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PT and the Greater Good

Productivity: Why Bother Speaking Out?

Published July 1, 2014 1:51 PM by Dean Metz

I was asked in a private message, "What are your goals in speaking out about the productivity issues facing therapists in nursing homes (and private practices) today?" A good question! We can whine and complain all we want; very little will come of that activity. If we complain to excess, people will stop listening. So what do we do?

Here is why we need therapists to get research active! It would be interesting to see how outcomes compare between facilities that are productivity-focused versus those that are more patient-centered. Facility-provided outcome data would probably not be helpful. If a facility is willing to fudge data just to get patients on program, how likely would it be to manipulate other data as well?

Instead, what would the re-hospitalization rate look like? How would patients rate their own improvement? What would rates of return to work or sports look like? There is a whole PhD project waiting to be designed and written about this.

I still haven't really answered why I'm speaking out. As bothered as I am that my fellow therapists are being mistreated, I'm even angrier that patients will be the ones really suffering from being on this rehab conveyor belt. If you're working at 90% productivity regularly, tell me, how well do the majority of your patients meet their goals? Could they have done better if you had time to case conference with family or other professionals?

How many patients had limited improvement because they weren't really appropriate in the first place? How much money is being spent from scant resources on unnecessary treatment? What is happening to our professions' reputation? Struggling to meet insane productivity levels hurts more than just the therapy staff.

Maybe, like me, you're not in a place to pursue this as a PhD project. I'll talk about an interesting approach to effecting change on a local level in the next blog post.

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4 comments

Jason, thanks for your reflection. One of the benefits I am able to enjoy working in the UK is that the CSP can function on a national level. The APTA can't because of the federalist set up of the USA. They would need to accommodate 50 different states labour laws. That task is insurmountable for them. However, that doesn't let them off the hook. They can make statements about appropriate professional treatment of their members and provide guidance on issues of employment (If they already do this, forgive me, I'm no longer a member since moving to the UK)

I like some of your suggestions. It sounds almost like you would support a single payor set up! That is essentially what the NHS is here in the UK. It makes things much simpler and allows more actual clinical time with patients. We also have standardised salaries here. I'm a Band 7 therapist (so anyone can look up and see what I make and what my cap is) Transparency is a very good thing.

The thing that might be an interesting fall out of your ideas…the elimination of subacute rehab. It is virtually non-existent here. The few that do exist are geared toward TBI and spinal injuries and almost no older adults. Older adults are seen in hospital, home or clinic. If you're wondering about the outcomes of that approach, the UK came in first of 11 countries comparing health status by the Commonwealth Fund.

I wonder, if it wasn't such a big money business, would subacute care need to exist? Could the treatments be delivered in other ways? Could that be the very answer to the problem? Something to consider.

Dean Metz July 3, 2014 2:32 PM

Dean you are right on many points.  It is almost as if the field has developed beyond fixing because so many are entrenched into the productivity mandates and there is little being done to rectify this.

I have yet to see our national organization take a stand on the issue of productivity and yet they really do not have to because the issue is beyond their control as well.  

If better outcomes is the solution why don't insurance companies pay for every therapy treatment that is provided?  There are treatments insurance carriers deem experimental.  They dictate how much is paid, how long we treat a patient, etc They are a business and need to make money too (unless we eliminate them)

If insurance companies are dictating how much money we get for services rendered and then audit us for those same services paid for, it is a never ending cycle.  We have to maintain a high productivity to compensate for what they don't want to pay for and for what they want back after the audit.

Regarding profit - loss threshold, pay bonuses instead of raises.  

Some Solutions:  Eliminate insurance carriers.  Therapists get a bonus if their patients are healthy and stay that way after treatment is completed.  Treat as long as it is clinically necessary.  Eliminate productivity standards.  Standardize pay scales (I should receive negative comments on this but it works).

Jason Marketti July 3, 2014 2:27 AM

Jason, I respectfully disagree with the blanket statement which starts your reply. Yes, it will be a difficult task…so what? We MUST start somewhere! Insurance companies keep cutting reimbursement. Could it be because of rubbish outcomes? You are right, that once a company starts losing money there will be no jobs. I must ask, your suggestion at unionising is interesting because it contradicts your previous statement. What good would it accomplish if the company isn't making enough money? How would you protect established and experienced PTs once they hit the profit/loss threshold? I'm not hearing solutions in your rebuttal, just more complaining.

Dean Metz July 2, 2014 2:26 PM

There are too many variables when it comes to productivity percentages, patient outcomes and goal attainment, and subjective data of how the patient rates themselves.

The big indicator is how much a therapist costs the company versus the return on investment.  If a therapist, who costs the company $80,000+ a year, runs at 70% productivity (or below) over time the company will lose money even though the outcomes are the best.  If a company loses enough money there will be no job despite the outcomes.  

So, do we decrease pay rates?  And how much time do we spend with patients that is not reimbursable just to attain better outcomes?

I queried in a blog a while back regarding unionizing the therapy field.  At the very least therapy could be organized similar to the the AMA which keeps a better eye on their field of medicine from low reimbursements related to coding for procedures.  This won't solve all the problems but with better reimbursements, our productivity will not have to be 90% and we will be able to spend more time with the patients who need it.  

Jason Marketti July 2, 2014 9:43 AM

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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