03.24.2022

How does your agency measure nursing productivity?

With the cost of skilled labor rising quarter over quarter, as we reported in the January issue of The Insider, agencies may be looking to maximize productivity from their clinicians.

Nationally, nursing productivity for the last quarter of 2021 was 4.5 visits per day, unweighted, according to data from The Financial Monitor, SimiTree's industry-leading data analytics and benchmarking tool.

That number showed little fluctuation throughout 2021, according to Brian Martin, Vice President of The Financial Monitor.

“If we measure productivity in terms of number of visits per day, it looks like productivity remained relatively steady overall throughout 2021," Martin said. “But it's important to note that our calculation of productivity is an unweighted visit methodology – meaning we do not assign extra weight for admission visits."

Admission visits typically require additional time for the completion of the OASIS and a comprehensive patient assessment, Martin said.

In addition to extra time for admission visits, factors which can impact the length of a visit - and therefore the number of visits per day – include travel time to reach patient homes, acuity level of the care delivered and many other circumstances.

Measuring productivity

Comparing productivity via number of visits can be tricky, Martin cautioned, because of the variables involved.

“From a comparison standpoint, each agency may be a little different with how they decide to weight visits, which is why we use an unweighted calculation," Martin said.

He offered these basic starting points for agencies looking to measure and compare nursing productivity by visits per day:

  • Calculation should be based on a 40-hour work week, excluding paid time off.
  • Determine the number of available days to work for each employee.
  • Calculate the number of billable visits made on the available days to work.
  • Count billable visits only.

Account for non-productive time

One of the important considerations when reviewing an employee's productivity is monitoring non-productive time, Martin said. Non-productive time is work time when the employee is not available to make home visits because of paid time off for vacations, sick days, or holidays. Non-productive time may also include time spent completing tasks other than home visits.

“This can include taking clinicians out of the field to provide education, keeping them up to date on regulatory items, syncing EMRs, attending in-service meetings or staff meetings, and performing other tasks outside the direct delivery of patient care," Martin said.

“Agencies need to be sure to account for this when analyzing productivity," he said.

Time unavailable to make home visits can quickly add up, impacting an employee's productivity. SimiTree consultants recommend agencies limit the employee's non-productive hours to 20 percent of their time.

“That means 80 percent or more of an employee's time worked should be available for home visits," Martin said.

Don't skimp on documentation

Documentation is not an area in which to shave time, Martin cautions. Accurate documentation is crucial to patient outcomes, quality care and reimbursement.

“Outcomes are still important and should never be sacrificed for greater productivity," he said. “Documentation should always be completed in a timely manner and should meet all regulatory and compliance requirements."

Other productivity considerations

Martin also recommends:

  • Measure productivity at the team level and make employee level detail available for review.
  • Aggregate data over a two-week period for reporting/performance. A longer time period for measurement enables accounting for natural ebb and flow, as when one employee performs several admission visits in a row, creating lower numbers. Unless the employee is conducting only admission visits, the number of visits should even out over time, Martin said.
  • Monitor travel time and proximity of patients. If one clinician sees multiple patients within a few miles of each other and another clinician sees multiple patients all over the service area, there will be disparity.
  • Consider the use of LPNs where applicable to help increase productivity for RNs.
  • Be sure to measure the number of missed visits and be mindful of this when looking at productivity. 

Brian Martin
Vice-President, SimiTree Financial Monitor

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The SimiTree Financial Monitor is an in-depth proprietary financial report SimiTree delivers to subscribers in quarterly increments to enable industry comparisons, benchmarking, and trend identification for stronger and more informed decision making.

The report reflects data from both national and SimiTree client reports.

Read more about The SimiTree Financial Monitor here

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