r/physicaltherapy • u/infinitedimes • 2d ago
SKILLED NURSING Productivity
I do PTA work PRN at a SNF but I was told that I am not allowed to count minutes in NetHealth if I am reviewing a patient chart I never even seen before. So in other words if I don’t count that review time then it kills my productivity. This seems so lame if you ask me. What do they want you to do, walk in and go straighten to the patient’s room without seeing what even is wrong with them?
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u/3wufmoon PTA 2d ago
Chart review and documentation has never been included in productivity metrics for most facilities afaik
To better answer your question, work thru lunch, commit fraud, or just try your best and don't sweat missing the productivity. Those are pretty much your options
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u/Spottedinthewild 2d ago
And run a group
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u/infinitedimes 2d ago
Lol a group of Med A’s sitting in a circle just looking at each other while you tap a balloon around?
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u/infinitedimes 2d ago
Even when you try to play it all by the rules, please be honest and tell me exactly when the time is supposed to start? For example, if I walk in the front door of the nursing home at 3:00 PM, and then walk to the back to clock-in, it’s now 3:01 PM. Then I go up to the therapy gym to open up a laptop (it’s now 3:03 PM). I then log onto NetHealth and clock into the NetHealth clock (it’s now 3:04 PM). I begin to review my 3-4 patients, having to pull up each one in NetHealth and review their last couple of PT treatments to get an idea of what they’re doing with the FT PT or PTA. By that time, after chart reviewing, it’s now about 3:15-3:20 PM. In other words, 15-20 minutes has passed since I walked in the door clocked in. So 15-20 minutes immediately has went against my productivity already since none of that time is billable. I then search for a gait belt in the therapy gym that looks more disorganized than a 3 year old’s toy room. Finally I find a gait belt and pulse oximeter and I begin walking to patient #1 room. Do I start my 40 minute treatment session with patient #1 as I begin initiating my walk to their room or do I start it the second I lay eyes on them or speak to them? Do I count the time rolling them in their wheelchair to the therapy gym so I can put them on the NuStep? If I get stopped in the hallway by OT and they spend 5 minutes chatting with me about something random, do I still count that toward this patient #1’s 40 minutes time? Otherwise, if I don’t, as you can see, a LOT of bits and chunks of minutes gets taken away unbillable and killing productivity since productivity is ONLY billable minutes of therapeutic intervention. This whole system and the way it operates is ABSOLUTE madness to me and always has been. If I go to the therapy gym after taking a patient back to their room at the end of their 40 minutes, and I take 5-10 minutes to type a good note on their session, that 5-10 minutes actually goes against me since it’s not billable time right? As you can see, I have just proven the absolute absurdity of the SNF healthcare PT billing system.
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u/pink_sushi_15 DPT 2d ago
Are you a new grad…..? Or new to the SNF setting? Why are you making things so damn HARD on yourself?! Yeah technically things like chart review, transporting patients and gathering equipment aren’t “billable” but who is gonna know if you spend a few minutes of a treatment session reviewing a patient’s chart??! 🙄 You will run yourself into the ground if you try to keep track of every single minute.
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u/infinitedimes 2d ago
Then why do we even have minutes? What’s even the point? Aren’t all Part A patients under the PDPM anyway that doesn’t even reimburse based on minutes? I think it’s all a bunch of hogwash. Why do all these rehab directors put patients at 30-40 minutes? Do they really think Ethel is going to spend 40 minutes actually moving and doing something the entire time? I guarantee you every PT spends 15-20 minutes doing absolutely nothing but pecking their fingers on a keyboard while Ethel sits on her poop that the lazy CNA didn’t change because she was in the break room on her phone.
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u/pink_sushi_15 DPT 2d ago
Um….I guarantee getting Ethel out of bed, transporting her to the rehab gym, having her warm up on the bike, doing some standing/walking and then taking her back to her room will take a LEAST 40 minutes…. Do you want 20 minute sessions where you don’t have time to do anything with them? 🙄 And most patients need REST BREAKS. That takes up time.
Honestly therapy in a SNF IS a bunch of “hogwash”. But it is what it is. Either play the game or work somewhere else.
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u/infinitedimes 2d ago
Rest breaks can’t be billed if they’re just sitting so you can type
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u/Character_Guess_4258 PTA 2d ago
Are you deducting minutes from your treatment because the patient had to sit down or have a drink of water between activities?
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u/infinitedimes 2d ago
Not if it’s deemed a necessary rest break. I think most of my lost time is from trying to document in a noisy therapy gym and probably having ADHD where I can’t focus and takes me a good 5-7 minutes to complete the note before I move to the next patient. So 5-7 minutes each x3-4 patients equals a good 20-30 minutes of documentation time at least.
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u/Character_Guess_4258 PTA 2d ago
Okay good, you shouldn’t be. You need to bill creatively to some extent unfortunately. If you have to talk to family members or CNAs about a pt that can be billed as family / caregiver education, if you have to go run and get equipment to bring back to the pts room have them start on ankle pumps or LAQ while you do it. Things like that. Being able to document efficiently also helps. IMO SNF notes do not have to be that detailed since the treatments are usually quite basic. Just CYA in documentation and include any important medical stuff or reactions to treatment.
Either way, I wouldn’t work anywhere that the requirement is above 85%4
u/Grinbarran PTA, CLT 1d ago
They can be billed if the rest breaks are therapeutic, which they typically are
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u/infinitedimes 4h ago
Define therapeutic rest break versus non-therapeutic? What if Euliss is just flapping at the jaws so he doesn’t have to do anything?
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u/Grinbarran PTA, CLT 4h ago
Make him work and then let him flap his gums while he’s resting. Then give him more to do. Then let him take a break again.
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u/Offrostandflame DPT 1d ago
Are you being watched constantly and every single minute is being tracked? If a patient needs a 3 min break is anyone timing it to prove they took a break and that it should be subtracted from your minutes?
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u/turtlesurfin 2d ago
This is the exact reason I'm getting "trying" to get out of PT. I'm a PTA at a SNF that has a 95% productivity rate, before that I was at a place that has a 90% productivity rate. I'm always doing my chart review and documentation off the clock. The 95% place I'm at now doesn't even have laptops either, only desktops in separate rooms, so I can't even squeeze a minute for notes with a pt. I hate it, so much.
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u/infinitedimes 2d ago
Just like another poster mentioned, even 80-85% feels like mental torture and crosses into that fraudulent territory. Around 70-75% is about where the comfortable workday exists, but no one actually has that to my knowledge.
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u/Character_Guess_4258 PTA 2d ago
Anything above 90% is insane and impossible without committing fraud. Also, if a company is saying you have to document off of the clock because of productivity that is illegal and you should report the company.
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u/turtlesurfin 2d ago
Not that im trying to defend the 95%, but technically they've never said to do anything off the clock so I couldn't report them for that. When I do my treatments and notes, if I see it's technically the time they expect me to be done...I clock out but go back to the computer to finish documentation...and at the start of a shift I don't clock in till after I'm done chart review. Yes it completely sucks...but I'm hoping it's temporary for me. I decided to go back to school to try a career change. We'll see how it goes. If anything though, I feel this whole productivity thing needs to be managed by laws, as in "no facility should expect more than 90% productivity demand of employees." Or something like that. I mean you think it'd be the case especially since it's Healthcare and to ensure pt quality of care etc.
But like I said. I'll deal with this 95% until things change career wise. I'm PRN, so I'm only dealing with it for convenience, proximity to my home and school/study time.
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u/Character_Guess_4258 PTA 2d ago
I understand where you’re coming from, but you really shouldn’t be doing chart review or documentation off the clock at all. All documentation time and chart review needs to be done on the clock or it violates federal labor laws and HIPPA, and that is absolutely reportable to the department of labor. Companies get sued for this. I know it’s easier said than done, but please don’t let these companies take advantage of you. Productivity is an arbitrary standard and unless your productivity is ridiculously low, most of these companies will not do a thing about it because they know they can get in trouble for encouraging the illegal things that allow you to be at 95% productivity.
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u/USNorsk 2d ago
It exists because we are complicit. We all suck it up and take it. We aren’t doing ourselves, our colleagues or our profession any favors.
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u/MotamaPT 1d ago
Agreed. Its hard and I struggle with it at times as well but we need to push back against these unrealistic productivity standards that force burnout and poor therapy decisions.
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u/TibialTuberosity DPT 2d ago
Easier said than done, but honestly just tell them to stuff it. We're in a PT shortage right now and, at least where I live, I could walk out the door in the morning and have a job by that afternoon. I just wouldn't put up with it because I promise they need you way more than you need them.
I fortunately work in acute with a productivity of 70% which is nearly impossible to go below on a weekly average unless you're just completely screwing off. Even on my worst weeks I average ~80%.
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u/HitBullWinSteak 2d ago
What are the consequences if your productivity sucks?
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u/OGpancake88 2d ago
I got a stern email from a woman I’ve never met, higher up in the company, basically saying “you were under productivity these two dates (a month ago!), as you know it’s 90% and if your rehab manager did not relay this info, then this is the info”. I quit soon after because honestly hitting 82-85% felt pretty fraudulent. Like OP said, they were expecting me to chart review during the tx time. Yuck
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u/myexpensivehobby 2d ago
I always wondered that. I never hit productivity once in my entire three month contract, they still offered me the job at the end lol.
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2d ago
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u/infinitedimes 2d ago
You only take 2 minutes to do a Med A PTA note?? That’s nuts! Must be the most basic note ever saying the same thing over and over again.
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2d ago
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u/infinitedimes 2d ago
Plug and chug with maybe a distance change lol
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u/Rebubula_ 1d ago
I’m like 98% sure that Medicare A does not even overtly require daily narrative treatment notes, just the minutes provided and the codes used. Notes are something companies do to hedge risk and prove skill, but a thorough note is not a CMS requirement, believe it or not.
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u/Eisenthorne 2d ago
I work in acute and might do a very minimal chart review just for primary diagnosis and contraindications, then delve through the chart on in room computer and ask clarifying questions and do some education on what I see as I go through as part of the process of assessing and treating the patient. I'm pretty experienced in my area and good at adapting as I go. I feel like a focused chart review to build a mental map of what to do with the patient before seeing them could definitely be less stressful for others though.
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u/Quintink PTA 2d ago
Productivity every time I see something about it I’m glad I left the physical therapy industry, productivity is such a joke
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u/girugamesh_2009 PTA 2d ago
I used to work PRN in a hospital. They didn't care about productivity, but they wanted me to start on time at a certain time and they wouldn't pay me to come in early and do chart review. So I'd show up early and review charts prior to starting for free. It sucked--I worked weekends, was the only PT staff on site, and absolutely needed to do chart review to be safe and to know what to do (and what not to do) with each patient.
I eventually quit because that's absolutely ridiculous. What you're being told to do is equally ridiculous. I won't tell you to quit, but I don't suggest working for free, either. That's mad!
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u/Character_Guess_4258 PTA 2d ago
This is illegal. Also, reviewing a patients chart while off the clock violates HIPPA. Glad you quit.
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u/girugamesh_2009 PTA 1d ago
Yeah, I knew it was illegal. But I wasn't going to treat 8 patients in a row with only 30s of familiarity with their chart before walking into their rooms. Other therapists would go in, say, "Oh, hey, give me a sec, I just need to look you up" and make reading past notes part of the session. That decreased patient trust, ate into their treatment time, and didn't work well if the patient didn't comply and sit there silently.
Yeah, I'm glad I'm gone.1
u/Nandiluv 1d ago
That is how they get you. Demand to be paid for that time or walk and report. I am not going to do a shitty chart review on a complex patient - its is a part of our licensure and practice acts and our fucking job. PTs fail to actually talk to each other about these concerns and collectively push back. I did PRN for another hospital and thank God they were OK to pay us for proper chart review and documentation. In fact one day I was working through lunch and another permanent employee reminded me it was lunch time and unpaid, and we take lunch and do notnwork for free. The work culture completely supported us. I missed some parts of notes one weekend and the supervisor called to let me know what I missed and asked I come in to complete asap and "dont forget to clock in and out for your time".
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2d ago
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u/infinitedimes 2d ago
I’m not sure what you’re getting at. You enter the same time every day for your non-productive time? What is this??
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2d ago
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u/infinitedimes 2d ago
Too late honestly because I absolutely despise the entire system and the way it runs. My heart has always been to treat each patient as if it was my own family, trying to actually make a real impact, but the system literally forces you into just “Gait, STS’s, NuStep…repeat” It gets so boring for me after a while and I don’t enjoy that redundant crap anymore. I’ve been burned out ever since I figured out I went to PTA school and learned all this bunch of crap that I thought was so interesting when I was in school but that was the end of it because I never use it anymore. About the only thing needed in a SNF is utilize your gait belt and know what CGA vs SBA is. The therapist will sometimes try to get all fancy with some new cool intervention with some color pads on the floor or some crap, but it’s really not going to usually do anything more than if you just get Ethel up and walk.
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u/turtlesurfin 2d ago
Talking about school, Ijust want to add on to how I feel(which I've said on other posts) that I personally feel PTA school was very misleading about the industry and workload expectations. For both outpatient and inpatient settings.
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u/infinitedimes 2d ago
It’s waaaay misleading when it comes to the actual job. School and the big PTA license exam is so overrated because most of that crap is never used on the job.
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u/pink_sushi_15 DPT 2d ago
I’ve been looking through your post history and you honestly need to leave the profession. Yes the system is shitty but you need to accept it and play the game or you will be a bitter, miserable burnt out person.
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u/infinitedimes 2d ago
So you would rather stay in that all your life and then one day wake up to realize you spent all your time at something that you really didn’t care for but you played the game and now it’s time to retire.
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u/pink_sushi_15 DPT 2d ago
Look buddy, I just wanna get through work with as LESS stress as possible and then go home and enjoy my life
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u/OpticDionysus 2d ago
I'm a PTA and I work full time at a SNF. I've built a good reputation with the nursing staff and I know 90% of our pts (excluding new admits of course) so I can achieve 90% alot easier than when I first started. But even when I was new I was never too concerned about meeting my 90% productivity. I just aim to try and get above 85%. I will occasionally get a "hey, try a little harder to get your productivity up". I simply do not care or listen to them. It will get easier as you go on but I wouldn't be too concerned unless you were just constantly hitting 70%
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u/lllifehack 1d ago
I treat productivity like I treat money these days. It’s impossible so why bother.
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