Guest guest Posted September 14, 1998 Report Share Posted September 14, 1998 I love the objective examples you are providing. However, we have a 34 bed skilled unit and an 11 bed skilled unit (2 campuses). Our problem is that the bulk of these patients are " doubles " , requiring a tech to assist the therapist or PTA because of their functional level for transfers, gait, assist needed with exercise, etc. Additionally we do not have a satellite clinic space where more than 1 pt. at a time can be treated. (Hopefully that will be addressed soon, but it will still require transport time to get there.) Our skilled facility is within an acute care hospital, and the bulk of our patients come from ortho, acute neuro, pulmonary, oncology, and cardiac. We staff the 34 bed unit with 2 PT's, 3 PTA's and 2 techs, and expectation is approx. 140 billable 15 min. units/day Patients are seen bid in most cases. Any ideas or comments from like facilities with similar issues? >>> 09/13 2:17 PM >>> Randy- The exact system of measuring productivity/efficiency has not been implemented yet in our facilities. We are currently having the therapists, even in PPS facilities, report productivity as # of mods/units treated divided by total labor hours. To translate PPS minutes into mods/units, they translate how many 15 minute units of actual patient care were delivered to PPS patients and include that in the productivity report. For example, if I see 4 Med A patients in a day, two patients are seen for 45 minutes one on one and the other two are seen concurrently for 60 minutes, I would include 10 mods/units in my productivity report (3 mods for each one on one patient and 4 mods for the hour spent doing two patients concurrently). I would also record on the report how many MDS-codeable minutes were provided. In this case it would be 210 minutes (45 to each one on one patient and 60 to each concurrent patient). If my total time spent on Med A patients this day was 170 minutes (this includes 150 minutes of direct treatment and a 5 minute note of each patient with these minutes not counting on the MDS), my efficiency for Med A would be 124% (210 minutes coded to the MDS divided by the 170 labor minutes used to do this). You asked " Are you using techs. to help deliver the care of the patients that are seen 2 at a time? " In some facilities we do use techs, but a therapist can deliver concurrent services appropriately to two patients at a time. I might set one patient up with a mat exercise program and begin gait training another patient. While the gait patients rests, I instruct the mat patient in new exercises. When my gait pt. has had the needed rest, I do another gait exercise. This needs to be done in a manner that meets the patient's needs- not all patients can be treated concurrently, but not all patients require constant supervision to do an exercise. It is the supervising therapist's responsibility to provide the appropriate care. I may choose to do a standing exercise program with a resident and alternate gait training with a second resident. In this case, I would use a tech to stand by the exercise patient for safety. You also asked " Also, how do you measure this if there are only 3-4 patients? Do you send them to another facility? " I assume you mean what if there are only 3-4 Med A patients in the facility. The scenario I described above with productivity/efficiency reporting is how we report it for all facilities, regardless of number of A patients. We rarely send our staff to other facilities because they are still treating Med B patients during the rest of their day. Hope this helps- let me know if the numbers are not clear. Anne Coffman, MS, PT, GCS ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 14, 1998 Report Share Posted September 14, 1998 Carol- Yikes! Your situation is definitely different from my practice settings. We provide contract rehab services and have a wide variety of facilities, but the problems you describe are all PPS nightmares rolled into one. Regarding BID treatments, our philosophy is that BID will be used extremely infrequently to never as the reimbursement for that intensity of care is not included in RUGS groups. It is a matter of educating administration on the changes and why BID may not be a good model. Though your patient mix sounds like BID could be used appropriately fairly often, it is a matter of allocating minutes and determining priorities in rehab needs. Regarding patients who require >1 staff person, you need to provide that level of care so you just need to include their costs in your time/costs allocations. Hopefully you can usually use a tech for the 2nd pair of hands as two PTs or PTAs will get very expensive! The space issue is something that we have struggled with in small facilities, but we work with administration to use facility space during down times. We use the dining room in between meals, the activity room or lounges during off times, etc. You may want to explore those options with administration. Unfortunately, there are no easy answers to your patient mix/staffing needs issue. Anyone else have ideas? Anne Coffman, MS, PT, GCS ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 1998 Report Share Posted September 15, 1998 Our state is pretty clear. I will be happy to quote it from our practice laws for you tomorrow when I'm back in the office. ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 1998 Report Share Posted September 15, 1998 Moira, I am curious about your practice act that specifically addresses technicians. Our does not. The reason I am interested (since I am not in your state!) is that I teach a Health Care Delivery class to local PT students and I would like to show them an example of a practice that does have specific language regarding technician usage (or nonusage, as the case may be). Thanks! Mark Dwyer, MHA, PT Manager of Rehabilitation Services Bethany Medical Center 51 North 12th Street Kansas City KS 66102 (Phone) (FAX) mdwyer1@... Re: efficiency >> >> You stated that you expect 25-26 units per PT or PTA. Do you have techs >> or aids working with them? Is this in an acute hospital setting, or >> outpatient? If you do use techs or aids, do you not include them in your >> productivity expectations? We count PT's, PTA's, and Techs in a division >> and expect 20 units/day/person in those 3 job classifications, because in >> our state, as long as the patient is seen for one of his treatments by >> the PT each day, the tech can see them the other time. Therefore, the >> tech is accountable for billable units each day, as long as supervisory >> regs are being followed. Thanks for your input. It really helps us to >> compare apples and apples, and see if we are in the ballpark. >> >> >>> " Mark Dwyer " 09/14 10:54 PM >>> >> Carol, >> >> Your goal of 140 billable 15 minute units per day for 2 PT's and 3 PTA's >> (28 >> units per therapists = 7 treatment hours per day per therapist) is close >> to >> what we expect. We allow 6.5 hours per day for patient care and expect >> 25-26 units. That may change when we go under PPS, but the fact is that >> we >> exceed 25 units fairly often. This is the expectation for PT and OT. >> >> Mark Dwyer, MHA, PT >> Kansas City, Kansas >> mdwyer1@... >> >> >> >> >> ______________________________________________________________________ >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Were your " effeciency experts " rehab specialists? Were you pleased with their service? Would you mind providing information regarding the service they provided for you? ^^^^^^^^^^^^^^^^ Todd Cepica, P.T. Assistant Director Physical Medicine and Rehabilitation University Medical Center Lubbock, Tx 79417 Ph: Fax: ntc@... Re: efficiency >You stated that you expect 25-26 units per PT or PTA. Do you have techs or aids working with them? Is this in an acute hospital setting, or outpatient? If you do use techs or aids, do you not include them in your productivity expectations? We count PT's, PTA's, and Techs in a division and expect 20 units/day/person in those 3 job classifications, because in our state, as long as the patient is seen for one of his treatments by the PT each day, the tech can see them the other time. Therefore, the tech is accountable for billable units each day, as long as supervisory regs are being followed. Thanks for your input. It really helps us to compare apples and apples, and see if we are in the ballpark. > >>>> " Mark Dwyer " 09/14 10:54 PM >>> >Carol, > >Your goal of 140 billable 15 minute units per day for 2 PT's and 3 PTA's (28 >units per therapists = 7 treatment hours per day per therapist) is close to >what we expect. We allow 6.5 hours per day for patient care and expect >25-26 units. That may change when we go under PPS, but the fact is that we >exceed 25 units fairly often. This is the expectation for PT and OT. > >Mark Dwyer, MHA, PT >Kansas City, Kansas >mdwyer1@... > > > > >______________________________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Mark You didn't exactly address this question to me, but I thought the information would be helpful. You wrote: I am curious about your practice act that specifically addresses technicians. Our does not. The reason I am interested (since I am not in your state!) is that I teach a Health Care Delivery class to local PT students and I would like to show them an example of a practice that does have specific language regarding technician usage (or nonusage, as the case may be). Thanks! The Texas Practice Act defines aide as a " person who aids in the practice of physical therapy under the on-site supervision of a physical therapist or physical therapy assistantand whose activities require on the job training. " The rules further define their role in the following manner: " All rules governing the direction of the physical therapist assistant are further modified for the physical therapy aide. A) The physical therapist or physical therapist assistant is responsible for the supervision of the physical therapist aide. The physical therapist aide may support physical therpay activities within the scope of on- the-job training and with on-site supervision by a physical therapist or physical therapist assistant within reasonable proximity of the physicla therapy aide. The physical therapist or physical therapist assistant must interact with the patient regarding the patients condition, progress and/or achievement of goals during each treatment session. C) The physical therapy aide may not: (i) evaluate, assess, and/or initiate physical therapy treatment including exercise instruction; or (ii) write or sign physical therapy documents in the permanent record. Hope this helps! ^^^^^^^^^^^^^^^^ Todd Cepica, P.T. Assistant Director Physical Medicine and Rehabilitation University Medical Center Lubbock, Tx 79417 Ph: Fax: ntc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Here goes! Licensed PTAs may assist in providing physical therapy services under immediate telecommunicative supervision as long as the PT services are rendered in accordance with the minimal frequency standards set forth in subrule 200.24(4). When providing PT services under the supervision of a PT, the PTA shall " a. Provide PT services only under the supervision of the PT b. Consult the supervising PT if procedures are believed not to be in the best interest of the patient or if the PTA does not possess the skills necessary to provide the procedures. c. Provide tx only after eval and development of tx plan by the PT. d. Gather date relating to the patient's disability, but not interpret the data as it pertains to the plan of care. e. Refer inquiries that require interpretation of patient information to the PT. f. Communicate any change, or lack of change which occurs in the patient's condition which may need the assessment of the PT. The PT must provide patient eval and participate in tx based upon the health care admission or residency status of the patient being tx'd. The minimum frequency shall be: Hospital, acute care Every 4th visit or 2nd cal. day Hospital, non-CARF same as above Hospital, CARF accredited beds: Every 5th visit or 5th calendar day Skilled Nursing Every 5th visit or 5th calendar day Home health Every 5th visit or 10th calendar day Nursing facility Every 10th visit or 10th calendar day Iowa educational agency Every 5th visit or 30th cal. day Other facility / admissions status Every 5th visit or 10th day. A PT may be responsible for supervising not more than two PTA's who are providing physical therapy per calendar day. This includes PTA's being supervised by telecommunicative supervision. However, a PTA may be supervised by any number of PTs. The signature of a PTA OR PT on a PT tx record indicates that the PT services were provided in accordance with the rules and regs for practice as a PT or PTA. The PT assumes responsibility for all delegated tasks and shall not delegate a service which exceeds the expertise of the assistive personnel. Following are activities which MUST be performed by the PT and can't be delegated to ANY assist. personnel including a PTA: 1. Interpretation of referrals. 2. Initial PT eval and re-eval. 3. Identification, determination or modification of pt. problems, goals, and care plans. 4. Final d/c eval and establishment of the d/c plan. 5. Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times. 6. Delegation and instruction of the services to be rendered by the PTA or other assistive personnel, including, but not limited to, specific tasks or procedures, precautions, special problems, and contraindicated procedures. 7. Timely review of documentation, rexamination of the patient and revision of the plan when indicated. OTHER ASSISTIVE PERSONNEL: provision of patient care independently. PT's are responsible for patient care provided by assistive personnel under their supervision. Physical therapy aides and other assistive personnel shall not provide independent patient care UNLESS EACH OF THE FOLLOWING STANDARDS IS SATISFIED: a. The supervising PT has physical participation in the patient's treatment or evaluation, or both, each treatment day. b. The assistive personnel may provide independent patient care only while under the ON-SITE supervision of the supervising PT. On-site supervision means that the supervising PT shall: 1. Be continuously on site and present in the dept. or facility where the assistive personnel are performing services; and 2. Be immediately available to assist the person being supervised in the services being performed; and 3 Provide continued direction of appropriate aspects of each tx session in which a component of tx is delegated to assistive personnel. c. Documentation made in PT records by unlicensed assistive personnel shall be cosigned by the supervising PT. d. The PT provides periodic re-evaluation of assistive personnel's performance in relation to the patient. PTA supervision of other assistive personnel: Physical therapy aides and other assistive personnel may assist a PTA in providing patient care in the absence of a PT ONLY if the PTA maintains IN SIGHT supervision of the physical therapy aide or other assistive personnel and the PTA is primarily and significantly involved in that patient's care. WHEW! That's it for IOWA...... >>> " Sheri L. Bjork " 09/15 2:32 PM >>> Carol and Moira: I am currently teaching (at a PTA program) the differenciation in task/responsiblilites/deleagtion of PT/PTA/ and aide. What states do you practice in, and would it be possible to send me the wording from your state practice act/rules so the class can discuss it? Sheri Bjork ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Our multiplier is .47 for worked hours and .50 for total paid hours(vacation, ill, etc.) These factors include both productive and " non-productive " staff (those not generating billable units, such as Mgr, transporter, clerical) Does your .44 include all staff as well? >>> " Mark Dwyer " 09/15 9:28 PM >>> Carol, > Do you have techs or aids working with them? Sometimes. I have only two (2) techs working with 4 PT's and 4 OT's, so you can imagine that each therapist does not get a whole lot of one to one help with techs. Mainly, the techs finish treatments that were started by therapists or bring patients from their rooms to the clinic (on the same floor). This has changed drastically from a year ago, when I had nine (9) techs and most therapists had one-to-one assistance (of course, I had more therapists back then, too!). > Is this in an acute hospital setting, or outpatient? The staff I listed above is for our inpatient hospital setting that inlcudes a 12 bed rehab center, 10 bed subacute unit, and 25 bed skilled nursing unit. For those units we have satallite clinics on each floor. We also have three acute floors, and all of those patients are seen in the room. > If you do use techs or aids, do you not include them in your productivity expectations? Our calculations are very simple. I calculate the total number of units charged per day and multiply it by a my target multiplier to get the number of hours we should have staffed for. Currently in P.T. that target multiplier is 0.441. So if we charge 100 units that day we should have staffed 44.1 hours. Then of course I compare the number of actual hours to that. This is the system that Columbia/HCA uses for all departments, with each department having different target multipliers. > in our state, as long as the patient is seen for one of his treatments by the PT each day, the tech can see them the other >time. I am assuming you mean that your practice act states this. Does it state it that clearly? Ours in Kansas is very open to interpretation and makes no direct statements about non-PT or PTA help. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... > >>>> " Mark Dwyer " 09/14 10:54 PM >>> >Carol, > >Your goal of 140 billable 15 minute units per day for 2 PT's and 3 PTA's (28 >units per therapists = 7 treatment hours per day per therapist) is close to >what we expect. We allow 6.5 hours per day for patient care and expect >25-26 units. That may change when we go under PPS, but the fact is that we >exceed 25 units fairly often. This is the expectation for PT and OT. > >Mark Dwyer, MHA, PT >Kansas City, Kansas >mdwyer1@... > > > > >______________________________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 I do not feel the group we used was helpful. I " d be willing to give you the details by phone, but they were many. It was not a good match. The expertise from the efficiency folks seemed to be in OP and they tried to apply this to all types of practice (acute, rehab etc..). In talking to other organizations where this group had worked I discovered that they had tried some of the same strategies and they had not worked...so they didn't seem to learn from thier mistakes. They kept telling us that healthcare was just like the automobile industry etc...They did not integrate any of the local " culture " or local perspective in their plan. They appeared unfamiliar with the challenges of a rural environment (although we are a tertiary care center and a teaching hospital). MM 9 > Re: efficiency > > > >You stated that you expect 25-26 units per PT or PTA. Do you have > techs or > aids working with them? Is this in an acute hospital setting, or > outpatient? If you do use techs or aids, do you not include them in > your > productivity expectations? We count PT's, PTA's, and Techs in a > division > and expect 20 units/day/person in those 3 job classifications, > because in > our state, as long as the patient is seen for one of his treatments > by the > PT each day, the tech can see them the other time. Therefore, the > tech is > accountable for billable units each day, as long as supervisory regs > are > being followed. Thanks for your input. It really helps us to > compare apples > and apples, and see if we are in the ballpark. > > > >>>> " Mark Dwyer " 09/14 10:54 PM >>> > >Carol, > > > >Your goal of 140 billable 15 minute units per day for 2 PT's and 3 > PTA's > (28 > >units per therapists = 7 treatment hours per day per therapist) is > close to > >what we expect. We allow 6.5 hours per day for patient care and > expect > >25-26 units. That may change when we go under PPS, but the fact is > that we > >exceed 25 units fairly often. This is the expectation for PT and > OT. > > > >Mark Dwyer, MHA, PT > >Kansas City, Kansas > >mdwyer1@... > > > > > > > > > > >______________________________________________________________________ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 I rarely do direct patient care any more, only in a pinch to help cover when volumes are high, staff illness, we can't find coverage for, etc. We serve as a clinical internship site year round. I have a clin. ed coordinator who is 80/20 (80% pt. care/20%coord. responsibilities). At the other campus, I have a clin. site supervisor. The majority of my time is spent with budget, Quality Improvement, " managing " 50 staff (FT, PT, and per diem) at two campuses, and participating in several committees currently which are looking at care delivery redesign, benchmarking, point of care documentation, etc. I strongly feel that PT needs to be directly involved in these areas, rather than sitting back and waiting to be told how we will do things, without input into how it will impact us. I feel guilty at times that I am not doing more patient care, but this seems very important to the future of the dept. which I guess should be my first priority. Are the majority of you doing an established or expected % of direct patient care as part of your job description? >>> " Lueke " 09/29 10:45 PM >>> I am the manager of a PT department in an acute care hospital. I also carry a 50-100% case load. We see both inpatients and outpatients. The therapists have the opportunity to rotate in each area. In June of '96, the hospital hired " efficiency experts " to look at our productivity. Their goal was 100%!!! (8 hours X 4 units /hr). We felt 75% was reasonable. After much observation, time keeping of all staff actions and charting, we actually ended up at about 80% over the six month period. For outpatient, where you can often manage 2-3 patients at a time, productivity still manages to average 80% per therapist. Since the techs also deliver modalities under supervision, we track their productivity. This includes units of service (non-billable) for preparing hotpacks, setting up EMS, traction and whirlpools, etc. Somebody has to do these things and you need to account for their time in order to justify staff levels. Inpatients are a much different matter. There are so many things that can interfere with efficient delivery of PT services. One-on-one is the minimum need. Frequently it is 2-3 (staff) on one (patient). We are a Level II trauma center. For example, to gait a trauma patient with a chest tube, fractured leg, head injury, 2 or more IV poles can take, say, 3 staff people. If you do this for 0-15 minutes, you can only bill for one unit of service, but we had to pay salary for 3 units (3 staff X 1unit of service). We have to have adequate staff in order to safely deliver patient care! We track the frequency for each unit of service that takes 1, 2, and 3 or more staff to deliever it and can come up with staffing levels. As such, our productivity for inpatients has consistently ranged from 59% - 65% per therapist. It seems that no matter how much we try to be more efficient, 65% is about tops. Re: efficiency >You stated that you expect 25-26 units per PT or PTA. Do you have techs or aids working with them? Is this in an acute hospital setting, or outpatient? If you do use techs or aids, do you not include them in your productivity expectations? We count PT's, PTA's, and Techs in a division and expect 20 units/day/person in those 3 job classifications, because in our state, as long as the patient is seen for one of his treatments by the PT each day, the tech can see them the other time. Therefore, the tech is accountable for billable units each day, as long as supervisory regs are being followed. Thanks for your input. It really helps us to compare apples and apples, and see if we are in the ballpark. > >>>> " Mark Dwyer " 09/14 10:54 PM >>> >Carol, > >Your goal of 140 billable 15 minute units per day for 2 PT's and 3 PTA's (28 >units per therapists = 7 treatment hours per day per therapist) is close to >what we expect. We allow 6.5 hours per day for patient care and expect >25-26 units. That may change when we go under PPS, but the fact is that we >exceed 25 units fairly often. This is the expectation for PT and OT. > >Mark Dwyer, MHA, PT >Kansas City, Kansas >mdwyer1@... > > > > >______________________________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 We have this same system. Our multiplier is .44 for PT/OT. It covers " productive " and " non-productive " staff. M Mulligan > Re: efficiency > > Our multiplier is .47 for worked hours and .50 for total paid > hours(vacation, ill, etc.) These factors include both productive and > " non-productive " staff (those not generating billable units, such as Mgr, > transporter, clerical) Does your .44 include all staff as well? > > >>> " Mark Dwyer " 09/15 9:28 PM >>> > Carol, > > > Do you have techs or aids working with them? > > Sometimes. I have only two (2) techs working with 4 PT's and 4 OT's, so > you > can imagine that each therapist does not get a whole lot of one to one > help > with techs. Mainly, the techs finish treatments that were started by > therapists or bring patients from their rooms to the clinic (on the same > floor). This has changed drastically from a year ago, when I had nine (9) > techs and most therapists had one-to-one assistance (of course, I had more > therapists back then, too!). > > > Is this in an acute hospital setting, or outpatient? > > The staff I listed above is for our inpatient hospital setting that > inlcudes > a 12 bed rehab center, 10 bed subacute unit, and 25 bed skilled nursing > unit. For those units we have satallite clinics on each floor. We also > have three acute floors, and all of those patients are seen in the room. > > > If you do use techs or aids, do you not include them in your > productivity > expectations? > > Our calculations are very simple. I calculate the total number of units > charged per day and multiply it by a my target multiplier to get the > number > of hours we should have staffed for. Currently in P.T. that target > multiplier is 0.441. So if we charge 100 units that day we should have > staffed 44.1 hours. Then of course I compare the number of actual hours > to > that. This is the system that Columbia/HCA uses for all departments, with > each department having different target multipliers. > > > in our state, as long as the patient is seen for one of his treatments > by > the PT each day, the tech can see them the other >time. > > I am assuming you mean that your practice act states this. Does it state > it > that clearly? Ours in Kansas is very open to interpretation and makes no > direct statements about non-PT or PTA help. > > Mark Dwyer, MHA, PT > Kansas City, Kansas > mdwyer1@... > > > > >>>> " Mark Dwyer " 09/14 10:54 PM >>> > >Carol, > > > >Your goal of 140 billable 15 minute units per day for 2 PT's and 3 PTA's > (28 > >units per therapists = 7 treatment hours per day per therapist) is close > to > >what we expect. We allow 6.5 hours per day for patient care and expect > >25-26 units. That may change when we go under PPS, but the fact is that > we > >exceed 25 units fairly often. This is the expectation for PT and OT. > > > >Mark Dwyer, MHA, PT > >Kansas City, Kansas > >mdwyer1@... > > > > > > > > > >______________________________________________________________________ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 In Georgia : the Responsibility of the Licensed PT in supervision and Direction of the PTA. The licensed PT shall be present in the same institutional setting, as defined as any nursing home, acute hospital, rehabilitation center other in-patient facility by any other name and out-patient clinic which would include a private office. The PT shall be present 50 percent of any work week or portion thereof that the assistant is on duty and shall be readily available to the assistant at all other times for advice, assistance and instruction, Adequate supervision is defined as follows: Evaluate each patient and interpret the results to determine and document a physical therapy diagnosis, plan each patients' treatment program and determine which elements thereof can be delegated to an assistant, provide periodic re-evaluation of the treatment program and of the assistant's performance in relation to the patient. Perform and record an evaluation of the patient and his response to treatment at the termination thereof and interact with the assistant in appropriate ways specific to the plan of care of the patients being treated by the assistant A Physical Therapy aide or anyone who holds himself out as being a physical therapy aide, is an individual other than a licensee, who aids the licensed phyiscal therapistsor physical therapist assistant in the provision of physical therapy services and whose activities do not require technical training through a formal course of study. The PT aide must have direct supervisi9n on the premises at all times when helping the physical therapist or physicla therapist assistant with patient care. Direct supervision shall mean on the premisies and immediately available at all times as judged appropriate of the patients condition. On the premises shall mean in the same building where the physica;l therapy services are being rendered. When the physical therpay aide helps with each patient care task, the licensee must assess the patient before, after, and as appropriate during each task. A licensee may supervise a maximum of two physical therapy aides when they are aiding with patient care. >>> " Sheri L. Bjork " 09/15 3:32 PM >>> Carol and Moira: I am currently teaching (at a PTA program) the differenciation in task/responsiblilites/deleagtion of PT/PTA/ and aide. What states do you practice in, and would it be possible to send me the wording from your state practice act/rules so the class can discuss it? Sheri Bjork ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Carol, I manage PT, OT, Speech, Ther. Rec., our Senior Services, and specialized speech program called the Language Care Center. The only patient care I now perform (after having the latter two departments above just added to my job description) is that I work one weekend day per month. I want to maintain my treatment skills at least on a minimum basis, so no matter how busy I get administratively I will not give that up. Up until last week when I just had PT, OT, ST, and TR, I would help out in a pinch during the week (nothing regular) and would work two weekends days per month. Mark Dwyer, MHA, PT Manager of Rehabilitation Services Bethany Medical Center 51 North 12th Street Kansas City KS 66102 (Phone) (FAX) mdwyer1@... Re: efficiency >I rarely do direct patient care any more, only in a pinch to help cover when volumes are high, staff illness, we can't find coverage for, etc. We serve as a clinical internship site year round. I have a clin. ed coordinator who is 80/20 (80% pt. care/20%coord. responsibilities). At the other campus, I have a clin. site supervisor. > The majority of my time is spent with budget, Quality Improvement, " managing " 50 staff (FT, PT, and per diem) at two campuses, and participating in several committees currently which are looking at care delivery redesign, benchmarking, point of care documentation, etc. I strongly feel that PT needs to be directly involved in these areas, rather than sitting back and waiting to be told how we will do things, without input into how it will impact us. I feel guilty at times that I am not doing more patient care, but this seems very important to the future of the dept. which I guess should be my first priority. Are the majority of you doing an established or expected % of direct patient care as part of your job description? >>> " Lueke " 09/29 10:45 PM >>> ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Carol, > Our multiplier is .47 for worked hours and .50 for total paid hours(vacation, ill, etc.) > These factors include both productive and " non-productive " staff (those not generating > billable units, such as Mgr, transporter, clerical) Does your .44 include all staff as well? Our is much the same as yours. Our target is based on productive time (regular, overtime, education) and it is what I previously wrote, 0.441. Before that we used a paid target of 0.50, but that was really messy since it was too hard to track all of the incidental vacation, non-work-time off, etc. So we had it recalculated and out came 0.441. ALL staff in a given department are included in our targets. So yes, I, my clerical staff, and technicians are included in with the therapists in this target. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 Do they place a limit on the number of PTA's a therapist can supervise at one time? >>> " Marcia J. Pearl " 09/16 2:01 PM >>> In Georgia : the Responsibility of the Licensed PT in supervision and Direction of the PTA. The licensed PT shall be present in the same institutional setting, as defined as any nursing home, acute hospital, rehabilitation center other in-patient facility by any other name and out-patient clinic which would include a private office. The PT shall be present 50 percent of any work week or portion thereof that the assistant is on duty and shall be readily available to the assistant at all other times for advice, assistance and instruction, Adequate supervision is defined as follows: Evaluate each patient and interpret the results to determine and document a physical therapy diagnosis, plan each patients' treatment program and determine which elements thereof can be delegated to an assistant, provide periodic re-evaluation of the treatment program and of the assistant's performance in relation to the patient. Perform and record an evaluation of the patient and his response to treatment at the termination thereof and interact with the assistant in appropriate ways specific to the plan of care of the patients being treated by the assistant A Physical Therapy aide or anyone who holds himself out as being a physical therapy aide, is an individual other than a licensee, who aids the licensed phyiscal therapistsor physical therapist assistant in the provision of physical therapy services and whose activities do not require technical training through a formal course of study. The PT aide must have direct supervisi9n on the premises at all times when helping the physical therapist or physicla therapist assistant with patient care. Direct supervision shall mean on the premisies and immediately available at all times as judged appropriate of the patients condition. On the premises shall mean in the same building where the physica;l therapy services are being rendered. When the physical therpay aide helps with each patient care task, the licensee must assess the patient before, after, and as appropriate during each task. A licensee may supervise a maximum of two physical therapy aides when they are aiding with patient care. >>> " Sheri L. Bjork " 09/15 3:32 PM >>> Carol and Moira: I am currently teaching (at a PTA program) the differenciation in task/responsiblilites/deleagtion of PT/PTA/ and aide. What states do you practice in, and would it be possible to send me the wording from your state practice act/rules so the class can discuss it? Sheri Bjork ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 1998 Report Share Posted September 16, 1998 I should have checked all my mesages. Sorry for the duplicate question. Do you actually come in at .44 most of the time? We've been down to .46, but that's our best so far. With so many staffings, family conferences, community re-entry, home evals, etc., and that concept is spreading to our skilled units. It's really hard to capture all of their time in billable units. >>> " Mark Dwyer " 09/16 2:26 PM >>> Carol, > Our multiplier is .47 for worked hours and .50 for total paid hours(vacation, ill, etc.) > These factors include both productive and " non-productive " staff (those not generating > billable units, such as Mgr, transporter, clerical) Does your .44 include all staff as well? Our is much the same as yours. Our target is based on productive time (regular, overtime, education) and it is what I previously wrote, 0.441. Before that we used a paid target of 0.50, but that was really messy since it was too hard to track all of the incidental vacation, non-work-time off, etc. So we had it recalculated and out came 0.441. ALL staff in a given department are included in our targets. So yes, I, my clerical staff, and technicians are included in with the therapists in this target. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 1998 Report Share Posted September 17, 1998 In a message dated 9/15/98 10:13:41 PM Central Daylight Time, mdwyer1@... writes: << in our state, as long as the patient is seen for one of his treatments by the PT each day, the tech can see them the other >time. >> Are you comfortable with this fact? This is the very thing that will affirm to those wonderful payors out there (who believe therapy is an " alternative " ), that if an " unlicensed individual can do it in the pm they can do it all the time. Not to insult janitors but I assume you'll be training them in mobilization and stabilization techniques before Y2K at this rate. Please don't take this as an attack on your integrity, instead a challenge to us all if we wish to still bring in 40K + salaries and love what we do. Lance ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 1998 Report Share Posted September 17, 1998 Carol, > Do you actually come in at .44 most of the time? We've been down to .46, but that's > our best so far. We have hit it from time to time in P.T., but not as often as is expected. I have had better luck in O.T., but that is mainly due to all of my clerical staff (1.8 FTE's) and my own time being allocated to P.T. The other problem is that I have only 4 P.T.'s right now whereas I usually have 5 (one is working full-time in our hospital computer implementation). With only 4 P.T.'s that does not leave as many people producing units to cover the non-treating staff. Also, with our computer implementation my therapists are working much more overtime due to the learning of the system. So my productivity numbers right now are a bit skewed as a result of those two things. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 1998 Report Share Posted September 18, 1998 > > Please don't take this as an attack on your integrity, instead a challenge to > us all if we wish to still bring in 40K + salaries and love what we do. As a new subscriber, I will take this opportunity to voice my opinion to support the aforementioned. I own a small private practice in New York State and employ 4 other PT's. We treat mostly back/neck and " hard to solve " problems and all have manual backgrounds and good exercise knowledge ( spine stab/ Sahrman/ Bookhout etc ). New York State will allow only PT Assistants to assist even in application of HP/CP. We also have some of the lowest reimbursement rates in the country. It is our professional organization, NY chapter of APTA that makes and enforces these recommendations. Most places now have one Assistant for every P.T. and many PTA'S are doing manual/mobs and MFR and Cranialsacral Therapy. It is only a matter of time that a P.T. will be replaced by a PTA in this state. To educate the public and not cave in to lower quality/standards is a lofty goal, especially when we all work long hours. Dorothy F. Bflo, NY > > > ______________________________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 1998 Report Share Posted September 18, 1998 Hi Mark - maybe I missed it but where does your target multiplier of .44 come from? thanks. ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 1998 Report Share Posted September 18, 1998 ..44 wasn't my budgeted target, that was another manager's I was discussing this with. We are budgeted for .48 worked and .51 paid for FY99. YTD we are .50 worked and .58 paid. But we have a lot of new staff hired on during July and August, so lots of orienting time and 1 employee who went per diem and cashed in her paid time off. (Got us off to a great staft, huh?) >>> " Mark Dwyer " 09/17 9:21 PM >>> Carol, > Do you actually come in at .44 most of the time? We've been down to .46, but that's > our best so far. We have hit it from time to time in P.T., but not as often as is expected. I have had better luck in O.T., but that is mainly due to all of my clerical staff (1.8 FTE's) and my own time being allocated to P.T. The other problem is that I have only 4 P.T.'s right now whereas I usually have 5 (one is working full-time in our hospital computer implementation). With only 4 P.T.'s that does not leave as many people producing units to cover the non-treating staff. Also, with our computer implementation my therapists are working much more overtime due to the learning of the system. So my productivity numbers right now are a bit skewed as a result of those two things. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 1998 Report Share Posted September 18, 1998 If we don't find an ethical and cost effective way to provide care, we won't have to worry about our 40k+ salaries. No, I don't have a problem with techs we have trained, seeing a patient for exercises in the afternoon, that a PT saw in the morning. Many of our techs are 2nd year PT students because we have a program in our city. I am much more comfortable with this setting where a PT is readily available then I am with ECF's where the PT stops by once a week. Most of our patients are of a high enough acuity that the PT needs the tech as a second pair of hands anyway. >>> 09/17 10:52 PM >>> In a message dated 9/15/98 10:13:41 PM Central Daylight Time, mdwyer1@... writes: << in our state, as long as the patient is seen for one of his treatments by the PT each day, the tech can see them the other >time. >> Are you comfortable with this fact? This is the very thing that will affirm to those wonderful payors out there (who believe therapy is an " alternative " ), that if an " unlicensed individual can do it in the pm they can do it all the time. Not to insult janitors but I assume you'll be training them in mobilization and stabilization techniques before Y2K at this rate. Please don't take this as an attack on your integrity, instead a challenge to us all if we wish to still bring in 40K + salaries and love what we do. Lance ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 1998 Report Share Posted September 20, 1998 Mark, (you wrote): << I am not saying that we should sell ourselves out, but WE have to be part of the solution and not dismiss things out of hand. We also need to be careful not to box ourselves into a position from which we cannot emerge. We have to be creative and put forth arguments that make sense clinically AND fiscally. The simple fact in the future is that the latter point is all that will matter if things continue on the same road as they are now. I hope this is not the case, but I see no indications to the contrary. >> I couldn't agree with you more. We do need to be very proactive in creating a solution. Indeed the road we currently occupy does raise serious concerns. It doesn't suprise me that we will soon start hearing arguments to create a single payor healthcare system. Consolidate the admin process, 1 head office and a questionable organization to run it? Hold on, fun times to come. Lance ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 1998 Report Share Posted September 20, 1998 , >Hi Mark - maybe I missed it but where does your target multiplier of .44 come >from? thanks. We are a Columbia/HCA facility and part of their Pacific division. There is a management engineer in Texas that took all 130 some odd Pacific division hospitals and averaged the paid hours for each department in a hospital. This was then translated into a staffing target for all of these hospitals to reach for each department. We calculate our data daily, and quarterly we submit our data to division headquarters which is then aggregated in a very large database that we can view over the corporate intranet. This allows us to compare ourselves to all other Pacific division facilities or just to those facilities of like size. Our target of 0.445 (P.T.) (OT is 0.401, Speech is 0.436 and Ther. Rec. is 0.441) is based on productive hours (regular, overtime, education). This was converted from the paid target of 0.50 (in P.T.) since it is too difficult to compute paid hours in our non-computerized payroll system. The way this is used is that the units charged for the previous day are multiplied by the target multiplier to get the numbers of hours that should have been paid, thereby making it a retrospective staffing assessment. Example: 100 units charged X 0.445 = 44.5 hours of staff in P.T. should have been utilized. This includes therapists, assistants, techs, clerical, and management. It is a simple system, but the main problem is that we cannot use this system to plan staffing for the day. We used to have a system based on scheduled visits, so each morning I could count the number of visits scheduled, compare it to predetermined staffing guidelines, and make staffing decisions based on that (i.e., let someone go home early, call in PRN). But now I cannot do this since I do not know how many units will be charged (although I have a ballpark idea). At times it feels as though I am a puppy chasing my tail and never quite catching it as the above targets are very difficult to reach. Especially in Speech Therapy since we now have to use CPT definitions, and almost none of the speech CPT's are based on 15 minutes. However, our productivity system is based on 15 minute units. Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 1998 Report Share Posted September 20, 1998 Lance, >Are you comfortable with this fact? This is the very thing that will affirm to >those wonderful payors out there (who believe therapy is an " alternative " ), >that if an " unlicensed individual can do it in the pm they can do it all the >time. Not to insult janitors but I assume you'll be training them in >mobilization and stabilization techniques before Y2K at this rate. You make a good point, but don't forget that it is up to us to determine what is appropriate or not. If we do not then others will do it for us. The fact is that we are only seeing the beginning of cost containment. After all, Social Security and Medicare are in trouble NOW, there are fewer young people paying into both programs but more elderly collecting, and the birth rate is at the lowest point in our history. Taken together, these things point to a bleak picture of our elderly entitlement programs, unless the workers of America are willing to put up with much higher taxes to support our old system. Also, if the stock market goes into a bear market (which most say is inevitable) and the world goes into a depression (1/3 already is, another 1/3 is close), then businesses are going to squeeze their belts tighter, meaning more managed care and less for employee health benefits. That does not even take into account that we are freaking out over PPS just for skilled. Don't forget that we still have PPS coming for outpatient and rehab in 2000, along with the final version for home health. Therefore, it is up to us to figure out what is appropriate for staffing in both a professional sense and a fiscal sense. If we don't others will or we simply will be bypassed in the medical continuum. We cannot be so naive as to separate the two, because those who pay the bills do not. If we pass practice acts that forbid us to practice in a cost-efficient manner (e.g, using techs/aides), then you can very well bet that the payors will find other means to get their people treated. I am not saying that we should sell ourselves out, but WE have to be part of the solution and not dismiss things out of hand. We also need to be careful not to box ourselves into a position from which we cannot emerge. We have to be creative and put forth arguments that make sense clinically AND fiscally. The simple fact in the future is that the latter point is all that will matter if things continue on the same road as they are now. I hope this is not the case, but I see no indications to the contrary. Mark Dwyer Kansas City, Kansas mdwyer1@... ______________________________________________________________________ Quote Link to comment Share on other sites More sharing options...
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