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COTA Thoughts

Do More With Less

Published June 5, 2014 10:47 AM by Tim Banish

I'm sure at one time or another you've been told to increase your productivity, add minutes to a patient, or screen more residents to fill the caseload. As a therapist in a long term care facility, especially a smaller facility, you are made aware of it in an almost constant system of reminders.

Notes and emails from nursing or MDS coordinators can sometimes indicate a resident who could benefit from therapy. Normally this would be a long term resident who has shown a decline, usually due to their diagnosis, but more often it seems like they were expecting therapy to produce a miracle. Of course when that type of person is picked up on caseload the next question is how many minutes do you think can you get with them? Or the MDS coordinator will adjust their reference date to bump them into the next higher category. That usually includes adding minutes too.

Of course there are the reminders from upper management to increase productivity in the building. Some like to make it a competition, but pitting a small 100 bed facility against a huge facility with its own 50 bed rehab wing isn't really fair. As a prn COTA I tended to always be placed in the smaller facilities with low productivity. After a while the numbers didn't mean much when your building was always last.

Another issue begins when you have a patient that requires a special piece of equipment.  There are always the questions of why, it's purpose and is there anything cheaper. These questions usually come from management, who are not therapists and don't think like a therapist. These questions always made me think I had to prove I knew what I was doing. Then once you convinced them the item was needed it often took weeks for it to show up.

 Years ago one administrator allowed me access to the company account to order anything I needed without her approval. That's something never to be seen again. This is just another reminder that therapy today focuses on dollars and not their patients. One therapist I worked with used to say "We have done so much with so little for so long; we are now qualified to do anything with nothing."

Therapy productivity really begins with the admissions coordinator though. If they bring in lots of people, there are bound to be a percentage appropriate for therapy. If admissions are few and far between, therapy is pressed even harder to add inappropriate people to the caseload or extend therapy time with current patients. With few admissions into the facility, the lack of needed equipment and managements constant reminders about productivity my only thought is you have to do more with less.


Until next time, hope all your "Thoughts" are Good-


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I am so tired of treating patients that met their goals and the boss tells me to keep them just 2 more weeks  just to make more money for the facility. I'm tired of the boss picking patients up just to fill the case load. Tired of creative Writing just to finish up the insurance money. I feel that I'm doing something dishonest but really who is to blame?  Me or the boss? Cant tell you how many times I'm told at the end of the week to add minutes to a patients bill even if I did not see them for that long just to get the RUGs. Therapy has become just a game. No one cares about the patient they only care about the money.

marie, cota/l August 10, 2014 1:51 AM

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