by Ed Dobrzykowski, PT, DPT, ATC, MHS
Productivity: there may be no other topic in the management of physical therapy and rehabilitation services that is more misunderstood and conflicting. How is productivity defined? How does one consider the variability among patients and practice settings? Why is the measurement of productivity needed? How do you benchmark?
As seen in this HPA burning question survey, there are patterns and variability seen. The 171 respondents include practices which may derive productivity data from their billing and financial information management systems, to practices which utilize multiple indicators and deploy methodology unique to their physical therapy practice.
The variability of responses is attributable to differences seen in the five primary areas of PT practice (acute care, skilled nursing, inpatient rehab, home health and outpatient) and patient mix.
BTU (billed treatment unit of 15 minutes) is the metric predominately used (39.2%). This data reflects my own experiences in queries of management class attendees. Visits per day or visits per week may be used in any practice type; I suspect that the majority are home health or outpatient services. The utilization of minutes of service are indicative of skilled nursing or inpatient rehabilitation where the time measurement is crucial to billing in these practice areas and reflective of their payment based patient classification systems. In home health, a combination of metrics is sometimes used, such as a point based system where values are assigned to opening of a case, completing an evaluation and a follow up visit.
The worked hours per unit of service question was unclear and did not permit responses that included decimal points. However, the expected level of productivity for a PT working 8 hours a day as reflected by BTUs averaged 22.76, and for PTAs averaged 21.74. This metric is available in financial software linking billing (units of service) to hours worked (exclusive of paid time off and sick time). Questions 7-8 indicate an outpatient target of 0.4 worked hours per unit of service for practices primarily of patients with musculoskeletal conditions, and slightly higher for practices containing primarily patients with neurologic or pediatric case mix. This is consistent with information that I have seen our own practices and with information sharing by rehab managers.
The expected level of productivity for 48% of respondents was nearly 23 BTUs, which equates to 72% productivity. The minutes of billable service was 67% using a denominator of 450 potential minutes (7.5 hour day); if assuming skilled nursing this level appears low based upon managers’ class surveys noting 80-90% billable time. The visit per day metric is used in home health and inpatient acute services; the visit per week metric is used in home health. The worked hours per unit of service responses are highly variable with a mean that is not interpretable.
The expected level of productivity for PTAs tends to be lower than for PTs, with the exception of CPTs billed and worked hours per unit of service responses which were similar to PTs.
The types of practices, variability in metrics, and results are in line with managers’ reporting in educational classes. In order to manage and improve productivity the following steps are recommended: 1) measure your staff efficiency to create a baseline; 2) set targets for improvements annually for both individual staff and practice; 3) utilize productivity measures in context of and balance with other practice metrics related to quality, patient satisfaction, outcomes, revenue, and expense. Our challenge in management is making improvements that continue to add value to the patient experience while reducing cost over time.
The HPA hopes that the Burning Question, the results from the survey and this blog have provided you with some valuable information on the topic of productivity. For members and non-members, please use this blog as a mechanism to continue the conversation on productivity.
For detailed information on the poll results, please visit the HPA website, where you can view or download the responses in spreadsheet format (members only).
A presentation is planned on this topic by Ed Dobrzykowski, PT, DPT, ATC, MHS at the APTA Combined Sections conference in Chicago on Feb. 9 (sponsored by the Acute Care Section).
- Arslanian L, Gonzales Dean M, Soper S. Productivity Metrics and Outcomes in Acute Care. CSM 2006
- Bohannon R. Productivity among Physical Therapists: An Evaluation of One Department. Phys Ther 1984; 64:1242-1244
- Kovacek, P. Improving Productivity Without Sacrificing Quality Rehab Services. 1994, 1995, Rev. 2011. www.ptmanager.com
- Wiersma, R et al: Rethinking Productivity and Efficiency CSM 2005. PT Magazine, May 2005, p. 54