It’s worse than I thought

Clock Productivity

I wrote a post in February 2015 about what 90% productivity looks like. I received a comment that my math was wrong. I put the amount of billable minutes (432) for an 8-hour day (480 minutes) into a 9-hour day (540 minutes). It looked pretty challenging to achieve, but that was actually 80% productive!

While preparing for a talk I am delivering to graduate students, I sat down and I crunched the numbers again. I checked and rechecked the numbers.

This is what 90% productivity looks like

This is freakin’ impossible. There are tears in my eyes. This is not what patient-centered care looks like. This is now what a healthy work environment looks 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 an average of 43 minutes per patient

This example* assumes a therapist only spends 3 minutes in between patients (to transport patients, switch out materials, and walk to next patient), which would be record speed since most buildings I have worked in have had 4 wings or floors with 100+ beds to traverse. This example also assumes all patients would benefit from the exact same number of treatment minutes.

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
8:51-9:34 Patient number 2
9:37-10:20 Patient number 3
10:23-11:06 Patient number 4
11:09-11:52 Patient number 5
11:55-12:25 Clock out for lunch and bathroom break.
12:25-12:28 Obtain materials for next patient, walk to patient
12:28-1:11 Patient number 6
1:14-1:57 Patient number 7
2:00-2:43 Patient number 8
2:46-3:29 Patient number 9
3:32-4:17 Patient number 10 (this one is 45 minutes to add the extra 2 minutes needed to have 432 treatment minutes a day)
4:20-4:30 Document session notes and time to complete non-billable necessary tasks

I have talked to some therapists (or seen comments on forums) who say 90% is a challenge, but it is achievable. If that’s you, please educate me. How do you achieve 90% productivity? If my math isn’t accurate, please correct me (I almost hope it isn’t accurate). This is impossible, right?

Non-billable tasks include:

  • 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.

Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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  • 27blink

    I have to be 92% productive. I know therapists who are required to be 94% productive.

    In my region, it’s much more common to see patients for 30 minutes. That means on average you have 14 patients in an 8-hour day. 92% gives you 38 minutes of non-billable time. 14 patients x 3 minutes of transporting SLP robot body = 42 minutes.

    Guess what? You’re already low productivity, and you haven’t done any of your documentation because there are no laptops available for you to use! And now you’re going into overtime so you get all of the minutes for the RUGs! Now you risk being written up for being BOTH low productivity and going into overtime.

    I’ve worked 6 hours PRN and have had 12-13 patients (15-25 minute visits). The math gets worse. I wish that I had a better answer.

    Why aren’t we revolting? Perhaps because we all have student loans to pay, PTO banks to grow, families to feed, health insurance to use, 401ks to build, etc?

    Using our math examples, seriously, who can we write to? ASHA has done nothing for us except “talk” about it. I commend them for starting the conversation, but I feel as though the ball stopped rolling immediately.

    • 27blink

      Also consider doing 2hrs PRN. At 92%, you get 10 minutes to review charts and transport your body to your 4-8 patients. Yes, 8 patients in 2 hours. 15 minutes x 8 patients = 120 minutes. It’s real and it happens out there. How do you explain that one?

      • Amanda

        Corporate will never care until they are made to care. We are nothing to them. Even when there is a shortage of therapists in a region, we have very little bargaining power. The only way we can stop this is to start working together. We need to organize.

        • Deborah Ann Schaefer

          I agree Amanda. We NEED a Union. We are ALL replaceable to these Rehab companies because they will hire inexperienced new grads who don’t understand the ethical issues involved, will work for less pay and are easily intimidated by facility managers and Area/Regional Managers. Debbie Schaefer, COTA

          • Rachel Wynn

            I spoke with a union organizer and they didn’t think it was a good idea for our situation. If someone else speaks with another union organizer and they feel it is a good idea, I’d love to have you guest post. Message me and we can talk about a guest post.

          • Amber

            I’m on day 2 in a SNF and already want to quit. I keep thinking “I could say something to my supervisor but what’s the point, I’m so replaceable!” I’ve been working for 3 years in other settings and felt super confident going into this job, but I’ve never worked in a SNF with strict productivity requirements and they’re allowing almost NO learning curve. By tomorrow (day 3 with minimal orientation at best) I need to be meeting 85-90% productivity and I have no idea how to maintain my integrity (i.e. do a real chart review, be truthful with billing, ummm put the patient first!) and meet this. Help!

  • Deborah Ann Schaefer

    It is unethical behavior. It is not achievable. The Rehab company basically “forces” you to commit fraud or they will “find” a reason to let you go or make your employment miserable so you quit. You will also have a Supervisory meeting with a” Plan Of Correction ” to support their termination. Been there. Done that. Left SNF/LTC after 26+ years and happily and ethically employed in Home Health Care. Debbie Schaefer, COTA

    • 27blink

      I quit SNF/LTC a few years ago and unfortunately couldn’t sustain myself as an SLP. As a PT/OT and ESPECIALLY an assistant, it’s much easier to drive to an ALF/ILF campus and crank out your HH caseload in a day. When I was trying to sustain myself in HH, I had to drive 120+ miles per day to see four patients. I wish that this weren’t the case for our discipline.

      • Deborah Ann Schaefer

        I understand 27blink. SLP are way underutilized in HHA. Education is needed because you have the skills needed for sequencing, problem solving, decision making, etc.

      • Rachel Wynn

        The HH territories in my area for SLPs are massive.

        • Shawna

          Our territories are large as well. I set boundaries regarding how far I will travel, no more than 30 min between and no more than 30 min from my home. I only do it part time. The schedulers do not receive instruction in assigning patients in any logical manner, simply as they come in. We have often seen the scenario of two therapists driving a far distance to see two different clients who are close together. It would have made more since to give both to the same therapist. If you can manage setting boundaries and getting the schedulers to think in terms of location and where you are on what day it can help. I find it very frustrating as I keep a set day and time with my patients the other therapies never know where they are going until they look at their tablets in the morning. Too many therapies are often scheduled for the same day. Sometimes they will have multiple assistants coming out to see a patient rather than maintaining consistency. Again, the primary focus is on money. If they could determine how to use an online scheduler or working out how to maintain some consistency the patients and clinicians would both benefit. Still, it’s much better than snf, especially if you aren’t trying to do it full time. Where I live it is impossible to qualify for health insurance without working 12 hour days. I am in a rural area.

    • Rachel Wynn

      Too many of us have experienced this.

  • Amanda

    I too want to know why we aren’t revolting? Why have we not organized to combat this? I know SEVERAL rehab companies that “unofficially” require their staff to work off the clock in order to meet these standards. Believe it or not, unless you work overtime off the clock, there is nothing legally that can be done about it and I have yet to hear of any of them being challenged in civil court.

    All of the shenanigans that go on to keep these companies “profitable” not only hurt our patients and ourselves, they hurt our profession. It keeps us from being taken seriously by our employers and the public. When are we going to decide enough is enough?

  • Kerry Graham

    I am only 2 yrs into the field and my time in SNFs trying to meet 90% productivity requirements has made me question not only my own moral character but the integrity of the field itself. One regional manager (who sent us home early if we didn’t have the caseload to support the “minutes” we needed) told us we were akin to “professional laborers”, comparing us to electricians who wouldn’t expect to get paid for a full 8 hr day if they didn’t have the work to support it. Needless to say I am putting in my resignation notice tomorrow in order to take a position in the hospital setting hoping I can retrieve some sense of dignity (and go back to being nice again to my husband, poor guy). Thank you Rachel for all your work in this area.

  • KG

    I am only 2 years into the field and my time in SNFs trying to meet 90% productivity requirements has made me question not only my own moral character but the integrity of the field itself. One regional manager (who sent us home early if we didn’t have the caseload to support the “minutes” we needed) told us we were akin to “professional laborers”, comparing us to electricians who wouldn’t expect to get paid for a full 8 hr day if they didn’t have the work to support it. Needless to say I am putting in my resignation notice tomorrow in order to take a position in the hospital setting hoping I can retrieve some sense of dignity (and go back to being nice again to my husband, poor guy). Thank you Rachel for all your work in this area.

    • 27blink

      Hey, at least your Regional admitted that we’re “professional laborers.” Everyone else just seems to keep it as a sick secret that everyone knows, but somehow denies on the surface. Congrats on your move!

    • Rachel Wynn

      I doubt you are sitting at your desk playing Candy Crush… Therapists can bring so much value to the long-term care. When census is low, we could be doing so many other things to bring more “value” to the building. Send me an email and identify your self as this commenter. I’ve got an idea, but I need some help.

      • ashley wey

        I would love to hear more about the idea as well. How do i email you on here? I’m new to gray matter online. thank you.

  • Sue Wilson Burris

    I am a therapist with over 30 years of experience, and this is not the way I want to see my profession going. The current system in place for SNF facilities is unrealistic and forces therapists into one of two behaviors to make production: lying about their treatment times or working off the clock. Neither of these behaviors are legal or ethical, but more importantly, neither lead to the excellent patient care that our clients deserve. Until we start complaining, nothing is going to change. If one took your written time schedule to court, it would be laughed out of the courtroom, and a class action lawsuit or individual one may be what it takes to elicit that change.

    • 27blink

      Class action lawsuit has been on my mind for quite a while. Not sure how to go about it, though.

    • barchi

      This is unfortunately why I’m working on an exit strategy out of the profession entirely. I’m hoping to make it through a few more years to make some PRN income while I earn a new professional degree to get out for good.

  • knz

    I’m a PT in a SNF and my productivity expectation is 98%. We can achieve this by grouping HMO, HMO B, caids together as same payors…. We also are allowed to treat another payor while a part A patient has a modality running. It takes a bit of practice and making sure everyone has enough of each payor to make it happen, but it’s possible. We average 12-15 patients in an 8hr day, with 11 full time therapists between all disciplines. We don’t always meet the 98% daily as individuals, but the expectation is that it averages out to that in a 2 week period. Our facility is also very large and has a very low number of part A, with caids being the highest percentage of patient demographic we have. That may help our situation, not sure. We get short term residents very rarely as well, leaving the bulk of our caseloads as long term frequent fliers on caseload.

    In my last position at an acute care hospital, our productivity expectation was 75% and that was almost impossible to meet based on the regulations in that setting and the amount of time it takes to track down nurses, find patients, etc.

    • 27blink

      This isn’t possible in speech. We don’t have any modalities to hook up our patients to (okay, maybe VitalStim, but we’re not leaving the patient alone for 20 minutes like what happens on the NuStep or estim), and we most often don’t have the resources to group anyone, as we can’t have two swallowing patients, one speech patient, and one cog patient in a group.

      PT/OT have always been different animals compared to ST, which is why ST continues to struggle a lot more with the productivity standards. In my early days, I’ve seen PT/OT do groups of 20, no joke, outside on the patio. Then they’d sit for five hours the rest of the day documenting or watching TV.

      • knz

        Our speechies do have a harder time with meeting the productivity than the other disciplines. They have to get really creative. We recently got an Omni virtual reality system that can have 2 patients playing cognitive games together. Having co treatments with another discipline helps as much as possible as well.

        • barchi

          Cotx doesn’t fix the individual tx issue with productivity, though. Concurrent can, but you can’t do group or concurrent with Medicare patients, or at least corporate won’t let you because it hurts the bottom line.

      • Rachel Wynn

        We can’t hook up patients to VitalStim and then leave. Not only is it unsafe, but VitalStim by itself doesn’t do anything. It’s the exercises during VitalStim that does something. And we can’t bill for VitalStim. We can only bill for the exercises performed during VitalStim. AND the research is mixed on the efficacy of VitalStim.

        And OTs and PTs that hook patients up to modalities and walk away are missing a huge opportunity to provide patient education about the modality, how to manage pain, energy conversation, etc. or simply build rapport with their patient. It’s often in those “not therapy” moments that we learn the most about a patient, what’s important to them.

        • barchi

          But they really really need to make it to the next Candy Crush level! Seriously, I’ve seen it time and time again.

    • Rachel Wynn

      But this is providing treatment based on payor rather than patients…. Groups can be great for some patients, but definitely not all.

      • 27blink

        Unless a patient is bedbound or on isolation, leadership doesn’t seem to care. They say “patient-centered care,” but it’s really “bottom line care.” I don’t mean to be so negative, but this has been my life as a DOR for 5+ years, which is why once again I left. So many thought that I was on the fast track for Regional, but I couldn’t even sleep at night as a piddly DOR!

    • Jenn

      When I first started in 2008, we used to have 2 hour long SLP groups each day, one at 10 for cog, and one at 12 for dysphagia. there were 2 SLPs at the time, so we could have up to 8 patients in each group. We had a rehab aid who assisted with transport, and the patients seemed to enjoy the group setting (especially for cog). When I had multiple aphasic patients, I’d try to group them at least a few times a week as well. For the other 6 hours of the day, I’d see bedbound pts or pts on isolation, do screens, documentation, meetings… everything listed in the article above, basically.

      Then Medicare regs changed, and we can’t group any more. Well, we can, but only once a week max, and it has to be a structured group of 4 and only 4, each of the 4 patients billed for 15 minutes of the hour, plus the time to transport our own patients since the aid now only works 4 hours twice a week (so he files some stuff? I don’t even know) and if one pt is unavailable, we treat 3 pts for an hour but still only bill 15 min/ea. OR, we start and stop the clock throughout the session, when Mr. A is being addressed, he’s on the clock, then it’s Ms. B’s turn, stop the clock for Mr. A, start it for Ms. B, and so on. So instead of being fully focused on the patient’s responses, cueing, etc I’m staring at my billing app trying to be sure I’m doing it correctly. It’s absurd.

      Now we have 3 SLPs (250+ beds) but right now we’re so low we can’t be on the clock for more than 6 hours. I’ll have to burn through ~10 hours of PTO this week just to be sure I get a full paycheck so I can pay my mortgage and school loans.

      I understand the pressure from the business side – CMS dictates reimbursement, it’s not like private insurance where physicians can negotiate rates with any given company. We have a primarily geriatric population, therefore primarily Medicare, therefore CMS makes the rules and nobody can say anything about it. But it’s extremely frustrating to be treated like an idiot hamster who can just never run fast enough on that wheel when we’ve gone through so much to get the education and training we have to treat our patients and we are so passionate about what we do. I feel so trapped because my company does pay well (from what I’ve learned) and I do have a lot of debt and want to stay where I am (near family, but in a city with a high cost of living).

      It’s made me want to leave the profession, but then I think about the bills waiting for me and I just put my head back down and keep trying to give my patients the best care. And honestly, we had an inservice a few years back where the company tried to scare the crap out of us re: fraud, the FBI coming to our doors… I’m not going to lie, I will turn in a second to cover my own butt because we all know the company won’t do a thing to protect us if (when?) the time comes.

  • jennifer lyonnais

    I have worked in SNF and agree that SLPs need to organize and I don’t feel the need to repeat what has been said in the comments. Patient centered care suffers. I will add that having a laptop or iPad mini helped me immensely to achieve better productivity. Dictation allows treatment time and documentation to be done simultaneously. Even weekly progress notes can be dictated with patients present. Not with everyone, of course, and I ask if the patient thinks it would be a helpful part of therapy to review progress with goals together. Going meta with it, as it were. After working in the SNF setting, I don’t have a problem with productivity rates, per se, but think average of 75% is acceptable.

    • 27blink

      I’ve never seen less than 85%. And that 85% was recently “updated” to 90%. In all seriousness, are you in a metropolitan or rural area?

      • jennifer lyonnais

        I had 85% productivity expectation. But if I ran a SNF I would have therapists aim.for 75% productivity. It’s sad but I think the days of salaried therapists with no discussion of productivity is gone and not coming back. But I think the situation could be much improved and I want to be a part of organizing a movement to improve.

        • Rachel Wynn

          I spoke with a union organizer and they didn’t think it was a good idea for our situation. If someone else speaks with another union organizer and they feel it is a good idea, I’d love to have you guest post. Message me and we can talk about a guest post.

        • Amber

          what can be done?? As long as there are therapists willing to continue the trend, nothing will be done. I’m on day 2 in a SNF with strict productivity requirements and have already want to talk to my DOR several times but felt like it was pointless. I would love to learn more about what can be done and be part of changing the pattern if possible.


    Today I was spoken to about my productivity in the SNFs (I have recently been splitting my days between 2 facilities due to low census/caseload in my primary building – I am in thr car anywhere from 40 minutes to an hr and a half depending on traffic) that I work in in thr state of CT. I am employed by the company that owns the buildings however we have a consulting company that over sees the rehab departments. The consulting company told the directors that my productivity needs to increase or my hours may be dropped. I work 32 hours – the minimum for benefits for my family. If my hours drop I will lose my insurance. Can a company do this?

    • Rachel Wynn

      I’m not sure. I believe so, but you might contact your state’s wage and hour board/department and ask them.

  • Mumtaz Shah

    This was a GREAT article. Thank you for posting. On a side note Rachel Wynn, you mentioned having spoken to a Union. Can you expand on this? Why did they say it would not be a good idea for the SLP field? I am curious as I was previously a teacher in my other life =) and was in a union. Teachers also are required to have four year degrees, many have their Masters and are considered “professionals” and not blue collar. So some similarities in that sense. If you get a moment, I’d really like to here your thoughts on this and additionally on how we as a profession can “take on the system.” I’m always in for a good just fight……….

  • Bob

    Have you looked into the benefits of establishing cooperatives that focus on patient care? For-profit healthcare and the race for greater profits seriously conflict with the ethics of patient care across the board, not just in SNFs but in hospitals and all healthcare settings as well. The largest cooperative in the US is a home healthcare provider. A union is one way to move forward, cooperatives may be another worth investigating.

    • Rachel Wynn

      Bob- I wasn’t aware of the cooperative home health company. I love the cooperative model. I’m on the board for a cooperative health insurance company and I think that it offers some interesting opportunities to provide better care.

      • Bob

        That’s wonderful you are involved in a cooperative Rachel! I love the model as well. I truly feel cooperatives offer a viable alternative to corporate businesses that focus on profits rather than people, and in no business are people more important than healthcare.The trouble is organizing resources and people behind the idea. Do you think that similar resources and energy put towards creating a SLP union could be put towards creating a reproducible cooperative therapy model for OT, SLP, etc.?

    • barchi

      Sadly, I’ve worked for a non-profit that functioned just the same as the for-profits. The only difference was that residents who qualified could receive some therapy that was written off. Productivity standards still stood the same. Same goes when an administrator has to write off therapy for Medicaid patients in a for-profit SNF.

      • Bob

        Cooperatives are not necessarily non-profit. In fact, most cooperatives are for-profit businesses. Cooperatives are much different structurally than non-profits. A non-profit may have the same business structure as a corporation where managers, a board of directors, or CEO dictate the conditions of the workplace. This is not the case for a cooperative. Members of a cooperative also known as worker-owners set the conditions of their work environment. It’s the ‘management’ of rehab organizations that urge certain levels of productivity, not their workers, am I correct? Worker-owners of a cooperative can choose the level of productivity amongst themselves, and vote on it at any time, including any of the other important components of the workplace environment.

        • Rachel Wynn
        • Rachel Wynn

          What you are describing sounds more like an employee owned business rather than a cooperative. New Belgium Brewing (just up the road from me) is a stellar example of an employee owned business. You might want to check that out. and If you are ever in Fort Collins, take the brewery tours. It’s the best tour I’ve been on (and that’s counting all the tours before I was diagnosed with Celiac’s disease and had to stop drinking beer).

          • Bob

            What I meant to say is that everything is democratically controlled by members of a cooperative, including leadership. Is that the issue you are trying to point out, Rachel? Cooperatives do not necessarily have a lack of leadership (like a board of directors), which you are a perfect example of by serving on the board of a coop. Employee owned businesses are another option. I like cooperatives because they give members the leadership they want, rather than the leadership they are ‘stuck’ with in normal corporate businesses models.

            Also, thank you for the links. I will look them over. I still have a lot to learn about how cooperatives are financed, and structured, so thank you for pointing out my error.

  • Senior Living Watch

    I see I’m not the only SLP considering leaving the profession. I haven’t worked as an SLP for a few years now, opting instead to volunteer as an advocate for nursing home reform. It’s time for me to go back to a paying job now and while jobs appear plentiful in healthcare where I have most of my experience, the mere thought of going back there repels me. The greed in SNFs continues to drive good people away. I really feel for all of the many good people, from nursing assistants to therapists, who stay because they love working with old people. Hospitals don’t seem to be too far behind in their zest for higher and higher profits. I don’t know how many times in just the past year I’ve seen rehab corporations come to a settlement agreement with the DOJ after a whistleblower (typically a therapist) comes forward with proof of pressure to provide unnecessary services or upcoding. The same rehab companies repeat the same offenses across the country with the same outcome. They agree to pay the DOJ millions in fines/restitution but these execs never do any jail time. The stiffest penalty I”ve seen is for the CEO of a major rehab corporation being banned from participation in Medicare for 3 years. This came after repeatedly being caught for fraudulent billing over the 20+ years he’s been in the SNF business. For them, getting caught and paying these fines is simply the cost of doing business. Expecting therapists to work off the clock or make 90% productivity is simply an extension of that. I believe I saw someone post here that these companies ‘force’ therapist to commit fraud. I understand the pressure to do so but any lies you agree to tell and sign your name to are your lies and your fraud. Please don’t let them pressure you into doing something you know is wrong. That will only keep this dysfunctional system from change. I’ve put in countless hours in nursing home and health care reform over the past 9 years and I’m finally walking away. I truly hope that SLPs, OTs, and PTs will find a way to unite in an effort to make ethical care and treatment THE only option for all of their patients.

  • Cindy

    Where is ASHA? Why aren’t they putting pressure on these rehab companies? They are the lobbying group that represents us and should be making a bigger deal about this. I don’t every see anyone saying “Sure! I love having 90% productivity!”. I covered PRN for a therapist for 2 weeks at Christmas one year. They told me my productivity was 90% and I hadn’t even been trained on anything. I just laughed. What were they going to do? Fire me? I won’t ever go back into one. Like one of the other comments said: as SLPs, we have so much to offer beyond reimbursing for therapy. Those numbers are unrealistic and the sign of a company that is more concerned about the bottom line than the health and safety of the patients AND employees.