Academic journal article Journal of Healthcare Management

Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study

Academic journal article Journal of Healthcare Management

Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study

Article excerpt


The Resource-Based Relative Value Scale is widely used to measure healthcare provider productivity and to set payment standards. The scale, however, is limited in its assessment of pre- and postservice work and other potentially non-revenue-generating healthcare services, what we have termed service-valued activity (SVA). In an attempt to quantify SVA, we conducted a time and motion study of providers to assess their productivity in inpatient and outpatient settings.

Using the Standard Time and Motion Procedures checklist as a methodological guide, we provided personal digital assistants (PDAs) that were prepopulated with 2010 Current Procedural Terminology codes to 19 advanced practice providers (APPs). The APPs were instructed to identify their location and activity each time the PDA randomly alarmed. The providers collected data for 3 to 5 workdays, and those data were separated into revenue-generating services (RGSs) and SVAs. Multiple inpatient and outpatient departments were assessed. The inpatient APPs spent 61.6 percent of their time on RGSs and 35.1 percent on SVAs. Providers in the outpatient settings spent 59.0 percent of their time on RGSs and 38.2 percent on SVAs.

This time and motion study demonstrated an innovative method and tool for the quantification and analysis of time spent on revenue- and non-revenue-generating services provided by healthcare professionals. The new information derived from this study can be used to accurately document productivity, determine clinical practice patterns, and improve deployment strategies of healthcare providers.


In 1989, the Physician Payment Review Commission (PPRC) drafted a report for the LI.S. Congress highlighting the need to reform the way in which the Centers for Medicare & Medicaid Services provides payments to physicians. The recommendations centered on the implementation of the Resource-Based Relative Value Scale (RBRVS) (PPRC, 1989). This scale assigns a relative value unit (RVU) to patient care services delivered by healthcare providers. Since the introduction of the scale, RVUs have become a primary method of payment and productivity assessment of health services in the United States (Bergman, 2003). Although it has been extensively studied and determined to be successful in setting payment standards (Bergman, 2003; Committee on Coding, 2008), the RBRVS system has encountered criticism and its application has demonstrated some limitations (Maloney, 1995; Zweifel and Tai-Seale, 2009; Martin et al., 2010; Eggleston, 2005).

In particular, the scale is limited in its assessment of preservice and postservice work and other potentially nonrevenue-generating healthcare services. Dunn, Hsiao, Ketcham, & Braun (1988) describe preservice and postservice as various fragmented, intermingled activities that take place in addition to the total work of a physician. According to Dunn et al. (1988), preservice activities include review of records and professional and family member communication, while postservice work includes documentation of service, observations, development of treatment plans with other professionals, and postprocedure communication with family members. Pre- and postservice activities have been referenced by lacobson et al. (2011) as an influencing factor in determining work intensity of physicians. They indicated that pre- and postservice activities, such as filling prescriptions, interacting with other providers and staff, reviewing records, and making appointments and referrals, are nonbillable actions that contribute to the overall work of physicians and should be taken into account when measuring work intensity. As primary investigators of pre- and postservice work, Dunn et al. identified similar nonbillable activities during the developmental stages of the RBRVS system. In the development of the RBRVS system, the researchers poorly estimated that the added values assigned to pre- and postservice activities were due to the extreme fragmentation and variability of those services. …

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