“Productivity” is one of the most controversial terms in the physical therapy world these days. The vast majority of staff therapists are judged, to some extent, by their productivity numbers—and many are held to unrealistic standards that allow no margin of error to account for bathroom breaks, patient refusals, or even conferring with other medical team members regarding a patient’s care plan. Because productivity is based on the time we spend performing tasks that can be billed to insurance, it creates a very stressful situation for therapists who spend time performing “non-productive”—but completely necessary—tasks throughout the day, such as:
- Documentation: The time we spend on documentation that justifies our treatments to payers and protects us from lawsuits is generally not considered billable or productive. Furthermore, our documentation requirements—and the time it takes to fulfill them—seem to increase all the time.
- Conferring with physicians and other medical professionals: If a patient changes status, has a concerning vital sign, or isn’t responding to treatments as expected, we frequently need to discuss these changes with other medical professionals like doctors, nurses, and additional therapy personnel. But, the time we spend having those conversations doesn’t contribute to our productivity.
- Ordering equipment: We often spend non-productive time completing the lengthy and convoluted paperwork required to secure funding for patients’ durable medical equipment.
- Reviewing charts: In many settings, it’s important for therapists to perform a thorough chart review prior to each session in order to deliver safe treatment, but we cannot bill for that review time.
Clearly, depending on a particular therapist’s caseload, a significant part of his or her day could be “wasted” on non-productive tasks that are vital to ensuring favorable outcomes for patients. And, in many of these cases, non-productive time is completely outside of therapists’ control. Nonetheless, quite a few facilities use productivity as one of the primary measurements of therapist job performance. While productivity does give insight into how clinicians spend their days, it doesn’t do much to assess the actual quality of the care we deliver on the job. So, if you’re a clinic owner or manager who currently uses—or is considering implementing—productivity goals for your therapists, consider these five problems with this metric:
1. It discourages clinical reasoning.
A therapist spends much of his or her day making decisions based on clinical reasoning—decisions like:
- whether to administer or hold treatment sessions,
- when to increase (or decrease) the intensity and frequency of sessions,
- whether additional personnel are required to safely deliver treatments, and
- which types of equipment a patient should use to maximize function.
The thing is, these decisions hinge on careful consideration of each patient’s unique case. Patients are human, and their health changes—especially in inpatient environments. But when therapists are judged solely on their use of CPT codes, they are essentially encouraged to push aside their clinical reasoning and deliver treatments that might not even be in a patient’s best interest, simply to rack up billable units.
2. Your facility starts to feel like a patient mill.
When productivity is at the forefront of your therapists’ minds, they’ll stop considering whether a patient really needs three sessions a week for eight weeks—or whether spending 10 minutes on the stationary bike is really necessary for every knee patient.
Therapists are intelligent and resourceful, but when you put them in a position where they need to achieve a certain number of units per day at all costs, they’ll do what it takes to get there, and their treatments might start to feel rushed and impersonal. Trying to cram in units often means deciding between working hours of unpaid overtime, billing fraudulently, delivering unnecessary treatments, or simply cramming in additional patients. Because therapists tend to have a great amount of integrity, they’ll often opt for the latter—and end up rushing from patient to patient, frazzled and overwhelmed, delivering cookie-cutter treatments that allow them to maximize their patient volume. And in this sort of patient-mill environment, therapists will not only burn out sooner, but their patients will also often feel devalued—and end up seeking care somewhere else.
3. Your therapists will feel expendable.
Nobody likes feeling expendable, but your best therapists—you know, the ones who attend all the best continuing education courses and spend their lunch breaks reading PT journal articles—will start to feel that way if you value them based solely on their billable units.
Attending continuing education courses costs money—not just for the courses themselves, but also for the travel, meals, and lodging. When your therapists invest in themselves by taking courses that require them to shoulder those extra expenses, they are doing so to help their patients first and foremost. But they also have loans to pay and lives to live, and they’re probably hoping their managers will recognize and reward their effort to bring greater value to the clinic.
When these high-performing therapists realize that their employers are perfectly happy to replace them with new grads who have much less experience—but the same ability to bill a certain volume of units—they’ll start to feel expendable, and they’ll likely stop making the effort to become better clinicians.
4. Safety might become compromised.
That hoyer lift might be helpful for your therapist’s third patient of the day, but if her first patient refused and her second was downstairs at imaging, she is already running behind. She has no units for the morning, despite doing her due diligence with chart review, checking in with nurses, and gathering appropriate equipment.
When she knows her productivity is already a lost cause for the day, she may be tempted to cut corners—by going against her better judgment in matters of safety, for example. And you’d never want to put your staff—or your clinic—in that position. It could end up severely damaging your organization’s reputation—not to mention get you into serious legal hot water.
5. Communication will fail.
Most PTs check each patient’s chart before a session, ask the nurse before seeing the patient (if applicable), and then report back to the nurse on how the session went.
But nurses can be tough to pin down sometimes (they’re busy, too!). So, when therapists are scrambling around from patient to patient, desperately trying to make their units, they’ll inevitably fail to connect with some nurses post-treatment—instead opting to leave information with cover nurses, who may or may not deliver the information correctly.
Alternative Performance Metrics
Obviously, practice managers still need to set some type of performance goal for their therapy staff. And while they can certainly still measure and track productivity, it shouldn’t be the single most important metric they use to gauge therapist performance.
There are all sorts of ways to look at performance: you can set up metrics to track everything from patient outcomes and Net Promoter Score® (NPS®), to soft skills and non-clinical skills such as leadership and attitude. You can also monitor your therapists’ participation in community events, track their patient satisfaction scores, and look at how they’ve been involved in interdisciplinary outreach and other collaborative efforts. All of these show commitment to one’s job and one’s profession—without relying on a single productivity number to assess an employee’s worth.
To learn more about these non-traditional performance metrics, check out this article.
How do you feel about using productivity to measure therapists’ performance? Do you have any other metrics that you use or recommend?
Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways.
