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COTA Thoughts

Micro Management of Minutes

Published December 19, 2008 2:29 PM by Tim Banish
I can't believe it, but someone has figured out how to analyze therapy minutes to the point that it tells you when too much therapy has been delivered!

The main idea this program was designed for was to compare the medical reimbursement rate VS the therapy rate for Medicare Part A participants, and of course allow the facility to determine a RUG category for the highest reimbursement rate. If the medical rate is higher than a possible therapy rate, then it seems like that person would get less therapy. And although there are the few who need more medical attention than therapy, does this cheat those who need both the medical and therapy intervention?

The big thing that stood out to me in this presentation though, was the set of figures that indicated where therapy minutes had exceeded a category. In one sample, a patient in a Very High RUG group and scheduled to receive 500 minutes of therapy actually received 580 minutes during their assessment period. This was indicated on the report to exceed the 10% overage exemption. In other words, you just gave away 30 minutes of treatment time over the allowed 10%. The total overage was there too, indicating that 80 minutes of therapy was "given away". 

Another sample was also presented, and this one showed that the medical rate would exceed the therapy rate unless therapy could deliver 720 minutes to place this person in the Ultra High group. The funny part was that even with a UH category, the therapy rate was not much more than the medical rate. The "suggested" therapy RUG group for this person was Low.

Now I know that if we delivered the exact number of therapy minutes for every patient for every RUG category, someone would be perusing through our books. And it's unethical to deliver fewer therapy minutes than the person needs regardless of the reimbursement rate. But I can see that before long, therapy minutes will be tracked closer and closer as more micro-management programs are developed and used.

Until next time, hope all your thoughts are good-

Tim

posted by Tim Banish

4 comments

I can believe this - I worked for a large national agency that managed minutes this closely.  I don't think I "gave away" any minutes of therapy

A. Therapist February 3, 2009 7:17 PM

I am amazed when the team I work with gets the phone call about over-delivery and giving away minutes.  We are usually dead-on about what we predict a person can tolerate and what will benefit that individual.  But, if they have one, or a few, of those days when everything is just working and they can do more... we'll get the call the next Monday.  And, we then have to justify and explain what happened, and sometimes write a plan of correction to show how it will not happen again!  

If I didn't believe in what I do, and enjoy seeing patients progress, this career could take a flying leap!

Mary, geriatrics - OT, SNF January 1, 2009 10:16 PM
Lincoln NE

Thanks for your comments Kathy-

I know we all face the same issues at times. I still enjoy being a COTA, though.

Tim Banish, LTC - COTA/L December 25, 2008 10:47 PM
Cincinnati OH

Hi, Tim,

I really do not have a comment on topic just wanted to let you know I enjoy reading them.  I just found them today and went back a month or two.  Almost, after each one, I found myself thinking been there, done that!!  I have been a COTA for 27+ years.  I have worked consistentently as I wanted and have touched almost every area that I was interested in.  I have never had any interest in becoming an OTR and have worked with wonderful and not so wonderful ones :).  Keep up the good work and thanks for what you do.    Kathy

Kathy, SNF - COTA, LIFECARE December 23, 2008 7:01 PM
College dale TN

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