 2017 saw a 76% increase of U.S. hospitals using telehealth. Now, since Covid-19, there has been an additional increase in the use of telehealth around the country. According to a recent study: “Daily telehealth claims for upper respiratory infections using ICD-10 diagnosis codes from private insurance increased nearly 12 times from the daily average over the previous month.” Evaluating new technologies like telehealth might be a good solution for many RHCs.
One Solution Does Not Fit All
There is no easy solution to staffing your clinic. As you have seen, everything must be catered toward your clinic’s needs. Hopefully with all of this taken into consideration, your clinic will benefit from an evaluation of your staffing needs. Remember, be aware of legal standards and standards of productivity. Keep in mind cost and what your clinic can afford for staff.
Patient satisfaction is key to the success of a clinic and knowing the types of patients and what they need, will help you staff accordingly. Lastly, know that every rural clinic is unique and fixing staffing issues in your clinic is not simple, nor easy, but is attainable.
If you would like some additional resources to look at for meeting productivity standards, check out these three resources. You may find them helpful with benchmark data and other important information.
- MGMA – Medical Group Management Association
- RHI – Rural Health Information
- PSR – Practice Support Resources