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    Pamela Ballou-Nelson
    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE
    Benchmarking your practice’s financial data is a critical step in your budgeting process. It involves monitoring the practice’s financial performance on a period-to-period basis to assess its annual budget. Comparing to the MGMA benchmark lets you assess how closely your performance fits the annual budget of other similar practices. While budgets and benchmarking may be a common practice, have you ever thought of comparing/benchmarking your employee turnover rate?

    Turnover is a generic term, referring to employees who do not stay in their jobs. It usually includes all workers who leave voluntarily, are terminated or laid off. Your turnover rate provides clues to the practice about the work environment and the overall success of the practice.

    What is an acceptable turnover rate? 
    Even though looking at the MGMA data for a standard employee turnover has a comparative benefit, this standard should not be accepted as a norm. Rather, practices should strive to lower their turnover rates as much as possible. In a small practice, a 20 percent turnover rate could cripple a practice’s progress toward practice transformation and value-based goals.  

    Why does turnover rate matter?  
    Every time an employee leaves, it costs money to replace them. The cost to replace a member of management can be as high as five times their yearly salary. To replace even an entry-level employee can cost up to 25 percent of an employee’s salary. Turnover is costly to the practice, not only in money, but also quality, as it may take months to get the new staff member up to speed with customized EMRs, doctors' idiosyncrasies, and so on. In addition, there are interpersonal costs, as staff must learn to work with other individuals and adjust to new work dynamics. Ignoring employee turnover equates to poor resource management and can translate into serious financial and quality difficulty for the practice.

    How do I measure my turnover rate?
    Employee turnover is a measurement of how many employees leave the company vs. how many new ones are hired. It's generally measured on a monthly, quarterly and yearly basis.

    To determine employee turnover during any given period, divide the number of employees who have left by the average number of total employees. For example, if two employees out of ten left during the quarter, your company's quarterly turnover rate is 20 percent.

    What causes turnover and tips to prevent it
    One of the key factors relating to employee turnover happens when those in charge of hiring do not take the time to properly evaluate applicants. Hire candidates whose personalities and skills match the job requirements, even if finding the right person initially takes a little longer.  New hires who are not a good fit for a job do not tend to stay in those positions, with hiring problems accounting for as much as 80 percent of employee turnover. 

    Provide training opportunities, or advancement opportunities, to encourage personal and professional growth. Training and promotions help employees feel like their employers are looking out for their best interests and believe in their potential.  

    Failure to fairly compensate the skills and work expected of staff will also lead to a short tenure. Allow staff to share in bonus incentives, and challenge staff to increase their knowledge to improve practice operations, giving them additional responsibilities, and increase pay as they add value to the practice. Provide regular recognition of what employees have achieved. Providing goals for employees also helps because it gives the employees direction. 

    Develop good team work skills among the staff. Everyone in the medical practice is important to the patient experience. Develop a sense of equality and importance among all staff. 

    Policies on discipline also must be established and enforced. These policies can subdue the conflicts that quickly erode a positive work atmosphere.

    How can the 2018 MGMA DataDive Practice Operations assist?
    The 2018 MGMA DataDive Practice Operations has multiple benchmarks that can be utilized to assist your organization with understanding where it stands among its peers regarding turnover rates. The Practice Operations report offers turnover rate benchmarks for various staff and provider positions. This allows you to dig into each key category and understand what areas within your organization are retaining employees effectively and on which areas your focus should be directed.
    Turnover Rates for Primary Care Single Specialties
      Count Median
    Ancilary support staff 51 0.00%
    Business operations support staff turnover 65 9.92%
    Clinical support staff turnover 89 15.83%
    Front office support staff turnover 91 20.00%
    Non-physician provider turnover 77 0.00%
    Physician turnover 96 0.00%

    Beyond turnover rates, the 2018 MGMA DataDive Practice Operations also includes benchmarks to help your practice improve the overall workplace experience for staff and providers. Seeing how peer organizations handle these key items and comparing that to your own organization may assist in identifying opportunities for improvement.
    2018 MGMA DataDive Practice Operations - Relevant benchmarks improving turnover
    • Practice had an employee appreciation program
    • Percent of health insurance premium costs practice paid for providers
    • Employee satisfaction survey frequency
    • Percent of health insurance premium cost practice paid for staff
    • Who reviewed employee satisfaction surveys?
    • Practice offered 401(K) match
    • Provider satisfaction survey frequency
    • Practice's time-off policy for sick and vacation
    • Who reviewed provider satisfaction surveys?    
    If your practice is below the MGMA DataDive Practice Operations data for employee turnover rates, celebrate! And then set a new goal to go even lower.  Involve your staff to look at positive ways to retain current employees. 

    If your practice is above the MGMA turnover rate, look at solutions based on hiring, training, opportunities for recognition and advancement, as well as at compensation and teamwork.

    Health care is complicated, and patient experience is valued. Keeping a consistent, well-trained, appreciated team will go a long way in a value-based model of health care. 

    Pamela Ballou-Nelson

    Written By

    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

    Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.

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