Re: 33 billable units/8 hour day, how?

April 12, 2007

As a point of matter, I have moved our facility into a total electronic

centralized database with REDOC, chart sentry etc. Our therapists can access

the

medical records and information and write full records within an extremely

timely basis. We have 15 computers within the facility and could not fathom

attempting to deliver treatment in a paper format especially with the dramatic

under valued payments we receive from Medicare and Insurances.

To follow medicare guidelines, all patients are seen by one therapist for

the time allotted to them in the schedule whether 30 minutes or one hour based

on acuity in a one on one basis. The minutes under Medicare are followed and

the note is written by the time the patient leaves the care of the

therapist. The minute rule allows for note writing if a facility is efficient,

i.e

does not have to retrieve medical records, track down charts, etc etc etc.

Realistically, our therapist can be 100% productive, complete their notes,

give above average care to our patients and leave at the end of the day

recognizing they treated ethically, professionally and legally. The key is

organization and electronic data management.

The billing can allow 4 - 6 units based on procedural interventions. Since

however some patients do not follow the CPT billing interventions it becomes

more difficult to track when the patinet is a perdiem.

So for what it is worth, efficeincy is the key

Kunkel MSPT

MLD-CDT

************************************** See what's free at http://www.aol.com.

April 12, 2007

We have a pretty similar set-up, try for about 6.5

hours billed in an 8 hour day.

Pat Cornwell

--- " Trumbull, (Rehabilitation Services) "

wrote:

> ... or, they could bill a single unit for 8 minutes

> of treatment + say,

> 5 minutes documentation time = 13 minutes ... which

> could net one 36

> units in an 8 hour (480 minute) day.....

>

> ... on the other hand, if an eval is worth 4 units

> at a given facility

> (we credit 3 units at our facility) and a therapist

> completes say 10

> evals in a day, that's 40 units of " non-timed "

> charges ...

>

> Personally, unless you do a couple of group

> treatments a day, I believe

> 100% productivity is not achievable (ethically?

> legally?). Not only

> because of documentation time, but because of other

> variables, most of

> which depend upon individual facility operations

> (number of

> techs/support staff, size and logistics of the

> facility and therapist

> " travel time " , patient timeliness and attendance,

> etc.)

>

> For the record, I ask our therapists and assistants

> alike to achieve

> between 65% and 70% productivity regardless of

> setting (Inpatient,

> Outpatient, Rehab Unit) measured as billed units /

> worked hours. As I

> mentioned above, we count Assessments as 3 units and

> I encourage some

> sort of treatment at the time of eval. We have a

> single Aide for PT, OT

> and Speech who assists with " heavy " patients, cleans

> equipment, and

> checks charges - so the therapists and assistants

> are managing

> everything patient related (travel between patients,

> gathering equipment

> needed for the session, charting and billing) and

> sometimes 2.6 to 2.8

> hours of non-billable time is not enough.

>

> I am with T. The system doesn't make much

> sense. Time for me to

> renew my APTA membership - I'll be sending the check

> in later today!!

>

> Trumbull

> Bloomington-Normal, IL

>

> ________________________________

>

> From: PTManager

> [mailto:PTManager ] On

> Behalf Of Cornwell

> Sent: Thursday, April 12, 2007 8:18 AM

> To: PTManager

> Subject: Re: Re: 33 billable units/8

> hour day, how?

>

> How is this possible? I am " assuming " that a unit is

> 15 minutes. For your therapist to be 100% productive

> at 33 units, they would be billing for 8.25 hours of

> treatment per day in an 8 hour workday. Since one

> cannot bill for documentation time, they would need

> to

> work at least another hour to do documentation. Do

> they really work over 9 hours to achieve 100%

> productivity. By my calculations, the math does not

> work.

> Pat Cornwell

> Palos Community Hospital

> Palos Heights Ill

> --- s <dosrinc@...

> <mailto:dosrinc%40att.net> > wrote:

>

> > We pay bonuses based on productivity, we consider

> > 100% productivity in

> > an 8 hour day to be 33 units (11 pts), our bonus

> > structure starts with

> > an average of 9 patients per day/ month (91%

> > productivity) or 27 units

> > and goes up from there. To add some insight, we

> > schedule all pts. one

> > on one, with evals x 60 mins, follow ups x 45 mins

> > (unless otherwise

> > specified by the PT) and 30 mins for lunch.

> > Hope this helps

> > E. s, PT, DPT, OCS

> > www.douglasspt.com

> >

> > >

> > > I realize this has been discussed many times

> > before, but I thought I

> > might get another guage about how much is enough

> in

> > terms of

> > productivity.

> > >

> > > How many units are you expecting (billable only)

> > in an 8 hour day?

> > >

> > > Todd Freeman, P.T.

> > > Nashville, TN

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> >

>

> Pat Cornwell

> Dir. of Rehab Services

> Palos Community Hospital

> Palos Heights, Illinois

>

> Don't be flakey. Get Yahoo! Mail for Mobile and

> always stay connected to

> friends. http://mobile.yahoo.com/mail

> <http://mobile.yahoo.com/mail>

>

> [Non-text portions of this message have been

> removed]

>

Pat Cornwell

Dir. of Rehab Services

Palos Community Hospital

Palos Heights, Illinois

________________________________________________________________________________\

____

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April 12, 2007

After reviewing the responses to my earlier post, it is obvious that

many of you are still living in the world of time clocks, hourly

wages and employer/employee mentalities. We are trying to change

that world and have established a practice along the lines of the

medical group model. We treat our Physical Therapists as autonomous

professionals, they are salaried and bonused, they are not

interchangeable parts. We work until the needs of our patients have

been satisfied, not until some imaginary whistle blows.

Yes, if we are seeing 11 patients per day, billing somewhere in the

neighborhood of 33 units, we are going to be working more than 8

hours per day, staying late or coming in early to do paperwork,

maybe doing some during lunch, but we are well compensated for this

time (see bonus structure). We work hard to streamline our

paperwork to make sure things run as effeciently as possible. We

are also very seasonal here in SWFla so we will average close to 50

hours per week or more from Nov through May and significantly less

than that over the summer. This type of system may not be for

everybody, it requires an individual who is ambitious and willing to

work hard but the rewards are also great and it has worked well for

us, we have not lost a member of the professional staff in the six

years we have been in operation. We are a work in progress, always

looking for ways to be better, more efficient while maintaining

effectiveness. Thanks for the input.

E. s, PT, DPT, OCS

s Orthopedic & Spine Rehabilitation, Inc.

Bonita Springs, Fla

> > >

> > > I realize this has been discussed many times

> > before, but I thought I

> > might get another guage about how much is enough in

> > terms of

> > productivity.

> > >

> > > How many units are you expecting (billable only)

> > in an 8 hour day?

> > >

> > > Todd Freeman, P.T.

> > > Nashville, TN

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> >

>

> Pat Cornwell

> Dir. of Rehab Services

> Palos Community Hospital

> Palos Heights, Illinois

>

> Don't be flakey. Get Yahoo! Mail for Mobile and always stay

connected to friends. http://mobile.yahoo.com/mail

>

April 12, 2007

" We work until the needs of our patients have

been satisfied, not until some imaginary whistle blows. "

This is what is not emphasized during PT school.

Steve Marcum PT

Pain Treatment Center

Outpatient Physical Therapy

Lexington, Kentucky

>

> After reviewing the responses to my earlier post, it is obvious that

> many of you are still living in the world of time clocks, hourly

> wages and employer/employee mentalities. We are trying to change

> that world and have established a practice along the lines of the

> medical group model. We treat our Physical Therapists as autonomous

> professionals, they are salaried and bonused, they are not

> interchangeable parts. We work until the needs of our patients have

> been satisfied, not until some imaginary whistle blows.

>

> Yes, if we are seeing 11 patients per day, billing somewhere in the

> neighborhood of 33 units, we are going to be working more than 8

> hours per day, staying late or coming in early to do paperwork,

> maybe doing some during lunch, but we are well compensated for this

> time (see bonus structure). We work hard to streamline our

> paperwork to make sure things run as effeciently as possible. We

> are also very seasonal here in SWFla so we will average close to 50

> hours per week or more from Nov through May and significantly less

> than that over the summer. This type of system may not be for

> everybody, it requires an individual who is ambitious and willing to

> work hard but the rewards are also great and it has worked well for

> us, we have not lost a member of the professional staff in the six

> years we have been in operation. We are a work in progress, always

> looking for ways to be better, more efficient while maintaining

> effectiveness. Thanks for the input.

>

> E. s, PT, DPT, OCS

> s Orthopedic & Spine Rehabilitation, Inc.

> Bonita Springs, Fla

>

> > > >

> > > > I realize this has been discussed many times

> > > before, but I thought I

> > > might get another guage about how much is enough in

> > > terms of

> > > productivity.

> > > >

> > > > How many units are you expecting (billable only)

> > > in an 8 hour day?

> > > >

> > > > Todd Freeman, P.T.

> > > > Nashville, TN

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > >

> >

> > Pat Cornwell

> > Dir. of Rehab Services

> > Palos Community Hospital

> > Palos Heights, Illinois

> >

> > Don't be flakey. Get Yahoo! Mail for Mobile and always stay

> connected to friends. http://mobile.yahoo.com/mail

> >

>

--

Steve Marcum PT

April 12, 2007

Given that the therapists are salaried and work until " the patients have been

satisfied " , then they will achieve 100% productivity whether they work one hour

and bill 4 15 minute units or work twelve hours and bill 48 15 minute units. If

an hourly or salaried therapist works ten hours and bills for seven and one-half

hours of treatment (30 units) then productivity is 75%. You get the same

productivity by billing for six hours when the therapist works an eight hour

day. Stating " productivity " of salaried therapists as it relates to an eight

hour work day is inappropriate if the therapist is working several extra hours

doing paperwork. When such comparisons are made what ends up happening is

hourly therapists work off-the-clock to acheive productivity standards, and

salaried employees put in ten and twelve hour days to achieve the 100%

productivity they were suppose to produce within eight hours.

Hansen, PT, PhD

Kansas City, MO

s wrote: After

reviewing the responses to my earlier post, it is obvious that