The Return of the Soup Nazi

This is the second installment of a series on staffing your HMG:

So, how do we determine the number of HOURS to cover per year, month, day, etc…?
This should be left up to the individual practices. One way to determine the staffing model is based on  the threshold encounter volume concept.

If the threshold encounter volume is 16 encounters per day per physician, this means that a physician should RARELY to NEVER be responsible for more than 16 patients per day.
This does not mean 16 is the average number of encounters per day for each physician. Here’s where the conversation with Finance gets tricky.
Given the variation in admission volumes seen over the course of a year, month, day of week, etc., the hours staffed is dependent on several variables:
1.) Hourly admitting cycles
2.) Day of week admit volumes
3.) Threshold volumes
4.) Revenue targets
Here’s how to estimatate staffing based on threshold encounters (see Figure 1). The figure below shows the actual daily volumes for a hospitalist program in May 2010. On the Y axis is number of patients. On the X axis is day of the month. On the Right Axis are various levels of FTE Physicians that could be employed by the program. The orange threshold lines for each level of program FTE correspond to the 14 patients per provider threshold. The red threshold lines for each level of program FTE correspond to 16 patients per provider. The dark blue area represents the AM census for the group. The light blue area represents the number of new admissions to the group that day. These two areas together represent the total number of patients seen by the group per day.
Figure 1

FIGURE 1 HMG DAILY CENSUS BY THRESHOLD VOLUMES PER PROVIDER

Follow the orange hashed line next to the 10 FTE mark. One can see that for the majority of days in May, the physicians started their day with more than 14 patients each. The hashed red-line just above this shows the number of days where the AM census was above 16 patients per provider.
Note that on 4 days in MAY, with a staffing level of 10 FTEs, the physicians were responsible for 16 patients each at the beginning of their shift. When adding the number of admissions to the group (the light blue area), one can see that for every day in MAY, the physicians saw more than 16 patients each.
Now, follow the 12 FTE mark at the orange solid threshold line. At this level of staffing, the group exceeded the 14 patient threshold only one day in May, but after adding in the number of admissions, they exceeded the 14 patient threshold every day in May and exceeded the 16 patient threshold 11 days in May. At the 14 FTE mark, the physicians start their day below their risk threshold on every day but one and never exceed the risk threshold of 16 patients.
Based on this data, the appropriate staffing level for this group is 13 FTEs. This group chose a model with 4 daytime physicians who work a 7/7  schedule in 12 hour shifts (48 hours per day).
So what about the other FTEs?

I will cover that topic in the next installment.

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