Rethinking Productivity Measurement

radiology tech helping patient into mri
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Rethinking Productivity Measurement

Pat Kroken, FACMPE, CRA, FRBMA
November/December 2021 RBMA Bulletin

This is a fictionalized story of a too-real challenge we face as the emphasis on productivity mounts and we have to decide who gets to continue playing—or not.  The tale is, however, relevant as groups adjust to shifting business patterns over the past couple of years.    

It was shaping up to be a rough week.  Rebecca, the operations manager at Superior Imaging, just received a call from the corporate office.  Annual operating costs and revenue projections were in review and productivity had been under close scrutiny for more than a year.  

Procedure volumes declined precipitously due to COVID-19, cost reductions were mandatory and now Rebecca was challenged with a decision about who stays and who goes, with a directive to cut MRI tech staffing by one person at the end of first quarter.  She flipped through the personnel folders and productivity reports for two people—Debbie and Maria.

Debbie practically launched off the page in terms of her productivity numbers.  Compared to national benchmarks, she was well above the 75th percentile and was a consistent flurry of activity.  Debbie moved on “fast forward” at all times and had received consistent pay increases over the past three years for hitting productivity goals.

Maria, on the other hand, scored right at median levels in productivity measurement and as much as she had been counseled, just couldn’t seem to improve her numbers. It wasn’t that she was unpleasant or unwilling either.  She was conscientious, dependable and consistent—just not fast enough.  Rebecca’s instincts told her Maria was an excellent technologist and at least as good as Debbie.   The pressure from corporate, however, was to terminate Maria.    

Productivity and Scheduling

When it came to the number of patients scanned per day, Debbie’s averages set the pace and Maria trailed behind—every week, month and year.  While looking at the procedure trends, Rebecca noted there were also fewer cancellations over the past couple of years and no studies had been started and uncompleted due to claustrophobia, previously a consistent cause of “lost” time blocks. 

As Rebecca reviewed the cancellation/lost scan trends, she decided to see if there was any link to the techs.  The schedulers were also interviewed regarding these improvements and asked why they felt the number of billable scans had improved.  They knew the answer.  As patients were screened for claustrophobia and other contraindications, they were carefully routed.

Claustrophobic patients were scheduled with Maria, since she seemed to have a knack for talking them through the studies and keeping them on the table when others failed.  The schedulers, who were also under scrutiny for the effectiveness of their work, knew cancellations brought them into the bright light and worked to minimize the impact of insufficient screening. 

The bottom line:  Maria received the tough cases in terms of patients who demonstrated anxiety due to claustrophobia.  But how could Rebecca verify that?  There weren’t reports breaking down successful scans by type of patient, although the center did verify when cancellations or rescheduling occurred due to claustrophobia. 

Patient Satisfaction

The answer began to fill in as Rebecca reviewed feedback from two years of patient satisfaction surveys.  Patients actually referred to Maria by name, with one woman stating:

“I was so scared about my MRI, especially since I freaked out the last time I had one and had to quit.  Maria was wonderful!!!  She talked to me before the exam and told me everything that was going to happen and what all of the sounds meant.  She told me the medication would help a lot, had me select music and then talked to me about slowing down my breathing and relaxing as I went into the scanner.  We did it!” 

Maria not only received high marks from her patients, she got fan mail and there were consistent testimonials regarding her patient interactions and compassion.

Debbie didn’t fail when it came to patient satisfaction, but definitely had more median responses and there were several examples of patients stating they felt rushed and/or that she viewed them as numbers rather than people.  If patient satisfaction were the only indicator, Maria would be a “10” and Debbie a “5,” exactly the opposite of the productivity results. 

Billing and Denials

Rebecca then progressed to the billing manager.  “I know you interact with the MRI techs sometimes and wondered if you could tell me what that’s like.  Are they helpful and easy to work with?”  She wasn’t quite ready for what she heard. 

“I’d love to talk to you about your techs,” Barbara answered.  “If they were all like Maria, this would be a great place to work but I end up knocking heads with Debbie all the time and unfortunately, she’s the one I talk to the most.  We get almost no cooperation from her whatsoever and her coding denials cause us problems every week.”

When asked for specifics, Barbara was quick to identify them:

Maria was meticulous about providing information about indications for the study and if not included on the referral, she talked with the patient to gather more information and then communicated it to the radiologist reading the exam.  As a result, the dictation related to Maria’s procedures was more complete and exams were either paid the first time or easily appealed. 

In contrast, Debbie entered scant (or no) information into the radiology information system and her denial rates escalated as a result.  While the staff might eventually track down appeal rationale from the referring physician office for Debbie’s denials, there were delays obtaining payment and more person-hours expended to get there. 

Maria and Debbie also had wide variances in other data quality issues, including entry of accurate procedure codes, advanced beneficiary notice (ABN) information and codes for locum tenens physicians.  

From Barbara’s standpoint, it appeared Maria was not only more careful with accuracy on the front end but appeared to double-check her work.  Barbara estimated Maria’s accuracy rate at 99.9% and Debbie’s at 65% at best. 

Anecdotal Support

Rebecca decided to hang out in the imaging center for a couple of days to watch interactions among staff members.  Debbie was her usual whirlwind of activity, quickly moving her patients down the hallway and back out the door when the exam was done.  There were numerous sticky notes on her workstation regarding information she didn’t have time to enter between studies and cryptic abbreviations about which patients were involved.  Hopefully the correct information would be entered later in the day. 

A new front desk staff member was shadowing Maria for the afternoon to learn more about terminology and the “how to” of an MRI scan.  Maria was explaining the difference between the types of sequences and the specific preferences of the radiologist on site for the week.  At the same time, she kept up a conversation with an elderly patient in the scanner and then steadied the arm of the woman to help her back to the dressing room.  The patient stopped to thank Maria for her kindness and patience.  Debbie whizzed by twice during this interaction. 

Rebecca also noticed Debbie dropped off a notebook to Maria and asked her to update the tech credentials section.  Rebecca asked about the assignment, since Debbie was officially charged with maintaining accreditation documentation.  Maria said she really didn’t mind helping, since Debbie didn’t like the paperwork and sometimes had problems keeping things organized—and Maria liked these kinds of duties.

Rebecca then dropped into the reading room to get the perspective of the radiologist.  Not wanting to tip her hand, she told him she was reviewing technologist performance and thought his input would be helpful.  She asked if there were specific differences working with Debbie and Maria in particular and commented on Debbie’s high production numbers.  The radiologist agreed Debbie was very fast and few people could move patients through as quickly.  However, he said Maria was more thorough and followed protocols more accurately.  And she was his “go to” person when problems cropped up—even if they weren’t related to her patients.  She was very good at smoothing ruffled feathers with a referring physician or office staff when things went wrong with a study. 

What does this tell us about productivity?

As managers, we struggle with maximizing production and minimizing cost and reimbursement pressures have only increased the problem.  There is probably general agreement that productivity measurement is not only helpful, but essential.  The risk is relying on simply one indicator when evaluating performance.

Rebecca’s view of her technologist staff led her to an instinctive feeling for Maria’s value as a tech.  Had she relied solely on productivity as measured by the average number of cases per scanner per day, she would have concluded Maria just wasn’t cutting it in terms of production.  When combined with other interrelated factors, including whether other jobs were made more complicated by technologist behavior, the picture changed dramatically.

Rebecca summarized her findings and submitted a report to the corporate office.  What do you think they decided to do?  What would you do? 

Patricia Kroken, FACMPE, CRA, FRBMA,
has an extensive background in radiology practice management and directs education and corporate communications for MSN Healthcare Solutions

She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.

She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management. 
Pat can be reached at pat.kroken@msnllc.com
or 505-856-6128

headshot of Pat Kroken Director of Education and Corporate communications, MSN Healthcare Solutions