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Productivity Expectations

 
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Productivity Expectations - November 28, 2000 7:34:00 PM   
Betty Smoot

 

Posts: 49
Joined: March 2, 2000
From: Sonoma CA
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SJ posted a reply to Joe's post ("Does this stuff really work") in response to his comments about how many patients he's expected to see in a day. I had some questions and it appeared a new thread was evolving. This is in response to that and is a topic I've been debating bringing up here for a while.
SJ, my apologies if I get some of your details wrong, but I think you wrote that you're expected to see about 2 patients an hour? I forget the exact numbers you indicated, but I do remember that you like to see about 24 pateints a day and sometimes see 30 (in a 9 hour day). This sounds stupid, but why do you exceed the expectation? Is it staffing, personal choice, patient request, etc.? Are you in private practice?
I'm curious about productivity expectations across the country and in various types of facilities. Advance magazine is doing a survey so something will likely come out there soon, but would some of you be willing to share?
I am.
We're expected (in our hospital based outpatient dept) to have a minumum of 85% billable time. If we exceed it, we get praise. If we don't meet it, we feel like slackers, but only because we're a competitive bunch, not because we get any static from the boss. We're asked to indicate (on our billing sheet) how we spent our day in the event we had down time.
We schedule patients every 30 minutes as a rule, but have the flexibility to schedule patients for longer sessions if we see fit. New evaluations still get an hour.
I know I'm very fortunate and wouldn't dream of working anywhere else, exept maybe as a food critic. Now there's a job!
Any comments?
Betty
Post #: 1
Re: Productivity Expectations - November 28, 2000 8:02:00 PM   
edilling

 

Posts: 139
Joined: January 11, 2000
From: pullman,wa,usa
Status: offline
Betty,

I am also quite fortunate in my work. Patients are scheduled every 30min with initial evals 60min. We have full flexability to double book or extend a patients individual treatment to 60min. We are not penalized for cancels or no-shows but attempt to be productive during these openings. Because of this flexability, I have no problems if (for whatever reason) I have a 30min eval booked or am asked to run over to the med/surg floor to see an inpatient.

I earn about $12,000 less than my previous job where all time was expected to be productive time and the schedule was much tighter, but I no longer have high BP and I go home to my wife smiling.

I recently spoke with a friend who works for Healthsouth. They are expected to make up no-shows and cancelations and are penalized if they do not meet "productivity standards" (even their supervisors are penalized). These productivity standards are based only on billing and patients seen. They do not consider diagnosis, prognosis, outcomes...
I doubt that I could ever work for Healthsouth-- any first hand stories about working for HMO's good or bad?

(in reply to Betty Smoot)
Post #: 2
Re: Productivity Expectations - November 28, 2000 10:00:00 PM   
JoePT

 

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Joined: November 21, 2002
From: Birmingham,AL
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Hello everyone,
You guys are right with your comments. I will not mention where I work other than it is an outpatient private practice owned by a businessman. However, the market is very tight where I work and the only other option for myself or the jaded therapist is to work at Healthsouth for about $10-15,000 less and still see the same amount of patients.
SJ, unfortunately we don't get the quality time you talk about. I attempt to answer patient's questions in the 5-10 minutes I have. Otherwise the PT techs handle the easy questions and call upon the PTs in an emergency.
Typically, we are allowed 20 minutes for an eval, subjective and objective and 10 minutes for treatment. As I said previously, we see approximately 5-6 patients an hour. We receive bonuses for seeing greater than 800 patients per month. Believe it or not, "JadedPT" was employee of the month last month. Luckily out paperwork is very simple. A real short intitial eval, no progress notes or discharge summaries. Yes, there is a 4 line daily SOAP note. DOn't ask me about billing, I don't know how they pull it off.
I am not proud of where I work. It is unfortunate and I hope to get out as soon as I can. Once job openings occur. I am in an area with 3 PT schools and most jobs look to hire a new grad for about $35,000.

(in reply to Betty Smoot)
Post #: 3
Re: Productivity Expectations - November 29, 2000 9:40:00 PM   
bonmar

 

Posts: 138
Joined: August 16, 2000
From: Boston, MA
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I work in an out-pt ortho practice owned by a businessman. I work 7 1/2 hour days and in that time I am scheduled 16 patients - alternating btwn 2 and 3 patients per hour. We do not utilize aides or PTA's (although I wish we would) so I feel like I basically run around all day - physically and mentally exhausting. (I have discussed with my boss that he is paying me alot of money to perform aide duties) I am allowed 1 hour for an eval and I very rarely treat that first visit - I give home exercises, discuss proper body mechanics/ rx plan/goals, etc. I definitely utilize the eval to get a good handle on my PT diagnosis and treatment plan.

Reading posts from rookie and joePT, I cannot understand how 24-30 treatments/day is possible?? I can barely make it with 16! I do remember, however, when I went to Dr. Stanley Paris' seminars, he stated he saw a patient for only 15 mins. He would come in , talk to the patient, mobilize (or perform the "skilled service"), and then have the PTA finish with the instructed exercises.

One thing I did not understand at all, however. How are you getting away with not doing discharge summaries or periodic re-evals? What ins cos. are reimbursing with nothing to back up the charges?

One last thing. It appears to me that jadedPT is burnt out. I know that when I feel that way, it is time to go to a seminar/course to update and refresh. It always works. Reading journals, etc is helpful as well (my personal favorite is BioMechanics). [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]

(in reply to Betty Smoot)
Post #: 4
Re: Productivity Expectations - November 29, 2000 10:15:00 PM   
JoePT

 

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Joined: November 21, 2002
From: Birmingham,AL
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Bonmar,

My typical workday is 40 patients. A slow day is 25-30. As for insurance reimbursement, I have no idea how we get reimbursed considering we hardly do any paperwork. But I am not going to complain. If I had to do actual paperwork I would probably be there all day. As for JadedPT and I, we have discussed taking a course together (as you mentioned). We could both use a good trip to get away from the clinic. After all, he was employee of the month last month after seeing 840 patients [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] We are looking into a strain-counterstrain course. Each trigger point is 90 seconds. That fits perfectly into our time allotments for patients. We could work on 3-4 trigger points per session. We'd be providing hands-on treatment and giving quality care.

(in reply to Betty Smoot)
Post #: 5
Re: Productivity Expectations - November 29, 2000 10:23:00 PM   
RookiePT

 

Posts: 11
Joined: November 22, 2000
Status: offline
i would like to know where you guys work?
i thought 25-30 patients a day was the norm.
i have been doing that since my affiliations.all my new grad friends are in similar situations. hey if you make me think about it i guess it is unethical, perhaps. but they dont really tell you about insurance,reimbursement, # of visits, billing codes, monthly expectations in school. i am beginning to feel that this PT isnt really what i thought i went school for. maybe i should of been a massage therapist. anyway i go to work everday because somebody has to pay the $50,000 i owe the gov't in loans.

(in reply to Betty Smoot)
Post #: 6
Re: Productivity Expectations - November 29, 2000 11:19:00 PM   
mcap

 

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Joined: February 9, 2000
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Joe and Rookie:

You guys are seeing way too many patients. If I had to see that many, I actually think I would pack it all in.

Where I work we see 3 patients per hour and have 40 min for the eval with one admin slot before lunch and before leaving. It gets busy at times but it is manageable. Some of the practices here in NYC see four/hour. But there are also many that see 3 and hour and even quite a few with 2/hr with 1 hour evals!!!

Six.....I don't think it's very manageable. But I don't know what the answer is for you guys.

mcap

(in reply to Betty Smoot)
Post #: 7
Re: Productivity Expectations - November 30, 2000 8:55:00 PM   
JadedPT

 

Posts: 13
Joined: November 30, 2000
Status: offline
Hello Group....I work with JoePT. He recently told me about this site and from what I hear, I have taken a lot of heat. I just wanted to stop by to defend myself and see what this forum is all about.
I have been practicing for 15 years. I used to be a young, eager, gung-ho PT. At this point I do not quite feel I have the nihilistic attitude that has been implied about me. I am probably somewhere in the middle. However, having been practicing this long, I do question many of the things we do and realize that much more research needs to be done and that we have to be accountable for our services.
It is unfortunate that I work in a facility where I sometimes have to cut corners to meet management expectations. The longer I work the more I discover that PT is ultimately a business (and hopefully we also do some good). Yes, I did see 840 patients last month and it can be very tiresome. However, there is no other facility that is going to pay a staff therapist in the 6 figures, as I am getting now. I am not going to take a 40% pay cut to work anywhere else. I don't think I am being greedy, but like everyone else I have a family and bills to pay. This is my reality.

(in reply to Betty Smoot)
Post #: 8
Re: Productivity Expectations - November 30, 2000 9:56:00 PM   
RookiePT

 

Posts: 11
Joined: November 22, 2000
Status: offline
hey sjbird,
i took your advice(as well as the others) and went to talk to my supervisor today. i brought the high patient load, the quality of care, the billing for appropriate services, and said it was bordering on my ethical values as a therapist. he opened his desk drawer and told me to take a look. inside was about 50-100 resumes. he told me if i dont like it theres the door.(so much for all your help being diplomatic). i then walked out of his office with my tail between my legs off to see my 6 patient per hour. i would love to leave this job to a cushy 2-3 patient per hour job like you so if you or any of the others have any openings let me know. i also will start taking up a collection to make my student loan payment. thanks

(in reply to Betty Smoot)
Post #: 9
Re: Productivity Expectations - December 1, 2000 8:11:00 AM   
JadedPT

 

Posts: 13
Joined: November 30, 2000
Status: offline
Rookie,
My check is in the mail...but seriously, Are you crazy???? Do you have such a "pollyanna" outlook that you actually thought you could walk into your boss' office and expect those changes to be made? Did you think he would say, "ok, let's try going to 3 patients an hour and see what happens." It is noble that you made an attempt but I think your expectations were too high. It seems people offer people write in advice on this forum as if we were in a perfect world. The reality is a lot different once you sign off the computer. So as a veteran let me explain the way it really is.
The only way you will see less patients and treat ethically will be if you get a new job. This isnt easy nowadays and I am sure will mean a pay cut for you, considering that the "mills" always pay a lot higher. A perfect job is almost obsolete due to the surplus that the APTA has created. Yes that's right, the one the APTA has created, for all you sitting there with your mouth wide open. So for now, go out and buy a comfortable pair of Rockports because it sounds like you have a lot of running around to do with your 6 patients per hour. Trust me, I know what it's like.\

(in reply to Betty Smoot)
Post #: 10
Re: Productivity Expectations - December 1, 2000 9:50:00 PM   
JoePT

 

Posts: 0
Joined: November 21, 2002
From: Birmingham,AL
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RookiePT,
Go get em killer! Good for you. As another new grad I think it is cool you actually stood up to your supervisor. Hey, you failed but so what. At least you made an attempt. So many others just sit back and take it. SJBird has a point, that you should have put a little more thought into it and showed them how it could hurt them financially. Plan it a little better and possibly confront your supervisor again. Perhaps we can both work on a strategy together. After hearing what you did, I would also like to confront my boss. However, I have learned from your mistake and will definitely put a plan together before I walk into the office.
One other thing, as with Rookie's office, my office has no paperwork either just an initial eval. Yet we have worker's comp patients who have been receiving PT for 2-3 years non-stop and actually have one patient on comp who has been coming since 1995 continually. Yet, there are no progress reports to the doc and nothing substantial in the daily notes - other than the modalities received, tolerated well and continue as tolerated. Go figure. Anybody else work at a facility like this or have seen anything like this??

(in reply to Betty Smoot)
Post #: 11
Re: Productivity Expectations - December 2, 2000 12:03:00 AM   
RookiePT

 

Posts: 11
Joined: November 22, 2000
Status: offline
LIAR,LIAR, PANTS ON FIRE!!!!!!!!!!!!!!!!
I just didn't barge in my boss' office and start venting. this was something i was considering for a while. i asked the rooms opinion of something to see what they thought. as far as my busy schedule goes i actually scheduled time with my supervisor a few weeks ago to meet to discuss several things. i was very diplomatic and professional. i dont work for a hospital or big company . i am in private practice and its his mill and he can run it whatever way he wants, i'm just the hired help. so trying to change the place or starting slowly doesnt stand a snowballs chance in hell. i would leave but i dont work in single traffic town with my clinic being the only one. i'm in the big city baby where PT's are a dime a dozen thanks to all those schools(great job by the APTA by the way but thats a different story) so if you didnt hear me before i cant quit without another job, jobs are very hard to come by, and billy-bob at the general store doesnt take my credit.
And another thing i never said i didnt do paperwork or efficient paperwork. i said i see alot of patients. my paperwork is very good, i may not give quality care but its all documented. unlike some people who work for nonprofit hospitals who pretty much get reimbursed for the majority of services.
As for joe where do you work??
i guess i would put up with that crap to if i was making six figures. my loan would be paid off in no time.

(in reply to Betty Smoot)
Post #: 12
Re: Productivity Expectations - December 2, 2000 9:48:00 AM   
bonmar

 

Posts: 138
Joined: August 16, 2000
From: Boston, MA
Status: offline
JoePT,

If you told me that you were seeing a w/c pt for 2-3 years 15 years ago, I might understand it. But in this state (MA), w/c reimbursement is only allowed with strict prior approval. I must justify in note form why SKILLED PT is required. I request a certain number of visits (not more than 12). If that patient has not made significant gains, continued PT would be denied. I think that is good, however. Why would a PT want to cont. treatment if goals are not being met?? There is something terribly wrong with the picture you are involved in! The patient population must have rotten view of what PT actually is. Obviously, the goals of PT in your clinic is not to foster independence. I can not think of a single dx that would justify 2-3 years of PT.

Where I work, I have had many pts. come to me (after being at another clinic) and be shocked that someone is actually touching them and talking to them. I have had pts. tell me that they have gone to PT and gotten their own hot pack, take it off, do exercises on their own, and then go home. When I asked why they would pay for a service when they were getting nothing in return, the reply was, "I thought that is what therapy was" !!! What a disgrace!! No wonder we, as a profession, have been losing ground.

The way your clinic is treating is one of the reasons PT's are not thought of as professionals. You are raping the system. You say that there are no other jobs around. I can understand that. But that does not justify ruining a profession for your own personal gains. That would be like me stating that I am going to be a stripper because it pays well. How can anyone fault me??? I have bills to pay!!......What ever happened to ethics and personal morality? You must not feel good about what you are doing. Also, it is not allowing you to develop better skills as a therapist. By thinking that doing only trigger point therapy is giving quality care (as stated in a previous reply) is either a joke made by you or a very sad situation for your patients.

I seriously advise you to take another look at your situation. Your PT lisence may be in jeopardy if you're clinic was ever investigated. Then you would have absolutely no means of support. Better to take the plunge now than to be working 100 hours/week at MacDonalds (and still not making it). Good luck.

(in reply to Betty Smoot)
Post #: 13
Re: Productivity Expectations - December 2, 2000 12:13:00 PM   
JoePT

 

Posts: 0
Joined: November 21, 2002
From: Birmingham,AL
Status: offline
BonMar,
Let me preface this by stating that I have full respect for strippers and the work that they do [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Based on your analogy, the best I can offer is this. As PT's we have spent a lot of money to go to grad school, undergone a lot of hard work to earn our degree, and then been burned by the APTA. We (the new grads inparticular) were promised the world and left with nothing. There were few jobs (oh sure, I could have gotten one for $35,000 with poor benefits) and the only ones paying something decent were the mills. So yes, in a sense I had to become a "stripper" in order to pay my $800 a month student loan and my $1000 a month rent.

(in reply to Betty Smoot)
Post #: 14
Re: Productivity Expectations - December 3, 2000 12:18:00 AM   
edilling

 

Posts: 139
Joined: January 11, 2000
From: pullman,wa,usa
Status: offline
Some history as to why the PT job market is as tight as it is:

Skilled nursing and long term care facilities were preassuring PT's to treat anyone they could bill for, for as much as they could bill for, for as long as they could bill for [IMG]http://www.rehabedge.com/forums/mad.gif[/IMG]. The PT's in these positions were very comfortable earning $70k--$100k and, knowing they could "only" make $40k-$50k [IMG]http://www.rehabedge.com/forums/rolleyes.gif[/IMG] in other clinical areas so they did as they were told (gait training those who would never walk and exercising those near death). After all, they had student loans and house payments that they had to pay off. [IMG]http://www.rehabedge.com/forums/redface.gif[/IMG]

When Medicare realized the degree of overutilization in many facilities they cut off the gravey train [IMG]http://www.rehabedge.com/forums/eek.gif[/IMG]. (this was just a few years ago) The skilled nursing facilities cut PT staff 50%-80%! [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG]

[IMG]http://www.rehabedge.com/forums/confused.gif[/IMG]The moral of the story: Reap what you sew.

Your choices affect you, your patients, your colleagues, and your future. Do what you feel you must but understand the potential consequences of your actions.

(in reply to Betty Smoot)
Post #: 15
Re: Productivity Expectations - December 4, 2000 9:36:00 AM   
mcap

 

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Joined: February 9, 2000
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Edilling:

AGREED!!!!!!!!!!!!!!!!!!!!!!!!!!! Let's not forget PT outpatient clinic owners who cared only about volume. They ruined us as well.

Joe PT:

I can fully sympathize with your loan and rent woes. My situation is quite similar. But honestly, if paying my loans back and making rent were my only concern then I wouldn't be in PT, or even healthcare for that matter.

If the care you deliver doesn't matter, then why are you in the field? Certainly there is more money to be made in sales and in financial jobs which in this economy seem to be quite plentiful.

Respectfully submitted:

mcap

(in reply to Betty Smoot)
Post #: 16
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