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.


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

Stand up take action. File your own fraud lawsuit against the company for making you do these unethical things. If you are adding Rx to just make higher RUGS that is wrong and no manger should even ask. Do not beef and bolster your notes. Put down the truth. Your residents matter more than the bottom line. Using tax payer dollars in a ethical way matter more than lining the pocket of the Rehab company that promised the facility they would make them a big amount of money.
All of us hold a license and we could be held responsible if we do not stand up. Stand up take action today.

Joe July 28, 2014

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

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