Ethics VS Productivity

In a few previous posts, I've touched on the productivity standards and how these standards can jeopardize our ethical commitment. Trying to maintain productivity on a consistent basis is a tough task. Cutting corners to keep numbers up detracts from our patients' treatment time. However, faced with keeping your job or not can easily lead to altering the minutes you report.

There are other things besides productivity that create an environment of unethical tracking of minutes. What about the near comatose patient your supervising OT just picked up on your caseload? Not that this is a bad thing, but usually they are placed in a high RUG category. What can you do for 55 minutes with a patient who can barely respond, requires max assist or is dependent in many areas? I had an incident once where a patient of mine was very near death, had no energy, and hurt with every movement. Yet, therapy continued with the patient in a very high RUG level. It was hard enough filling ten minutes worth of treatment, much less 55 minutes. This patient passed away one afternoon. However, that morning I was disciplined because I had only been able to complete 40 minutes of treatment. The patient was in the final day of assessment and now they would lose thousands of dollars!

Hmmm..... did no one think this is a human being we are dealing with? Not just a body to provide therapy to in order to generate dollars for the contractor and nursing home. Needless to say, I soon left this position.

Another situation from some time ago is the DON who promised a family that the patient would stay on therapy so Medicare would pay for the room. The family was currently seeking a long term placement for this patient in a facility closer to home. When after three days the patient just would not participate in therapy, the OT wrote D/C orders. The DON pulled this order from the chart without telling anyone, and two days later tried to discipline us for non-compliance. Fortunately, the floor nurse had saved a copy of the order, and we were able to prove we had discharged treatment. Yes, I left this job soon after this incident.

Another situation I find at times is that many companies hire an OTR to do evaluations in several buildings. They are often told they have 30 minutes to complete an eval, and the person needs to be picked up. Most often they do not treat the patient after the eval, and will set unrealistic goals to achieve. When the supervisor is approached about the concern that this person is not progressing, the response is "we'll have the OT change the goals". However it is usually several days before the OT is back in the building.

All of these stories are situations that I've found myself dealing with. At the heart of all of these is ethics. It's easy for someone who has no repercussions on their licensure to demand more minutes or require an unethical treatment. However, the license at stake is yours, and penalties can range from fines, suspensions, and possible jail time.

Again, we are dealing with a system that has high expectations for the work we do. Being unethical will only make OT seem less of a viable profession to outsiders who do not understand the system. I am not aware of any other job that has a productivity requirement, but I say we start with the House of Representatives and the Senate.

Till next time, hope all your thoughts are good,

Tim