On this episode of the #AskMikeReinold show we talk about productivity standards for outpatient physical therapists. There are definitely two different perspectives on this, one from the therapist and the other from the clinic owner, but there is also an ethical line we need to be careful of not crossing. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 187: Should Physical Therapy Clinics Have Productivity Standards?
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Show Notes
Transcript
Mike Reinold: On this episode of The Ask Mike Reinold show, we talk about how you should deal with productivity standards in your physical therapy clinic.
Evan: James from Minnesota, “What are your guys’ thoughts on handling productivity standards in private practice outpatient setting? I have expectations for billing four units in a 40 minute treatment session and expectations for starting patients at three times a week for 50% of overall caseload. I believe in putting the patient’s needs first and tailoring my treatment to meeting their needs. Love the show guys, keep up all the great work.”
Mike Reinold: Wow, that’s pretty great. So, I like this. This is a good question on productivity standards which I feel like the cycle of physical therapy in this country kind of continues. Like, you see these big neck, big conglomerates get larger and then they all kind of like foul.
Mike Reinold: I don’t know what happens, right? But you get a big mass of HealthSouth and then things happen and then it disperses and you get these like waves and what tends to happen is you start with like a nice small private practice, right? And you do things right, you do things the way you want to do it, those sorts of things. And then over time you get into these big conglomerates and it becomes more about like less about the person and it becomes a business, right? And productivity standards, how many people per hour should you see? How many units should you bill? Stuff like that. Right. So, specifically to this one though, four units in 40 minutes? Is that legal? Yeah, I guess so. Right, right. So this is like pure hitting the limit of like how to maximize it.
Mike Reinold: And then the other thing is you should be seeing your patients three times a week?
Evan: For 50% of the overall caseload.
Mike Reinold: Yeah, so it sounds like what they’re doing in your environment is there, there’s probably a larger corporation type thing and they probably have some metrics that they know are the averages, right? So they’re trying to say, “Hey, you’re below the averages.” Right? And what they’re saying is hopefully is, this is the average, but if you do enter a situation where somebody is saying like, “Hey for every avow they should be scheduled three times a week initially.” Then yeah, that gets a little awkward. So who wants to start? I mean, you guys, Len, we’ve had some experience in the high kind of volume type thing. Like, did we have productivity standards like that or is it more just…
Lenny Macrina: I know later on in my time down in, Alabama we did and I was definitely, I was part of the management so we were challenged from higher up to relay the message to staff of where their units were, units per charge and we’ll charge just per unit and units billed per visit and blah blah blah and reimbursement. So we did, we tried to, relay it along. I don’t think I, certainly wasn’t like, a stickler, but I just did what I was told and, and it was what happened. But it definitely does happen. I think we’re definitely bordering on, a very gray area of what, what’s legal and not legal by telling people they have to come three times a week for a certain, fraction of the patients that you see. This just doesn’t sound right. Like who definitely needs three times a week? Not many people. Right? So…
Mike Reinold: It sounds like they’re, they’re making decisions based on the business.
Lenny Macrina: No doubt.
Lenny Macrina: I mean, I don’t know if I’m- we definitely don’t do any of that stuff here. We don’t even think we really have much productivity that we look at. We’re not, I don’t think we’ve ever told you guys do you have to see more people? It’s just, how it happens we have stats that we look at, we’re looking at trends and who comes in, but we’re certainly not telling them that they have to see more, never.
Mike Reinold: I think like from a business owner perspective, it’s not necessarily bad. Like let’s say, let’s say you were, billing a certain code, but you think that you could substitute it for a different code that would be ethically and logistically fine, but you would get more reimbursement. I think that’s appropriate, right? Because the clinician doesn’t understand that. So there are some games we typed up. We tend to play. Or billing like based on time if, if you don’t quite understand it. I think there’s, there’s a strategy towards billing that I think people get with productivity.
Lenny Macrina: I am on, I’m always scouring Facebook and looking at, the different groups and it’s amazing the lack of education and the lack of conformity amongst PTs and how to bill, how to bill private insurance versus Medicare. Is there a difference? Eight minute rule versus 15 minute rule. We are lacking severely in how to understand billing and what codes should be used for a manual and therex neuromuscular rhea. And if we can bill dry needling and if a Medicare patient is there, how that affects things. It’s, it’s all over the place. And I think, I think even management struggles to, to get that to trickle down to staff because I think people are still all over the place. And so I think fundamentally, we don’t know. We really don’t know. Yet we’re just trying to use these parameters to track and bill accordingly. So…
Mike Reinold: So, and that’s always a, that’s not necessarily bad, right? It’s just trying to maximize, the game here, right? But when does it cross the line, Dan, what do you think? When does it cross the line to what we’re starting to do isn’t in the best interest of the patient?
Dan Pope: It’s, that’s really hard. And obviously I kind of left a facility that was kind of like or physiotherapy associates, nothing against a company. I liked the company but I think that people, physical therapists in general, we have to have a little bit of empathy for the business. Right? And I think in general physical therapists are undervalued. So the reason why we got to see more and more people is to try and make money. Right? So we can pay for the overhead. So we’re in a tough situation from that perspective again, obviously I kind of left that type of facility.
Dan Pope: I like to be able to treat people less frequently cause I feel like that is optimal for a lot of people that I do see. But the flip side coin is that these business have to run and we have to value yourself as clinicians. So part of it is that, if you are able to see people more times throughout the course of the week. And you think that will actually benefit them further? I think that’s okay for more perspective, but I think as a physical therapist here, you got this, and I read this, there’s a term for this, I forget what they’re calling it, but you’re forced to see people more than you think you need to see them and when you leave at the end of the day you feel poorly for that. Right? But if you are able to actually fill that person’s time with stuff that’s very valuable and you’re adding to them and adding them from a physical therapy or wellness perspective, that might help you deal with some of those feelings. Right. What was your original question?
Lenny Macrina: But I think ultimately it’s the PTs decision to figure out if that’s appropriate. If you think you can add stuff two to three times a week and it’s going to help them get better faster and back to their goal, then fine, but not management telling them you have to see people three times a week and I know it happens. Trust me, I know it. Besides this question, I heard it a gazillion times in my career. It does happen. I don’t agree with it. It’s something that I hope will change. But.
Mike Reinold: Yeah, I mean, and every patient population is going to be slightly different like a post-operative person, like come in more frequently than a non-operative person, for example. Right? So I think we’re stating the obvious with some of these things. I think the question comes down to is just making sure that as a young clinician you understand that there is some part of a business behind it. I think Dan brought up a really good point is look, it costs a lot of money to run a business, right? And there’s a lot of financial risk that happens from the ownership group with running a business, right? There’s a lot that goes into this. So you have to understand that a little bit and you have to do your best to maximize how much profit you make. But if that is how you are making decisions on your clinical career, on your clinical decisions, then that’s where we cross the line. And it becomes a real, real problem, becomes very unethical.
Mike Reinold: So it’s one thing if you’re being educated on, hey, maybe there’s some ways that we can optimize revenue without sacrificing your clinical judgment. I think that’s completely appropriate. But if somebody is telling you to just see people more often than I think you’ve learned right there, that that is the type of business that you probably don’t want to be associated with or you wouldn’t have asked this question. Right, right? And I think a lot of people will feel uncomfortable in that situation too. And over time maybe that manager, that person will understand that that’s not the best way to do business. And hopefully, when all the therapists leave and they kind of keep replacing them with new grads and then churning them out and spitting them out and then moving onto the next one, they’re going to realize that that’s not the best sustainable business model over time. Right? So I don’t know.
Mike Reinold: Any other feedback? Let’s flip gears because we can talk about this over. Let’s flip gears and I didn’t want to interrupt you if you have more, by all means. But like if you’re in the situation, what’s our advice to that person?
Lenny Macrina: That’s what I was going to say. So flipping it a little, if it was me, obviously I don’t know, to me results speak volumes. If you get good results with your patients and your clients. And I think we do a pretty good job here. Word gets out. So I think management has taken it from a different view. They just get people in as much as possible. But I think the people will automatically come in if you are producing good results where you’re with your patients and they leave feeling good about how they’re progressing. And I only had to go to PT once and I felt amazing. That word gets out on the street in the community and then people want to come in and get that same approach because they know they’re going to get better faster than going down the street where they had to go two or three times a week.
Lenny Macrina: So I think you flip it that it’s the results that matter. Marketing is going to be important. Whether you go to a doctor or you going to some kind of a other facility, if you’re trying to be become nichey, you’re going to a crossfit facility, baseball facility where you’re spending time and learning and then that gets out into the neighborhood that you’re making an effort to make yourself better and you’re trying to get a certain amount of clients in or some type of client in. And so I think all that snowballs and I think that’s a better approach than just blanket three times a week.
Mike Reinold: Yeah, I think we’ve always established business here, and this is the same way of what we do online is we just do what’s right, right? We do, we do what we think is best and we do what’s right and we don’t ever focus on profit. And when you, when you don’t focus on profit, I think you end up having a better product and over time you become more profitable, right? So that’s a general strategy. The second you start making decisions for finances, it tends to just spiral out of control in the wrong direction because you’re making decisions for the wrong reasons. That’s not why any of us got into this. So anything else, Dan?
Dan Pope: I was going to say it. If you’re kind of going for what Lenny said, you probably need to communicate with the management a little bit. I think that’s a tough sell because I’ve kind of had this same conversation because you’re trying to get maybe people in the door get them better, faster, right? Giving them more autonomy. But if they don’t understand what you’re actually trying to do and they keep on looking at your numbers, it doesn’t make sense. They’ll be upset at you and meanwhile you’re not communicating what you’re trying to accomplish and then you’re going to go home and be upset at the end of the day and probably going to leave your work eventually. So if you communicate well with the that the managers, I guess it sounds like you’re dealing with right now, maybe you’ll feel a bit better at the end of the day and you’ll, you’ll hit some numbers that are more profitable and maybe they’re not breathing down your neck quite as much, I guess.
Mike Reinold: Yeah, I would say keep an open mind. And have a conversation with your manager first about, all right, well what do you think I’m doing wrong? Here’s why I’m treating this way. What do you think I’m doing wrong? Maybe there’s an educational opportunity for you here. So I would definitely say I would recommend go talk to your management and say, “Hey, I’m not comfortable with this productivity standard,” but instead of just immediately saying that they must be wrong, just ask like, “what am I missing here?” And let them try to explain it to you. And if it becomes really clear that all they care about is the money and not the person, then I think you just figured out a lot about that place and whether or not that fits your values and if you want to continue working there. But maybe during that conversation, like Dan said, you’ll kind of get like, like some thoughts and maybe you’ll realize, okay, no I think you’re right.
Mike Reinold: Like okay, maybe, maybe if I did see people a little bit more often I would have better outcomes. Right? Because they might be comparing you and your frequency of visits and your outcomes or something like that. You never know what they’re comparing. I’d say hear them out first and let’s not immediately take it as an insult. Right? And hear them out first, but then it’s no big deal. Don’t get stressed out, don’t get flustered about it. Hear them out and see what they have to say. And then you make a decision. Is this business doing it the way I want to do it and do I want to be a part of this? Right? It makes sense? Awesome. All right, good question. I mean, tough situation to be in, right? And it stinks that sometimes we are, but you never know, right? Maybe they’re about to go out of business.
Mike Reinold: Maybe their lease just went up and who knows, right? Maybe they’re about to go out of business. Figure out the situation in there and figure out what’s going on and ultimately always do what’s best for the person in front of you. Otherwise, you got into this for the wrong reason. And plus there’s way better professions to make money than being a physical therapist, right? None of us got into this to be rich, right? We did this because we want to help people, so hopefully that helps. So if you have questions like that, head to mikereinold.com click on that podcast link and you can fill out the form and ask us more questions and we’ll see you on the next episode.
