PT Management - Staffing

what is the definition of management?

the process of leading and directing all or part of an organization through deployment and manipulation of resources

how are PTs resources?

-available source of income

-source of aid and support for patients

-your knowledge is available for others to benefit

-PTs are scarce in supply

what is meant by PT deployment?

how many PTs are needed to complete the work

what needs to be considered when determining PT deployment?

-work type

-number of patients

-auxiliary personnel (PTA/ tech)

-evaluation turnover

-documentation

-state laws (supervision needs)

what are the average patient load for the different settings (don't need to know exact numbers, just trend)?

-outpatient: 15+

-inpatient acute: 15+

-inpatient rehab: 7

-long term acute care hospital (LTACH): 12

-nursing home: 13

how do you calculate work load by census?

number of PT patients / work environment

-ex: 110 inpatient acute care / 15 = 6.67

-therefore staffing should be at least 6 full time PTs (maybe even 7)

how can auxiliary personnel (PTAs) be helpful?

instead of staffing 6 full time PTs, you could staff 2 PTs and 4 PTAs and save way more money

describe an instance of evaluation turnover and supervision roadblock.

-if the average length of stay in an acute hospital is 11 days

-and every day will have about 8 new evaluations needing to be done

-so each PT will need to do 4 evaluations, 7 sixth visits, and 4 discharge summaries (A DAY)

-also if one PT calls in sick one PTA/tech will be unable to work

-maybe time to rethink PT staff deployment

why is it important to remember a worker's desire?

-remember they tend to want a job that's both enjoyable and rewarding

-when considering staffing ratios, take into account your desire to work in those conditions

-there are more accurate ways to measure staff ratios

what does manipulation equal?

productivity

what is productivity?

-the outcome yielded by work, or in the case of PTs, by treatments

-treatments are measured by units typically established by CPT codes divided into treatment or 15 minute units

what are some things to keep in mind about PT productivity?

-there is a difference between worked hours and productivity hours

-PTAs will normally have a productivity benchmark like PTs

-technicians normally do NOT have an individual calculated productivity benchmark

what are productivity hours?

-the number of hours a therapist was actually able to see and generate patient billable units

-in a perfect 8 hour day by CPT code standards, a therapist can generate about 32 units (4 units per hour worked)

explain a scenario of figuring out productivity levels.

-if a company wanted 75% productivity from a therapist:

-8 hours worked x 75% = 6 productive hours

-therefore, 6 x 4 = 24 (projected unit benchmark)

-in the LTACH setting:

-24 units/12 pts = 2 units per pt

-2 units per pt x 15 min per unit = 30 min tx per pt

-this leaves the therapist 2 hours for non-billable duties (staffing, paperwork, family conference, etc.)

explain what to take into consideration with the alternative productivity calculations.

-with the onset of managed care, the amount it costs to perform the pt treatment is more important than the amount of the pt charge

-must consider the cost of therapy as a whole and not only cost of PT services

-try to account for OT, COTA, ST, and techs

describe the alternative productivity calculations.

-one model uses company set standards = total rehab hours worked / patient days (census)

-a company would set 1.8 hours from rehab per patient in the hospital (this time would include all rehab staff)

-so now you have a formula with 2 set constants and only one variable... rehab staff

describe a scenario that uses this alternative productivity calculation.

-assuming pt consensus is budgeted for 100

-1.8 hours/pt day = x / 100 pt days

-x = 180 hours to be used by rehab for hospital coverage

-180 hours/ 8 hours FTE = 22.5 or 22 FTE budgeted

-now we need to divide up the 22 to complete the coverage

what is the resource utilization group (RUG) score?

-shows the type and quantity of care required for each individual resident

-RUG scores consist primarily of the levels of occupational, physical, and speech therapy a pt requires along with the intensity of nursing services the pt requires

-moving away from RUG levels but may still see them on rotations

what are the two RUG areas pertinent to therapy?

-rehab plus extensive

-rehab

-each will have a 3 letter code such as RUX, RVL, RVA, etc.

list the hierarchical classification of RUG scores.

-ultra (U): 720+ minutes; 2 disciplines (one seen 5 days; second at least 3 days)

-very high (V): 500-719 min

-high (H): 325-499 min

-medium (M): 150-324 min

-low (L): 49-149 min

what are RUG scores shifting to?

patient driven payment models (PDPM)

describe PDPM.

-focus on clinically relevant factors instead of volume-based services

-this shift of focus can improve payment accuracy and tend to each pt's unique needs

what are the components of PDPM?

5 components: PT, OT, SLP, nursing, NTA (non-therapy ancillary)

what are the differences between RUG and PDPM?

-therapy minutes removed as factor for reimbursement

-what determines payment

-primary disciplines

-focus on outcomes

-importance of primary diagnosis