Calculating and reporting healthcare statistics answer key

HEALTHCARE STATISTICS

Healthcare Statistics By

Jacqueline K. Wilson, RHIA

About the Author

Jacqueline K. Wilson is a Registered Health Information Administrator (RHIA) who has more than ten years of experience consulting, writing, and teaching in the health care industry. She’s a professional writer who has authored training manuals, study guides/materials, online courses, and articles on a variety of topics. In addition, Ms. Wilson develops curricula and teaches both traditional and online college courses in health information technology, anatomy and medical terminology, and standards in health care. In 2005, she received the distinguished national award of being included in Who’s Who Among America’s Teachers.

Copyright © 2012 by Penn Foster, Inc.

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Printed in the United States of America

11/3/14

All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text should not be regarded as affecting the validity of any trademark or service mark.

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INSTRUCTIONS TO STUDENTS 1

LESSON ASSIGNMENTS 5

LESSON 1: UNDERSTANDING HEALTHCARE STATISTICS 7

LESSON 2: COMPILING AND PRESENTING HEALTHCARE STATISTICS 25

RESEARCH PROJECT 51

SELF-CHECK ANSWERS 57

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INTRODUCTION

Statistics are used in a wide variety of fields, including business, academics, science, government, and of course, healthcare. Individuals and organizations use statistics to interpret data and make informed decisions based on those interpretations. As you’ve probably guessed, statistics play a very important role in the healthcare field, since they have a great impact on the types and quality of healthcare services offered to patients.

No matter what career you choose within the field of health information management, you’ll likely deal with statistics regularly. Therefore, this course provides an overview of the basic types of healthcare statistics and describes how this information is used within the healthcare industry.

OBJECTIVES

When you complete this course, you’ll be able to

n Apply basic statistical principles

n Define data elements for institute-wide collection

n Calculate and report institutional healthcare quality indicators

n Calculate routine institutional statistics, such as length of stay, death rates, autopsy rates, occupancy rates, bed turnover rates, and morbidities

n Prepare and present research data

n Distinguish between descriptive statistics and inferential statistics

n Explain percentage of occupancy

n Analyze patient data with quality improvement tools

n Design reports using database information

n Perform statistical analysis of patient information

n Participate in committees utilizing health record information

YOUR TEXTBOOK

Your textbook, Calculating and Reporting Healthcare Statistics, Fourth Edition, by Loretta A. Horton, contains the material on which you’ll be tested. You need to become familiar with this textbook prior to beginning your course. Begin by reading the contents on page iii. This will give you an overview of the entire textbook. Appendix A begins on page 263 and lists all the statistical formulas discussed in the textbook, along with the corresponding page number references. Appendix B begins on page 271 and is a complete glossary of health- care services and statistical terms. Following Appendix C is an index on page 323.

YOUR STUDY GUIDE

This study guide is intended to be used as a supplement to the textbook. Therefore, it shouldn’t replace your textbook reading. The study guide is designed to follow the topics in your textbook, so it’s arranged in an outline format based on the textbook headings and subheadings.

Each assignment in the study guide lists the page numbers of the corresponding assignment in the textbook. When you approach each assignment, you should first read the infor- mation in the study guide and then study the corresponding assignment in the textbook. The study guide provides an overview of the information in the textbook and highlights important passages that you should examine carefully. If you don’t understand a topic or section in the textbook, take the time to reread the information. Because much of the material discussed in this course will be new to you, it’s natural that you may need to read some sections more than once.

Throughout your study guide, you’ll come across small sec- tions of text that are set apart from the main text material. These sidebars are included to provide additional information, to suggest readings, and to clarify or emphasize important points. Whenever you see one of these sidebars, refer to the corresponding passage in the textbook to be sure you fully understand the material presented.

Instructions to Students2

COURSE MATERIALS

This course includes the following materials:

1. This study guide, which contains an introduction to your course, plus

n A lesson assignments page with a schedule of study assignments as well as exams for the two lessons you’ll complete during this course

n Assignment lessons emphasizing the main points in the textbook

n Self-checks and answers to help you assess your understanding of the material

2. Your course textbook, Calculating and Reporting Healthcare Statistics, which contains the assignment reading material

A STUDY PLAN

As mentioned, you’ll use two texts for this course: Calculating and Reporting Healthcare Statistics and this study guide. For each lesson in this course, follow these steps:

Step 1: Carefully note the pages where your assigned read- ing begins and ends. These pages are identified in the Lesson Assignments section of this study guide.

Step 2: Skim through the assigned pages (in both the study guide and the textbook) to get a general idea of their content. Try to develop an overall perspective on the concepts and skills being taught and practiced in each assignment.

Step 3: Carefully read through the study guide’s assigned pages. These pages contain background informa- tion about the material covered in the textbook.

Step 4: Study the assigned pages in your textbook, and take notes on any important points or terms that you feel are especially significant.

Instructions to Students 3

Step 5: Complete the self-check exercises at the end of each assignment in the study guide. You don’t have to send any of the answers to the school. These exercises are intended for your personal use in evaluating and directing your progress.

Step 6: When you feel you’ve mastered all of the material presented in each assignment, complete the exami- nation at the end of each lesson.

Instructions to Students4

Lesson 1: Understanding Healthcare Statistics For: Read in the Read in

study guide: your textbook:

Assignment 1 Pages 7–10 Pages 1–7

Assignment 2 Page 11 Pages 9–20

Assignment 3 Pages 12–14 Pages 23–39

Assignment 4 Pages 14–15 Pages 43–54

Assignment 5 Pages 15–18 Pages 57–67

Assignment 6 Pages 18–19 Pages 71–91

Assignment 7 Pages 20–21 Pages 95–109

Assignment 8 Pages 21–23 Pages 115–133

Examination 409411 Material in Lesson 1

Lesson 2: Compiling and Presenting Healthcare Statistics For: Read in the Read in

study guide: your textbook:

Assignment 9 Pages 25–29 Pages 137–165

Assignment 10 Pages 30–35 No textbook reading

Assignment 11 Pages 35–42 Pages 171–191

Assignment 12 Pages 42–45 Pages 195–225

Assignment 13 Pages 45–47 Pages 249–257

Assignment 14 Pages 48–50 Pages 227–245

Examination 409412 Material in Lesson 2

Research Project 40941300

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Lesson Assignments6

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Understanding Healthcare Statistics

INTRODUCTION

Healthcare statistics come from a number of different sources, and they’re used by many organizations within the health- care field. As you’ll learn in this lesson, your role as a health information management professional is to familiarize yourself with the types of statistics available and to use that information to better serve the patients within your healthcare facility.

ASSIGNMENT 1: INTRODUCTION TO HEALTHCARE STATISTICS Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 1–7 of your textbook, Calculating and Reporting Healthcare Statistics.

The Importance of Healthcare Statistics

Statistics play an important role in all aspects of health infor- mation management. They provide information that’s essential to the quality, prioritization, effectiveness, cost, and reimburse- ment of patient care. For example, population statistics inform healthcare facilities about the types of services needed for patients in their area. Statistics from patient surveys help healthcare facilities improve their levels of service. Statistics from the Centers for Disease Control and Prevention (CDC) provide important information about contagious diseases and how they’re controlled.

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Nationwide, healthcare statistics allow facilities to identify trends and collect information regarding different groups within the population. According to the National Center for Health Statistics (NCHS), healthcare statistics allow facilities to

n Document the health status of the population and of important subgroups

n Identify disparities in health status and the use of healthcare by race, ethnicity, socioeconomic status, religion, and other population characteristics

n Monitor trends in health status and healthcare delivery

n Identify health problems

n Support biomedical and health services research

n Provide information regarding changes to public policies and programs

n Evaluate the impact of health policies and programs

Who Uses Healthcare Statistics?

Each department within a healthcare facility relies on infor- mation from healthcare statistics. In a hospital, for example, administrators use healthcare statistics to analyze the costs of patient care and to create opportunities to introduce cost- saving measures. Nurses use statistics to keep track of the types of patients they treat and the frequency with which they treat them. These statistics help nurses with supply orders and staff schedules.

The use of healthcare statistics isn’t limited to patient care facilities. For example, government agencies maintain health- care statistics to determine which coverage services are needed and to identify specific areas of outbreak within the population. National registries, such as cancer registries, collect information about the available treatments and survival rates for diseases. This information affects federal funding for research and vaccine development.

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Your Role in Healthcare Statistics

Gathering, maintaining, and storing information is an important role for health information management (HIM) professionals. According to Mervat Abdelhak, the president of the American Health Information Management Association (AHIMA), “As the healthcare industry moves further into the information age, the role of the HIM professional is becoming even more critical. The move from paper to electronic health records will help doctors make important healthcare decisions on a real-time basis, but these decisions will rely on secure access to clear, concise, accurate, and easy-to-understand information.”

As a health information management professional, you’re required to gather and analyze healthcare statistics. You may be responsible for reporting on a variety of statistics needed by your facility and by outside organizations. Most of the information you’ll gather will come from the ICD-9-CM and CPT coding manuals. Other statistical information you may be responsible for as an HIM professional includes data related to

n Birth and death records

n Health records

n Interview surveys

n Cancer rates

n Poisonings

n Accidents

n DRG case mixes

n Transcription errors

Types of Statistics

As your textbook describes, the two main types of statistics are descriptive statistics and inferential statistics. Descriptive statistics summarize and describe a collection of data. Inferential statistics identify patterns in seemingly random

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data and draw conclusions based on that information. They also help people make observations about the processes or population being studied.

Inferential statistics are derived from a random sample of a particular population or a random process that’s observed over a finite period of time. These statistics are based on probability and include the following techniques to draw conclusions from data:

n Point estimation

n Interval estimation

n Hypothesis testing

These techniques will be discussed in depth later in this course.

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 1.

Self-Check 1

At the end of each section of Healthcare Statistics, you’ll be asked to pause and check your understanding of what you’ve just read by completing a “Self-Check” exercise. Answering these questions will help you review what you’ve studied so far. Please complete Self- Check 1 now.

Complete the Chapter 1 Test on pages 7 and 8 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 57.

Lesson 1 11

ASSIGNMENT 2: MATHEMATICAL STATISTICS REVIEW Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 9–20 of your textbook, Calculating and Reporting Healthcare Statistics.

Chapter 2 in your textbook serves as a review of the basic mathematical principles used in statistics. You should be familiar with each of these processes. Be sure to review the entire chapter to gain a thorough understanding of each of the following mathematical expressions:

n Fractions

n Quotients

n Rounded numbers

n Percentages

n Ratios

n Rates

n Averages

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 2.

Self-Check 2

Complete the Chapter 2 Test on pages 20–22 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 57.

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ASSIGNMENT 3: PATIENT CENSUS DATA Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 23–39 of your textbook, Calculating and Reporting Healthcare Statistics.

Introduction to Patient Census Data

An inpatient census reports the number of patients present in a healthcare facility during a specified period of time. Inpatients are classified as those patients who receive room, board, food, and care for a period of 24 hours or more. A daily census is generally calculated from midnight on one night to midnight the next night.

To calculate census statistics, you must completely under- stand census terminology.

n A complete master census shows the number of patients admitted, discharged, and transferred each day. It’s also referred to as the total hospital census.

n A daily inpatient census shows the number of inpatients present on each unit during the census-taking time each day. This census includes inpatients who were admitted after the previous day’s census and those discharged prior to the next day’s census.

n An inpatient service day denotes the services received by one inpatient during a 24-hour period. An inpatient service day is also referred to as a patient day, an inpatient day, a bed occupancy day, and a census day.

n A total inpatient service day is the sum of all inpatient service days in a given period.

Lesson 1 13

Calculating Inpatient Service Days

As your textbook discusses, the calculation of inpatient service days takes place between midnight one night and midnight the next night. During this 24-hour period, the following information is recorded:

n The number of patients admitted

n The number of patients discharged (including deaths)

n The number of intrahospital transfers (patients trans- ferred from one unit in the hospital to another)

Note that adults and children are reported separately from newborns because newborn statistics can skew information, since the maintenance costs of newborns differs from the maintenance costs of other patients. Newborns are counted as inpatients only if they’re born at home or on the way to the hospital.

Calculating an Average Daily Census

An average daily census is the mean number of hospital inpatients present each day for a specific period of time. A mean is calculated by dividing the sum of a set of terms by the number of terms. A mean is also known as an average. An average is based on a specific time period, generally the number of days in the month in question.

Several variations of the average daily census are reported within a healthcare setting:

n Average daily inpatient census—the average number of inpatients present each day in a given period

n Average daily newborn census—the average number of newborns present each day in a given period

n Average daily census for a patient care unit—the average number of inpatients in a specified care unit in a given period

Review the formulas and examples for calcu- lating inpatient service days on pages 29–31 of your textbook.

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Be sure to review the formulas for calculating the average daily inpatient census, the average daily newborn census, and the average daily census for a patient care unit on pages 38–39 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 3.

Self-Check 3

Complete the Chapter 3 Test on pages 41 and 42 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 58.

ASSIGNMENT 4: PERCENTAGE OF OCCUPANCY Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 43–54 of your textbook, Calculating and Reporting Healthcare Statistics.

The percentage of occupancy refers to the official percentage of beds occupied by inpatients in a given period. The percentage of occupancy is also referred to as the inpatient bed occupancy rate. Healthcare administrators are often very interested in this percentage because, in general, the greater the occupancy rate, the higher the revenues for the facility.

As your textbook discusses, each healthcare facility is licensed for a specific number of beds based on certain factors, such as facility type and staffing needs. Each bed included in the inpatient bed occupancy rate must be ready for patient care and staffed for use.

Lesson 1 15

The following factors either determine or affect occupancy rates:

n Bed count days

n Bed occupancy ratios/percentages

n Changes in bed count

n Newborn occupancy ratios

n Bed turnover rates

Be sure to study each of these formulas on pages 45–53 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete Self- Check 4.

Self-Check 4

Complete the Chapter 4 Test on pages 54–56 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 59.

ASSIGNMENT 5: LENGTH OF STAY Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 57–67 of your textbook, Calculating and Reporting Healthcare Statistics.

Introduction to Length of Stay

Length of stay (LOS) refers to the total number of patient days for an inpatient stay. For each patient that’s discharged from the hospital, a length of stay is calculated. As your textbook discusses, the length of stay is often reviewed to determine if

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services are over- or underutilized. Generally speaking, the longer the length of stay for a patient, the more resources are used. As a result, reimbursement to a healthcare facility may not be enough to cover the costs of overused resources. As you can imagine, hospital managers and administrators are very interested in length-of-stay data.

Calculating Length of Stay

To calculate length of stay, subtract the date of admission from the date of discharge. If a patient is admitted during one month and discharged during another, this formula can’t be used. To adjust for a patient admitted and discharged during different months, subtract the date of admission from the total number of days in that month, and then add the num- ber of days in the new month. For example, the length of stay for a patient admitted on December 25 and released on January 2 is calculated as follows:

(December 31 – December 25) + 2 days in January = 8 days for LOS

Partial Days

Partial days aren’t reported as fractions. If a patient is admitted and discharged on the same day (even if he or she dies), that day is counted as an entire day because the patient used resources. For example, if a patient is admitted at 8:00 A.M. on February 1 and dies at 3:00 P.M. on the same day, February 1 is still reported as one day for LOS.

Total Length of Stay

Total length of stay is sometimes referred to as total discharge days. The total length of stay is used to determine the total days for a certain group of inpatients during a specific period. The total length of stay is calculated by adding the lengths of stay for all patients discharged during a given period of time.

Lesson 1 17

Let’s consider an example. Suppose three patients are in an intensive care unit on March 15. The length of stay for each patient is as follows:

Patient A: 5 LOS

Patient B: 3 LOS

Patient C: 4 LOS

To calculate the total length of stay, add together the length of stay for each of the three patients.

5 + 3 + 4 = 12

The total length of stay for March 15 is 12.

Average Length of Stay

Average length of stay, or ALOS, refers to the mean length of stay for hospital inpatients discharged during a specified period of time.

The formula for calculating the average length of stay is as follows:

Total length of stay for a given time period

Total number of discharges (including deaths) for the same period

If we continue with the previous example, the ALOS for three patients discharged from the ICU on March 15 is 4 (12 � 3 = 4).

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 5.

Newborns are calculated separately. Review the formula for average newborn length of stay on page 64 of your textbook.

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ASSIGNMENT 6: MORTALITY RATES Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 71–91 of your textbook, Calculating and Reporting Healthcare Statistics.

Mortality is the incidence of death in a specified population. In a healthcare facility, the death rate, also known as the mortality rate, reflects the inpatient discharges that end in death.

The hospital death rate, or gross death rate, is the number of inpatient deaths for a specific period of time divided by the total number of discharges (live discharges and deaths) during the same period.

You may wonder why we need to track and report information about hospital deaths. As your textbook discusses, death rate statistics are reported because they help us to

n Isolate items that cause death or increase death rates, such as handguns and motorcycles

n Bring attention to causes, such as campaigns for heart disease and cancer research

n Understand causes of death in certain populations

Self-Check 5

Complete Exercise 5.2 on page 59, Exercise 5.5 on pages 63–64, and Exercise 5.7 on pages 66–67 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 61.

Lesson 1 19

n Plan for health services

n Improve patients’ quality of care

The following death rates are calculated within healthcare organizations:

n Hospital death rates (or gross death rates)

n Net death rates (or institutional death rates)

n Postoperative death rates (or surgical death rates)

n Anesthesia death rates

n Maternal death rates

n Newborn mortality rates

n Fetal death rates

n Cancer mortality rates

Be sure to thoroughly review each of the mortality rate formulas in Chapter 6. Once you feel comfortable with the material cov- ered in your textbook and study guide, complete Self-Check 6.

Self-Check 6

Complete the Chapter 6 Test on pages 92–94 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 62.

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ASSIGNMENT 7: AUTOPSY RATES Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 95–109 of your textbook, Calculating and Reporting Healthcare Statistics.

Understanding Hospital Autopsies

An autopsy, also referred to as a necropsy and postmortem examination, is an examination of a dead body to determine the cause of death. Two kinds of autopsies are generally performed:

1. A hospital inpatient autopsy is performed on an inpatient who dies during a hospital stay.

2. A hospital autopsy is performed on a previous patient who wasn’t in the hospital at the time of death.

Healthcare facilities typically report the following autopsy rates:

n Gross autopsy rate

n Net autopsy rate

n Adjusted hospital autopsy rate

n Newborn autopsy rate

n Fetal autopsy rate

Newborn Autopsy Rates versus Fetal Autopsy Rates

It’s important to distinguish newborn autopsy rates from fetal autopsy rates, since the two are sometimes confused. Newborn autopsy rates are derived from the number of autopsies per- formed on newborn infants. Fetal autopsy rates are derived from the number of autopsies performed on stillborn infants who are classified as either intermediate or late fetal deaths. As in other statistical computations, newborn autopsy rates are calculated separately from other inpatient autopsies.

Review each of the autopsy rate formulas discussed in Chapter 7.

Lesson 1 21

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 7.

Self-Check 7

Complete the Chapter 7 Test on pages 109–113 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 64.

ASSIGNMENT 8: MORBIDITY RATES Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 115–133 of your textbook, Calculating and Reporting Healthcare Statistics.

Understanding Morbidity

Morbidity is the state of being ill or diseased. It includes any illness, injury, or abnormal health problem. In statistical cal- culations, morbidity generally refers to the number of cases of disease in relation to a specific issue.

It’s important to note the distinction between morbidity rates and mortality rates, since they’re sometimes confused within the healthcare community. Recall that mortality rate refers to the incidence of death within a specified population; morbidity rate refers to the incidence of illness. Misinterpreting morbidity rates as mortality rates can result in a huge misrepresentation of data.

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The most common hospital morbidities are nosocomial infections, or infections that patients acquire during a hospital stay. Nosocomial infections can be contracted in a number of ways. For example, patients may acquire a nosocomial infection from a healthcare provider who doesn’t wash his or her hands properly or from an adverse reaction to the insertion of an intravenous tube. Other common morbidities are postoperative infections, which occur in patients who recently underwent surgery or another similar procedure. Both nosocomial infection rates and postoperative infection rates are reported as percentages.

Miscellaneous Rates

Several other miscellaneous statistics are reported by health- care facilities, including Cesarean-section (C-section) rates and consultation rates.

C-section rates reflect the percentage of C-sections (deliveries via abdominal incision) compared to the percentage of vaginal or spontaneous deliveries. C-section rates are often tracked due to concerns of adverse reactions to the mother and child and because of the costs associated with the procedure.

Consultation rates reflect the percentage of opinions or consul- tations requested by one healthcare professional to another. For example, a family physician may request a consult from a podiatrist if his or her patient is experiencing a specific foot problem, like a heel spur. The consultant typically prepares a consultation report that consists of his or her opinion of the patient’s condition and recommendations for treatment.

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 8. When you’re finished, proceed to your first examination.

Review the formulas for morbidity rates on pages 116–117 of your textbook.

Review the formulas for calculating C-section rates and consultation rates on pages 124–127 of your textbook.

Lesson 1 23

Self-Check 8

Complete the Chapter 8 Test on pages 133–135 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 66.

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Compiling and Presenting Healthcare Statistics

INTRODUCTION

Most of the statistical information gathered and reported within a health information management department deals with the business aspects of a facility, not the clinical aspects. As an HIM professional, you’re responsible for calculating, compiling, and presenting the business statistics in your facility. In this lesson, you’ll learn how to calculate employee compensation costs, unit labor costs, productivity levels, staffing levels, and budgets. You’ll also learn how to verify statistical reports, maintain and update spreadsheets, conduct research for statistical reporting purposes, and prepare data for presentation.

ASSIGNMENT 9: THE HIM DEPARTMENT AND STATISTICS Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 137–165 of your textbook, Calculating and Reporting Healthcare Statistics.

Employee Compensation and Unit Labor Costs

As you can imagine, it’s important for health information managers to track the costs associated with the productivity of staff members within a facility. One way HIM managers can do this is by keeping track of employee compensation and unit labor costs.

Employee compensation refers to the amount of money an employee is paid. In some cases, employees are paid on an hourly basis. Other times, they’re paid an annual salary. To calculate the annual compensation for an individual

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employee, you must consider the number of hours the employee works per year, the amount he or she is paid per hour, and the percentage of benefits he or she receives.

Unit labor costs are the costs of labor per unit of output. These costs are calculated by dividing an employee’s annual compensation by his or her annual productivity. Unit labor costs rise when compensation and benefits rise faster than labor productivity, so it’s important to keep track of this information.

Other Labor Unit Costs

As you can imagine, additional labor unit costs are calculated within a health information management department. Some of these costs are associated with the amount of time staff members spend maintaining patient health records. Such maintenance responsibilities include

n Chart pulling

n Record scanning

n E-mailing

n Filing loose papers

Technological advancements greatly impact health record maintenance costs. For example, many facilities now store patient records electronically, reducing the costs associated with paper chart retrievals. Yet as patients increasingly use e-mail to communicate with healthcare providers, the costs associated with maintaining e-mail systems and answering patient e-mails also increase.

Productivity

Just as important as the labor unit costs associated with the HIM department is the productivity of each staff member. Productivity is the ability to yield results, benefits, or profits. Each area of the HIM department has a different standard of productivity. For example, a transcriptionist’s productivity is based on the number of reports he or she accurately transcribes

Review the formulas for calculating employee compensation and unit labor costs on pages 138–141 of your textbook.

Lesson 2 27

within a specific period, while a coder’s productivity is based on the number of records he or she accurately codes within a specific period.

Staffing Levels

Statistics regarding labor costs and productivity levels help facilities determine how many staff members are needed to complete the work within the HIM department. To calculate staffing requirements, HIM professionals must consider the current and future staffing needs within the department. Out- patient facilities typically determine staff levels by dividing the number of patient encounters by the expected productiv- ity of the department. Hospitals often determine staff levels based on the number of patients discharged from the facility.

Budgets

All of the costs within a facility are considered in the creation of a budget. A budget is a plan that lists the amount of money a facility will spend and the amount it will record as profit within a specific period of time.

Your textbook discusses two different types of budgets:

n An operational budget, or operating budget, is an annual budget that estimates the total value of resources required for the operation of the facility, including reimbursable work and services for other facilities. It also includes estimates of workload in terms of the total work units identified by cost accounts.

n A capital budget is a plan to finance long-term items and fixed assets, such as facilities and equipment. During capital budgeting, the HIM manager decides whether or not to invest in specific capital projects or assets. Since capital budget items are generally costly, an HIM man- ager must consider whether or not the project will last for more than a year and produce a favorable return on investment (ROI). For example, if a coding department

Review the productivity formulas on pages 147–148 of your textbook.

Review the staffing formulas on pages 148–149 of your textbook.

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Review the ALOS verifi- cation example on page 155 of your text- book and the case-mix formula on page 158 of your textbook.

needs five new computers and printers, an HIM profes- sional must calculate the return on investment and payback period for the capital budget.

Verification of Statistical Reports

Another part of the job of an HIM professional is to verify the statistical reports produced by the computer system in a healthcare facility. Because only certain information can be entered into the system for certain reports, manual verifi- cation and calculation of computer-generated reports may be necessary.

An HIM department may be responsible for verification and manual calculation of the following computer-generated hospital reports:

n Discharge reports

n Financial statistical reports

n Readmission rate reports

n Case-mix index reports

You may wonder why the HIM department is responsible for verifying and calculating information from financial reports. Remember that an HIM department is responsible for coding patient records, and coding is directly related to reimburse- ment for the hospital. Therefore, the HIM department plays a major role in reporting and verifying certain types of hospital financial information.

Spreadsheets

A final requirement of an HIM professional is to create, main- tain, and update spreadsheets for the facility. Spreadsheets are computerized programs that automatically perform calcu- lations based on information that’s manually entered into the program. (Although many different spreadsheet programs are available, you may already be familiar with one you’ve used at school or work, such as Microsoft Excel.) For example, it may be necessary for you to extract information from computer-

Review the formulas for operational and capital budgets on pages 152–155 of your textbook.

Lesson 2 29

generated hospital reports and enter it into a spreadsheet to track certain information for your department or area. The spreadsheets will help you create charts, graphs, and diagrams that can be presented at meetings.

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 9.

Self-Check 9

Complete the Chapter 9 Test on pages 165–169 of your textbook, Calculating and Reporting Healthcare Statistics.

Check your answers with those on page 67.

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ASSIGNMENT 10: INFORMATION SOURCES FOR HEALTHCARE STATISTICS Read through the following material in your study guide. Note that while there’s no textbook reading for this assignment, you’re still responsible for the material covered here.

Introduction to the Benchmarking Process

Members of an HIM department are often responsible for benchmarking within their facility. Benchmarking is the process of comparing rate historical data with another specific data set to analyze current information and project information for the future. For example, HIM professionals in a hospital may want to compare the average length of stay for C-section mothers and babies to the average length of stay for the same group nationwide. This comparison helps HIM professionals determine whether their facility uses more or less resources than other facilities across the nation. Such a comparison can also help identify and correct problems within the facility related to the care and services provided to this group of patients.

HIM professionals obtain information for the benchmarking process from a number of sources of healthcare statistics. We’ll discuss each of these sources and their role in health- care statistics in the next few sections.

Centers for Disease Control and Prevention

As part of the Department of Health and Human Services, the Centers for Disease Control and Prevention, or CDC, is committed to public health efforts that help to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. In addition, the CDC provides a large amount of data and

statistical information that’s compiled from worldwide research findings. You can visit the CDC Web site at http://www.cdc.gov/.

As an HIM professional, you may occasionally need to rely on information and resources compiled by the CDC for statistical reporting purposes. These helpful resources include

n Cancer Surveillance, Epidemiology, and End Results (SEER)—Statistics on new cancer cases grouped by age, gender, race, year, state, county, or ICD-9-CM code (http://seer.cancer.gov/)

n Fatality Analysis Reporting System (FARS)—Information on deaths caused by traffic accidents (http://www-fars.nhtsa.dot.gov/)

n DATA2020: The Healthy People 2020 Website— Provides an agenda for improving national health (http://healthypeople.gov/2020/)

National Center for Health Statistics

As part of the CDC, the National Center for Health Statistics, or NCHS, is the principal health statistics agency in the United States. The NCHS plays a key role in national public health by providing statistical information that helps to identify and address critical health problems.

Health statistics compiled by the NCHS allow us to

n Document the health status of the population and of important subgroups

n Identify disparities in health status and the use of healthcare by race, ethnicity, socioeconomic status, region, and other population characteristics

n Monitor trends in health status and healthcare delivery

n Identify health problems

n Support biomedical and health services research

n Provide information for making changes in public policies and programs

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n Evaluate the impact of health policies and programs

The NCHS collects data from many sources, including

n Birth and death records

n Health records

n Interview surveys

n Physical exams

n Laboratory tests

Some of the NCHS resources that may prove useful for HIM professionals include birth and mortality data. You can find this information by visiting the NCHS Web site at http://www.cdc.gov/nchs.

National Health Care Surveys

The National Health Care Surveys are part of the CDC and NCHS. These surveys are designed to provide information to healthcare policymakers, healthcare professionals, and researchers. The surveys typically include information on the following topics:

n Factors that influence the use of healthcare resources

n Quality of healthcare

n Safety of care

n Disparities in healthcare services

n Resource use, including costs and staffing

n Diffusion of technologies

n Drugs

n Surgical procedures

n Patterns of care for specific conditions

n Special topics

n Bioterrorism and emergency preparedness

n Electronic medical records

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According to the CDC, the surveys are nationally representative and provider-based. They cover a broad spectrum of health- care settings. Within each setting, data are collected from a sample of organizations that provide care (such as home healthcare agencies, inpatient hospital units, and physician offices) and from samples of patient (or discharge) encounters within the sampled organizations.

Examples of National Health Care Surveys are as follows:

n National Ambulatory Medical Care Survey (NAMCS)— Provides information about ambulatory medical care services in the United States

n National Hospital Ambulatory Medical Care Survey (NHAMCS)—Collects data on the ambulatory care services in hospital emergency and outpatient departments

n National Hospital Discharge Survey (NHDS)—Provides information on characteristics of inpatients discharged from nonfederal short-stay hospitals in the United States

n National Survey of Ambulatory Surgery (NSAS)—Provides a nationally representative sample of ambulatory surgery visits. In 2006, the NSAS went back in the field to collect data from hospital-based and freestanding ambulatory surgery facilities.

n National Home and Hospice Care Survey (NHHCS)— Provides information about agencies that provide home and hospice care and about their current patients and discharges

n National Nursing Home Survey (NNHS)—Provides informa- tion about nursing homes, residents, and their staff

You can find more information about the National Health Care Surveys at http://www.cdc.gov/nchs/surveys.htm.

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Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality, or AHRQ, is part of the Department of Health and Human Services. Formerly the Agency for Health Care Policy and Research (AHCPR), it was renamed AHRQ in 1999.

The AHRQ provides practical healthcare information, research findings, and clinical quality data. It also includes information regarding

n Evidence-based practice

n Clinical practice

n Technological advancements

n Outcomes and effectiveness

You can find this information by visiting the AHRQ Web site at http://www.ahrq.gov/.

The AHRQ also hosts the National Guideline Clearinghouse, which is a public resource for evidence-based clinical practice guidelines. Visit http://www.guideline.gov/ to learn more.

Institutional Review Boards

All healthcare organizations that conduct research and gather statistics require an evaluation from an institutional review board. An institutional review board, or IRB, is a committee of physicians, statisticians, researchers, and community advocates. The goal of each committee is to ensure that clinical trials and studies are ethical and that the rights of study participants are protected. All clinical trials in the United States must be approved by an IRB before they begin.

Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 10.

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ASSIGNMENT 11: DESCRIPTIVE STATISTICS IN HEALTHCARE Read through the following material in your study guide. After you’ve read the study guide commentary, read pages 171–191 of your textbook, Calculating and Reporting Healthcare Statistics.

Recall from Assignment 1 that descriptive statistics are used to describe information from a specific group or population. In this assignment, you’ll study the following types of descriptive statistics used in the healthcare industry:

n Rank

n Quartile

n Decile

Self-Check 10

Indicate whether each of the following statements is True or False.

______ 1. Benchmarking is the process of comparing rate historical data with another specific

data set.

______ 2. The National Center for Health Statistics is part of the CDC.

______ 3. Information on deaths caused by traffic accidents is provided by FARS.

______ 4. The AHRQ is the principal health statistics agency in the United States.

______ 5. The purpose of an institutional review board is to gather statistics from healthcare

organizations.

Check your answers with those on page 69.

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n Percentile

n Measures of central tendency

n Measures of variation

n Variability

n Range

n Variance

n Standard deviation

n Correlation

Rank

A rank indicates the position of a score or number compared to other scores or numbers on a list. For example, Table 10.2 on page 171 of your textbook ranks the 15 leading causes of death in the United States in 2006. As you can see, diabetes ranks higher than pneumonia, while heart disease ranks highest on the list.

Quartile

Analyzing large amounts of healthcare data can sometimes be an overwhelming process. To make health information easier to understand, it’s often helpful to divide it into quartiles, or four smaller groups of information that contain an equal number of observations. The information within each quartile can be compared to that of the other quartiles, or it can be analyzed independently.

Decile

Just as health information can be divided into quartiles, it can also be divided into deciles, or 10 equal parts. Such divisions are sometimes necessary when a very large amount of data is being analyzed.

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Percentile

Data is more often analyzed in terms of percentiles than quartiles or deciles. Percentiles represent information that’s divided into 100 equal parts. You may already be familiar with the term percentile rank, which is a distribution of scores in which a specific score is greater than or equal to others. For example, if you score in the 99th percentile of your class, your class rank is greater than or equal to 99 percent of all of your other classmates.

Measures of Central Tendency

An average number that represents a set of data is called a measure of central tendency. For example, when new parents compare their newborn’s length and weight to that of typical newborns, they’re making a comparison using measures of central tendency. The three most frequently used measures of central tendency are mean, median, and mode.

Mean. The mean is determined by calculating the arithmetic average of items in a frequency distribution. When you hear people refer to the average of a range of data, they’re referring to the mean.

To find the mean, divide the sum of all of the items included (represented by the symbol �) by the total number of items (represented by the symbol N ) . The formula for determining the mean is as follows:

Let’s look at an example.

Find the mean of the following test scores: 87, 100, 91, 98, 87, 88, 91, 92, 99, 90, and 100.

Step 1: Add all of the test scores together.

87 + 100 + 91 + 98 + 87 + 88 + 91 + 92 + 99 + 90 + 100 = 1,023

Step 2: Divide the sum of the scores by the total number of scores included in the calculation.

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1,023 ÷ 11 = 93

The mean is 93.

Median. Finding the median of a group of data is also help- ful in data analysis. The median can be found by arranging the items from lowest to highest, and then finding the mid- point of the distribution. Think of the median as the value that’s located halfway through the ordered data set. There’s an equal number of data values below and above the median.

Let’s revisit the example we just used involving test scores. If we arrange the test scores in order from lowest to highest, we can determine that the median, or middle point, of the scores is 91. Exactly half of the scores lie above 91, and half lie below it.

87, 87, 88, 90, 91, 91, 92, 98, 99, 100, 100

Now suppose that instead of 11 test scores, there were 10. In this case, the median would fall halfway between the fifth and sixth scores in the ordered set. You would find the median by adding the two scores together and dividing the sum by 2. Let’s look at an example involving an even number of test scores.

Find the median of the following test scores: 100, 100, 99, 98, 92, 91, 91, 90, 88, and 87.

In this case, the median lies somewhere between the fifth score (92) and the sixth score (91).

To find the median, add the fifth and sixth scores together and divide by 2.

The median test score is 91.5.

Mode. The most frequently or commonly occurring value in a data set is called the mode. Let’s use another example involving test scores to find the mode. Suppose the list of test scores is as follows: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 86. In this example, the mode is 91 because the number 91 occurs more frequently than any of the other numbers. The median in this example also happens to be 91.

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In some cases, there can be more than one mode if two or more values are equally common. The measure of central tendency is called bimodal in the case of two modes and multimodal in the case of more than two modes.

Measures of Variation

The measure of variation shows how information is spread out around the measure of central tendency. Think of the measure of variation as a range. For example, all examination scores, from the highest score to the lowest score, represent a measure of variation.

Variability

Variability indicates the differences among members of a group within a scale of measurement. In the medical field, heart rate variability (HRV) is a measure of the differences, or variations, in heart rate. Heart rate variability is usually calcu- lated by analyzing the time series of beat-to-beat intervals from the electrocardiograph (EKG) or arterial pressure tracings.

Range

The range is the measure of variability between the lowest and highest items in a frequency distribution. Range is the simplest measure of variation to calculate because it equals the highest value minus the lowest value. Since the range involves only the largest and smallest values, it’s greatly affected by extreme values. Therefore, it’s not resistant to change.

Let’s use test scores again to illustration range.

Find the range of the following test scores: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 86.

Subtract the lowest score from the highest score.

100 – 86 = 14

The range of the test scores is 14.

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When calculating ranges, you should be aware of the outliers. Outliers are the unusually large or small values within the data sample. These values can greatly influence the range and may not provide the most accurate information.

For example, find the range of the following test scores: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 64.

100 – 64 = 36

In this case, the range of the scores is 36. Because the lowest test score (64) is an outlier, the range of the scores increased and isn’t representative of the total group of scores.

Variance

Variance is a common measure of dispersion. It’s the squared differences between the data values used and the mean of those data values. Its use is important when considering the dispersion of the data values. If there’s a small sample or population of data, then variance can be intuitively felt with- out putting an exact number on it.

For example, suppose a student takes two subjects, math and English. Each subject has three exams. The student scored 90 percent on each of the exams for math, which is a high B grade. The student also scored 70 on each of the exams for English, which is a D and just passing, since 69 is failing. The data looks like this: