Productivity in Today's SNF

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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.


What can we do as therapists? We are trapped by money driven rehab companies and pushed to the limits of our ethics. How do we ease the pressure? Medicare will have to step in and take a stand to stop the abuse. Patients are the ones that loose.

Adam ,  PTAMarch 25, 2014

The company I work for requires 88% productivity from its therapists, however, our DOR requires 96%. Often times we are told to use a modality to increase our productivity even when it's clear the patient does not really need the modality. The therapists are working in fear of losing their jobs and continue to be pressured to produce unreasonable levels of productivity. What is happening in our field is an injustice to our practice, to our patients and to the taxpayers who fund Medicare. These companies must be stopped dead in their tracks. I am writing letters to all possible agencies and political leaders and I urge all therapists to stand up and be heard.

Marsha Green,  Cota,  SNFFebruary 23, 2014
Charlotte, NC

Working off the clock has become a routine experience for many therapists attempting to meet a 90% efficiency target. I do not believe that the standard is realistic on any routine basis. Therapists are forced to comply, on paper at least, if they want to keep their jobs. I do not believe that patients receive optimum care when their therapists are unable to devote any significant amount of time planning for and evaluating their treatments. No wonder many therapists fall into a pattern of supplying similar treatment to a wide range of patients, regardless of their patients' actual needs. There is simply no time, given a 90% efficiency standard, to develop creative alternatives. The source of efficiency standards is not Medicare. Medicare personnel would like to believe that they are paying for quality care. Unfortunately, in the face of ever increasing productivity standards, most therapists are forced to rob Peter to pay Paul. Any therapist who claims to provide high quality treatment to each patient seen at an efficiency rating of 90% is either lying, working off the clock, seeing more than one patient at a time while billing individual treatment, or has received a biomechanical brain implant, which would qualify him or her as a cyborg. I would urge every therapist reading this post to contact their state and/or their national association and ask for action on this issue. Companies are hiring therapists at efficiency standards of 100%. Therapists are being told that writing notes while providing treatment is a "positive way to maximize efficiency". Therapists are being told that the efficiency standard is not the problem, their work habits, such as treatment planning, case conferencing between themselves, discussions with physicians, phone calls to caregivers, contacts with other departments (activities, dietary, etc.), and, Heaven forbid, reflection on the impact of a session are the real culprits. The good news is that it is, at least theoretically, impossible to be more than 100% efficient. The bar can only be raised so high. I believe that there probably is some percentage range at which a human therapist can operate most efficiently. I would submit that that range is not between 90 and 100% over the long haul. We do a patient no good if we have a coronary in the middle of their treatment session and burnt out therapists tend to provide mediocre care at best.

Dee Saylor,  TherapistFebruary 17, 2014
Richmond, MI

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