Part 5. Reducing the Administrative Burden of Time Studies

Although time studies are essential, they can feel like a monumental task for the ones overseeing the program. Distributing surveys, chasing responses, sending reminders, collecting data, and preparing the annual Medicare Cost Report — it’s a process that can feel thankless.

This part of our series focuses on the administrators, coordinators, and finance teams tasked with overseeing the time study program. We’ve focused on the requirements of time studies and the role of clinicians. Today we’ll zoom out and look at ways to make the time study (and cost report) process more efficient.

BEFORE | Set Up for Success

Unlike direct clinical care, which offers a clear reimbursement benefit, time study administration is often viewed as a necessary chore. It's high-stakes with compliance standards and reimbursement dollars on the line, but many organizations have lacked investment in modernizing and simplifying the process from start to finish.

Some of you may have experienced the time-consuming process as described by this reimbursement professional: 

“Since [the time studies] had to be printed out for our reimbursement team, I would line the entire wall of a building with the different months, and I would start stacking them. Then my reimbursement team required them to be in alphabetical order, and there were 300 people. So then I would sort them. I would be here all weekend, and this would happen once a month.”

CASEY ROWE, DIRECTOR, BARNES-JEWISH HOSPITAL

Administrators can make their lives easier – and increase buy-in throughout the organization — by investing in process improvement. A few professionals manage the program and must get dozens or even thousands of busy clinicians and staff to participate. From designing surveys through following up to aggregating data, the full process is time consuming. And the more manual your procedures, the more time it takes. 

▶ Set up the structure.

The balancing act is to design a time study program that meets compliance needs without burning out the people managing it. Update your process by leveraging technology to save time and effort at each step. 

The first step is designing effective surveys that support your reporting and business goals. (For more information on this, refer to Part 4.)

▶ Select staff members to receive time studies. 

Who needs to complete the surveys? Practitioners typically included in the Cost Report range from physicians and nurses to occupational therapists, administrators, and clinical psychologists. These practitioners should complete the time studies.

▶ Design the schedule.

How often should time studies be collected? CMS requirements detail a schedule of one full week per month. What level of detail is needed for compliance? Can you categorize time under large umbrellas, or do you need more granular assessment? Your answers to these questions help you build the surveys and include the right level of detail, which influences the upfront education needed and the effort required for submitters. 

▶ Deliver surveys conveniently. 

Some organizations still rely on paper forms for time studies, but paper forms raise a risk of getting lost or simply feel like more effort by physicians who have to complete them and keep track of them. Digitized surveys that responders can fill out on desktops or smart devices not only make life easier for respondents but also for those receiving the data. You can easily distribute the surveys, automatically receive responses, and track who completes them.

▶ Incorporate integrations with your tech stack. 

For the most modern solution, integrate your time study platform with other technology platforms you use, such as scheduling platforms or the EMR. This enables you to prepopulate some time fields through these integrations to support real-time completion. This reduces the burden on respondents and improves reporting accuracy.

DURING | Keeping Staff On Task

Whether you call it being a “cat herder” or a “professional nag,” this is one of the greatest challenges of administering time studies. You’ve done your best to make the time surveys as simple as possible, but you still need ensure that the team is following through in a timely manner. 

There is no secret to doing it well: it’s all about clear, timely communication and deputizing others to help carry the load. Following are the key aspects to achieve success.

▶ Upcoming Time Study Alert – Notify each staff member a few days ahead of time for when they are expected to complete time studies. Briefly reinforce the process and expectations about completeness and timeliness.

▶ Intra-Period Reminders – Whether it’s daily or a couple of times during the time study period, a reminder to collect time daily increases accuracy and reduces effort because it’s still fresh. Doing it days later is a lesson in frustration.

▶ Overdue Notification – After the period is complete, if one has not submitted their time study then send a “late notice” and remind them of the deadline. If possible, have this come from a superior, such as the Chief Medical Officer.

▶ Review and Return, If Needed – Once a team member submits their time, review it and ask clarifying questions right away. The best time to make a correction is in the moment, not weeks or months after the fact.

▶ Enlist Support to Enforce – Get help from department leads or administrative assistants who can follow up with respondents. Send them lists of those with outstanding time studies to encourage completion. 

Using automation and standardization can streamline this process. You can program systems to send reminders and notifications. Oddly enough, a depersonalized “system” reminder tends to elicit a response better than if it comes from a co-worker, especially someone not on their immediate team.

Also, being able to monitor completion rates in real time can let you know who might need help, so you can proactively contact them. Administering surveys digitally allows you to feed responses into a larger database, reducing errors associated with manual data entry. This sets you up for an easier time when the Cost Report is due. 

AFTER | Time to Prepare the Cost Report 

Collecting time study data is only half the battle. It needs to be translated into a format suitable for the CMS Medicare Cost Report—accurately, completely, and on time. The entire reason for completing time studies is to allocate wages for the CMS Provider Cost Report Worksheet S-3, Part II, and other wage-related reporting.

As an example, let’s show the basic formula for doing this is for Physician Part A Administrative Time:

Example 1. Formula for converting time study data into Physician Part A wage allocation.

This will be a similar process regardless of whether your wage allocation is for transplant, GME, or paramedical, but the reimbursable time will vary. 

The challenge is gathering the data and running it for all of the staff members who have completed time studies. It’s a daunting task – and oftentimes takes weeks to accomplish when using manual processes. The data entry alone can accumulate to additional weeks of work throughout the year.

Far too many organizations scramble at the last minute to pull together data scattered across paper files or siloed spreadsheets. This not only increases the risk of error but also makes audit defense more difficult. It can take hours or more to track down a cell in a spreadsheet that was entered incorrectly. 

Without a streamlined digital process, many organizations have one person who spends weeks compiling information, tracking down missing data, and manually calculating compensation for each individual for the Medicare Cost Report. 

By structuring data in a centralized database, one purpose-built for time studies, you can significantly reduce manual effort, time spent, and the risk of errors. This allows you to: 

▶ Automatically calculate compensation and export data for easy translation to the Cost Report

▶ Develop a defensible audit trail

▶ Free up days or weeks of accounting staff time

Time saved by automating and streamlining the process, as well as compiling the Cost Report, can greatly contribute to improved job satisfaction. Reducing the time a highly trained professional spends on data entry, which can amount to tens of thousands of dollars per year, allows them to focus on broader solutions for the organization and aids retention.