How Many Minutes Are Enough?
This morning I was involved in a discussion about getting the most minutes from each patient. This can be taken two ways. Financially more minutes translates into better reimbursement. Therapeutically it results from the belief that every patient should receive as much therapy as possible. If one were to be charitable, you could argue the financial interpretation comes from the therapeutic one.
Those arguments are flawed in so many ways. I don't know where the belief that everyone should have as much therapy as possible comes from. It simply isn't true. Anyone who has worked in rehab or long-term care knows our patients have limitations. The facility wanting three hours of therapy doesn't always translate into the patient tolerating three hours. The same is true in a SNF. Patients who can barely maintain alertness are routinely scheduled for 50 minutes of therapy per session.
The truth is that every patient is different and what is enough for one might be too much for another. Setting arbitrary therapy levels for reimbursement isn't ensuring optimal therapy. It means someone will spend the required amount of time trying to get the patient to do something so she can charge for her time.
Sadly the person I had the discussion with was a clinician who recently moved up to management and should have known better. The same person told me we must spend adequate time with our lower-level part B patients. That's fine. Just realize by definition, "lower-level" means not able to do as much so less time is necessary for a treatment.
Everything revolves around how much time I spend with a patient. Very little is said about what I do during that time. Allowing someone to rest for half of the session isn't very therapeutic. If the patient needs that much rest, the session is too long.
Until someone figures out a way to calculate reimbursement by means other than how much time the patient spends in therapy, this isn't going to change.