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Toni Talks about PT Today

Performance-Based Payment

Published May 25, 2010 11:28 AM by Toni Patt

In a very short time payment for medical services will be partially based on patient satisfaction. Hospitals that have happy patients will get more money. Hospitals, such as the one I work at, with fewer happy patients will get less money. The purpose of that system is to improve patient care as measured by patient satisfaction. The problem is not all patients can be satisfied. I work in a level-three trauma hospital with a neonatal ICU and neuro-trauma ICU. Those are not units associated with happy outcomes. The patients in those units often have diagnoses that aren't compatible with life. There is no way to make that hospitalization a happy experience for those families. Those families aren't going to give glowing reviews of the hospitalization no matter how hard we try.

Another problem is our population has a disproportionate number of non-resource patients. Sometimes funding is available to help pay for the care, usually not. The hospital ends up losing a lot of money on those patients. This results in extreme cost-cutting measures. It has become a nasty cycle. Staffing, supplies and services have been cut to the bone. Two few people are being asked to do the work of many. That situation is not conducive to high patient satisfaction levels.

I'm sure many other hospitals are in similar situations. In the end, we're going to get less money for the same work that will cost us more to provide. The rehab department is already feeling it. There are four open PT positions for acute therapists. There is also a temporary hiring freeze. Patient treatments are being missed. Doctors are complaining. It wouldn't surprise me if lengths of stay are increasing because patients aren't being evaluated as quickly.

I don't see how this will help health care. Nor will it help the APTA reach Vision 2020. Specialization and advanced training is expensive. Education budgets are being cut. I can remember having all of my CEUs paid for as well as my license. Today I have to fund my own education and specialty examinations. The APTA is pushing for certification. That's going to be difficult to do if no one can afford to pay for it. The APTA is so focused on direct access that it is losing sight of its other goals.

I see another problem developing that hasn't been mentioned yet - therapist burnout. People can only do so much for so long without a break. The push for patient satisfaction has almost become giving the patient anything he wants. That often falls on the PTs, because we spend so much time with our patients. Suppose I get each of my patients a fresh pitcher of water after therapy. That probably takes 5 minutes. My average caseload is 10 patients. That becomes almost an hour of my day spent doing something that has nothing to do with PT. Meanwhile I still have 10 patients I need to see. Add to that the normal distractions and interruptions of the day and you have burnout waiting to happen. Wouldn't it have been better if reimbursement was based on employee satisfaction?

This really hit home to me last week. I was working with a patient in the hallway with a tech. We were taking a break and overheard a woman talking loudly on her cell phone. She was unhappy with her mother's stay in the hospital. She didn't like the doctors. She didn't like the room. She didn't like the nurses. She said being in our hospital was like being in the ghetto. A minute later she told whoever she was talking to that her mother had been approved for charity funding and wouldn't have to pay her hospital bill. How do you satisfy someone like that?

1 comments

There is a way to improve patient care in the acute care setting for patients in need of PT/OT or some type of mobility assistance. The PT/OTs should be providing ONLY the "SKILLED" care that only they can provide. However the majority of what IP Acute PT/OT provides is low level non skilled services. Just because the MD or RN request PT/OT does not mean it is skilled. Most hospitals could improve patient care and satisfaction if they would hire more CNA, Patient Care attendants etc. They could increase the head count of total staff and provide patient assistance (out of bed, lifts, supervised ambulation, etc.) around the clock. This would reduce the need for Licensed PT/OT staff providing non skilled services. I have looked at this and it would either save money or be neutral and not increase cost. Ask yourself why should a patient have to wait for a PT/PTA to come get them out of bed to sit in a chair??? And we need a DPT to do this???

Russell Porter, PT - Hospitals May 26, 2010 11:40 AM
AL

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