Calculating and Reporting health statistics

Exercise 9.10 1. In deciding whether to purchase or lease a new dictation system, the HIM supervisor calculates the payback period. The hospital's required payback period is three years. If the equipment costs $28,000 and generates $3,500 per year in savings, what would be the payback period for this equipment? Should the department purchase this equipment? 2. The coding section in the HIM department shows its first-quarter budget analysis as having an expected cost of operation of $62,000. However, the actual cost of operation was $76,000. Calculate the budget variance. Round to one decimal place.

1 8 years The department should purchase the equipment if it will pay back its cost in savings within three years. To find the number of years it will take to pay back the cost, divide the cost by the annual savings. $28,000/$3,500 = 8 In this case, the department should not purchase this equipment because the savings do not justify its purchase. 2.22.6% The budget variance is the difference between actual cost and expected cost, multiplied by 100 and then divided by the expected cost $76,000 - $62,000 = $14,000 ($14,000 x 100)/$62,000 = 22.58 = 22.6

Exercise 9.4 Inpatient records: Pediatrics Obstetrics Psychiatric Newborn Medical Surgery Clerical/primary: Filing Admissions Combining records Tumor registry Correspondence Record completion Certificates Supervisory Transcription Coding Subtotal outpatient/ ambulatory surgery Total hours worked

Service/Division Number of hours Hours Worked Inpatient records: Pediatrics 11.75 h/w x 4 weeks 47 Obstetrics 59.5 h/w x 4 weeks 238 Psychiatric 98.5 h/w x 4 weeks 394 Newborn 50.75 h/w x 4 weeks 203 Medical h/w x 4 weeks 447 h/w x 4 weeks 1,707 Surgery 447 h/w x 4 weeks 1,788 Subtotal inpatient records 4,377 ED Records: Clerical/Processing 28 h/w x 4 weeks 112 Correspondence 7 h/w x 4 weeks 28 Supervisory 5 h/w x 4 €weeks 20 Subtotal ED records General clinic: 160 Clerical/processing 6 h/w x 4 weeks 24 Supervisory 0.5 h/w x 4 weeks 2 Transcription 0.10 h/record x 170 records 17 Subtotal general clinic 43 Outpatient/ambulatory surgery Clerical/primary: 21.5 h/w x 4 weeks 86 Filing 5.25 h/w x 4 weeks 21 Admissions2.5 h/w x 4 weeks 10 Combining records 1 h/w x 4 weeks 4 Tumor registry 1 h/w x 4 weeks 4 Correspondence 0.25 h/w x 4 weeks 1 Record completion10.75 h/w x 4 weeks 43 Certificates 3.25 h/w x 4 weeks 13 Supervisory 5 h/w x 4 weeks 20 Transcription 0.10 h/record x 620 records 62 Coding 0.12 h/record x 850 records 102 Subtotal outpatient/ ambulatory surgery 366 Total hours worked 4,946

Exercise 9.5 Your physician clinic's chief financial officer has determined that it costs the clinic $3.75 per telephone call for the receptionist to set up an appointment with a physician in the clinic compared to $1.50 per online request via the Online Appointment Request Form. What would the cost savings be if, during one day at the clinic, 150 patient appointments were arranged by online request rather than by telephone?

Telephone requests: $3.75 x 150 = $562.50 Online Appointment Request Form: $150.00 x 150 = $225.00 Cost savings: $562.50 - $225.00 = $337.50 or $2.25 per appointment

Exercise 9.3 average request 542 Postage $456 Service contract (includes copier) $216 Equipment (includes copies) $135 Supplies (includes toner, printer cartridges, paper) $110 Wages $11.00 per hour

The monthly cost for the ROI services is the sum of the costs per request multiplied by the number of requests. Postage: $0.84 per request $456/542 = $0.84 per request Service contract: $0.40 per request $216/542 = 0.398 = $0.40 per request Equipment: $0.25 per request $135/542 = 0.249 = $0.25 per request Supplies: $0.20 per request $110/542 = $0.20 per request Wages: $11.00 x 2,080 = $22,880 annual salary $22,880/12 = $1,906.66 $1,906.66/542 = 3.5217 = $3.52

Exercise 9.9 1. Community Hospital wants to make the transition to an electronic data management system. The process will involve scanning 5,000 inpatient records, 2,000 outpatient records, and 1,500 ED records into the new system. The hospital estimates that there are 30 pages per inpatient record, four pages per outpatient record, and three pages per ED record. Assuming that one scanning clerk can scan 1,500 pages per day, how many days will it take to complete the transition? 1. The HIM Department would like to complete this project in 30 days. How many FTEs will the HIM Department manager need to hire to complete this in the month?

The number of days required is the total number of pages required divided by the number of pages per day that can be scanned 5,000 inpatient records x 30 pages = 150,000 2,000 outpatient records x 4 pages = 8,000 1,500 ED records x 3 = 4,500 (150,000 + 8,000 + 4,000)/1,500 = 108.0 days The number of FTEs will be the total number of days required divided by the total number of days available for the project. 108/30 = 3.6 FTEs needed. or the student could determine that if one scanner can scan 1,500 pages each day, how many pages would be scanned in each day to complete in 30 days. 162,000/30 days = 5,400 pages needing to be scanned 5,400/1,500 = 3.6 FTEs needed

1. Transcriptionist A is a full-time employee earning $13.00 per hour and an annual salary of $27,040. She transcribes 1,200 lines per day for a total of 312,000 lines per year. What is the unit medical transcription labor cost for transcriptionist A (or, how much does a line cost when transcribed by Transcriptionist A)?

The unit labor cost is found by dividing total compensation by total productivity $27,040/312,000 = 0.087 = 0.09 or 9 cents per line

2. Transcriptionist B is a full-time employee earning $10.00 per hour and an annual salary of $20,800. He transcribes 900 lines per day for a total of 234,000 lines per year. What is the unit medical transcription labor cost for transcriptionist B?

The unit labor cost is found by dividing total compensation by total productivity 0.9 or 9 cents per line $20,800/234,000 = 0.089 = 0.09 or 9 cents per line.

3. On average, the ROI section brings in $1,500 per month. What is the difference between cost and income?

$1,323.82 $2,823.82 - $1500.00 = $1,323.82

2. What is the monthly cost for the ROI services?

$2,823.82 $0.84 + $0.40 + $0.25 + $0.20 + $3.52 = $5.21 per request x 542 requests = $2,823.82

Exercise 9.11 1. The report in figure 9.1 gives the gross death rate (hospital death rate) as .01 percent. Recalculate this rate and round to the second decimal place. 2. Recalculate the gross autopsy rate in figure 9.1. Round your answer to the second decimal place. 3. In figure 9.2 which Medicare severity diagnosis-related group (MS-DRG) has the greatest ALOS? 4. Recalculate the readmission rates for the medical services and the overall rate in figure 9.3 to verify their accuracy. Which readmission rates were not accurate? Round your answers to two decimal points .5. Recalculate the rates in figure 9.4 to verify their accuracy. Are there any that were calculated incorrectly? If so, which ones? How many Medicare patients were discharged during the fiscal year to date? What month end was this report calculated?

1. 1.38% The gross death rate is calculated by dividing the total number of deaths by the total number of discharges. [(7 + 2) x 100]/650 = 1.38% 2.22.22% (2 x 100)/9 = 22.22% Note that, according to this computerized statistical report, the net autopsy rate is the same as the gross autopsy rate. The reason for this is that no coroner's cases are listed. 3. MS-DRG 844, Other myeloprolific disorder or poorly differentiated neoplasm diagnosis with complication or comorbidity has an ALOS of 23 days. Note that this category has only one discharge. MS-DRG 208, Respiratory system diagnosis with ventilator support less than 96 hours has the greatest ALOS with more than one patient. 4 .FRP: (5 x 100)/75 = 6.67% GI: (5 x 100)/27 = 18.52% MED: (59 x 100)/511 = 11.55% MON: (26 100)/67 = 38.81% NB: (1 x 100)/129 = 0.78% NPH: (42 x 100)/162 = 25.93% ORS: (2 x 100)/14 = 14.29% PED (1 x 100)/55 = 1.82% THS: (3 x 100)/37 = 8.11% VSS: (1 x 100)/26 = 3.85% Overall rate: (188 x 100)/2,046 = 9.19% 5.6831.0912/3,230 = 2.1149 Case-mix - All financial classes for Month End 10/20XX: 3396.8017/1,626 = 2.0891 Case-mix - Medicare only for Month End 10/20XX: 1364.1506/658 = 2.0732 There were 1,367 Medicare discharges year-to-date. This report was calculated for month end October.

Exercise 9.8 Community Physican's Clinic is a large clinic in your community with 85 physicians. They treat about 8,600 patients each week. Coders are expected to code 100 clinic records each day. How many FTEs are needed to code these records?

17.2 FTEs The number of FTEs will be the total number of patients divided by the total number of records required per week (assume a 5-day work week). 8,600/(100 x 5) = 17.2 FTEs

1. Use the information in the table below to answer the following questions. Each employee worked eight-hour days during the 21 workdays in September. Round all answers to two decimal places. a. What percentage of the total number of records did each employee code during the month? b. How many records is each coder coding each workday? c. How many records is each coder coding per hour? (Use an 8-hour workday.) d. On the average, how many minutes does it take each coder to code one record? e. What percentage of records is not passing the quality screens for each coder?

A 425 4 B 502 3 C 373 11 For each coder, multiply the number of records that coder coded by 100, then divide by the total number of records coded by all coders Coder A: 32.69% (425 x 100)/1,300 = 32.69% Coder B: 38.62% (502 x 100)/1,300 = 38.62% Coder C: 28.69% (373 x 100)/1,300 = 28.69% b. For each coder, divide the number of records that coder coded by the number of workdays Coder A: 20.24 425/21 = 20.24 Coder B: 23.90 502/21 = 23.90 Coder C: 17.76 373/21 = 17.76 c. For each coder, divide the 60 minutes in an hour by the number of records the coder codes in an hour. Coder A: 23.72 60/2.53 = 23.72 Coder B: 20.07 60/2.99 = 20.07 Coder C: 27.03 60/2.22 = 27.03 d. Coder A: 0.94% (4 x100)/425 = 0.94% Coder B: 0.60% (3 x 100)/502 = 0.60% Coder C: 2.95% (11 x 100)/373 = 2.95%

Exercise 9.7 1. The totals for each department and each week 2. The proportion of loose sheets received from each department

Department W #1 W #2 W #3 W #4 T Proportio n Lab 27 34 48 54 163 0.27 Radiology 15 21 26 42 104 0.17 Pathology 25 26 28 31 110 0.18 Nursing 17 22 36 41 116 0.19 Physical therap5 4 2 12 23 0.04 Miscellaneous 20 21 22 26 89 0.15 Totals 109 128 162 206 605 1.0 17.2 FTEs The number of FTEs will be the total number of patients divided by the total number of records required per week (assume a 5-day work week). 8,600/(100 x 5) = 17.2 FTEs

Exercise 9.6 1. The Health Information Committee has requested information about the electronic signature system being used in your facility. They would like to know percentage of physicians using the system from each location. Review the information in the table below and determine the percentage of use from each site. Round to one decimal point. 2. What is the percentage of physicians not using the electronic signature system? Round to one decimal place.

Medicine, 2 West 45 19.5% Medicine, 2 East 35 15.2 Pediatrics, 3 West 20 8.7% Obstetrics, 1 West 9 3.9% Physician's lounge 65 28.1% HIM department 42 18.2% Physician home 15 6.5% 7.6% are not using the electronic signature system 231 of the 250 physicians on staff are using the system. Nineteen are not using it. (19 x 100)/250 = 7.6% are not using the electronic signature system.

2. What percentage of the total hours is spent in each category of inpatient records, and what percentage is spent in inpatient, emergency department, general clinical, and outpatient/ambulatory surgery records? Round to two decimal places.

Pediatrics (47 x 100)/4,946 = 0.95% Obstetrics (238 x 100)/4,946 = 4.81% Psychiatric (394 x 100)/4,946 = 7.97% Newborn (203 x 100)/4,946 = 4.10% Medical (1,707 x 100)/4,946 = 34.51% Surgery (1,788 x 100)/4,946 = 36.15% All inpatient records (4,377 x 100)/4,946 = 88.50% ED records (160 x 100)/4,946 = 3.23% General clinic records (43 x 100)/4,946 = 0.87% Outpatient/ambulatory surgery records (366 x 100)/4,946 = 7.40%

Using the information in the table below, calculate the cost breakdown per item and the monthly cost for the release of information (ROI) services at Community Hospital.

Postage: $0.76 per request $365/482 = 0.757 = $0.76 per request Service contract: $0.18 per request $85/482 = 0.176 = $0.18 per request Equipment: $0.25 per request $122/482 = $0.25 per request Supplies: $0.19 per request $92/482 = $0.19 per request Wages: $11.50 x 2,080 = $23,920 annual salary $23,920/12 = $1,993 monthly salary $1,993/482 = $4.13 per request Monthly cost: $2,655.82 $0.76 + $0.18 + $0.25 + $0.19 + $4.13 = $5.51 x 482 requests = $2,655.82.

3. An HIM department has eight full-time transcriptionists. Five of them produce 1,000 lines each per day. Of these five, one earns $12.00 per hour, three earn $12.50 per hour, and one earns $13.00 per hour. Two other transcriptionists in the department produce 1,100 lines per day. Of these two, one earns $13.00 per hour and the other earns $14.00 per hour. Finally, the eighth transcriptionist produces 1,200 lines per day and earns $12.00 per hour. a. What is the difference in cost per line between the employee who produces 1,000 lines per day and makes $12.00 per hour and the employee who produces 1,200 lines per day and makes $12.00 per hour? b. What general observations can you make about the unit labor cost and the two employees just mentioned? c. What is the difference in cost per line between the employee who produces 1,000 lines per day and makes $13.00 per hour and the employee who produces 1,100 lines per day and makes $13.00 per hour? d. What is the total unit cost for medical transcription?

Transcriptionist who produces 1,000 lines per day: 0.096 or 10 cents per line $24,960/260,000 = 0.096 or 10 cents per line Transcriptionist who produces 1,200 lines per day: 8 cents per line $24,960/312,000 = 0.08 = 8 cents Both make $12.00 per hour, but one produces 1,000 and one produces 1,200 lines per day. As the production increases, the labor unit cost decreases. Transcriptionist who produces 1,000 per day: 0.10 or 10 cents per line $27,040/260,000 = 0.10 or 10 cents per line Transcriptionist who produces 1,100 per day 0.09 or 9 cents per line $27,040/286,000 = 0.09 or 9 cents per line Total compensation/total productivity The total annual salaries for the eight transcriptionists = $211,120. Students could perform this calculation by either multiplying each of the eight hourly salaries by 2,080 and adding them together or adding the individual hourly salaries and multiplying by 2,080. Productivity could be calculated by either multiplying each individual transcriptionist's production by 5 workdays per week x 52 weeks and adding them together or by adding the total production and multiplying by 5 workdays per week x 52 weeks. 2,184,000 lines per year The total medical transcriptionist's annual productivity = 2,184,000 lines per year. The unit cost = $211,120/2,184,000 = 0.97 or 10 cents per line