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Toni Talks about PT Today

Overtime Issues

Published July 31, 2013 10:39 AM by Toni Patt
I've noticed a growing trend to prohibit overtime. Until recently, overtime was frowned on but permitted if caseload supported it. That isn't happening anymore. The same is true to a lesser extent for using contract labor to fill staffing gaps. Many facilities and rehab companies have in-house contract therapists who must be used instead.

Just last week I ran into this. By Friday I had one hour of overtime, which meant I had to leave one hour early. That sounds great except I had to do the same amount of work in less time because our caseload didn't support an extra person. I think everyone can guess how this played out. I was able to see all the patients on my caseload but everyone got shorter treatments. For me, the day was rushed and I'd rather have worked the extra hour to make things easier on me.

This week there will be two of us in the same situation. We'll need to leave early one or more days to prevent the overtime. That's great if caseload doesn't continue to build and nothing happens. More than likely, Friday will come and both of us will be scrambling to get everything done. Somehow we'll manage but at what cost? Sure, it's stressful to constantly monitor your time. But the real losers are the patients.

No overtime is permitted in the SNF where I work on Saturday. This doesn't affect me directly since I only work there once a week. But indirectly, it means a higher caseload because someone went home early and didn't get enough minutes. Or, none of the regular staff can work the weekend because it would mean overtime. I'm sure there are occasions when Part B patients are missed so Part A patients can be seen when staffing is tight.

This all arises from the need to cut costs due to cuts in reimbursement. There were times I needed my overtime to survive. Getting weekend work isn't as easy as it used to be since that's another area of cost cutting. I wonder when the people making these decisions are going to decide enough is enough and put the emphasis on quality of care rather than cost of care.

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6 comments

Posted recently on this blog and wanted to share a new update that may make therapists think twice about putting one single extra minute in for free. I was happily going about my hectic day as usual when the contract that I work at, suddenly pulls off almost every Part B we have on caseload fearing the issue of overextending the cap. Left all of the therapists blindsided. What does our therapy company we work for have to say to us? Sorry, you will all just have to leave early and that's it. No reassurance, no assistance finding other places to work to fill in the gap, Nada!! Feeling very "punched in the face". I put in so much extra free time!

Therapy girl, Rehab - PTA, Comm. Manor August 14, 2013 6:13 AM
Farmington MO

The responses are disconcerting. Obviously the problem is more widespread than I originally thought. So you've worked your behinds off to become a respected DPT, and are treated like a garment worker in Bangladesh.

At what point do we stand up and say "No more!" ?

Dean Metz August 7, 2013 7:35 PM

Indeed.. maybe a PT Union... but then again.. more politics.. ha ha.  You know, I think we all learned "Just do the right thing" can also mean getting yourself fired.  

I work with therapists that wont speak up. All talk about it, then when we have a meeting I wind up talking and they just stare straight ahead as if in a trance.  That's OK with me.  Corporate manipulation.. oh what a good expression.  True, true....

Really, I have been keep a 'Dear Diary' for the sake of sanity and my own protection. I am trying to put dates, times and people with the notes for back up.  I will stay until the bitter end or until I am threatened with house foreclosure for lack of income!  Then, I think I will sit back.  I will apply for unemployment, food stamps, Medicaid.  I will take my unemployment check and go for a 3 day cruise to the Bahamas and when I get back go see my lawyer who has filed a class action suit and my whistleblower attorney.  When Medicare (The Feds) win their claim, my former company can plead not guilty but agrees to pay all the fines (plus their attorney and the Federal/Medicare attorney fees).. I will wait for my 'whistleblower'  percentage check to arrive.  Ya know, I have been thinking about a road trip to nowhere. LOL

Pat Thompson August 6, 2013 3:04 AM

My employer is one of the largest therapy based companies in the USA.  They employ OT/PT/SLP staff as well as Nurses/RT/Administrators mainly in SNF and Home Health settings and as Travelers.  Across the board, in SNF settings, PT/OT/SLP to have 85% productivity per day (not averaged for the week) and PTA/COTA to have 90% productivity.  

This is where it is getting scary!  The company distributed IPad Mini to all therapists to do Point of Service documentation.  We do not have a soap note format, we are using an OPRA note format.    In my humble opinion the OPRA format give minimal information about that patient.  It does allow for more productivity, however, any therapist that would see your patient or any auditor has very little idea of the actual functional ability of the patient or progress.  

This is what I mean as scary.  First, IPad is wireless and because of layout of the building the wireless only works in the department.  Second, the 'client' will not allow use of the IPad as it is capable of taking pictures, HIPPA.  Third, therapist MUST do note on computer (wireless- does not work out of department).

So, therapist must bring patient into the therapy department so therapist can input note on computer to be billable time.  So, it has boiled down to working off the clock in order to get productivity every day.  Director of Rehab has stated that anyone not meeting their daily productivity will be written up and fired if not corrected.  Corporate has advised us we will be fired if we work off the clock.  Every therapist/assistant in my department is working off the clock.  Working off the clock means we have all become liars in order to keep our jobs and make productivity look good on paper.  We are donating our time.  

The situation is not that we are all sitting around reading newspapers or watching tv in the patients rooms.  It is that the standard is too high for our facility.  We are not allowed to take a patient off the hall unless they have had their medication, we are not allowed to talk to the nurse when at the medication cart or even if in a room (or be fired if caught/reported).  Nurse's are pretty good at this facility and most CNA's are also quit good on the hall where majority of therapy patients are located.  

When patients waiting on medications, not dressed or waiting on showers, gone to beauty shop, at an activity all hinder productivity.  Not to mention  when CNA(s) on hall know nothing about the patient, how they transfer and on weekends- do not understand that the patient must still be dressed and up.  

Weekends, only PT staff see patients. No Therapy Tech in our department.

What I see happening is the company is forcing therapist to bend rules for the sake of keeping their job, setting standards of productivity that can not be achieved.  I see it as things to come in our future, if we allow this.  Trust me, this is only the beginning. Companies will push the productivity for the sake of money due to low reimbursement and GREED.  Therapist will begin to justify why they really only saw the patient for 30 minutes or less of a 45 minute treatment and let the patient sit for 15 minutes while the therapist writes the note on the computer, prints it out, files it in the soft chart and one to the medical hard chart.  The patient does not get a 45 minute treatment and the 30 minutes they do get is partial or as I say "a kiss and a promise" treatment because therapist will be so worried about getting the note/paperwork done and trying to get to the computer before one of the other therapists get on the computer.

I reported to the therapy director that I put on my Daily Activity Log (aka schedule) all the reasons for low productivity such as patient not ready, patient at hair appointment, patient seen bedside, patient at activity or whatever.  My director said "you are wasting your time, it does not matter, you MUST get your productivity"... my comment "how in the world can I get my productivity when there are situations I can not control"... she states again "you MUST get your productivity every day or you will be written up and may need to be fired" ...

It is not ignorance to the fact that healthcare is a business and must make a profit. It is the schedule that gives you 16 patients to treat and less than a 8.5 hour day to do it in and meet productivity.  As it is, none of the therapist take brakes, hardly get a lunch and at the end of the day wonder if they even used the bathroom or are getting a UTI because short term memory is really becoming a problem!  Just today, the OT had come in at 7:30 am, she had 3 patients to treat and 3 evals and given only 225 minutes of treatment time for each patient and expected to meet 85% productivity or be written up.  I left at 5:00 pm and she was still typing like crazy on the computer.  

WOW!  BTW... I saw that almost an entire hospital medical staff walked out for 3 days to protest just this kind of thing!!  

What do you think?  Any comments??

Pat August 6, 2013 2:07 AM

I COMPLETELY know what you are talking about. I am the Program Manager where I work, and it has become the accepted "norm" to work off the clock. I am an hourly employee with a very high productivity expectation (compared to other Rehab. companies) and find it completely impossible to do all of my management duties while effectively treating a full caseload of patients. Speaking for myself and other managers, I think we should be salary, due to the fact of the amount of extra unpaid hours and the unreal amount of texts and phone calls I receive from staff even on my days off. Very frustrating when the caseload goes down and we are sent home early, when I think of all that extra "free" time I have given

Therapy Girl, P.T. - PTA, Community Manor August 5, 2013 6:39 AM
Farmington MO

I've seen many places that bank on PTs and other professionals doing the right thing and working late to take care of patients. It is corporate manipulation.

Leave every day on time. Do not work even one minute over because then you will have a very hectic Friday every week and the patients will still suffer.

When management whines that people are not doing their jobs, and they will, ask them to support how they came up with their productivity numbers. Odds are, they can't. Not until every PT starts working in this way and probably a few cases wind up being brought to labor boards, will things change. It won't work in "right to work" states like Florida unfortunately as you can be fired for pretty much any reason under the sun.

Time for a PT union?

Dean Metz August 1, 2013 8:36 AM

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