Productivity in Today's SNF

The U.S. Department of Labor definition of productivity states it "is measured by comparing the amount of goods and services produced with the inputs which were used in production.

"Labor productivity is the ratio of the output of goods and services to the labor hours devoted to the production of that output."

In today's Medicare PPS reimbursement schedule, how can we accurately define productivity for a SNF Rehab department? Foremost, in order for any business to thrive it must be productive and efficient. A skilled rehab department, like any other business, needs to support salaries, bonuses, benefits and so on, which reflect how the practice/business is performing.

Most nursing/rehab facilities measure productivity by factoring therapist minutes on the premises over number of minutes billed; thus a therapist billing 385 minutes in a 8-hour or 480-minute day would be 80 percent productive. Does this truly measure the productivity of a therapist/assistant? Patients are not products and therapists are not factory workers. However, we do find ourselves to be at close comparison when factoring productivity. When measuring therapist productivity by counting worked minutes/billed rehab minutes, it can not only demoralize therapists/assistants but also create less than favorable outcomes regarding the quality of patient care delivered.

Consider a few example scenerios. In example A, a therapist in her facility is required to be 80-percent productive and her manager informs her to capture the highest category possible in order to get the best reimbursement (not an uncommon scenario). The therapist has five patients placed in a "very high" or RVL catagory (500 minutes); she sees them BID totaling 100 minutes each for five days a week. This means the PT will be well over 100-percent productivity using the given formula. At RVL (500 minutes), PPS reimbursement is $447.49 a day per patient.

In example B, a therapist has six medically compromised patients and scores an RMX (150 minutes) in which he sees each patient about 30 minutes for five days per week. The therapist has a daily total of 180 rehab billable minutes/480 minutes on premises, making him 37-percent productive. At RMX, reimbursement is $465.68 per day per patient.

If we compare, therapist A with more than 100-percent productivity with five patients at RVL $447.49 per day per patient will have generated less in terms of reimbursement than therapist B at 37-percent productivity having six patients at RMX at $465.68 per day per patient. Moreover, the therapist with the lower "productivity" not only generates an increased reimbursement but can also treat other patients, screen more patients and/or develop new programs.

We need to look beyond the "standardized productivity" measures for SNF therapists and properly use the RUGs catagories the way they were designed, which is to fit the needs of patients while maintaining the integrity, ethics and professionalism of therapists.


I am so relieved to read the above comments, because they have verified that my feelings/concerns are validated.
I was recently terminated due to not following billing practices that I felt were unethical.
The evals completed on every patient, as far as billing is concerned reflect that each patient, despite diagnosis and treatment ability, are placed at the highest/Ultra high/Rug. At rounds twice a week we are forced to plan D/C's around ARD dates, even if the patient has met goals and is ready to D/C. In regards to productivity we are told we must complete all documentation at point of service and it was ok if we talk to the patient. We are also told to bill for transportation time, which they feel is ethical if we are talking to the patient. I am so frustrated and angry that the company I worked for has no clue how unethical their billing practices are. When I confronted the DOR her reply was, "That's the nature of the business." I also asked about the continued statement, "The patient always comes first." I received the same answer that this is a business and the patient coming first is not really true any more. There is so much more to tell, but I feel those who read this understand my frustration.

Mary Straiton,  COTA,  Unemployed/January 11, 2016
Bloomington, MN

I just returned to the States from a deployment abroad after a year and found myself interviewing with multiple companies in an attempt to procure a position as an OT. I was floored by the productivity requirements the managers as well as therapists in some of these facilities are expecting; the percentage is 95% to 100%... "for a therapist that manages his/her time well and is a team player". The saddest part is the fact that this is projected by the rehab team as a whole and not just the managers, it is sad because there were a lot of new grads employed at these facilities and they technically do not know any better and follow blindly employed "seasoned therapists that encourage these practices. The math just does not add up...480-30(lunch) leaves 450 mins, in a perfect world where other issues such as residents not being ready, appts, medications, screens, meetings to mentioned a few are not computed could only make you 93% productive.....in a perfect world, that is.... and we know a day in a clinic is far from perfect. The problem is that we tend to close our eyes and do not question these questionable practices,....for seasoned therapists to actually encourage these practices is just "preposterous". In 2009 companies attempted to use the group minutes loophole to overbill Medicare and no one questioned it by 2011 after Medicare put one and one together it was stopped; again "WE" followed blindly. As the professionals that we are, we cannot continue to go "along with the program" to be labeled TEAM PLAYERS, it does not serve the populations we serve and it undermines the title of THERAPISTS by making us look as factory workers.

David Arredondo,  OTR,  N/ADecember 31, 2015

Star green productivity has become such a big issue with working in SNF. I am working as a travel therapist placed in SNFs. I have had the director complain to my recruiter about not being 90% everyday. I explained to my recruiter why it's not possible to do that everyday. There is no tech. It may take me going to 3 people before I get a patient. I refuse to work off the clock. The other therapist that worked made me look bad cause they would work off the clock doing paperwork. As being a travel theraoust, I worry that a company will let me go if I'm not doing 90 every day. I will not be unethical. They give patients rug that are high and ridiculous. It's like I get in trouble for refusing and being unable to do 90 every day. Sometimes I wish I wasn't in this game of numbers. I got in this for the patients.

Kwameshia  Carter ,  COTAJanuary 04, 2015
California, TX

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