Part 4. Keys to Increasing Time Study Participation Rates
Physician and staff participation is the Achilles heel of most hospital time study programs. Clinical staff – and even administrators – can see time studies as one more obligation in a sea of reporting tasks. Yet, having physicians participate fully can lead to significant increases in reimbursement reaching into the millions of dollars for Physician Part A, transplant organ acquisition, and other areas.
It’s not that clinicians don’t care about the implications of time studies, they’re simply overwhelmed. Healthcare worker burnout is reaching all-time highs, with many choosing to retire early because of the growing demands on their time. With just a few changes to your process, you can increase participation by relieving the burden.
Matching the strain on healthcare workers is an equally critical pressure on a hospital’s bottom line. This is why maximizing Medicare reimbursement can make a huge impact. As we showed earlier in this series, we covered why accurately capturing the wage allocation for Part A and Transplant time makes a material difference, and participation rates are the crux of it. Increasing participation rates from 60 percent to 85 percent can yield millions of dollars.
Time study participation rates are a problem worth solving, and improvement is imminently achievable. The process is intuitive (or use the MBA term of “change management”) that boils down to a few key principles as follows:
Your organization likely already understands the financial stakes. The question becomes, how do you drive greater participation in the time study program? The following are six strategies to drive up participation in time studies.
1. EDUCATE | Share the “Why”
An additional administrative task disconnected from a clear “why” doesn’t motivate or inspire compliance. Be sure your team knows why they are asked to complete the surveys. These are educated people, so invest some time in giving them information, which can pay dividends.
Ventura County Medical Center sought to improve participation for a specific aspect of its time study program. They focused on teaching and instilling accountability. Leadership sent a letter with FAQs that provided instructions for completing the survey, but also detailed the funding implications for not capturing this data and emphasized that participation is part of the job. The medical center even went so far as to quantify that, without participation, the organization could have lost $1 million in the previous year in graduate medical education (GME) funds.
Could you clarify how this reimbursement contributes to hospital operations, staffing, training, and compensation packages? Tying the additional income to investments in headcount, equipment, charitable care, or another key resource earns their buy-in. Ensuring physicians understand these consequences and benefits increases the willingness to complete their surveys.
2. EXECUTIVE SUPPORT | Win Leadership Backing, Especially the CMO
Having buy-in at the C-suite level supports efforts by the finance department to increase participation and promote accountability. Communication from the Chief Medical Officer (CMO) can go a long way to underscore the importance of completion for physicians. In some hospitals, the CMO or Medical Director needs to review and approve time studies. While not workable for all organizations, it is easy to see that participation rates would be much higher in this situation!
Other organizations make completing time studies part of a physician’s job requirements, which has to be instituted and supported from the top down. Referring once again to VCMC, the FAQ makes clear to physicians that completion of the time study is required.
3. EASE | Reduce Friction in the Process
Once you have cultural buy-in and an understanding of the “why” behind time studies, you still need to make sure the process is easy. Make completing a time study instantaneous, intuitive, and accessible.
Some hospitals go beyond what’s necessary for the cost report through time study surveys. (While you have their attention, why not?) Asking unnecessary questions or making the survey needlessly long discourages participation and, in turn, the amount of data you can collect.
To reduce friction and increase compliant responses:
4. TIMELINESS | Encourage Real-Time Completion
The human memory is fickle, and the more time that passes between the desired reporting period and the actual reporting, the higher the probability of mistakes, as well as making the task exponentially more challenging.
Ideally, a time study participant can complete a simple 1-minute survey the same day. It is possible, but that is only possible with the scaffolding of a rock-solid process to communicate and provide reminders.
Set deadlines upfront and communicate them clearly in advance.
Send encouraging and persistent reminders when a survey period is underway to keep the reporter on top of it.
If time reports are overdue, alert them right away that they are required to report.
Automate the reminders so a staff member isn’t burdened to send them, plus “system notification” is far less intrusive than a personal message.
A process that can monitor participation in real-time also helps identify those who are behind and those who consistently lag. This allows for more personalized follow-up and avoids sending unnecessary notifications to those who report on time.
5. INCENTIVES | Drive Team Participation
Keeping time studies at the top of one’s mind is a constant challenge, so some organizations have found creative ways to drive up participation rates. Some fall into the “carrot” category, whereas others are “sticks.”
Positive reinforcement for achieving targets, for example, 100 percent participation, could earn a person or a team a prize. Mike Polito, Third Party Reimbursement Solutions, LLC, said he has seen organizations provide successful teams with pizza parties, monetary rewards, golfing events, or other signs of appreciation.
Another simple technique is publishing or posting the team’s results on a bulletin board without comment. Because many folks in healthcare have a competitive streak, it would stand to reason that no one would want to be at the bottom of any list.
Finally, if results are poor, an organization might have to consider other options. Examples of this include making time study completion rates a standard that is included in annual performance reviews. In cases of a contractor, make time studies a contractual requirement for their payment as part of their agreement.
6. ACCOUNTABILITY | Urge Accurate Time Capture
While this may not move the needle on participation, accountability can provide a check on accuracy and completeness, critical factors in a successful time study program. Using strong language in the attestation of the time study is an overlooked but useful technique.
For example, stating that the submitter has “accurately and truthfully” reported time in accordance with the organization’s code of standards or ethics will serve as a reminder of the gravity of their signature. So if someone was tempted to put in a week’s worth of 8-hour blocks of “Patient Consultation,” they might think twice before signing their name on the dotted line.
Physician time studies don’t need to be a significant burden. Refining your program to prioritize efficiency and user experience can unlock more reimbursement while reducing the administrative burden for those reporting their time as well as for finance professionals. 
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