BEST PRACTICES

Getting your headcount just right

Whether it’s practice-wide or department-specific, here’s how to accurately assess your employee needs.

By Andrew Maller, MBA, COE

How to determine the correct number of staff necessary to meet an ophthalmic practice’s needs is a constant topic I address as a practice management consultant. While the specific questions vary depending on who is asking (owner or administrator) or on the business model type (solo vs. group practice), they often take this shape:

• How many technicians do I need to properly support the number of MDs and ODs in my practice?

• My practice annually generates $5 million in collections; how many billers do I need?

• What is the best way to determine whether I am overstaffed?

These questions usually arise from subjective concerns or observations. To get accurate answers, you need to do some research, network with colleagues and use objective data points for comparators. An effective, objective assessment tool is benchmarking, whereby we can compare the practice’s results to similar or better-performing groups. Three main benchmarking metrics are used to determine staffing efficiency:

1. Staff-payroll ratio: Gross staff wages divided by the practice’s collections during the same time period. (BSM Consulting benchmark range: 20% to 26%)

2. Number of staff per MD/OD (BSM Consulting benchmark range: 4 to 8)

3. Net collections per staff (BSM Consulting benchmark range: $140,000 to $200,000 annually)

I recommend that all practices track these benchmarks as starting points in assessing staffing levels. Scrutinizing these ratios will give practices the objective data points necessary to acquire a better understanding regarding how the practice is performing and if it is appropriately staffed to meet both physician and patient needs. These three metrics assess efficiency, however, at the macro-practice level. To determine if an issue exists in a specific practice area, be it the front or back office or billing department, further analysis is necessary.

DEPARTMENT-SPECIFIC BENCHMARKS

When trying to answer department-specific staffing-level questions in your practice, consider tracking these efficiency metrics:

• Number of front office staff per provider: The front office staff is the first point of contact between patients and the practice. Being staffed properly at the front desk is crucial to overall efficiency and the patient experience. At the front desk, I recommend practices have in the range of one to two full-time employees (FTEs) for each full-time provider (MD or OD). Keep in mind that this ratio can fluctuate based on the roles and responsibilities of the department (i.e., whether the front desk answers the phone) or if patients complete any of the registration process prior to their appointment. Additional responsibilities, such as assisting in completing new-patient paperwork or obtaining pre-authorizations, will require more staff. Consider all these factors when evaluating specific department efficiency.

• Patient workups per hour: Another common question I receive is: How long should it take a technician to work up a patient? Regular surveys completed by my company reveal the average is about 16 minutes. This average is for a new patient receiving dilation but does not factor in additional diagnostic testing, nor refraction. Extrapolated to an hourly rate, this means each technician should work up three to four patients per hour or 12 to 16 patients per four-hour clinic session.

How does your practice compare? To calculate your number, divide the total number of patient visits, new and established, by the total amount of hours worked by all technicians during the same time period. To interpret the results, consider that an average lower than the range (less than three patients per hour) could indicate that the department is overstaffed or it could be a training-related issue. A higher result (more than four patients per hour) could be a sign of an efficient team, but also look for potential complaints from patients or physicians about technicians not being thorough enough. Seeing such a high volume of patients could signal that the staff levels should increase.

This is also a particularly good metric to monitor when adding a new practice-provider. For example, new physicians typically see many new patients, adding increased time for the tech team. Techs should have an appropriate schedule mixture of new and established patients so they can see patients within the national benchmarks.

• Practice collections per FTE billing staff: This metric can be useful in assessing the number of billing staff required to meet practice needs. The results of this metric will vary significantly by practice based on: 1) the scope and responsibility of the billing staff and; 2) specific subspecialty issues. For example, retina practices often have to invest in additional billing staff to manage preauthorizations for intravitreal injections.

Although there is no well-defined benchmark range for this metric, most practices fall somewhere in the range of $1 million to $1.8 million in collections per full-time biller. I recommend using this metric to help determine if a practice needs additional billing staff members when it brings on a new provider. By reviewing the collections metric along with your billing staff’s capacity, you should find that this metric can help answer the “do-we or don’t-we” hire question in an educated way.

THE PATH TO IMPROVED STAFFING EFFICIENCY

I hope you find these ratios helpful in examining staffing efficiencies at the departmental level.

It is important to note that the benchmarks quoted here are not absolute, but are more directional in nature. Practices will want to layer in their current and historical results to identify areas of opportunity to right-size staffing levels to better meet the needs of practice physicians and patients. After all, that is the true purpose of benchmarking. OM

Andrew Maller, MBA, COE, is a principal and consultant with BSM Consulting, an internationally recognized health-care consulting firm headquartered in Incline Village, Nev., and Scottsdale, Ariz. For more information about the author, BSM Consulting or content/resources discussed in this article, please visit www.BSMconsulting.com.