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PTA Blog Talk

Time Limitations

Published June 13, 2012 4:45 PM by Jason Marketti

Let me vent about this whole system of seeing patients for a designated time in relation to reimbursements in a SNF setting. It does not work.

If a patient comes in and is set at 720 minutes but we only see him for 700 minutes in the assessment reference date period, we get reimbursed at the lower rate of 500 minutes. We do not get reimbursed for the actual time we spent with the patient. Imagine if the MDs were treated like that; I am sure Medicare would bow down and change the reimbursements because the AMA would most likely put some pressure on Congress. Don't we have an organization that is supposed to represent therapists?

So going back to the scenario with the minutes. We get reimbursed for 500 minutes of work but we treated the patient for 700 minutes. We basically worked for free on the patient for 200 minutes. Imagine over three hours of labor given away (non reimbursable) and multiply that by hundreds of therapists in a company nationwide. So the pressure is real for therapists to ensure patients get the treatment they deserve, yet be mindful of getting the correct minutes for a higher reimbursement. Any other profession losing that much time on labor would not stay in business long.

And remember in a SNF, patients have bingo and other activities, hair appointments, family and friends to visit, and X-ray and MD appointments to go to. Plus if they are not properly medicated for pain, they are not going to be able to perform as well during therapy so treatment time may be shortened. And not only that but one discipline (OT, PT, ST) has to see the patient for at least five days in a row or there is a whole mess of paperwork and yelling by the MDS coordinator.

There is real stress for therapists to perform in a SNF. It is challenging because of the barriers that we have to negotiate on all fronts and the rewards are tremendous when we see the patients succeed and go home. Our time is a precious commodity in the SNF so I hope facilities are using us wisely and effectively to help remove the barriers. That way we can see the patients with a minimum of interruption.


In my opinion, it is a system that encourages fraud. What happened to the days of being able to treat patients based on what they needed ON THAT DAY in your professional judgement? It's all about money!!!

Renee May 19, 2013 1:42 AM

At the rehab company I work for, I am told the exact minutes to get with each patient based off of the PT's initial evaluation.  Rug levels are met almost exactly.  If I am over more than 2-3 minutes a Rx, my supervisor will have a "talk" with me.  So much for a very high being 500-719 minutes.  The company loses money every minute over 500, so guess who wins the battle of $ vs what's best for the patient?

Sandy, PTA October 19, 2012 5:56 AM

Well its "worked" since the late 90's, maybe not perfectly, and initially a lot of therapists lost their jobs, but it is a system the new therapists are using and they do not know any different.  It is not a perfect system but isn't that how the government works, create a system not perfect and keep it running until people get use to it.

karen June 18, 2012 9:08 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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