Joined: April 28, 2004
I have worked in the SNF industry for 6 years and recently have thought about leaving the field. I go to work everyday and hear the same old story about productivity and "we must speed it up". It seems like the job is getting more and more demanding. I am asking for help....does any one have any opinions on this topic?
Joined: January 25, 2003
The only way to maintain such productivity requirements in SNF's is to bend your ethical code. I and many others know, that such productivity typically means working with several patients at one time, having them all perform Thera-ex in a big circle in their wheelchairs. Don't really know how Medicare would feel about that. I have been with one corporate PT company that encouraged such actions. I left to study medicine...while others found jobs in other fields. This kind of practice is borderline fraud and a reason I left the field. But remember, not all groups/clinics are like your employer.
Joined: October 9, 2001
From: Pittsburgh, PA USA
Well, if they are billing group therapy for all the Medicare patients, even the "circle exercise routine" is OK.
As long as the care that is delivered to the patient is optimal, and is in their best interests, then the "issue" gets shifted to the PT. What I mean is this: I have constantly had to adapt over the years due to payer changes, employment changes, etc. I make sure I give the best care I can, regardless as to how the environment is at that time. Now the stress is placed onto me, and I have to either find a way to deal with it, manage it so everybody benefits, or leave. So far, I have always found a way to manage the situation so that everybody benefits.
However, health care is getting streamlined, as the Wall Street mentality dictates what happens to EVERYBODY! What tests you get, how long you get to stay in the hospital, etc.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
Joined: January 25, 2003
If the productivity is being stressed and times are lean in the rehab dept...I bet your bottom dollar thera-ex is being charged in 15min units with several people at one time. I have seen it happen too many times when people NEED to make productivity markers. I can't imagine a company stressing productivity by a PT wants the PT to charge less money for group therapy. Might as well hire a PTA. That is all I am saying.
Joined: April 28, 2004
Thank you for all your help. I still am not sure what to do. I may look into changing jobs. Does anyone know of a good company to work for. This forum has several job postings. I have replied to "PreventaCare", but have never heard of them before. Does anyone know information on this company or any other company that I should look into.
Joined: October 22, 2002
ShadPT3: Have you thought about starting your own company? When you have your own company sometimes it helps to look at your ownself with wearing another hat. Also, there is more money in being your own boss. There are also more risks and uncertainty in where your next patinet is going to come from........The "P" word is not always a bad word.
Joined: April 22, 2004
From: Tacoma, WA, USA
[QUOTE]Originally posted by goodlooks58: ShadPT3: Have you thought about starting your own company? When you have your own company sometimes it helps to look at your ownself with wearing another hat. Also, there is more money in being your own boss. There are also more risks and uncertainty in where your next patinet is going to come from........The "P" word is not always a bad word.[/QUOTE]
Goodlooks58 - you are correct it is helpful to step back and look at yourself and the way you perform. There is more money in becoming your own boss...but there is also much more hardships. A group of therapists started a small rehabilitation company in Seattle, WA (PreventaCare Inc.). This company was started because we had the same concerns as Shadpt3. All of us have worked for the "big" corporations with the same high productivity standard. We got tired of the whole process. We are doing well and have found a few key factors that have helped us to succeed. First of all we do not worry so much about productivity. I have found that if you treat your therapists with respect and as professionals then they will have no problems with keeping the standards high. PreventaCare is not interested in becoming a giant corporation. We take the profits from the company and spread it out to the employees. Our therapist are paid at a higher rate then most therapists working for large corp. We also believe that to have a successful company you must make sure that your employees feel like they have a "say" in what the company does. We have a weekly meeting (often our meetings are held at the Mariners basesball games) to discuss the focus of the buisness. I believe Shadpt3 should find a company like PreventaCare and give them a try. Not all corps. are like the one the requires 85% productivity.
Joined: February 21, 2003
From: New York, New York, USA
Really you should watch your language!! "Might as well hire a PTA" How about expanding on that in specifics.
There are, believe it or not PTA's out there that provide a higher level of care, in all settings including manual therapy, than many PT's. All it takes is a passion for what you do, a passion to help patients make functional gains, thousands of dollars in quality continuing education courses that have a high lab component, teaching (which enhances learning), having excellent communication and co-tx.s with very skilled therapists (and these believe it or not are sometimes co-tx.'s that the PT has asked for help from the PTA), etc.
As for the post at hand, I have worked in a Level 1 trauma center, short-term care facilities, home care and private practice. The worst setting pushing for productivity were SNF's. I only did contract work at them but on my first day I was asked to see a pt. bedside. When I got there he looked like he was on death's doorstep and I couldn't even rouse him. I returned to my supervisor and she said "can't you just do PROM at least"...I refused...the next day I saw they marked that they worked with him (don't know if they actually did) and FYI he died an hour after I had gone up there the day before. I didn't loose my contract. There were 2 plinths in the rehab gym and the only time they were ever used was for naps the PT's took at lunch until I came there. I never made remarks to anyone there on why that was. I just took pt.'s to the plinth and worked on function, bed mobility, transfers, PNF rolling, etc. Then I got them up and worked on gait which was already usually improved by the mass patterns re-trainined in rolling. Eventually, as they saw the results, other therapists came and asked me about what I was doing and they began to get really turned on by the possibilities we have to offer and started taking coureses. Prior to that the tx's. were pulleys in w/c and what I called "drag therapy" when they drag them across the floor any old way, a little farther every day just to say the walked 30 feet. They never improved in functional gait and independence.
The thing to do is make use of your time with patients for functional gains. PNF techniques are probably the most functional enhancing techniques you can utilize. Just focus on one specific task at a time and encorporate PNF into the treatment for the outcome you want. PNF gait also an amazing tool. I suggest it is what you do if it can't be how much time you have to do it. Take some amazing courses to get passionate about this challenging job or go into another setting. Maybe try that before you just leave the profession. Not every place is that bad, especially other settings.
Joined: January 25, 2003
I replied to your comment on the post noted specifically for me. As I stated previously, in the SNF with productivity being a huge issue, hiring a PTA makes sense...hence "might as well hire a PTA". As I am no longer a practicing PT, there are no political agendas made in my statement (as you obviously read into it). As I previously suggested earlier, get thicker skin.
Dr. Wagner DO Moderator of Medical Complexity Forum
Joined: May 4, 2004
From: audubon nj usa
before you throw in the towel maybe as a few of the others have mentione go into private practice because sometimes when you work for your self you can get more stisfaction out of the care you give and the response of the patient to the care. Yes these days it's hard to be a lone wolf but sometimes that is what is best for some people take what you have learned from this experience and turn it into good on your own