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Re: How many patients do you see in a week?
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Re: How many patients do you see in a week? - February 18, 2006 1:04:00 PM
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OAK
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"I feel lucky compared to most of you who are seeming to be working hard with seeing in excess of 60 patient's a week. I used to do it too. Now I am fortunate enough to treat 10-12 patients a day (8 hours a day), deliver quality care, maximize bill appropriately, and still make a decent profit margin, if I mangage my cases well - IE) payer mix. Just remember it's about quality of care - and are your patients on the receiving end of it? Katie"
Another example of "quality" of treament being being incorrectly measured by how many patients are treated in a day.
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Re: How many patients do you see in a week? - February 19, 2006 2:41:00 AM
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SJBird55
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OAK, here in the states, we could practice as you describe and see quite a few patients in a day. In my mind, the issue here in the states has nothing to do with quality (when discussing the number of patients treated), but knowing the codes that are used for billing purposes - whether they are timed or not timed. What drives how busy we are in the clinic comes down to codes and their definitions.
I have a small amount of data (n = 296) that with my patient population where with half the data, I was able to practice as I would like (group situations - meaning an overlap of patients) - and in those cases I WAS using the group billing code... and then a cabash was put on me to NOT get into group situations and use that code because of lack of reimbursement... so I also have data collected with that change in practice patterns. When I look at my outcome data separating practicing as I wish and overlapping patients (but billing appropriately) and then being administratively forced to practice in a manner in which there is no group situation ever occuring brings up interesting findings.
In practicing how I wanted to practice - sheduling as I saw fit with what I could handle and also bill appropriately:
Completed data was obtained for 60 patients total and only the patients that had goals met or plateaued were looked at. Now, mind you, this isn't published or anything, it was just me looking at data to get a feel for how I practice and the results that I do or don't achive. Standardized outcome measures (self-report) were used. For patients treated for a cervical body part my effect size was 1.14. For an upper extremity body part the effect size was 1.18. For a lumbar body part the effect size was 1.54. For a lower extremity body part the effect size was 1.38.
The average overall effect size was. 1.31.
Then, I looked at the data for basically one-on-one treatments (as management dicated to me to perform). Complete data was present for patients that were discharged with goals met or a plateau for n = 78. For patients treated for a cervical body part my effect size was 1.75. For an upper extremity body part the effect size was 2.08. For a lumbar body part the effect size was 1.23. For a lower extremity body part the effect size was 1.2.
The average overall effect size was 1.57.
From just looking at those numbers, it appears that I have better outcomes when I am one-on-one with patients with cervical or upper extremity involved body parts. The numbers look statistically significant to me. When looking at the lumbar and lower extremity outcomes, since I'm not a stat wiz... either there is no difference between the situations of group or one-on-one, or there just might be a slight advantage to group situations.
The issues I have with "quality" is that no one has ever published or looked at IF one-on-one IS quality. Only assumptions have been made... Looking at how I practice and with my specific population, I'd question if better quality could occur when treating lumbar spine or lower extremity body parts in a situation where there is more than one patient treated at a time. Also, a possible important note - in analyzing my numbers, I didn't use supportive staff to do any treatments with patients. I didn't delegate patients to an assistant. And, when looking at a guesstimate of number of patients in a day... the range in the group situation was 17-20/day. In the one-on-one the range was 9-14. Cancels always killed productivity when it was mandated to switch to one-on-one treatments only.
In my mind, the one-on-one stuff is only because of the codes that we have to use. No one has ever determined which type of service provides the best outcomes.
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Re: How many patients do you see in a week? - February 19, 2006 2:47:00 AM
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SJBird55
Posts: 2432
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From: Michigan
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I also need to make a formal apology in regard to an error in something I posted with BCBSM. I was spreading a rumor up above... a rumor that the NATA wouldn't like continued to be propogated. I posted my comment based on something that was verbally told to me - and that verbal communication to me was inaccurate. Friday I received written information from the Michigan district of the NATA. The written information was different than the verbal communication.
BCBSM is following Medicare's rule with "incident to" billing when physical therapy services are billed under a physician's or a nonphysicians's number. The effective date is in 2007. BCBSM has not come out with a formal statewide policy to be in effect that limits ATC provision of care within any of the other settings as of yet. I do know that some BCBSM policies specifically state that services are required to be performed by a PT only - one learns that when calling in on the Caren line and checking eligibility and benefits.
I apologize for the inaccuracy in my post.
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Re: How many patients do you see in a week? - February 20, 2006 8:38:00 PM
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Randy Dixon
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I wrote this earlier but apparently I sent it into space. I am wondering about some of these numbers, and if supervisors were asked what the numbers they would state. I've found that PT's start getting an ugly look in their eye when the expected productivity is more than 12 pts/day. While they can usually handle more than this for a short time, 40 hour weeks then are not the norm. If you are seeing Medicare patients you are limited to the amount you can see in a day and even with some private inurance/private pay thrown in it is hard to exceed that by much.
150/wk. That's about 15 minutes each, if we don't include time for evals. which should be around 20 or 25/wk, prep, and paperwork. I don't see how it is possible to even figure out the name much less remember the patients conditon, status, and providing good treatment. I'm not sure what is meant by "how much one on one is needed for a tennis elbow?" I suppose that depends on the cause of the tennis elbow, but I'm not sure how you are treating it without one-on-one.
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Re: How many patients do you see in a week? - February 21, 2006 12:43:00 AM
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SJBird55
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Randy, there is inconsistency in how productivity is reported.
When someone says they treat X number of patients in a week, does that mean that the person treats them independently OR does that number mean that the person is responsible for X number of patients per week with assistance of supportive staff?
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Re: How many patients do you see in a week? - February 21, 2006 5:08:00 AM
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tnpta2
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While one-on-one can be looked at from many angles, it does feel like the right thing to do.
While my state practice act. doesn't say how many to treat, our state does limit the number of kids you can teach.
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Re: How many patients do you see in a week? - February 21, 2006 4:47:00 PM
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Randy Dixon
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SJ,
pts./wk or day as a measure of productivity is just a ballpark figure that is easy to share. Obviously it depends on your patient population, ancillary staff, insurance mix etc. I don't know of a good way of stating those variables with one figure. For instance 20/day in an inpatient setting is very reasonable. What do you use?
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Re: How many patients do you see in a week? - February 21, 2006 4:49:00 PM
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Randy Dixon
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I usually would use units/day, but the equivalent is 12 pt. visits a day.
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Re: How many patients do you see in a week? - March 2, 2006 4:20:00 AM
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dosrinc4
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OAK, you say we cant judge quality by the number of pts we see in a day, I disagree. Maybe you provide great care, maybe your pts do well and you have great outcomes, maybe they think you and your style are the best for them, or maybe they just dont know any better. I have had a lot of PT's try to justify seeing as many pts as you do per day, they make it work all kinds of ways in their heads. I do know that I eventually end up seeing a lot of their disgruntled cases, those who fall through the cracks and think all PT is BS because that is all they know. You tell me all I need to know about your style when you say "how much one on one is needed to treat tennis elbow".
Rick
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Re: How many patients do you see in a week? - March 2, 2006 8:02:00 AM
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OAK
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dosrinc4,
If I treat a patient and accomplish our goals within a short period of time, and if the client is satisfied with that treatment, one can logically conclude that quality treatment was given.
If I spend 2 hours one on one with a patient, the only thing I can conclude is that I've spent 2 hours one on one with a patient. It may be quality treatment or it may not be.
You're wrong to critisize another therapist without looking at the whole picture.
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Re: How many patients do you see in a week? - March 2, 2006 9:45:00 AM
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dosrinc
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From: Bonita Springs
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not critisizing just stating the facts as I have seen them to be in my area, in fact my #1 strategy for location of a new clinic is to find the busy outpt. clinic in an area that treats with a philosophy like yours and open across the street, guarantees walk-in of dissatisfied patients who fell through the cracks or were left to work out on their own, seems that as soon as they see the difference the word of mouth spreads like wild-fire.
The way I see it, when you treat 3-4 pts at a time you have a tennis elbow over here, a total knee on the bike an ankle sprain on the leg press ect, ect
When you treat one on one, you've got a human being in front of you and dont simply treat a diagnosis.
I have no doubt that you are a good PT and get good outcomes, but, if you haven't tried it my way you may be surprised at how much better you can be.
Rick
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Re: How many patients do you see in a week? - March 2, 2006 10:14:00 AM
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SJBird55
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Randy, honestly, I don't measure it. I just opened and my practice is a bit slow. Theoretically, how I plan on measuring it is by my schedule... if my time slots are filled, would then mean that I'd be looking at total timed code minutes per day - combined with reimbursement (am I getting paid for the time I provided?). I'd want to see a low percentage of passive, untimed procedures. Productivity would be based on the codes that I used. We're basically capped in an 8 hour day how many timed code units can be billed... so to be the most productive would mean no more than 32 timed code units in an 8 hour day.
Dos, unless you have specifically defined quality in a measurable way and have specific measures in place to measure quality through your definition, then technically you can't state that Oak is wrong. Until there is data to substantiate anyone's belief, no one is right and no one is wrong.
But... here in the states we do have the definitions of the CPT codes for third party reimbursement and via those codes, technically, we are reduced in how much revenue we can generate in an 8 hour day which does potentially limit the number of patients that can be seen in an 8 hour day depending on the needs of the patients and the CPT codes utilized.
For example, I have a lady that just started here. She had one-on-one care at the hospital setting. She had crap therapy. Evidence was not used in her treatments. She had one visit with me on Monday and I just called her today for a follow up call and one of her complaints has been eliminated. So, was her one-on-one care that was provided at a different facility quality?
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Re: How many patients do you see in a week? - March 2, 2006 11:55:00 AM
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dosrinc
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From: Bonita Springs
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SJ, 33 units really, we take 45 mins for lunch, so we set 100% productivity at 33 units per day, and yes, I agree one on one care can be crap care and one on three care can be good care BUT, good one on one care beats good one on three care any day, thats what my pts tell me anyway.
Rick
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Re: How many patients do you see in a week? - March 2, 2006 1:33:00 PM
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SJBird55
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If you use say 15 minutes/unit.. then 4 units/hour x 8 hours = 32. With the 8 minute rule, I've never really done the math, but technically it would be less than 32 timed code units. Rick, are you saying your therapists work 8.25 hours/day?
If we forget the billing rules and regs and just look at what a therapist can handle and provide, personally, I would say that if the physical therapist had complete control in scheduling, that yes, excellent care can be given in a one on three situation too. It takes someone who has good time management skills, can pre-visualize who needs what and pre-plan good flow, and has excellent skill at re-assessing the patient's status in a quick, expeditious manner.
What really speaks volumes though, and I've never seen it measured, would be the percentage of return patients (for a different problem) or family/neighbors/friends of treated patients. That right there indicates quality. If you suck (whether it is one-on-one provision of care or multiple patients at one time) and if the patient did not like the way services were provided or did not like dealing with front office staff... do you think they'd ever return or recommend you to anyone? If the patient perceives quality, business will be directed your way via word of mouth.
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Re: How many patients do you see in a week? - March 2, 2006 2:31:00 PM
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Andrew M. Ball PT PhD
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Assuming 23 minutes per patients (one 15 minutes unit plus an additional 8 minute charge), and given the fact that an 8 hour day is 480 minutes, the most patients that can be seen by a therapist who schedules 30 minute slots but sees patients for 23 minutes, is 20 (or 21 for an 8.25 hour day). This translates into 40 maximum units per day. No one EVER schedules this way, however, and patients always are coming early, late, etc. so the assumption of 30 minutes is a better one, as such, the most patients that can be seen is 16 (or, as SJ points out, 32 units of care). If we assume one passive modality for each patient, and a tech to put it on under our supervision, that number can inch up to 48 to 60 units of care per day. Per week, this translates to 240 to 300 units of care (or 120 to 150 patients).
That's possible, but that PT has tech help, and is "hoofin' it" all day, every day.
There is the "mill" model, and I dont' hear of many PT's working this way anymore, but I suppose it's possible to see a maximum of one patient every 8 minutes for 1:1 codes such as manual, therex, US, whatever --- and have all other passive modalities administered by a tech, under the supervision of the PT. I'm a pretty organized guy, and I don't think I could do that AND provide quality care, . . . but assuming someone could, we're talking 60 patients per day seen 1:1 by the PT (48 if they're scheduled every 10 minutes, and not every 8), that works out to 240 patients in a 40 hour week. No time for paperwork. 300 if scheduled every 8 minutes, which no one does. Even if poor quality care is provided, I would think a PT working in this kind of environment would burn out pretty quick.
To answer your question, for fiscal 2005, I averaged 10 patients per day (some 30 minute patients, and some 60 minute patients), averaged an 8 hour work day, and billed an average of 20.8 units per day, and an average of 2.25 to 2.5 units per encounter. I was considered one of the more productive therapists in my hospital, and throughout the national hospital system that I work.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: How many patients do you see in a week? - March 2, 2006 5:20:00 PM
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dosrinc
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SJ, they dont have to (work the 8.25 hr day) but they make bonus at 91% productivity (10 pts per day, 30 units) averaged on a monthly basis and the bonus scales up from there, the more they produce the more potential bonus, so, in season we all tend to work 9-10 hour days.
Rick
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Re: How many patients do you see in a week? - March 3, 2006 2:13:00 AM
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tr6454
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Drew,
At that volume did you generate enough revenue to pay your salary, overhead, and generate a profit for the employer?
_____________________________
Terry
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Re: How many patients do you see in a week? - March 3, 2006 2:36:00 AM
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SJBird55
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From: Michigan
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Drew, your numbers seem low. Billing an average of 20.8 units per day (and I'm assuming timed codes) is low. I'm kind of thinking along the same lines as Terry. Billing 20.8 timed units/day equals about 312 minutes and in an 8 hour day there are 480 minutes. You're paid for 480 minutes and billing out for 312 minutes, ummm, what was going on for the other 168 minutes in your day? No one will ever capture 100% productivity, but 168 unaccounted for minutes that could be used for generating revenue is quite high. It really doesn't matter if you see patients for 30 minutes or 60 minutes, but you should try to be billing out for your time.
Rick, 30 timed code units/day on average seems reasonable - provided that the therapists have a very low percentage of cancels or no shows.
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Re: How many patients do you see in a week? - March 8, 2006 3:49:00 AM
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Timothy
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Could anyone hazard a guess at this....how many episodes of service would it take per week, if continued for one year, to ensure that a new graduate would be burned out?
I know the ambition,style and the personality of the therapist has immense bearing on this but can anyone spot a trend perhaps.
You know...."Over the years I'ne noticed that as soon as a new grad. see's 80 per week, they start to get very stressed".
What is the ideal number, when using a rational, thorough, evidence based approach?
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Re: How many patients do you see in a week? - March 8, 2006 5:14:00 AM
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Rwantz
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It would have to depend on the person's ability to cope with the stress. Some are better than others. Also, it would be greatly affected by the amount of work required in (and quality of) the "episodes."
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