I found out today that in two weeks, my 40-hour position (covering one site) that was pitched to me this time last year is now being reduced to 30 hours (covering two sites). On top of that, they expect that I will be working 5 6-hour days. So, they essentially want to cut my pay by 25%, but can't cut me any slack to find a second job during normal week hours? I do have the offer to float to other sites in the area as needed to fill in the other 10 hours, but back when I was working four buildings, I was insanely stressed and felt a lot of pressure to keep up with the demands of my home site.
This change is based on a lot of things, not the least of which is the tightened belt of medicare. But that's another whole can of worms. I work for a pretty large rehab company that staffs sites nationwide, so we have the whole economy of scale thing on our side against the stingy medicare peeps. That being said, I do get paid a pretty dang good rate for a first-year therapist. I have a pretty tricky caseload that requires me to do a lot of walking, a lot of waiting, and a whole heck of a lot of typing. It's pretty tough to stay "efficient" when there are a lot of inefficient requirements to do my job... like, getting to where the patient is... and, like, writing a saga (as one of my patients fondly called my erratic typing during her session) to medicare to say just exactly what it is I'm spending their money on (besides airline tickets and rent and cute clothes... jk... sorta).
To paint a mathematical picture... my employer expects me to perform at an "80%" efficiency level. This means that in an 8 hour day, I should have completed about 6.5 hours of therapy treatments with different patients... In a 5-day week, that's 32 hours of patient visits. (Technically I could have a caseload of 12 residents, 3 times per week, for an hour each with some leeway, but in reality it simply doesn't ever play out this way). That means in a 30 hour week, I'll be expected to log 24 hours. I hate to say it, but 24 hours of patients is about how much I've
been logging in 40-hour week.
So essentially I was told today that I need to be doing the same amount of work I
have been doing, except a lot faster, a lot more poorly and sloppily, and get paid 25% less for it.
Let's look at the challenges in a typical day. I'll round down to 6 hours treatment/day to make it more simple. 2 hours of extra "non productive" time seems pretty substantial... but it fizzles away very very quickly. 6 hours could be 6 1-hour treatments... or maybe 8 45-minute treatments... or maybe 2 1-hour treatments, 4 45-minute treats and a few random 15-30 minute "treatments" with folks who weren't feeling up to par that day but needed their 3rd visit for the week.
*Transition time. Let's just start with time in between each of those 6 or 8 scheduled patients, and in the case of different buildings, 10-20 minutes of drive time and transition time between each building (gathering/putting away belongings, logging out/in computer, etc.). Some days I have had up to 10 treatments in one day... in 3 different buildings. On an efficient day, that's 15 minutes
just for transition time on the low end, and an hour on the high end.
*Sticking to the appointed schedule. Once you have made it to the designated part of the building, sometimes you have to actually search for a patient if they are not in their room or a common area. Hey, maybe they are lost in another resident's room thinking they were at the bus station. Maybe they are sound asleep, or they forgot they had an appointment, or they went out to lunch, or they had a surprise visitor come from hours away to see them. So, once you find your person, you still might end up spending up to 10 minutes either figuring out how to reschedule them another time, or convincing them it's a good idea to participate in a session that day even though they're sleepy. Hopefully you win that battle, but sometimes you don't and you have to cut your losses. When that happens, then you spend another 5 minutes tracking down a "back up" person who just happens to be available and enjoys therapy so much they will come at the drop of a hat... hoping that you can go back later and get the person you missed. Locating patients for appointments and managing last minute cancellations or refusals is probably one my the biggest time sucks, and a lot of times, you end up having to reduce a planned 1-hour treatment to 45 minutes in order to stay on track with rest of your 8 hour day schedule.
*Evaluations. You usually get about one hour to spend with a person new to caseload to review their chart and figure out their case, investigate their prior level of function, and then determine just exactly how they perform every aspect of their self-care and how much assistance they need. Assess their vital signs, range of motion, strength, fine motor coordination, balance, vision, cognition. Make sure and look at how they transfer... and not just from the chair, but from the toilet, the shower, the bed, the recliner, the couch, the dining room chair. Oh, and then call their family to let them know what you thought, and write 4-5 specific and measurable and functional short term and long-term goals. Don't forget to ask the physical therapist or the speech therapist what their findings were. Also, check in with nursing staff, day and night shift, to see if they observe anything different. In an hour. Oh, and when you're done, make sure you put it all in a giant form... which prints out 6 pages worth of OT jargon when you're all through. Evals are beasts! I can handle no more than two in one day. It seems like no matter how much I type while I'm with the patient, it still takes me about two hours altogether to complete one of these puppies in good detail. And as picky as medicare is, I'm not sacrificing the detail.
*Daily documentation. Each of my 6 to 10 treatment sessions daily requires a treatment note explaining what modalities I used, what activities I facilitated and how the patient performed. I might also state topics of patient education, or a family conference, or an in-service with the nursing staff related specifically to that resident. "If it's not written down, it didn't happen." Good daily documentation is a fine art. I try to include note writing throughout the entire session, so this is usually not a big factor in my productivity. Except when our computer systems are down. Like they were last week. And the beginning of this week. And ungodly slow and inefficient all the rest of the time. And you better PRAY TO GOD each time you hit "save" that it actually "saves" the document instead of erases everything completely. When you get stuck with having to do a short 15 or 30 minute session with someone, it is a little more difficulty to finish the note within the time frame, because it's such a short time... but that being said, it's only a few minutes to quickly type it up, and short sessions are rare.
*Bi-weekly/monthly documentation. This requires a little more extensive attention compared to the daily documentation. I am much more efficient with these documents when it is my patient who I have been the primary treating therapist for which I know the ins and outs of the case.
*G-codes. This is a new coding/documentation section required by medicare in outpatient settings, which, in my book, just means that even AFTER I have written all of the above documentation with exceptional care and detail, I have to write another paragraph of OT jargon.... Just please don't take a quality sample out of one of these. Once I've gotten through everything above, my creative writing skills are a little worn out.
*Meetings, mandatory in-services, surprise phone calls from a vendor or a family member, screenings, slow computers, slow printers, slow walkers, checking email once a day, answering questions from nursing, being cordial to staff or resident that stops and wants to talk in the hallway...... the list goes on and on and on.
*I am the only occupational therapist at the site, so I can delegate very little. All OT related questions and issues get directed to me and I make all the decisions and take all calls related to the caseload.
*Our tech systems in place are average, in my opinion. There are many times I would prefer paper documentation because it doesn't randomly erase work or take ages to load or freeze up. Slllloooowwwwwww........ My patients require all my patience... after that, I have none left.
*Our patients have busy lives! And I love it! I want nothing more than my patients to be active and involved in things that are fun and meaningful to them! Putting on pants and doing putty exercises aren't
that important right this second. That being said, they're also very independent. If they choose not to participate, you can only do so much motivation and education and modifying the activity to get them to work along with you. I could be pulling teeth for a month to get therapy participation, but if it is not meaningful or important to them, they are not really going to get any benefit or change from it.
I know the expectations are in place because of financial strain on the company because of reimbursement and inefficiencies in the overall health care system. But it stinks that the only way it seems there is to meet my company's expectations, is to do less quality work, more quickly, and do it all with the patient next to me so that I can bill for it.
On that note, I submitted 5 job applications tonight, and I have an interview tomorrow for a weekend per diem position at a Transitional Care Unit in an orthopedic hospital (this was already set up before I got the news today).
Somebody out there needs my hardworking, detail-oriented, passionate,
ethical, honest and patient-first OT services and I'm gonna find em.
But not before my
*retention bonus* is due to me in 22 days! ;)
I mean hey, our company has to get reimbursed for services... and so does this girl!
