THIS POST HAS BEEN UPDATED. See most updated post here.
I’ve written about productivity before. Productivity isn’t the problem. The problem is what productivity causes – a focus away from patient care. And yes, I have heard the argument ‘We think patient care is the most important thing too. That is why we want you to spend X% of your time on patient care’.
Unfortunately, we are working in a billing system that doesn’t reimburse for indirect patient care. <-- See what I did there? "Indirect patient care", because things like caregiver education are patient care. However, lawyers, bill indirect services and it still leaves room for many problems,
“Treating legal services as a commodity that can be measured in units of time diminishes the importance of both the quality of the work produced and the results achieved. Few other industries would thrive if they measured productivity by the time their workers spent without regard to what those workers created. The standard invites inefficiency, not to mention fraud.”
Efficiency isn’t the name of the game
In graduate school, I remember hearing bits and pieces about productivity expectations (though none of my clinicals were in the SNF setting). I casually thought, “I have always been an efficient worker with good results (in my prior career). Meeting productivity expectations won’t be a problem for me.” Little did I understand. I thought all the time I spent working toward the goals and tasks of my job would be “productive”, because that totally makes sense, right?
As I prepared to talk to people outside our field about ethical concerns, I figured they would have the same ill-informed notion. So I created a document to explain what 90% productivity looks like and what it doesn’t include. I hope this illustration will help students and those outside the field to understand the responsibilities of therapists beyond direct patient care.
What does 90% productivity look like?
90% Productivity for an 8-hour day looks like this:
- 8 hours = 480 minutes
- 90% billable time = 432 treatment minutes
- 10 patients a day means roughly 43 minutes per patient
This example assumes a therapist only spends 3 minutes in between patients, which would be record speed since most buildings I’ve worked in have had 4 wings or floors to traverse. It also assumes that all patients would benefit from the same amount of treatment. Of course, some patients would benefit from more and some from less.
8:00-8:05 Drop personal things off, pick up today’s schedule, gather materials for first patient, walk to patient
8:05-8:48 Patient number 1
8:48-8:51 Transport patient, walk to office, obtain materials for next patient, walk to patient
8:51-9:36 Patient number 2
9:36-9:39 Transport patient, walk to office, obtain materials for next patient, walk to patient
9:39-10:22 Patient number 3
10:22-10:25 Transport patient, walk to office, obtain materials for next patient, walk to patient
10:25-11:08 Patient number 4
11:08-11:11 Transport patient, walk to office, obtain materials for next patient, walk to patient
11:11-11:54 Patient number 5
11:54-11:57 Transport patient, walk to office
11:57-12:27 Clock out for Lunch and bathroom break.
12:27-12:30 Obtain materials for next patient, walk to patient
12:30-1:13 Patient number 6
1:13-1:16 Transport patient, walk to office, obtain materials for next patient, walk to patient
1:16-1:59 Patient number 7
1:59-2:02 Transport patient, walk to office, obtain materials for next patient, walk to patient
2:02-2:45 Patient number 8
2:45-2:48 Transport patient, walk to office, obtain materials for next patient, walk to patient
2:48-3:31 Patient number 9
3:31-3:34 Transport patient, walk to office, obtain materials for next patient, walk to patient
3:34-4:17 Patient number 10
4:17-4:20 Transport patient, walk to office, obtain materials for next patient, walk to patient
4:20-4:30 Document session notes and time to complete unbillable necessary tasks such as:
- Calling families to update on status and recommendations for discharge planning.
- Attend care plan meetings with families, nursing staff, social worker, doctor, etc to discuss status and discharge planning.
- Complete screenings of patients who have been admitted to the building recently, annual screenings, or nursing concerns.
- Complete evaluations and obtain standardized scores.
- Write up evaluations, discharge summaries, weekly progress notes, 30 day recertifications, etc.
- Attend therapy team meetings to discuss status, collaborate to improve patients outcomes, etc.
- Consult with other professionals (SLPs, social workers, psychiatrists, psychologists, etc) regarding complex patient cases.
- Write orders updating treatment frequency and duration.
- Write orders and educate nurses and CNAs regarding diet texture and consistency changes.
- Obtain patient records from modified barium swallow studies, prior speech therapy, gastrointestinal specialists, otolaryngologists, etc. to update plan of care.
- Problem solve behavior and communication challenges and train nurses and CNAs to provide appropriate level of cueing and assistance to maximize independence and while maintaining safety.
- Complete inservice trainings with new staff or current staff at regular intervals to ensure that appropriate referrals are being made and staff is equipped with skills to manage dysphagia and cognitive-communication disorders.
- Troubleshoot computer and documentation software issues. I have never worked with software that was so buggy as the documentation software used by therapists in SNFs.
- Copy and prepare materials for therapy. Such as patient education handouts and obtaining food for trials from the kitchen.
- Supervise graduate student interns or clinical fellows.
- File paper copies of progress notes, evaluations, recertifications, and discharge summaries in paper charts.
- Complete company required continuing education.
- Reading email and written notes from managers (often about failure to meet productivity expectations) or having meetings with managers about failure to meet productivity requirements.
- Performance reviews and other human resources related activities.
These non-billable tasks are important and make a difference in patient outcomes.
**This schedule does not account for the 10-15 minute paid breaks that many states grant workers for every 4 hour period work. Google “paid rest break” + your state to learn more about your state’s laws.
***Very seldom does a schedule go as smoothly as this schedule. Often a therapist will go to see a patient and they will be in the shower, out for a doctor’s appointment, working with another healthcare professional, visiting with family, refuse, etc. Which means therapists are walking to the patient’s room. Finding they are not there. Then they have to consult with CNAs and nurses to locate the patient. The therapist is unable to see the patient, but spent 10 minutes trying to locate the patient. Then the therapist goes to the next patient. Rarely does a SNF have a schedule for therapy. Therapists are given names and required minutes for the day, and it’s essentially a free for all.
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