Summary

The article discusses the negative impact of strict productivity requirements on physical therapy professionals and patient care.

Abstract

The article, written by an experienced Physical Therapy Assistant (PTA) of over 22 years, critically examines how increasing productivity demands have detrimentally affected the quality of care in physical therapy. The author reflects on the transition from enjoying patient interactions to feeling overwhelmed by the need to constantly bill or document every minute of work. The concept of productivity, while useful for measuring employee value, has been taken to extremes with requirements reaching up to 96%, which the author argues is unethical and impossible to achieve without compromising patient care. The article details that productivity only accounts for billable treatment time and ignores necessary unbillable tasks such as documentation, coordination with healthcare teams, and other administrative duties. The author points out the impracticality of maintaining such high productivity rates while still performing essential non-billable aspects of the job, leading to stress, burnout, and potential harm to both patients and therapists. The article suggests that the focus on productivity undermines the therapeutic environment, leading to a cyclical problem of incomplete healing, repeated services, and dissatisfaction for therapists, patients, and insurance companies alike.

Opinions

The author believes that productivity metrics, while useful in principle, have been implemented to an unreasonable degree in physical therapy settings, with requirements as high as 96% billable time.
There is a strong sentiment that the focus on productivity compromises the quality of patient care by forcing therapists to rush through or multitask essential aspects of their job.
The article expresses that the requirement to maintain high productivity rates is not only unethical but also unsafe and leads to increased stress and burnout among therapists.
The author argues that the healthcare industry's obsession with profits is overshadowing the ethical duties of healthcare providers and is detrimental to patient outcomes.
A critique is made against so-called "solutions" like Point of Service (POS) documentation, which is seen as inapplicable in many real-world therapy settings where hands-on care is required.
The article suggests that the true solution to the problem is to eliminate unrealistic productivity requirements to prevent burnout and improve both patient and therapist experiences.

How Productivity Requirements Killed The Physical Therapy Community’s Will To Care For Their Patients

I used to love doing Physical Therapy with clients. As a PTA for over 22 years I have seen many of the insurance changes, ways of working, documenting and treatment approaches come and go… and then come back. By far, the worst one is productivity.

Who doesn’t want big brother breathing down their necks every day? Photo by Akshar Dave🌻 on Unsplash

Productivity itself is not a bad thing to have. It is a good metric for how valuable an employee is and if you can afford to keep them on. In your personal life it’s a good way to keep yourself on track with daily tasks. It can be great when it it used correctly.

I recall the first time I had heard the term productivity used in regards to day-to-day work. I had been a PTA for 11 years at that point and I was interviewing at a sub-acute rehabilitation hospital for a staff position. It sounded a bit confusing at first.

I was going to be tracked for every single minute of the day? I had to prove I was always either billing or documenting?

It seemed overkill and micromanaging, but the facility was really nice and the other staff were nice and worked well together (and the pay was really good) so I decided to go ahead and accept the position. While I am glad I did because that was a great workplace and I learned a lot in that role, I do not miss having a strict productivity requirement that is placed on me by anyone other than myself.

The productivity demands only became more intense from there. The first facility I had one at was for 78%. Then it went to 90% and then it crept up to 96%. It was just possible at 78%. There is no ethical way to attain or maintain one at 90% or above.

What Is Productivity in the Rehab World?

Productivity is the time spent doing work that is directly billable. This would be treatment time with a patient. Productivity does not include time spent doing the other aspects of patient care that are necessary to complete the job.

This is where I feel productivity goes sideways.

It’s not focusing on downtime activities like breaks or idle time in between work, the sole metric is the time spent billing for services.

The issue-> the other aspects of the job are not negotiable. You have to do them. They cannot be billed for, but they must get done regardless.

These things include:

documentation
transporting patients before and after sessions
phone calls with family members
updating the rest of the health team (nurses, doctors, administrators, etc…)
any other paperwork
Patient care meetings
donning/doffing protective equipment
ordering equipment
assisting patients outside of sessions (for instance if you walk past a patient room and see someone has fallen and you stop to assist them)

This was a short list of things that are part of the patient care package. They all have to be done in the day and take up time.

This doesn’t leave time for the other things that are a normal part of a work day:

bathrooms breaks
restocking equipment
organizing the workspace/ gym
cleaning after patients
gathering supplies in between treatment session, etc…

The labor laws in some states allow for two 15 minute breaks each day, but they are not capable of being taken because they go against productivity.

If you calculate how much time there is to get all of the things done and maintain a 96% productivity rate it would mean an employee gets 2:40 to do everything on the lists above for every hour they see a client.

So you have 7 hours of billable treating time in a day, that is only 18 minutes and 54 seconds to complete every other thing that needs to be done in the work day!

Imagine trying to cram the 14 things from the lists above into approximately 19 min. (And that wasn’t an all inclusive list)

Why is This Such an Issue for Therapists?

Getting a computer to fire up and logged into all the documentation systems can take 2-3 min on it’s own each time you want to use it. Let alone having to stop to pee or take a sip of water or answer a phone call from a doctor.

Having to daily prove your worth and be expected to provide a hands on service that is critical to the needs of someone that is injured or sick is draining.

Companies try to find “solutions” to the productivity issue with tips and tricks. One of these tips is Point of Service ( POS) documentation.

POS is done by having a laptop, tablet, or iPad with you and documenting as the treatment is progressing.

In theory it’s fine, but in reality it is very difficult to do in many settings. I’ve found it’s only reasonable for some outpatient clinics or onsite industrial facilities. That’s not the case for home health, SNF, or in-patient settings.

The work is too hands on and is too dangerous to allow POS.

If I have a client that is a maximum assistance of 2 and needs my entire body and another persons as well to support them, how am I supposed to do that and document the treatment at the same time? Or what if they have an easily communicable disease? Should I take a computer into their room? How am I expected to help a client walk, pull a wheelchair behind them and also hold onto a tablet? Or to stretch or to demonstrate exercises or, or, or…. You get the idea.

Of course there are ways to get things done. BUT WHY?

Why not allow the time to get these things done that don’t cause unnecessary stress and increase the safety risks?

It’s A Numbers Game

The answer to why is easy. It’s a business and businesses want to make money.

Too bad it’s at the expense of the employees and the patients.

I’m sure the pressure to make a profit is intense. There are salaries to pay and stakeholders to keep happy.

Even knowing all this, there is more to business than profits. In the medical profession there are ethics and codes of conduct that should be held to a higher standard than the current market rate of the dollar.

What happened to first do no harm?

While productivity isn’t doing direct harm, it is actually harmful because it dilutes the session. Instead of a treatment being completely focused on the patient and their care, therapists and assistants are forced to think about the billable time and all of the other things they are trying to multitask into the session as well.

It junks up the works.

There is too much to think about at once and that leads to an increased risk of human error. There is no need to force that sort of stress onto an employee.

Unreasonable Productivity Leads To Burnout

I know some will argue about what is unreasonable and what isn’t. I’m sure they have wonderful points.

I’m also sure that productivity is a major cause of the burnout that is prevalent across the therapy world. People are leaving en masse.

When you don’t have a moment to de-escalate and are forced to go go go for 8 hours straight, and you can’t enjoy your time with your client. Both the client and the clinician feel the stress in the air.

It’s not a healing environment. The feeling of I have too much to do is ambient energy that is negative. How are the patients supposed to heal in those conditions? How is the therapist supposed to provide healing?

So What Is The Solution?

Get rid of it!

If companies are determined to keep productivity requirements around then they can continue to expect to get the same results.

Therapists will burn out and leave. — > The patients will recycle through the facility because they didn’t heal properly the first time. — > Insurance will not payout for repeated services. — > The company will harp on therapists about billing and treatments. — > Back to the beginning.

It will continue into infinity until only new grads that haven’t left yet are the only ones around. Then a new crop will leave and a new crop will graduate and on and on it goes.

Pretty soon seasoned pros will be a thing of the past.