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Battle between ethics and productivity requirement at work

Last post 10-20-2015, 6:22 PM by truth bear. 14 replies.
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  •  08-01-2011, 8:03 PM

    Battle between ethics and productivity requirement at work

    Help, I work for a large national staffing company for SNFs. The requirement for 100% productivity I feel like it is breaking me. I haven't been in the field that long but and this is only my second job, but every day I feel like I am being pushed to do things and document in a way that stretches the truth to the limit. This is a big company and so that I know a lot of others work for them doing the same thing and they seem to manage so I just don't know if I just can't handle the profession or what.

    How do other people handle this? Is it only in SNFs, so do I have to find another area to work in. 

  •  08-02-2011, 6:23 PM

    Re: Battle between ethics and productivity requirement at work

    This is something that is very common in the SNF field of work in several different companies that I have seen. I work as a therapy director in a SNF. This is the new paradigm with regard to working in the field of SNF therapy due to Medicare cutbacks and the need for the companies to be able to make a profit and be able to keep their doors open.

    I certainly don't advise being totally unethical but you need to have some realistic expectations on what is needed to be a profitable business in the healthcare field. If being 100% productive is needed for you to fulfill your job description then you must expect to fill your role otherwise your company, as any company will, will replace you with another therapist who will do the job asked of them. 

     It is easily within the realms of any therapist to report to be 100% productive during their day.

  •  08-22-2011, 11:58 PM

    Re: Battle between ethics and productivity requirement at work

    I have been a therapist and director of rehab in a SNF setting for the past 15 years and understand your concern re: ethics and meeting productivity requirements.  While I do understand the "business" aspect of this setting and the need to make a profit, unfortunately, I have witnessed some "questionable" behavior by therapists that feel pressured to meet productivity (i.e. billing for minutes that were not given, doing concurrent treatment or group therapy but billing/documenting it as individual treatment, etc.)  I have also experienced other ethical dilemmas when working for a contract rehab company in a SNF.  These have included feeling "pressured" by the facility to keep patients on caseload that are no longer appropriate for skilled therapy and/or picking up patients that are not appropriate for skilled intervention.  What you need to remember is that it is your license that is on the line and that you will have to justify your actions and documentation, not the company or the facility your company is contracted with.  If you feel like your ethics are being compromised, my advice is to stand up for what you believe is right.  I'm not sure about other therapists, but I learned clinical decision making skills and ethical decision making in PT school and that is something that should come into effect when working in any type of setting. Because of  all of the medicare cuts and changes coming, and the "unethical" behavior I have witnessed by other therapists due to the continued "pressure" to be 100% productive, I have decided to try a different type of setting.   Maybe that is something you may want to consider....
  •  01-02-2012, 2:58 AM

    Re: Battle between ethics and productivity requirement at work

    Being productive for 100% of the time is impossible (unless doing group therapy).  That will mean you are unable to take your 15 minute break in the morning and 15 minutes in the afternoon if working an 8 hour shift. (This is the law and some companies forget it) Companies that require 100% productivity standards need to be called out and challenged. 

    Productivity rates will fluctuate based on the nursing staff, medication needs, family involvement, etc.  Ideally between 85% and 90% is feasible and managable but only if the other departments do their job.   If you feel the environment is unethical, call the state board of therapy and Office of Inspector General.  Report them, you have an obligation to do so. 

    And yes, SNF's are notorious for increasing standards everytime there are cuts and every place has some sort of requirement for productivity. 

  •  06-23-2012, 7:43 AM

    Re: Battle between ethics and productivity requirement at work

    I am very interested in how it is "easy" to ethically  be 100% productive, or did you mean it is easy to report being 100% productive without acturally doing that?  With the time it takes to find/get the patient, not being able to bill for concurrent like we once did or do groups for part A patients and then document on what occurred as it is not always possible to document at point of service due to using laptops, infection precautions, being in the bathroom with them or physically engaged with them and impossible to write or type.  I have seen some therapists working with 3 patients at a time and no concurrent time is billed.
  •  09-19-2012, 9:05 PM

    Re: Battle between ethics and productivity requirement at work

     I'm in an OP clinic, mostly Medicare, mostly orthopedic - I work with the geriatric population, on balance, vestibular and neuro, whether PD, stroke, MS, etc. I see roughly 1 patient every half hour. Evals are given 1 hour. I spend 30 minutes, one on one treatment, utilizing gait training, NMR, therex. We have support staff, aides, one assistant, and an athletic trainer. I'm having an ethical and moral dilemma, I can certainly justify 30 minutes of billing for my treatment, but I've been told that that is not enough, and that I need to utilize the support staff to bill another 2 codes. This is under Medicare. That would mean that seeing 13-16 patients a day, It would appear that I would be working a 16 hr day.  I don't. My boss's reasoning is, that since every clinic is getting audited anyway, and we will be owing medicare money under the audit, it is better to overbill than bill correctly, since the audit agencies hired by Medicare will always find a way to deny even the most meticulously correct billing, since they get a piece of what they 'recover'.

    But this is MY license we are talking about. He is unmoved by that.  What do I do?  

  •  11-24-2012, 10:38 AM

    Re: Battle between ethics and productivity requirement at work

    Dear Michelle:   From what you are saying then, SNF/Nursing Homes would have all had to close their doors, if therapists remained at 80-85% productivity, rather than 95-100%?  So is it my understanding that rehab services alone are the reason SNF's/Nursing Homes exist?  Is there no profit to be made from the delivery of SKILLED NURSING SERVICES and the over 6,000 per month that residents are charged to live in the nursing home?  Why are these facilities called SKILLED NURSING FACILITIES if nursing does not provide the financial stability for these centers to operate.

    Your statement, " It is easily within the realms of ANY THERAPIST  to REPORT to be 100% productive during their day" is an amazing statement.  Yes, I suppose they will REPORT TO BE 100% productive for fear of losing their job.  WE all know that 100% productivity does not factor in patient refusals, sickness, schedule conflicts, etc.  It's a sad day for rehab services to turn what was once a PROFESSION into an assembly line mentality.  The pressure to be 100% is killing the heart and soul of rehab.

    What a sad day indeed it is. 

  •  11-24-2012, 10:50 AM

    Re: Battle between ethics and productivity requirement at work

    Dear Patti:  What could I personally do as a professional to protest this type of requirement? When did our profession become controlled by the business office rather than the authority of the therapist to determine what is ethical regarding which patients to pick up for therapy, when to discharge, etc?  

    I would think that the government would value therapists who are trying to do the RIGHT THING in this regard?

    It certainly is a discouraging day for healthcare!

     

  •  11-24-2012, 11:00 AM

    Re: Battle between ethics and productivity requirement at work

    OTHERWISE THE COMPANY WILL REPLACE YOU- Again this is the threat that these companies hope that you will feel.  You are pressured as a professional to work like a machine with the constant threat of not being able to support your family if you don't FOLLOW COMPANY POLICY.  Yes, indeed, there must be a new BREED of new therapist coming up who will do WHATEVER IT TAKES as dictated by GREEDY companies.  This continued trend will the the ultimate downfall of our profession in this setting.

    IT'S A SAD DAY FOR OUR PROFESSION! 

  •  12-03-2013, 1:46 AM

    Re: Battle between ethics and productivity requirement at work

    I have also experienced other ethical dilemmas when working for a contract rehab company in a SNF.  These have included feeling "pressured" by the facility to keep patients on caseload that are no longer appropriate for skilled therapy and/or picking up patients that are not appropriate for skilled intervention.  What you need to remember is that it is your license that is on the line and that you will have to justify your actions and documentation, not the company or the facility your company is contracted with.  If you feel like your ethics are being compromised, my advice is to stand up for what you believe is right.  I'm not sure about other therapists, but I learned clinical decision making skills
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  •  12-21-2013, 3:07 AM

    Re: Battle between ethics and productivity requirement at work

    It is not a single person's problems. It is a general problem. We have to work as our company demands from us. If we are not capable doing that we have no right to work in the company. I am sorry for being rude, but it is the reality. So keep the hard work going and hope for the best.
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  •  01-30-2014, 3:11 AM

    Re: Battle between ethics and productivity requirement at work

  •  03-12-2014, 7:43 PM

    Re: Battle between ethics and productivity requirement at work

    You are not alone and you need to contact your national and/or state association(s).  Let them know that this is a critical issue for members.  All of us providing therapy services know that 90% and better productivity standards lead to off the clock work for therapists and/or medicare fraud (treating multiple patients while billing individually).  Document ANY example of leadership encouraging unethical behavior in order to achieve the standard (just "dove-tail" your patients, write your notes while you treat your patients, don't waste time contacting family members in order to provide education, etc.).  I think that it will be up to therapists to bring this issue to the attention of Medicare.  I am sure that the Medicare administration (which is really all of us) does not want to pay for therapy being provided by a person who is typing on a computer.  They do not want to receive bills for individual treatment when, in reality, a room full of people were being treated by a single therapist.  REPORT FRAUD...REPORT THAT AGENCY POLICIES PROMOTE OR ENCOURAGE FRAUD.
  •  12-10-2014, 12:16 PM

    Re: Battle between ethics and productivity requirement at work

    I completely understand your dilemma. You are not alone.   I wonder where are our lobbyists?  Who fights for us?  These problems have been going on for more than a decade now and are getting worse.  Think about the conditions that we are required to work under.  No other profession in the medical field are treated the way therapists are. Therapists are micromanaged to the point that they are required to stamp in and stamp out of treatment time with each patient on an electronic device and required to account for each minute they are not with a patient.  We are forced to spend time with patients that are clearly at the end of life and unable to comprehend, tolerate or participate in therapy.  Our professions now demand higher degrees to do the same job with the same pay as our peers with lesser degrees.  You end up paying 3 times as much on your education with a masters or doctorate than your co worker who has a bachelors degree .  Companies aren't offering full time positions with benefits.  You may be a full time employee but if census is low and you aren't productive, you are sent home. How can you assure you pay your bills?   Why do we work everyday with the threat of losing our lively hood as we are forced to ride so close to the "ethical line".  How do we do effective help a stroke victim to recover when we have so little time to work with them before they are sent home and watch the window close on them for potential return of function?  

    Why is Medicare's billing of therapy services so convoluted and unrealistic that it forces demands of SNF's and therapy companies to make such unreasonable demands on us?  How can we change Medicare billing, our job demands and the ridiculous micromanaging behavior of some of the largest therapy companies in the US?  Who can lobby for us?  Shall we start a union ?  Why hasn't anyone done anything? Something needs to change.  We need to have our voices heard publicly and not just int he OT forums.  We need to have people expose what happens in the mainstream and let the public know how these insane practices and the treatment of therapists work

  •  10-20-2015, 6:22 PM

    Re: Battle between ethics and productivity requirement at work

    Hello who can we call to report having to be at 95% and have to work off the clock at a snf?