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  • From the House of Delegates: Help in Responding to 'Productivity' Issues on Its Way

    By this time next year, physical therapists (PTs) and physical therapists assistants (PTAs) may have a few more tools at their disposal when it comes to talking with employers and others about productivity and performance.

    This year's House of Delegates (House) voted overwhelmingly to identify and develop resources that will help PTs and PTAs negotiate successfully around productivity and performance in ways that ensure the provision of quality physical therapy care. The motion was approved during the 2014 session held June 9-11 in Charlotte, North Carolina.

    According to the statement supporting the motion, the need for more analysis and tools has arisen in the face of a changing health care climate that has created "uncertainties" that have caused some employers to turn to "productivity" measures as the primary measure of PT and PTA performance. These productivity measures may not be realistic and generally do not reflect the value of PT care and the patient related outcomes of PT practice.

    "At such times, PTs and PTAs need not just ethical courage to stand up for what is right, but also tools and resources to fortify them to engage vigorously and effectively in the dialogue and negotiations with administrators/employers and consultants who are pressuring [them] to adopt productivity measures or practices that may represent sincere but archaic or misguided notions of the nature and role of PT practice," according to the supporting statement.

    The motion adopted by the House could result in the development of resources for PTs and PTAs who, according to the support statement, "seek to balance their clinical, ethical, and professional responsibilities against the demands inherent in the employment relationship." The 2015 House will receive a progress report on the efforts [RC-16].

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.


    • This is good news!! I asked to begin a dialogue on this very issue at a TPTA meeting 2 years ago and NO ONE wanted to touch it. It was extremely disheartening to me. The new productivity standards out here in the workplace are a real threat to patient care, to ethical decision making in general. We need to at the very least have an official stance on it from our professional organization. Thank you!!

      Posted by Elizabeth Herring on 7/10/2014 6:28 AM

    • So glad they are addressing this issue for those therapists on the "front-line" dealing with productivity requirements of >=90%.

      Posted by Tracy Wright -> >FRbCH on 7/10/2014 8:20 PM

    • Finally ~ No Mc-therapy please . .

      Posted by Kathleen Flagge on 7/11/2014 6:28 PM

    • YAY! We need help out here!

      Posted by Dee PT on 7/11/2014 10:34 PM

    • I am pleased as well that our professional association has finally taken up discussion on this subject of productivity. This is not helping our profession and our ability to be autonomous in our practice, I have personally been affected by this issue and felt alone in having to deal with this in an ethical as well as a professional manner. Productivity alone cannot be the measure of our success or failure as a clinician. We do need to discuss this in an open forum where we are not in danger of losing our jobs!

      Posted by Gerald Pica on 7/11/2014 11:50 PM

    • The pressure to be >85% productive has staff "working off the clock" to meet expectations. Especially vulnerable new grads who state " I have student loans to pay" and "I need a job". Clearly illegal and giving away hours. The employers ignore their employees right to breaks (in our state) and count them against the day's productivity.

      Posted by S. PTA on 7/13/2014 4:47 PM

    • ...This is an initiative that cannot be divorced from the economic realities of our time. Like it or not, professional compensation and contribution are inherently interdependent and cannot be disconnected if there is to be financial fairness, and job security, and practice sustainability. Declining reimbursement, unreasonable utilization controls, high deductible insurance plans are underlying drivers behind current compensation the productivity challenges that have been evolving for well over a decade. Retrospective salary surveys have become irrelevant in the context of eroding reimbursement, irrational legislative rules, , an unlevel playing field, and inefficient healthcare systems. The value-add of competent caring professionals operating in a and competitive health market gets overlooked. Financial accountability has come to the practice of physical therapy. It is not a battle between professionals and their employers but rather a loosing battle with powerful special interests. The new age of compensation accountability is here. It will only be solved through innovation that enhance productivity... the possibilities are endless.

      Posted by Bob Wiersma on 7/13/2014 7:26 PM

    • Reinmbursement and insurance mix drive procuvtivity standards. If 50% of your business is from an insurance company that only pays you $50 per visit, then this is going affect productivity. Many therapist want to practice in a bubble and have no idea of the declining reimbursement landscape we are in, yet they still want to get paid like they been have in the past. This is not realistic and as a profession we have to deliver care more efficently with better outcomes.

      Posted by James Caron on 7/14/2014 9:17 AM

    • no doubt about it productivity standards are here to stay. I think reasonable productivity ranges should be recommended by the APTA. Patient care is always first and patient care cannot be performed while typing on an Ipad. We also need to look at how we calculate productivity and what therapists bring to the whole continuum of care and not just billing codes such as 97110. At least we are having the discussion.

      Posted by Justin Johnson -> @GT_?N on 7/14/2014 9:38 AM

    • Changes in the healthcare delivery system, reimbursement, and case mix certainly impact our profession. However, our profession cannot allow pushing unrealistic productivity standards. I can and only will speak from a PT standard in the SNF setting. >=85% productivity with a fragile elderly population within the setting of the SNF environment is not only unrealistic but placing our colleagues in a daily ethical dilemma. Do I go back and treat the elderly woman for an additional 20 minutes or do I leave work early, lose pay, and risk my insurance benefits? Do I refuse to "get the minutes" and risk being reprimanded and/or fired. As a manager do I direct the therapists to "get the minutes" no matter what or get placed on the "not singing the corporate song" list? The choices facing these PT's are unconscionable. How does ever increasing productivity affect quality? Speaking with MD's, NP's, CNA's, nurses, family members, and other rehab team members is a huge part of quality patient care. Documentation that is cohesive, well thought out, accurately describes the need for physical therapy services is also part of quality care. Providing patients your undivided attention is another part of quality care. And who made the decision that only billable time counts as productive time? Some professions cannot be adequately measured by productivity standards meant for manufacturing. The APTA has initiated the discussion, however, ASHA and the AOTA have come out with strong statements regarding ethical behaviors and issues surrounding productivity. The therapists practicing in SNFs need the APTA support now! Not a year from now.

      Posted by Janet Mahoney on 7/18/2014 7:21 PM

    • Interesting that no one has mentioned the fraud that must take place if a therapist is working at a productivity >85 %. Either payroll fraud or insurance fraud is taking place at these levels of productivity.

      Posted by Jon Milan on 9/6/2014 12:36 AM

    • So glad I'm reading this. An overdue subject that was in need of being addressed at the higher level, for the best interest of our profession and personal integrity.

      Posted by Jimena Vasquez on 10/15/2014 2:52 PM

    • These "resources" are way over due. My wages are being garnished now, and ethical lines are being crossed as I am typing this. The system is broke. Therapy is about individual, not commodity. We are set up to daily choose failure to reach an unrealist expectation or be part unethicaly/fraudrulent actions. PLEASE, PLEASE, PLEASE do something soon! Therapist are becoming exhausted. FYI: as a contract therapist, I know there are SNF's requiring 90% from therapit and 95% productivity from assistance (in and 480 minute day that leaves very little time for answering call lights, doing required Medicare/payer source documenting, or to be ethical).

      Posted by Tracy on 10/16/2014 9:21 PM

    • while I agree that excessive standards compromise integrity of care,there has to be a reality check on both sides of the coin. Declining reimbursement and ever increasing costs of the employee are a reality. The rates therapist and assistants are asking for are ever increasing. It is a reality for providers that they, at times, pay more for the employee per hour than they get reimbursed under some payers.

      Posted by guest on 12/28/2014 3:22 PM

    • I am a prn employee in subacute rehab setting. My first day back after two months, i was called in to DORs office to reprimand me for my 90% productivity. They require 95% for PRNs!!!

      Posted by Marilyn Borrell on 3/6/2015 5:54 PM

    • The productivity scale no longer fits our healthcare systems laws, rules, regulations. Working as a PTA in a SNF I face everyday to do the ethical thing and have been repeatedly reprimanded as I am not producing the numbers required. In my opinion chasing a w/c down or looking for an oxygen tank much less a tank holder does not qualify as quality care. Putting a patient on a machine while I do my billing to save time towards my productivity is not quality care. The system is broke. I love my job however I'm afraid the political aspect of it is breaking me. I refuse to be unethical and I'm tired of being reprimanded for it. I'm tired of being put into ethical/unethical decision making day everyday.

      Posted by Deborah Wheeler on 3/17/2015 9:00 PM

    • Dealing with this issue daily. Being forced to write a letter of explanation every day that productivity is not at 95%.

      Posted by Katherine Davis on 6/1/2015 10:49 PM

    • I am new to SNF. I am working PRN and only have worked 13 days so far. I am getting talked to daily about my productivity. I had poor training and am finally at an 82-87% range the last few days but am told that is not good enough. I have not taken one lunch or break. I feel I am the hardest working therapist in the facility however according to my productivity I am not. I am struggling with this. When I asked fellow therapist how they are able to maintain the 92% required their response is to double patients, cut time down for note time or put pts on a bike. I refuse to reduce myself to this type of treatment. I will not put my license on the line nor ignore my patients to do my notes. I am frustrated and not sure I can stay in a job like this.

      Posted by Holly Stadel on 6/8/2015 1:39 PM

    • I have been a therapist for over 11 years and the field has gone down the drain. Anyone who defends 90% plus productivity in SNFs is either ignorant to the fact that it is impossible to achieve or have a warped sense of reality. I personally would be willing to work for less $$ and not have to having to explain on a daily basis why I didn't achieve an unethical productivity %. After 11 years experience I would like to think I have excellent time management skills and point of service documentation...so I know for a fact that 90 plus productivity is impossible to achieve without counting time you are running down the hallways, fetching wheelchairs, or cleaning up your area after the patient is through....the best part is that companies that demand 90% and higher typically don't even provide techs to help line up this unethical assembly line! Our entire profession is turning into a big fat lie, but since the companies reimbursement rates are low, I guess that makes it ok? Come on people.

      Posted by Scott on 6/22/2015 4:37 PM

    • As a rehab director and being a PTA I fully understand that my company expects a lot from me. I don't really treat a lot of patients I usually sit through one meeting after another. This consumes a large portion of your day as well as answering call lights, getting ice for residents, fixing and cleaning wheelchairs, helping out in all ways possible. What really burns me up is not the fact that we are the only department that has to prove what we do all day, but if you happen to be a cigarette smoker you can take breaks all day long, no questions asked. Our 2 15 minute breaks that we are allowed are a joke if you are a cigarette smoker. I have personally witnessed several nurses, housekeepers, kitchen personnel, and maintenance workers who smoke at least 3/4 to a pack a day every day. if you think about it a cigarette is probably a 5 to 12 minute ordeal and the laughing, joking and general chit chat with your fellow co smoker could be 15 to 20 minutes a clip. this is what kills me as well as the drama of the cell phone conversation crowd that seem to be outside in the same break area. This goes on constantly and I seem to be the one who gets pulled aside for productivity,falling short of med a rug rate or not meeting part b budget for the month. The demands put on me I can deal with but what gives for the other 200 employees who are allowed to get these breaks and not a second thought goes into it. I should'nt say 200 because its a much smaller group but its just absolutely ridiculous that my group who works their tails off has to justify their entire day. Frustrated but have been dealing with it for over 15 years. Guess I needed to vent

      Posted by Eric E. on 8/17/2015 1:14 PM

    • A recent graduate of 2015, excited on what I was about to embark into...well, my bubble busted on my 1st week of employment. All is true on this blog. No one has ever explained to me , fully, including school, what is productivity and why it's necessary not to EVER have "missed minutes". After 3 months on the job, I have figured this all out on my own. It boils down to the time you clock in/out must be equal to or close to your treatment time. If you have 6 hrs for treatment, you must clock out by the 6th hr (and some minutes ) to get this "oh so productivity numbers! "

      Posted by Nana C. on 12/22/2015 5:24 PM

    • well, It is almost February 2016. Besides some rich companies paying hefty fines and still being allowed to stay in business and still requiring the high productivity, how are AOTA, ASHA and APTA going to help us fight this and still have employement?

      Posted by Susan on 1/30/2016 3:33 PM

    • I'm with Susan. As a travel PTA working in a building with 95% standards for assistants and even my DOR has a 90% expectation I really want to see what the APTA is doing to help protect us. Where are these resources. Companies seem to think these are totally reasonable demands and turn a blind eye to therapists bending the boundaries of laws and ethics whIle patient care goes out the window. I know I had ethics in school and many states require it as a CEU, so what's the point if you're not going to use it?! We need some support out here.

      Posted by Charlie on 6/1/2016 9:36 PM

    • It's nearly 2017. Whatever came of this? Rehab companies in my area are regularly expecting upwards of 90% productivity, and as a brand new grad, I'm already grossly regretting having gotten into this industry. It's not healthy, and it's not ethical. Where are we on this? Do I have anything to look forward to? Or should I start telling my friends that they're better off becoming personal trainers and working on their own terms?

      Posted by Lisa on 12/4/2016 2:58 PM

    • This is all very true and if you get higher than 100% then drop to 80% they scrutinize everything you do and watch yo closer to see if your "padding" the minutes. As a new grad ( and I see a lot of new grad comments) this is disheartening. I take the best of care with all my patients for the time they are alotted. Yet my best isn't best enough even though I work through lunch to get documentation done. It is now 2018, where has this come about? And when you worked hard to get your license to practice, it's your integrity that nags at you to do your best for those patients. Anything over 80% is ridiculous for anyone to do and give good quality patient care.

      Posted by Kim on 2/12/2018 7:40 PM

    • We have to fight back. We must organize, unionize and fight for our integrity, for the right to provide ethical, effective care. We must stand up for ourselves, because no one else will.

      Posted by Mike on 5/17/2018 2:16 PM

    • I also would like to know what came of this? According to this article we shoudl have had some progress by July 2015. It is not July 2018 and I can't locate anything new on productivity as far as tools and resources from the APTA. Anyone?

      Posted by Donald Rull on 7/6/2018 11:29 AM

    • I am also looking to see a response on this. Did the APTA post any guidelines on this issue? (Aug 2018)

      Posted by Andy Robinson, PT, DPT, NCS on 8/30/2018 9:37 PM

    • Its 2019 and no one has done anything. Spirits are broken. I'm a new grad too and already, the field I have dreamed about since I was 14 has turned out to be a nightmare. I'm desperately searching for a position in anything but a SNF. There's still some hope for outpatient places for PTAs but with how things are going I wonder what the future actually holds for this career. It started out trying to help people and like most good things money and greed has completely ruined it.

      Posted by Kathryn on 2/11/2019 8:16 PM

    • This is fake news. It is now 2019 and no changes in the system. Volume is weighed heavier then value in today's society.

      Posted by Amy Bevard on 7/3/2019 4:59 PM

    • Productivity is a difficult issue no doubt. I think it encompasses much more than dollars and cents and perhaps a bit more dollars and sense. As a profession we have pushed to be doctorate level providers, primary care providers even yet we continue, even as the APTA, to encourage an "employee" mentality. We struggle with issues of Professionalism and demands of overtime. As a practice owner, I struggle to provide a viable practice w/ ever declining reimbursement yet continue to provide, as a therapist, and as a boss, a truly valuable service to our customers and working environment for our staff. The struggle is real to find balance. Several things come to mind. 1. To provide a viable service we must maintain high levels of productivity. 2. As a doctoring profession we must move away from 'employee' structures to practice and professional level standards where we eliminate the barriors of punching a clock. If we are ever to be considered respected professionals among other professions other than our own we must understand that being a physical therapist is a 24/7 state of being and not an 8-5 job. This we are not teaching in our schools and we are not nurturing in our employer relations. 3. We must accept that its 'okay' to utilize support personnel to aid in completion of our tasks as professionals just as medical doctors 'order' labs, utilize MAs, CNAs, PA-Cs. We must be willing and capable of delegating appropriate patient centered tasks to other paraprofessional tasks in order to accomplish our own. 4. We must elevate the education level of PTAs to narrow the gap between the doctorate level PT and the associate level PTA. We must create and support certified technician positions. 5. We must become politically involved and demand that payment be fair and equitable for our services. Yet we must understand that mediocrity in delivery of care, which is an epidemic in our Profession, with the expectation of doctorate level reimbursement is an unrealistic dream. Certainly there are no easy answers. But we are far from even coming close to being a "doctoring profession". You can't just wear the title and not have the behaviors match the expectations. Further the expectations and standards need to match the title. Its time to buck up buttercup and tear down the walls of a time clock and meet the definition of a doctoring professional.

      Posted by Tina McLean on 8/12/2019 1:04 PM

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