Welcome: Productivity Guidelines

Hello everyone. Welcome to my little space on the new ADVANCE Blog Community. I'm quite excited about this new endeavor. I get to voice my thoughts, and hopefully get your responses to them. Through this blog I hope to present many of my thoughts that affect COTAs. Some of these thoughts will be about current issues that concern me, and others may be about some of the changes I've noted over the years. Many of those concerns are from my personal experience of 17+ years in the field.

Some of the topics I hope to present here in the future will touch on CEU requirements, CEU costs, ethics in the workplace, salaries, and more. All of these are issues that affect us as COTAs, but most importantly our patients as well. I'm sure many of you have had similar experiences and concerns. Let's discuss them here!

So let me jump right in and toss out my first thought which concerns the current productivity guidelines many companies employ. I realize that companies have to make a profit to stay open and employ us. Often though, I feel like profit margins are their only motivation to be involved in the business. I am aware of the fact that Medicare only pays the contractor while we are actually providing treatment, but productivity requirements of 80-90% make it very hard to give your patients quality care. 

As the majority of COTAs are employed in SNFs, and most through a contractor, I'm sure at least a few of you have faced the same dilemma. For those who work in a SNF, you probably know the typical daily routines. From activities, med passes, beauty shop appointments, doctor visits, and so on, it's not always easy to find your patient. Add the fact that it may be a large facility and you have to walk some distance to and from the department. Add those few minutes several times per day, and there goes your productivity. Even at places that I've worked where schedules are used, there were always days that I called "Murphy's Law days". These are days when nothing seems to be on schedule.

Additionally, as I work as a part time contractor, there are other issues that tend to hinder my productivity. I usually don't know the facility layout very well. Room numbers may be absent or poorly posted. Patient names may not be posted due to HIPPA regulations. I also don't know the staff, meal times, etc. Most importantly, often I don't know the patient by sight. Try finding a patient by a staff member description "the little gray haired lady with glasses sitting in the wheelchair in the dining room." I've also had patients with dementia who would tell me they are my patient, Mrs. X, when they are actually the roommate of the patient I'm looking for. Many of these same issues could also affect newly hired staff.

Productivity looks good drawn out on paper. Therapist A is here for 400 minutes, so they can see patients for 360 minutes. This would give you 90% productivity. But if it took 10 minutes to find your first patient then you've lost one quarter of your spare minutes. Add to this paperwork time, not just the daily documentation required, but notes to other team members, placing minutes into the master logs, scheduling and more. These minutes add up fast throughout the day.

So is there a good answer to help maintain good productivity? I doubt it, but one thing I've always found is to be prepared for most anything. Changing gears quickly is a trait that every OT should develop.

Scheduling patients in overlapping or concurrent sessions sometimes works, but only if you have higher level patients. This is an area that begins to touch on ethical concerns, which is where I'll head next time.

Until next time, I hope all your thoughts are good!

Tim