Lecture 4 Productivity and the millennials workplace – Flashcards
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Describe the millennials
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-birthdates between early 1980's and early 2000s (range from 16-35 yrs of age) -more likely to have responsibilities for generation below ; above -economically stressed with debt that limits options
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millennials seek employment at sites that:
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-share their personal values -provide leadership development (even if they already have senior positions) -make full use of their skills
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Describe the reality vs perception of productivity measurement.
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-reality: productivity measurement is essential -perception: it can feel like administrative micromanagement in support of profit (rather than in support of best practice) so productivity may be deemed 'not in line with the employees personal values'
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Define productivity (US department of labor)
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-is measured by comparing the ratio of goods and services to the labor hours devoted to the production of the output -productivity increases by getting more work done in allotted time or getting same amount of work done in less time/for less money/with fewer resources invested *think of it as a measure of efficiency that is often evaluated based on revenue generated vs expenses
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Is productivity tracking necessary?
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With a continuous push for efficiency and the projected rise in the demand for physical therapy (and associated allied services) care, it is essential for providers to consistently strive for higher productivity.
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Describe an assumption someone may make if someone has low productivity?
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-lazy or conscientious steward of resources
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Describe an assumption someone may make if someone has high productivity?
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-poor quality care or efficiency
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Name 4 or 5 things that employers may use to calculate productivity.
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1. volume of patients treated 2. number of procedures performed 3. time spent performing patient care 4. relative value units earned (# units) or 5. some combination of these metrics
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Factors improving productivity.
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-therapist attitudes -therapist beliefs (quality, acceptable quantity) -therapist behaviors (billing choices, intervention choices, interaction with support staff) -therapist skills -seasonal clinic variations (weather, deductibles) -changing patient mix (new referral sources, insurance contracts, complexity of care, etc)
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Productivity prevalence in practice: "In 1999, 47.2% of respondents indicated that their facility had established a productivity standard. In 2000, the number dropped slightly to 45.4%. However, in 2002, it rose to 62%.
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FYI
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44.4% of responders in a survey stated there was a productivity standard within their facilities. Which settings are the productivity standards tracked?
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-SNF/extended care facilities/intermediate care facilities (67.5%) -acute care hospitals (65.1%) -sub-acute/rehab hospitals (inpatient) (62.5%) -hospital-based outpatient facilities or clinics (59.3%)
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Hospital based OP facilities expected how many hours out of 40 to be generating income (direct patient care)
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-31.5/40 hours (78.75%) -41.8 completed visits (roughly 1.04 visits) in a typical workweek
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What ethical missteps does AOTA caution therapists to avoid in regards to productivity?
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1. under-performing due to low (easily attained) productivity benchmarks 2. inappropriate use of assistants, technicians, and/or students 3. over utilizing groups with 1:1 services would produce better results 4. failure to comply with state & national laws, rules, and codes that identify what is acceptable OT practice
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Name 2 ways APTA/AOTA in which these organizations are helping productivity issues.
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1. identify resources that will help therapists respond to employers who use only productivity as performance measures 2. develop (if none exist) these resources
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Why is productivity so important in the financial health of a practice?
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Time Management When asked how they managed their time during a typical week: -all settings indicated the largest % of time was spent on patient management (with a chance of financial return). -private practices nearly two-thirds (64.8%) of time spent on patient management(with a chance of financial return). -All settings second largest % of time was spent on administration or patient related paperwork (with no chance of any financial return).
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Productivity is hard to quantify across all settings. Example of OTs in school systems - caseload vs workload.
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-caseload: refers only to the # of children seen by an OT as part of the IEP or IFSP -students are not pulled out of class for appointments as much now bc that approach does not meet IDEA intent. *caseload tracking often under-reflects OT activities
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Define workload.
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-encompasses all of the work activities an OT performs that benefit students directly and indirectly.
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Name some examples of workload.
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-Hands-on services to the child (individual and small groups) -Activities that support child/student programming (collaborating with team, planning meetings) -Activities that support children/students in natural environments or general education curriculum (in-service to kindergarten teachers on fine-motor centers) -Activities that support other federal, state, and local requirements( documentation, data collection
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Productivity results can impact more than numbers name 4 other things productivity may impact.
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1. staffing pattern influence 2. promotion/merit raises 3. morale 4. availability of new graduate mentoring
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Acute care productive hours definition
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the total departmental hours of all therapists and assistants during a two week pay-period (minus vacation/PTB/sick time and time pre-arranged for research and education). Includes overhead such as "nonproductive" supervisor hours and students time.
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Acute care efficiency units
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15 min patient contact units (not directly correlated to charges or CPT codes)
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Acute care productivity formula
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-dept productive hours divided by dept efficiency units (for a 2 week period)
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Describe the PT/OT/speech productivity standards in acute care
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-PT goal: 0.38 (every 22.8 min 1 efficiency unit occurs) -OT goal: 0.38 (same) -Speech goal: 0.40 (every 24 min 1 efficiency unit occurs) **This is essentially a measurement of how often during an hour a therapist must accomplish one 15 minute efficiency unit. It doesn't leave much time for people who can't get organized quickly to move from patient to patient. Adding group treatments to supplement individual treatments has a huge positive impact on efficiency indicators and will also likely reduce cost of care at the same time. It may not affect collections.
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Practitioners weight in on productivity. Name some of the points they made..
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-Degree of repetition in task: group v. individual (easier to be productive with the former) -Fatigue potential of job: heavy lifting; cognitively challenged patients) -Dependence on others decreases productivity: inpatients; patients receiving several rehab services back-to-back; shared equip in facility -Outside Interference: patient mode of transportation; phone calls from physicians; lack of support staff; encouraging families to attend therapy
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Describe how to measure productivity in short term
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-Salary/fringe offset method --Paid: 8 hr day at $20 hrly = $160 25% benefits = $29 daily pay = $189 ($23.63 per hr total) --Non DC time: 30 min lunch 30 min paid documentation 30 min (2 fifteen min breaks) 90 min lost time = $35.44 --Actual DC hrs available: 6.5 hrs • Paid: $189 daily so productivity requires service delivery during 6.5 hrs that bills at least $29.07 hrly if manager hopes to offset salary...no profit unless much higher For ease of calculation, assume annual salary of $20 hrly or $41,600 for 2080 hrs of FTE
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Name some issues to consider with productivity
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-Not realistic as to how much time is lost to actual direct patient care by issues that arise. -It can improve documentation when note writing time does not affect direct care productivity expectations -Builds in some cushion to keep productivity up (therapist could always engage in more direct care during breaks or note time) -Patient volume declines at some times of year -Unexpected patient cancellations have huge impact on productivity
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Billed treatment units (BTU) (75% = 24 units in 8 hr day)
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set # of units (1=15 minutes; 2 = new eval) increments established per day EX: 24 units per therapist and assistance (2-3 units per patient x 11 patients) (feedback from OT indicates 24 unit is also typical but can vary) -24x21 workdays in January = 504 BTU units expected as monthly productivity figure
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Name some issues to consider with BTU.
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-Bad weather, therapist illness, year 1 or weak student, or vacation has negative impact on productivity -Discourages therapist/assistant working together as a team or co-treatment since all practitioners need to meet the set standard -Monthly BTU # might not be possible with type of patients and typical treatment approach -Easy to end up with more supervised modalities
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Name some potential problems with using BTU to measure productivity.
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-does this foster a 'quantity not quality' approach? Does it lead to a view of students as money-generators rather than learners? -what happens to teamwork and safety? will you want anyone to help you and 'take' your units?
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Another way to measure productivity in the short term: # of individual patient visits.
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-Therapists are usually expected to see certain # patient visits per day. Often 2-3 per hour =16-24 per day. Assumption is that volume will offset any worry about billings. -Acute care often lower (13 visits a day or 1.62 patients/hr) -Works well in a facility with a waiting list, frequent walk-in patients, extended hours, or IP facility with readily available patients. -Clinic closure or low IP census has immediate negative impact on everyone's productivity
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What are some things to think about when using number of patient visits to measure productivity?
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-Therapists who self schedule control their productivity and work speed which can be + or- -New evaluations will cut into productivity b/c they take longer (some sites count eval as 2 patients but there is only 1 set fee collected) -Encourages frequent but short intervention sessions -Certain diagnoses require lengthy 1:1 sessions with unbillable interactions that decrease productivity -Needs to be an incentive for therapists to immediately fill any vacancies in their schedules
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Another way to measure productivity in the short term is to use bill specific number of minutes per day. How does this work?
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-bill specific number of minutes per day -75% productivity = 360 minutes (6 hours) -can work well in busy OP clinic where therapists have high volume but don't always see patient for entire session (use care extenders); allows short but meaningful treatments that still meet 8 min rule to be counted
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Name some things to think about when using specific numbers of min per day to measure productivity.
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-pressure to add min or two when recording times -pressure to extend length of treatments even when the patient could work on his own -reluctance to pass patients to aides/assistants even when appropriate
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A way to measure productivity in the long term is to use yearly billings divided by collections. How does this work?
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-add up # of CPT codes & $$ they represent -divide by actual payments (some CPT codes might have been rejected or self-pay patients might not have paid) -result is your productivity which needs to offset salary & fringe (assume $41,600 of $10,400 = $52,000) and expenses of practice -might use this figure to decide whether to offer contract for additional year
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Name some things to consider when using yearly billings divided by collections to measure billing.
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-Weak biller (but productive therapist) who CPT lacks accuracy or edits may have high % denied claims -Weak or absent documentation affects reimbursement -Might be difficult to track closely since some reimbursement takes longer to appear in accounts receivable -Assistant and therapist often submit one bill with charges from both so hard to separate for productivity -Willingness to provide indigent care may decline -Staff who suspect they will face termination may job hunt and quit Q: What if someone meets quota before end of year?
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Name some strategies to work with productivity
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-Computerized documentation -Front desk receptionist to complete paperwork -Biller pre-authorizes to make sure patient's insurance covers services -Voice mail for therapists to allow messages to get returned later -Charge for cancellation/no-show -Dummy workstations so notes can get done at various places in clinic in between patients -Use of groups when safe and appropriate
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Regardless of method used, data needed to set effective productivity standards include:
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-Avg procedures billed per provider work hour -Avg procedures billed per visit (across entire staff) -Typical # visits per 8-hour day -Typical # visits per patient (most common 3 dx) -Initial evaluation cancellation rate -Follow-up visit cancellation rate -Payments (collections) per procedures -Payments (collections) per visit -Compensation cost per visit -(Therapist salary/fringe - 3rd party payer collections = total compensation to practice EVEN IF the therapist bills nothing)
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Describe the proposed system on the D2L handout "3 Therapists' Schedules" for OP clinic
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-Each timed CPT code (eg, 97110 Therex) gets a weight of 1; initial evaluations have a weight of 3; modalities have a weight of 0.5. Therapists were expected to bill 3-4 unit charges per hour of patient care time (for a total of 4-5 'weighted charges**') and each patient visit lasted between 45-60 minutes. Average of 11 visits expected. **When the supervisor looks at productivity, all treatments are not viewed equally. Therapists engaged in higher level activities (evaluations, hands-on work) can be distinguished from those who simply push a great deal of modalities.
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There are some questions to prepare to engage in conversation regarding productivity.
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-What services are we supposed to provide? -What resources are needed to provide these services? -Are we efficient? (How do we judge this criteria?) -Are there national benchmarks that are applicable for our setting? -What is our current level of productivity and how does it look in light of the first 4 questions?
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Is increased productivity the only option for enhancing revenues?
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-overview of possible cost reduction strategies *productivity: manipulate direct care parameters --fewer visits & shorter visits *lower payroll costs --paycuts & heavier utilization of lower cost aides/assistants *lower supply costs *accept less profit
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How can we use the staff to enhance revenues?
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The staff: -Pay/fringe is biggest piece of budget -Intelligent in areas other than patient care -Revenue loss: Boutique practitioners who cannot generate enough specialty patients for their programs; unnecessary staff at meetings -Staff in charge of own scheduling may not dovetail as tightly as needed -Revenue enhancers: Create list of 'down-time' activities and evaluate results on performance eval; use time clock to track hours when busy; consider split shifts instead of traditional 8 hr shift; consistently accept upper level students; offer in-house CEU programs
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How can we use the facility to enhance revenues?
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The facility -often an underutilized resource -Costs money 24/7, even if lights are off and heat is lowered at night -average size of facilities are between 2,000 and 4,000 square feet to accommodate the patient pathways between areas, rehabilitation equipment, business operations, staff, and private treatment areas. -Revenue loss: unused equipment, modalities that take floor space, private offices, keeping non-revenue generators (billing, scheduling) onsite -Revenue enhancers: make space available for CEU courses, allow "kiosk" in off-times for trainer or massage therapists, create 'supervised gym', etc
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Productivity creates a potential dilemma in which setting?
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-SNF
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Why might productivity cause a potential dilemma in SNF
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-PPS for reimbursement -all potential admissions are screened with MDS tool to classify them into Resource Utilization Groups (RUGs) that reflect the clinical condition/functional ability/expected utilization (amount) of services needed) -there are 8 categories of RUGs with 53 subcategories -Of the 8 RUG categories, -2 are Rehabilitation and Rehabilitation Plus Extensive—our services fall there 6 are for those who get little/no therapy --Issues: our 2 categories have a payment rate of about 2x as much as the other 6 Our two categories are further subdivided into 5 levels based on number of minutes of therapy provided. So within the category, more minutes = more $$
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Name some ethical implications while trying to measure productivity
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-Pressure to over-estimate the # minutes a patient needs to receive (influencing category)* -Pressure to over-report the # minutes actually provided. -Inappropriate use of care extenders to meet minute requirements -Overutilization of concurrent therapy (groups)* **see changes in 2011 to address these issues
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What questions would you ask while job hunting.
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-Do staff collaborate to meet productivity? - Is teamwork affected by your productivity policies? -Is there any co-treatment/interdisciplinary work going on that makes it difficult to calculate your productivity formulas? -Q to ponder : When seeking to reward, why do most employers remain fixated on productivity standards rather than focusing more on performance standards (ex: best practices, ensuring our work is documented and billed correctly, evidence-based service provision, etc)? Would changes to these factors impact profitability as much as productivity does?
