Chapter 1 and 9

Exercise 9.9 An HIM manager must determine the number of FTEs needed to code 750 discharges per week. It takes 20 minutes to code each record. Each coding professional works 37.5 productive hours per week. How many FTEs will the HIM manager need? Round to one decimal place.

20 minutes x 750=15,000 minutes 15,000 minutes/60 minutes in an hour= 250 hours 250hours/37.5 productive hours= 6.67 FTE's needed

Nursing facility

A comprehensive term for long-term care facilities that provide nursing care and related services on a 24-hour basis for residents requiring medical, nursing, or rehabilitative care.

The annual productivity

multiply the amount of work completed (for example, lines transcribed, number of records coded, and such) per day by the number of workdays in the year (5 workdays per week × 52 weeks per year = 260 workdays). Note that this calculation includes any vacation time or sick leave that an employee may take. This is necessary since the amount budgeted for the salary includes paid time off.

Example 9.1: Two full-time coding professionals in the HIM department each code 20 records per day. One employee earns $15.00 per hour and is paid an annual salary of $31,200; the other employee earns $15.65 per hour and is paid an annual salary of $32,552. What is the unit labor cost for these two professionals?

First, determine the annual productivity, by multiplying the number of records coded by the two employees (20 per day per coding professional or 40 per day) by the number of workdays in the year (5 workdays per week × 52 weeks per year = 260 workdays). Note that this calculation does not include any allowance for paid time off. 2(260 WORKDAYSX20 records)=10,400 records coded per year Next, determine unit cost, by adding the two salaries ($31,200 + $32,552 = $63,752). Finally, divide by the total number of records coded by the two employees in one year (10,400). Unit Labor Cost = $63,752/10,400= $6.13 per record

Example 9.2: If an analyst is compensated at $14.50 per hour and analyzes six records per hour, what is the unit labor cost?

First, determine the employee's annual productivity, by multiplying six records per hour by 2,080 worked hours per year. Total Productivity= 6 records/hour x 2080hours/year=12,480 records per year Next, determine the employee's annual salary, as follows: Total compensation= $14.50/hour x 2,80 hours/year= $30,160 per year Unit Labor Cost= 30,160/1,480=$2,416=$2.42 per record

Statistics

First, it is a number computed from a larger group of numbers, which collectively constitute a sample of data—for instance, the average number of days that patients stay in the hospital overnight. Second, statistics is more broadly defined as a branch of mathematics concerned with collecting, organizing, summarizing, and analyzing data.

Provider-patient email:

As patients become more comfortable with emailing their physicians through patient portals, and as healthcare insurers begin to reimburse physicians for their time used to email patients, this will become an everyday issue for healthcare organizations. Email and text messages are considered healthcare business records and thus are subject to the same rules and regulations as any other health record. Facilities will usually make all email messages sent or received part of the patient's medical record. Email can be used to schedule appointments, refill prescriptions, transfer department results, or request that information be sent to other providers. Organizations may decide to keep track of the time spent responding to emails, gathering information before the email is answered, and deciding what can be answered via email

Example 9.7: At Community Hospital, the new HIM director wants to determine the number of employees needed in a coding section. She knows that the average number of inpatient records coded is six per hour. The hospital discharges an average of 65 patients per day. How many FTEs are required for inpatient coding? Assume that the FTEs work 7.5 hours per day and round to two decimals. First, calculate the number of records each FTE can code per day:

(6 records per hour) x (7.5 hours per day) = 45 records Required number of FTE= Number of encounters/productivity rate 65/45=1.44 Round to two decimals: 1.44 FTEs or one full-time employee and one 44% part-time employee. A 44% part-time employee would work 40 hours/week ×0.44 = 17.6 hours per week. Another way to determine the number of employees needed is to calculate how many minutes and hours it would take to perform all the work, then divide by the number of productive hours.

Use the information from number above to determine how many hours it will take to reconcile these denials if each denial takes 1.5 hours to review and resubmit the bill?

1.5 hours x 176 denials= 264 hours

Example 9.4: Your physician clinic's CFO has determined that it costs the clinic $3.50 per telephone call for the receptionist to schedule an appointment with a physician in the clinic, compared with $1.50 per online request to schedule an appointment.

1.What would the per-appointment cost savings be if, during one day at the clinic, 250 patient appointments were arranged by online request rather than by telephone? First calculate the cost of each method: Telephone appointment: $3.50 × 250 = $875.00. Email appointment $1.50 × 250 = $375.00. Calculate the cost savings: Cost Savings: $875.00 - $375.00 = $500.00. 2.What percentage of savings does this represent? Round to two decimals. % Cost Savings: savings/total cost = 500/875 = 0.57142. Convert to a percentage: 0.5714 × 100 = 57.142%. Round to two decimals: 57.14%.

Accurate Transcription Company is taking on your hospital as a new client for a one-month trial period. You report that the average number of transcribed lines per month is 142,500. The daily production standard they require is 950 lines per day per transcriptionist. With 20 workdays in the month, calculate the number of FTEs needed for this volume.

142500/20=7125 lines per day 7125/950 required lines = 7.5 FTE's needed

Example 9.8: An HIM director would like to know how many FTEs are needed to analyze the weekly discharges in her facility. There are 350 discharges per week. It takes one employee 15 minutes to code and analyze one record. Using a productive week as 37.5 (7.5 ×5 days) hours, the director determines that she will need 2.3 employees to analyze the week's discharges.

15 Minutes x 350 records=5,250 minutes 5,250 minutes/60 minutes (in one hour)= 87.5 hours 87.5 hours/37.5 productive hours=2.3 FTE

The supervisor over the coding division in the HIM department at Community Hospital reviewed the productivity logs of four newly hired coding professionals after their first month. Use the information in the table that follows, create an Excel spreadsheet to determine which employee will require additional assistance in order to meet the standard of 20 medical records coded per day.

20 records per day x 5 days x 4 weeks = 400 records to be coded. Coder 1 coded 400 records Coder 2 coded 405 records Coder 3 coded 345 records Coder 4 coded 400 records Coder 3 requires additional assistance

The coding manager would like the denials listed in number 2 reconciled within one month (20 workdays). How many FTEs will the coding manager need?

20 workdays x 7.5 hours= 150 hours 264 hours/150= 1.76 FTE

Community Physician's Clinic is merging with the Medical Center Physician's Clinic. They will be adding 24 physicians who treat 65,104 patients per year. The coding supervisor at Community Physician's Clinic will be responsible for adding credentialed coding professionals to her current staff. The coding professionals will be expected to code 100 clinical records per day. How many more FTEs will be needed to code these records?

65,104 records per year/52 weeks= 1252 per week 1252/5 days a week=250.4 more records per day 250.4 records/100 records to be coded each day=2.5 additional coders

Community Physician's Clinic is a large clinic with 85 physicians. They treat about 9,000 patients each week. Coding professionals are expected to code 100 clinical records each day. How many FTEs are needed to code these records? (Assume a five-day work week and 7.5 hours as a productive day.)

9,000/(100X5)= 9000/500=18FTE The number of FTE's will be the total number of patients divided by the total number of records per week (assume a 5 day work week)

How they use statistics: Cancer registries:

A cancer registry may be maintained by a separate department or may be a function of the health information department. States may also have a state cancer registry that is responsible for collecting data about cancer. A cancer registry collects data about the diagnosis, treatment, and follow-up of cancer patients. These statistics are important in tracking cancer survival rates. Facilities may choose to undergo accreditation through the American College of Surgeons Commission on Cancer. This is an evaluation by an independent team to determine whether the facility's cancer registry meets their standards, which guide treatment and ensure patient-centered care. Statistics must show the facility is providing high-quality care and follow-up to its cancer patients. Physicians and researchers conduct research studies to learn about the biology of cancer, investigate new treatments and tests, and learn how to prevent cancers from occurring.

MCO

A type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care

Hospice

An interdisciplinary program of palliative care and supportive services that addresses the physical, spiritual, social, and economic needs of terminally ill patients and their families

Home Health

An umbrella term that refers to the medical and nonmedical services provided to patients and their families in their places of residence; also called home care.

Calculate the cost per request based on the statistics in the table that follows.

Community HospitalHealth Information DepartmentRelease of Information CostsAverage Requests per Month = 410 Item Cost per Request Postage: $510 per month $510/410 = $1.24 Service contract (includes copier): $250 per month $250/410 = $0.61 Equipment (includes copies): $125 per month $125/410 = $0.30 Supplies (includes toner, printer cartridges, paper): $90 per month $90/410 = $0.22 Wages: $14.00 per hour = monthly salary of $2,427($14.00 × 2,080 hours = $29,120 annual salary, $29,120/12 months = 2,426,66 = $4,427 per month $2,427/410 = $5.92 Total $8.30

Two simple formulas that accurately calculate labor productivity have been suggested

Completed work=Total work output-Defective work and Labor Productivity= Completed work/Time to produce total work output Determining the total work output and the hours worked is clear; however, determining the defective work involves auditing the work for any errors. The manager could perform a review of all the work performed or the manager could perform a review of a fixed percentage of the work chosen through a random sample. The last suggestion is the most efficient. This method requires the manager to select a fixed percentage of an employee's total work for review. The manager also has a predetermined quality standard in mind and then reviews the work and classifies it as completed work or defective work. Additional work could be reviewed if more information is needed to determine the type of defect or until all the work has been reviewed

Secondary data source

Data derived from the primary patient record, such as an index or registry

Vital statistics

Data related to births, deaths, marriages, and fetal deaths

Census

Defined as a survey of a population. The US government conducts a population census; that is, a count of the people residing in the US and their location. The US Constitution requires that a population census be taken decennially (every 10 years), mainly to determine the number of congressional representatives in the states. Over the years, Congress has authorized gathering more information about each person. The census now is used in many ways. For instance, the amount of government money given to school districts is based partly on the number of children in a district. Congress also has requested that other types of censuses be taken periodically. These include a census of the types of businesses and industries in the US; for example, farms and fisheries and construction, foreign trade, manufacturing, and energy companies. Aggregated census data, or data that have been clustered together, are available to the public. Healthcare researchers use the US census when they want to determine statistics about the population at large. For example, if researchers want to show the rate of maternal deaths in a population, they must know information about the size of the population, which the US census provides. Healthcare facilities also have a census, which is the count of patients present at a specific time and place. A hospital inpatient is a patient who is provided with room, board, and continuous general nursing services in an area of an acute care facility where patients generally stay at least overnight. In hospitals, this census is referred to as the inpatient census. The hospital census is a source of primary data. Ambulatory care facilities also may keep a census. An ambulatory care facility is a healthcare facility that provides preventive or corrective healthcare services on a nonresident basis in a provider's office, clinic setting, or outpatient setting. Patients treated in a hospital setting such as the emergency department or clinic are classified as outpatient. The census for this setting usually represents the number of visits or encounters during a specified period, usually one day. A visit is a single encounter with a healthcare professional that includes all the services supplied during the encounter. An encounter is defined as the direct personal contact between a patient and a physician or other person authorized by state licensure and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient.

How they use statistics: Home health (HH):

HH agencies provide care to elderly, disabled, and convalescent patients in their homes. This is also called home care. These agencies keep statistics to determine the types of services used by their patients and their outcomes. For example, a HH agency would need to know the number of nursing visits, HH aide visits, physical therapy treatments, and patients using various types of equipment, such as oxygen machines or other respiratory aids. Additionally, agencies will report patient outcomes, such as the number of patients who have improved, the number of patients who were compliant with taking their medications, or the number of patients who had to be readmitted to a hospital.

Performance improvement activities:

HIM managers will often keep track of the activity in the department to determine if they are meeting their performance improvement targets. For example, the coding supervisor may monitor the number of days it takes the coding professionals to code a discharged record. The HIM department may be responsible for resubmitting claims that have been denied.

Health Information Statistics

Health information professionals can improve processes and procedures by keeping track of common statistics such as employee compensation, unit labor costs, staffing and productivity, and department budgets and verifying statistical reports generated by the HIM department and others. The HIM professional is at the center of all this data and should use the data to help make informed decisions.

Staffing levels

Healthcare organizations use a variety of methods to determine appropriate staffing levels. For example, many outpatient facilities use patient encounters per full-time equivalent employee (FTE) per month. A patient encounter is any personal contact between a patient and a physician or other person authorized to furnish healthcare services for the diagnosis or treatment of the patient. These may include laboratory services, x-ray services, physical therapy, and other ancillary services. The staffing level may be determined by dividing the number of patient encounters by the expected productivity for each FTE. An FTE is the total number of workers, including part-time, in an area as the equivalent of full-time positions. The number of FTEs does not always equal the actual number of employees because two or more part-time employees might equal one FTE. Required number of FTEs=Number of encounters/expected productivity

Inferential statistics

Helps organizations make inferences or decisions about a larger group of data by drawing conclusions from a small group of the population. The smaller group selected from the population is called a sample. The results obtained from the sample, if gathered carefully, are assumed to be representative of the entire population.

Budgets

If you are responsible for supervising a group of employees, you will most likely also be responsible for budgeting. Usually, health information departments are involved with expense and capital budgets. A budget is a plan that converts the organization's goals and objectives into targets for revenue and spending. Planning for the budget begins several months before the facility's fiscal year begins. A fiscal year is any consecutive 12-month period an organization uses as its accounting period. During the planning process, the HIM supervisor uses skills learned in statistics to help approximate the department's expenses for the coming year. Departmental expenses may include employee wages and benefits, supplies, travel and education, membership dues, subscriptions, postage, copying, and equipment maintenance contracts. The HIM department may also generate some revenue for the department, for example, if it is responsible for the ROI activity or provides transcription or coding services for hospital physicians. A fiscal year is a consecutive 12-month period used by an organization as its accounting period. The fiscal year does not have to be a calendar year but must be a period of 12 consecutive months. For example, the US government's fiscal year begins October 1 and ends September 30.

How they use statistics: Healthcare department managers

Individual department managers in healthcare organizations use statistics to implement their department goals. For example, a manager needs to know if he or she is staying within budget. If not, the manager will need to investigate.

How they use statistics: Hospital leadership:

Inpatient facilities use health statistics to help address staffing issues and to determine the types of services to provide. For example, if the number of patients in the intensive care unit is increasing, the hospital administration may want to consider adding beds and staff to meet the growing need. Conversely, if a request is made to the hospital administration for new facilities and equipment that cannot be substantiated by the statistics, it is unlikely the request will be granted. Quality management departments in healthcare facilities collect data to determine how the facility is performing regarding patient care and how it can improve their patient care services. Leaders also use statistics to determine if they have the correct mix of medical specialties to treat the citizens in their communities.

How they use statistics: Nursing facilities:

Long-term care (LTC) or nursing facilities may use statistics to determine the types of payers their patients have. These statistics also are helpful in demonstrating to the public the types of patients being cared for and the quality of care given. For example, an LTC facility will collect data on the number of patients who are incontinent. This will tell the facility if protocols need to be established for patients in order to help them void. The American Health Care Association, a nonprofit association of LTC associations, publishes statistics on the trends in nursing home care.

Loose papers:

Often these are copies of health records sent from other healthcare facilities or prenatal records coming from obstetricians that must be included in the EHR. The number of pieces of paper received in the HIM department for filing is a significant factor in determining staffing levels. Loose papers may be measured in inches or by individual pieces, which is a more accurate measure. Because of the time involved in tracking this information, departments may choose to sample this activity for a one-week period several times a year.

Employee Compensation and Unit Labor Costs

One example of where health information managers must make effective decisions is regarding employee compensation and unit labor cost. Unit labor cost is determined by dividing total annual compensation by total annual productivity. For example, coding workload in an HIM department is commonly measured in number of records coded. To determine the unit labor cost, divide the total annual compensation by the total annual productivity, as shown below: Unit Labor Cost= Total annual compensation/Total annual productivity

National Vital Statistics System

Part of the National Center for Health Statistics (NCHS) of the CDC. These data are provided to the NCHS throughout the 50 states; Washington, DC; New York City; and the five territories of the US—Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. Vital statistics refers to a special group of statistics that record important events in our lives, such as birth, marriage, death, divorce, and fetal death. Healthcare facilities are interested in births and deaths, fetal deaths, and induced terminations of pregnancy to drive quality improvement initiatives. Facilities generally are responsible for completing certificates for births, fetal deaths, abortions, and occasionally, death certificates. All states have laws that require this data. The certificates are reported to the individual state registrars and maintained permanently. State vital statistics registrars compile the data and report them to the NCHS. The NCHS has developed standard certificates and procedures that states and territories must use to facilitate the reliable collection of data. The standard certificates represent the minimum basic data set necessary for the collection and publication of comparable national, state, and local vital statistics data. The standard forms are revised about every 10 to 15 years, and the latest adoption to the 2003 revisions of the US Standards Certificate of Live Birth were completed in 2015. The NCHS is currently working on the development of an e-Vital Standards Initiative that will provide support for the development of vital statistics standards to enable an exchange of data regarding births and deaths from a healthcare facility's electronic health record system directly to the state registrar and then to the NCHS. Data from the states and territories provide important information for use in medical research and are extremely valuable in estimating population growth areas of the country and essential in planning and evaluating maternal and child health programs. The NCHS prepares and publishes national statistics based on vital statistics data because the figures are important in the fields of social welfare and public health. Because of their many uses, the data on these certificates must be complete, reliable, and accurate.

Example 9.10: A new copy machine costs $3,000, and the department will realize a savings of $1,000 per year. Calculate the payback period for the new copy machine. Round to one decimal place.

Payback period= 3,000/1,000= 3.0 years

Favorable variances occur when the amounts spent are less than or equal to the amounts budgeted, as shown in the table that follows. Item BudgetedAmount ActualAmount Variance Supplies $10,000 $8,000 $2,000 Education/training$3,500 $2,000 $1,500

Percent Variance for supplies: Variance amount/budget amount 2,000/10,000= 0.2000 Covert to percentage 0.2000 x 100 = 20.00% Round to one decimal place

Calculate the percentage of denials: The coding department at Community Physician's Clinic developed the following report for the denials committee at the clinic. The billing report shows the following information. Create an Excel spreadsheet to calculate the percentage of denials for each third-party payer category and the total. Round to two decimal places.

Percentage of denials: Medicare: 43 denials x 100 = 4300 4300/460 claims sent= 9.35% Medicaid: 35 x 100= 3500 3500/345= 10.14% Tricare 14x 100= 1400 1400/182= 7.69% Commercial: 83 x 100= 8300 8300/1307= 6.35% Workers comp 1 x 100= 100 100/6= 16.67% Total: 176 denials x 100= 17600 17600/2,300 claims sent= 7.65% denials

What is the Type of Data Source for Health insurance data pulled from national census

Primary data

What is the Type of Data Source for Hospital Census

Primary data

What is the Type of Data Source for Patient Health record

Primary data

What is the Type of Data Source for State vital statistics

Primary data

How they use statistics: Hospice

Provide interdisciplinary programs of palliative care and supportive services that address the physical, spiritual, social, and economic needs of terminally ill patients and their families. These services may be given in either the home or an inpatient setting. A hospice needs to know types of illnesses in order to match the appropriate caregiver with each patient.

To be useful, the data used to calculate statistics must be ________. a.Fair and exact b.Valid and reliable c.Honest and justified d.Simple and clear

b.Valid and reliable

Example 9.6: Community Physician Clinic, a large clinic with 85 providers, experiences 1,500 patient encounters per day. A coding professional is expected to code 150 records per day. Determine the number of coding professionals needed.

Required number of FTEs=Number of encounters/productivity rate 1500/150=10 Hospital HIM departments often use discharges as their method to determine inpatient staffing levels. When computing FTEs, the manager does not ordinarily round up or down to a whole number. For example, the administration may only want to approve a person working 50 percent time (0.5 FTE) if a full-time employee is not needed to perform the work.

How they use statistics: Healthcare researchers:

Researchers depend on healthcare statistics to conduct research and help develop solutions to healthcare problems. Some examples include research in managed care, health law and regulations, mergers and acquisitions of healthcare facilities, physician practice issues, different types of illness and risk factors, telehealth issues, pharmaceutical research, drug and alcohol research, and so on. Healthcare statistics can also help researchers understand our quality of life.

What is the Type of Data Source Productivity reports pulled from patient visit report

Secondary data

What is the Type of Data Source for Hospital disease index

Secondary data

What is the Type of Data Source for Tumor registry

Secondary data

Unit Cost for Release of Information

The Health Insurance Portability and Accountability Act (HIPAA), commonly referred to as the Privacy Rule, allows a facility to charge a reasonable, cost-based fee for any requests for release of information (ROI). ROI is the process of disclosing patient information from the medical record to another party. Federal, state and local regulations exist to govern the release of a patient's medical record information. Time studies would need to be performed in order to validate the cost. The HIM department also may consider nonlabor expenses such as those listed in example 9.3. However, the facility's chief financial officer (CFO) is usually consulted to determine whether other nonlabor costs can be applied. Another aspect that will need consideration is that some health information departments are copying records onto a CD or thumb drive and giving them directly to a patient. This may affect the cost of the ROI. Health information exchanges (HIEs) may also affect the time it takes to answer an ROI request. The health information director should calculate the time needed to transfer the information rather than copy the information.

How they use statistics: Federal government:

The US government collects data for public health issues. For example, the CDC reports data on births, deaths, birth defects, cancer, and HIV/AIDS, just to name a few of the categories of data. CMS uses data collected by quality improvement organizations for its quality improvement projects. Legislators and other policymakers use healthcare statistics when working on new laws, conducting program oversight, and considering the amount of the budget that should be allotted to federal health agencies.

Encounter

The direct personal contact between a patient and a physician or other person authorized by state licensure law and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient

WHO

The international organization founded by the United Nations (UN), is the directing and coordinating authority on international health within the UN's system. This organization is also responsible for a number of international classifications, including The International Statistical Classification of Diseases & Related Health Problems (ICD-10) and The International Classification of Functioning, Disability & Health (ICF).

Descriptive statistics

The primary focus is to organize and describe the features of data in a study. Describe what the data show about the characteristics of a group or population; in other words, they may be used to describe a particular population. For example, it might be necessary to know the average age of patients or which service is used most in a given facility. A database including the age of each patient may be used to calculate the descriptive statistic average age.

How they use statistics: Outpatient facilities:

These include physician clinics, surgery centers, emergency centers, and the like. Outpatient facilities often use statistics to determine whether they are providing the proper level of care to the community.

How they use statistics: Mental health facilities:

These may be inpatient or outpatient facilities. These facilities use health statistics to determine whether they are providing the proper services for patients in the community. Because the economic burden of psychiatric illness is great, the CDC collects data about mental illness and its impact on the country.

How they use statistics: Accreditation agencies:

These organizations use healthcare statistics to determine the most common diagnoses and procedures and whether the resources are available to treat patients with those diagnoses.

How they use statistics: Drug and alcohol facilities:

These programs may be inpatient, ambulatory, or a combination of the two. Statistics are important in this area to show the success rates of these facilities' clients. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism are centers in the National Institutes of Health that each collect statistics to conduct research.

Importance of Data

To obtain the knowledge they need to make decisions, organizations first must determine what data to collect. Data are raw facts and figures that can pertain to a process or activity that an organization is interested in measuring. Information is derived from data for the purpose of making decisions. The data used to calculate these statistics must be valid and reliable. Validity answers the question of whether one measured what one intended to measure, and reliability means that there is some consistency or ability to replicate results. For example, if a supervisor is checking the coding work of a new employee, the codes assigned should be the same for the supervisor as they were for the employee for the results to be considered reliable.

Example 9.9: Determine the percent budget variance for each of the departments listed in the table that follows. Round to one decimal place. Item Budgeted Amount Actual Amount Variance Supplies $3,000 $4,000 ($1,000) Training $1,000 $2,000 ($1,000)

Use the information in the preceding table to determine the variance for supplies is $1,000, or 33.3 percent, over budget. Percent variance for supplies= Variance amount/budget -1,000/3,000= -0.3333 Converted to percentage: -0.3333x 100= -33.33% Round to one decimal place: -33.3% The variances computed above are examples of unfavorable variances; that is, the amounts spent were more than the amounts budgeted.

Example 9.5. Use the information in the table that follows, create an Excel spreadsheet to calculate the inpatient coding productivity for one month.

Work Output: number of work units as recorded by the employee or the process Total Hours Worked: number of hours worked by the employee to produce work, which does not include time for meals, breaks, and meetings Average Work Output per Hour: work output divided by total hours worked Completed Work Percentage: percentage of completed work from audit Completed Work Output: work output multiplied by completed work percentage Completed Work per Hours Worked: completed work output divided by total hours worked

CDC

a division of the Department of Health and Human Services (HHS), is recognized as the lead agency responsible for protecting the health of the US population by providing credible information to help individuals make the right healthcare decisions and promoting quality of life through the prevention and control of disease, injury, and disability. The organization compiles and uses health statistics, such as birth and death statistics, to understand the conditions of life and health in our country.

Agency for Healthcare Research and Quality (AHRQ)

a part of HHS, tries to make healthcare safer; of higher quality; and more accessible, equitable, and affordable. Publishes research-based fact sheets for patients and consumers on a variety of issues, such as patient safety and reducing errors when a patient is in the hospital. Works within HHS and with other partners to make sure that the data and statistics are understood and used. Conducts research on the elderly, children, and various healthcare conditions to provide information to consumers and other HHS agencies so they may meet their objectives. For example, their work around how to reduce readmissions is intended to help hospitals by providing tools to identify causes of readmissions and aid in the development of prevention strategies

How they use statistics: Managed care organizations (MCOs):

a type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care. MCOs use statistics to determine whether they are providing an appropriate level of care and preventive services to their members. Additionally, MCOs contract with healthcare facilities to provide specific services to their members at a prenegotiated rate. The MCO pays the agreed-upon amount each time a member uses the service.

Facilities may choose to pursue accreditation for their cancer registry with the ________. a.American College of Physicians b.American Cancer Society c.American College of Surgeons d.National Institutes of Health

a.American College of Physicians

To be reliable, statistical data must ________. a.Be reproducible b.Be applicable to what is being measured c.Be collected from one source only d.Have multiple meanings

a.Be reproducible

World Health Organization (WHO)

an international organization founded by the United Nations (UN), is the directing and coordinating authority on international health within the UN's system. Provides leadership on critical health matters, works to support countries to ensure all of their citizens have accessible and safe healthcare, and helps prevent the spread of communicable diseases, especially vaccine-preventable diseases. They support good health through the continuum of life and are working toward reducing quality of life disparities among countries. Supports healthcare research in maternal, child, and adolescent health; malaria; tuberculosis; HIV; Ebola; and other global healthcare issues. For example, in 1988, helped launch the Global Polio Eradication Initiative to help protect all children from polio. As a result of this immunization initiative, the number of polio cases has dropped by 99 percent. Today, 80 percent of the world's population lives in polio-free regions.

Secondary Data Sources

are data derived from primary sources and may be reported by someone other than the primary user. For example, the disease and operation index is a secondary source of data. The disease index is a listing of patients discharged with a specific diagnosis code, and an operation index is similar to the disease index, but the patients are listed by the operation or procedure code. All data in the index comes from a primary data source, the health record. Registries are also considered secondary data sources. A registry is a listing of patients who share a common characteristic. For example, data from patients' health records may be used to create a cancer or trauma registry. This is a listing of patients in the facility who have been diagnosed with cancer and will include their treatment information as well as follow-up information.

Examples of healthcare statistics include

average longevity; birth rates; death rates; number of people with a disease in a county, state, the US as a whole, or the world; and the frequency of usage of a particular type of service within a healthcare organization.

The division of HHS that is responsible for administering the Medicare program is the ________. a.CDC b.CMS c.AHRQ d.WHO

b.CMS

The number of inpatients present in a healthcare facility at any given time is called a(n) ________. a.Survey b.Census c.Sample d.Enumeration

b.Census

Which of the following is a secondary use of a patient health record? a.Determining the results of a diagnostic test b.Identifying patients that have a cancer diagnosis c.Recording the health and physician information during an office visit d.Submitting diagnoses and procedures for claim submission

b.Identifying patients that have a cancer diagnosis

The type of statistics that make conclusions about a population by drawing conclusions from a sample is called __________. a.Descriptive statistics b.Inferential statistics c.Generalized statistics d.Mathematical statistics

b.Inferential statistics

Which user of statistics has the primary job of supporting terminally ill patients and their families? a.Home health agencies b.Nursing facilities c.Hospice d.MCOs

c.Hospice

A secondary data source includes ________. a.Vital statistics b.The health record c.The physician's index d.A videotape of a counseling session

d.A videotape of a counseling session

Which of the following is not a primary source of data? a.Health record b.Vital statistics c.Hospital census d.Disease and operation index

d.Disease and operation index

The CDC is the lead agency that __________. a.Accredits and licenses acute hospital facilities in the US b.Is responsible for providing vital statistics to various agencies, such as the NCHS c.Develops and updates ICD-10 for the world d.Is responsible for protecting the health of the people of the US

d.Is responsible for protecting the health of the people of the US

The NCHS keeps statistics on ________. a.The licensing information on all healthcare providers in the 50 states b.Cancer and other deadly diseases in the 50 states and the US-owned territories c.Vital statistics, such as births, deaths, and fetal deaths, in North America d.Vital statistics, such as births, deaths, and fetal deaths, in the 50 states and US territories

d.Vital statistics, such as births, deaths, and fetal deaths, in the 50 states and US territories

An international organization founded by the UN that is the directing and coordinating authority on international heath is called the ________. a.CDC b.AHRQ c.NCHS d.WHO

d.WHO

Which of the following is a primary source of data? a.Inpatient census b.Vital statistics collected by the NCHS c.Health record d.a, b, and c e.b and c only

d.a, b, and c

CDC

division of the Department of Health and Human Services (HHS) that is recognized as the lead agency responsible for protecting the health of the US population by providing credible information to help individuals make the right healthcare decisions and promoting quality of life through the prevention and control of disease, injury, and disability.

The annual compensation

for an individual employee is calculated by multiplying the number of hours worked per year (2,080 for a full-time employee) by the hourly wage and then multiplying that number by the benefits received. Then, add the amount of the benefits to the base salary. A sample calculation follows: (2080 hoursx$15 per hour) x 30% benefits= $31,200 x .30= $9.360+31200=$40560

Health record

h.Record developed by healthcare professionals in the process of providing patient care

Operational Budget

is a type of budget that allocates and controls resources to meet an organization's goals and objectives for the fiscal year. During the year, usually each month, a department director receives budget reports showing amounts budgeted and actual amounts spent. This report generally alerts the department director as to whether he or she is over or under budget. Any differences between the budgeted amount and the amount actually spent are called variances. A budget variance is a disagreement between two figures. The variance can be used as a device to monitor the department's activities. Budgets also may be available on the organization's intranet for viewing at any time. This is an easy way for the manager to stay aware of his or her department's budget. An intranet is a private network that works like the internet but can only be accessed by certain individuals, such as employees of a company. The term variance has multiple meanings depending on the context. In the budget context, variance is the difference between a value and a target. In the descriptive statistics context, variance is a measure of the spread or dispersion of a set of data points. The department director should check the budget report at least monthly to determine whether any adjustments must be made in order to stay within the budget. Often the director may be required to explain budget variances if the department is over or under budget. This assessment of a department's financial transactions to identify differences between the budget amount and the actual amount of a line item is called a variance analysis. To determine the percent variance, subtract the budgeted amount from the actual amount and then divide the difference by the budgeted amount.

Capital Budget

is allocation of resources for long-term investments and projects. It accounts for the major assets the facility will purchase during the fiscal year; for example, equipment for the HIM department or a new CT machine. Capital budget items usually are "high-dollar" purchases. Each facility defines what "high-dollar" means. For example, one facility may consider any assets purchased at a cost of more than $500 to be part of the capital budget. Moreover, items included in a capital budget usually have a "life" of more than one year; that is, each item's usefulness should last longer than a year. Health information professionals are usually involved in assisting the department director in a cost justification for the capital budget. This is very important because only a certain amount of dollars can be allocated to the facility's departments and supervisors who wish to have their projects approved. The department director may ask the supervisor to calculate the payback period of the project. The payback period is a financial method used to evaluate the value of a capital expenditure by calculating the time frame that must pass before inflow of cash from a project equals or exceeds outflow of cash. The formula is as follows: Payback period=Total cost of the project/annual incremental cash flow The annual incremental cash flow refers to the savings that a department realizes from the project. For example, if the HIM department needs a new copy machine, the department director may ask the department supervisor to determine, first, how much a new copy machine costs, and then, what kind of savings would be realized from the purchase of a new machine. The supervisor would investigate the cost from different vendors and then calculate an estimate of the savings. Savings considerations might include the time not spent recopying pages, fixing the copy machine, or releasing papers trapped in the machine, as well as the cost of additional paper.

Productivity

is defined as a unit of performance defined by management in quantitative standards. Productivity allows organizations to measure how well the labor is converted into a product or service. Most HIM departments have productivity standards for different areas in the department. For example, in the coding section, a productivity standard may be that employees should code four inpatient records per hour. In a 7.5-hour workday (considering breaks the employee will take), 30 inpatient records would be coded per day. But how does the HIM manager or supervisor know how many records should be coded in a day? Several factors influence this decision. Some things the supervisor should consider are as follows:. •Does the coding professional do anything in addition to coding, such as abstracting, answering the phone, or querying the physician for additional information about the diagnoses and procedures? •What kinds of records is the coding professional coding? Are they long or short lengths of stay? Are they complex or relatively simple cases to code?

CMS

is the division of HHS that is responsible for administering the Medicare program and the federal portion of the Medicaid program. Publishes information on death rates among Medicare patients, and patients in diagnosis and procedure categories. Researchers use this information for studies, which may lead to improvement in patient care and services.

Statistics computed for use within the health information management (HIM) department usually relate to

labor costs, productivity, and staffing and often are used in determining whether the department may be able to hire a new employee, set benchmarks for productivity, determine absentee rates, and so on.

primary data source

refers to the record that was developed by healthcare professionals in the process of providing care or services to a patient. Health records are one of the most important primary sources of health statistics because they contain a systematic record of a patient's medical history and care. The patient's health record contains administrative data, such as admission and discharge dates, patient data, and billing data, as well as clinical data. Notes from physicians, such as orders, progress notes, operative reports, history and physical examination, and a discharge summary, may be included. Nurses' documentation includes their notes and assessments on admission and throughout the hospital stay and medication records. Reports from clinical departments in the facility, such as laboratory, blood bank, radiology, pharmacy, rehabilitation services, and dietary services, may also be included in the health record. Hospital departments also keep statistics on the activities they perform for patients. For example, the laboratory department may keep data on the number of lab tests performed. The radiology department may keep track of the number of chest and hip x-rays. The physical therapy department may use statistical data, such as the number of patient visits, to decide whether to hire additional physical therapists or add physical therapist assistants to their staff. These reports may be used in turn by the managers of the departments for productivity measurement and combined with other departments to produce a report of activity for the entire facility. The administration of a hospital might ask staff to keep data on the number of patients transferred to another hospital for procedures the facility does not offer in order to determine the need for that service at the facility. Another example of a primary source of data is vital statistics. Another primary source of health data is the census.

Unit Cost for Release of Information Some activities involved could be the following:

•Looking up the patient in the master patient index •Keeping track of the time it takes to review and log the request •Determining the location of the health record, either paper or electronic •Determining whether other departments have portions of the medical record and have possibly made a disclosure •Retrieving the record if it is a paper record or locating the record online and printing any scanned documents •Preparing an invoice for the patient •Updating the release of the information log

Scanning of records: Some facilities choose to scan the paper record to make it available online. These facilities may have an electronic document management system to help manage all their documents for a patient. This technology allows users to do the following:

○Scan documents ○Move documents from other systems to the electronic health record (EHR) ○Enter information online ○Handle the electronic signature of records, which is any representation of a signature in digital form, including an image of a handwritten signature ○Allow text-editable deficiencies, which are those that a physician or other healthcare practitioner can enter through the computer or mobile device to make changes to a specific document ○Index documents as they are entered into the computer system ○Access information from a variety of locations ○And more The main calculations for this function are productivity and quality. These are regularly computed and used for staffing issues and benchmarking. New technologies will continue to evolve, and managers in health information departments will continue to determine the costs and benefits of these new systems.