How to be a More Productive Therapist: The Right Way
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As I’ve mentioned before in other posts, most travel therapy positions are not ideal. There are the occasional great assignments but most have openings because they are difficult to staff. This is mainly either because of location or the job itself. I’d say 90% of the “not so great jobs” have been in skilled nursing facilities (SNFs).
Why? Because not only are productivity standards typically outrageous for permanent staff but often travel therapists are supposed to be more productive. I make it a habit to try and avoid SNFs but sometimes it’s inevitable. I compiled a list of things to keep in mind in order to stay ethical while on tough assignments. Also included is practical and ethical tips to increase productivity.
- Travel Therapy Resources
- Steps you Need to Take Before Signing a Traveling Healthcare Contract
- The Pros and Cons of a Traveling Team
- How to Find Housing for your Travel Assignment
- Why I Chose Travel Therapy
First of all, productivity should be called what it actually is; billable time. Just because tasks we do as therapists are not always billable, it does not mean they are not important and necessary in order to provide excellent patient care.
I do understand that whether I like it or not, most healthcare facilities are a business, and operate as a business. There has to be some profit otherwise the healthcare company would not be able to stay running or pay its employees.
One way healthcare companies make a profit is by maximizing billable time during a therapists work day. Similar to other direct care providers, our interventions are directly reimbursed by insurance. This is opposed to nonclinical staff (ie administration) who do not get directly reimbursed for their necessary job functions. Thus, direct care providers have to essentially make up for all of this, in order for a facility to remain up and running.
What is a typical productivity standard?
I’ve had different productivity goals for different settings. For home health, I’ve been expected to see 25-30 visits a week and in a hospital, the goal was typically 6 patients a day. However, in these settings, I didn’t receive much slack as long as I wasn’t turning away patients or visits.
The skilled nursing home is typically not a per visit or patient productivity goal but a percentage. I’ve been expected to be 88-92% productive during most of my SNF assignments. This means that typically 90% of my day has to be with patients, utilizing skilled and billable interventions. That leaves me the other 10% of my day to complete documentation, patient care coordination, answer call lights, train staff, oh and apparently take 2 mandated 15-minute breaks.
What is a typical productivity standard?
Typically companies have the mindset that because a traveler cost them more money, that we should be more productive. The reality is, it doesn’t matter if travelers cost more than a perm employee, we still have the same barriers and difficulties that the perm staff do. Thus, I typically make my goal whatever the perm staff productivity is. I feel it’s difficult for management to come up with a valid reason how a traveler is supposed to be magically more productive than other therapists.
It’s understandable and perfectly fine to have productivity goals for staff, as mentioned before I understand that a profit needs to be made. The constant badgering and pressure to meet productivity or you will be fired attitude is not acceptable. I find it stressful as a travel therapist, but I know it’s even more for the perm staff who simply can’t move on to another position if it doesn’t work out.
So how do we deal with these often unattainable standards? I think first and foremost, don’t take it personally. It is literally someone’s jobs to look at our productivity numbers on a sheet all day. They don’t know the in and outs, they don’t know that you are a great therapist. All they are doing is looking at a number, sadly we are sometimes just numbers.
Not meeting productivity standards has nothing to do with your ability to create positive outcomes in the lives of your patients, it solely affects your company’s ability to maximize profit.
Your number one priority is your license and credibility. A job is your paycheck but your license and certification are your ability to make money for the rest of your life. Always value your license and your clinical judgment first.
Make patient care first
I find that therapists who work well with other staff and disciplines and receive great feedback from patients aren’t badgered as much by management. It’s difficult for management to really threaten a therapist who has excellent customer service skills and who goes above and beyond. Therapists that have a good reputation still get talked to about productivity but I have noticed it’s not as much as a therapist who doesn’t.
I think the best way to do this, is by putting your patient needs first. For example, whenever I am finished working with a patient I always ask, “Is there anything I can get you right now?” Most of the time it’s no, but it’s always appreciated when you ask. The worst thing that can happen is me needing to spend 5 minutes of non productive time getting an ice water, helping a patient call a relative, turning the TV on, etc It’s really the little bit of extra customer service, and I think people just liked to be asked even if they don’t need anything. I noticed patients seem to talk and remember little extra things that I do rather than my actual treatment sometimes, figures haha.
Another way to keep patient care first is by staying up to date on the latest evidence-based practice. I highly recommend Medbridge for those looking for quality online CEU courses. Click here or use the code “tiny van” for $175 off a year prescription!
When you feel like your getting badgered at work for productivity standards it’s hard to see the whole picture sometimes. We get so jaded and burnt out that we end up resenting the job and the whole healthcare system itself. If a manager is being difficult with me, I vent to myself or a friend for a bit and then tell myself to get over it.
The truth is that people don’t act certain ways just to annoy you, it’s not about you. There is typically someone else badgering them about budget and productivity standards.
The best example of this would probably have to be an assignment I had with an awesome rehab manager but an absolutely terrible rehab company. One day she was giving me a hard time about a low productivity day. She then stopped and said, “ I want to show you something.” She showed me emails from her regional manager with mine and other therapists productivity highlighted with exclamations points and sayings like “ This is NOT acceptable, this NEEDS to improve.”
I felt bad for my director who not only has to answer to someone every day when I don’t meet productivity standards but also was expected to keep a certain productivity standard while also handling all the administrative aspects of running a rehab department. I decided to be a little more understanding than it became a joke’ “ Sarah your productivity was 70% yesterday, please try to improve next time.” She would say it in a robot voice mocking how corporate expected us to be productivity robots.
Essentially you need to understand that people are hired to make sure we make money so the company can continue to operate. Most will never set foot in an actual rehab gym and understand the daily challenges of being exceptionally productive and provide excellent and ethical quality care to patients. I think it’s important to be understanding of that. It’s difficult for someone looking at a spreadsheet to understand why we cannot make more money for the company. I think it’s equally difficult for us to look at our daily struggles and barriers and understand how we can reasonably be more productive.
I’m not saying it’s right, but I’m saying its solely about the profit of the company nothing to do with your ability as a therapist. Be understanding that your manager might be receiving just as much heat about productivity that you are.
Actual tips to be more productive
I addressed how to keep priorities and be understanding about productivity. Now I’ll provide some tips I have learned over the past few years to increase my productivity the right way.
Learn what is billable and what is not
Do not trust what your management says about what is truly billable to Medicare, most of the time corporate interprets certain rules in their favor. Some billable services are difficult to interpret with vague medicare guidelines but there are some big no-nos. One thing that I see often and most therapists are ill-informed of is billing for progress notes or recertifications.
Obviously completing your assessments and actual skilled treatment with the patient is billable but not actually writing the document. So you can’t sit outside the patient’s room write up your recertification and then bill Medicare 15 minutes. SO many companies say this is okay but is not.
One way to help decrease the amount of time documenting not with the patient is completing the goals with the patient present. I tend to show my patients their goals, talk about their progress with them. Ask the patient what they think their barriers are and have them engaged in upgrading and creating new goals.
This also makes the patient more motivated and feel more involved with their plan of care. I typically complete the assessment parts with my non-productive time, but I feel updating and creating new goals is a good chunk of time. Check out this great post about specifics for billable time here.
If your manager doesn’t, please ask them to have a schedule ready for the next day before you leave so you can plan ahead. If they give you a hard time, explain this could make you MORE productive.
As an OT sometimes I will find a patient I need to complete ADLs with and say “If it’s okay with you I am going to see you first at 8 am to review dressing.” If the patient is cognitively aware enough they can usually tell the nurse that they are waiting for me. I usually tell staff too but sometimes things don’t get passed along to the next shift.
Schedule treatments when you can
Creating general schedules with patients who are more cognitively aware too is a great time saver. If you see your schedule ahead of time it’s a little easier to plan. I typically have 2 or 3 patients I can schedule the day before. I often ask if they can propel themselves or walk if they are able to down to the gym at a certain time. This saves time on having to locate them. Obviously, this won’t work with some people but it should with at least one or two. If your manager is a last-minute scheduler, I would really advocate being able to see your schedule in advance otherwise it’s like starting scratch each day.
Make transportation therapeutic
Transporting people depending on the size of the building can be really time-consuming. I try to make it therapeutic if appropriate. This can be having the patient self-propel themselves in a wheelchair or walk and retrieve items from various places to work on reaching and dynamic standing balance.
Establish communication about appointments
Some facilities I have worked have a system down for this, some are such a mess. The current facility I am at has a binder with appointments listed at all the nurse’s station. This is usually the first thing I do in the morning is check appointments. That way I can quickly prioritize who needs to be seen before or after lunch, or if there’s a chance the patient might not be able to be seen at all.
At facilities where there was no such system, I make it clear that I essentially don’t want to hear it. If minutes or a treatment gets missed because of an unexpected appointment it’s not my problem. I think it’s ridiculous for facilities to expect us to be so productive when there isn’t even effective communication. I can’t help it if it’s 3 o’clock and a patient leaves for an appointment and no one had any idea. As you can tell, I have had a lot of issues with this in the past.
I don’t find home health productivity standards to be as taxing as SNF but expectations can be unrealistic. My first HH job I was expected to make 6 visits a day while driving close to 300 miles a day. It took me a while to stand up for myself and say this was not possible. Here are some tips to increase productivity in the home health setting.
Don’t ask for appointment times
When I first called to schedule visits I would say things like “ What time works for you?” This quickly becomes difficult to deal with as your schedule becomes more full. I found myself on the phone for 10 minutes each time while the person tried to figure out a time. Now, I typically say, “ I will be visiting tomorrow for an evaluation at 10 AM.” Believe me, if the time won’t work they will let you know.
Schedule the next visit during current visit
I always attempt to make a regular schedule with the patient at a time of eval (ie every Tuesday at 1) for 4 weeks out. If this is not possible I will at least schedule one week out. This cuts down on phone calls which is my least favorite part of home health.
Document in the home
If the patient is not opposed, I spend 10 minutes at the completion of my session to finish my note. I typically ask,” do you mind if I finish my note before I head to my next patient?” I explain that it helps me be more accurate and remember what exactly happened. This is opposed to me trying to complete all my notes at the end of the day. I find except for a select few, most enjoy the extra few minutes of socializing. I also make it a habit of making any phone calls I need to make for the patient before I leave the driveway.
Hang in there
So in summary, I think we can find a happy medium. Creative ways to balance billable time in an ethical and non-fraudulent way. There is a good chance of big Medicare changes coming which may completely change productivity standards in the therapy world. We’ll have to wait and see what happens but use these tips to keep your sanity in the meantime!
How do you balance productivity while remaining an ethical therapist? Leave a comment below.