Over the last month we’ve published a series of articles outlining our concerns that management’s scheduling and productivity demands have had negative economic, personal, and professional impacts on our members who work in rehab services. It is our opinion that the productivity matrix used by OHSU forces employees to work off the clock in order not to be penalized by management for productivity concerns and to provide the best care possible for our patients.
Not all time spent working off the clock is before or after their shift. Much of this off the clock work occurs during lunch and breaks which are times employees normally do not clock out.
Further, we went to our members and asked them how they would respond to concerns that their problems with the productivity matrix are that they are simply not managing their time well.
In response, Rehab members asked us to share specifics about how the productivity matrix used by OHSU forces them to work off the clock to complete their work, and how it impacts patient care.
As you will read, the issue is not about more efficient use of time but rather about inadequate time scheduled and budgeted by management.
Members tell us that adult outpatient appointments are booked back to back. Documentation time for each patient takes at least 10-15 minutes, if not more. An employee working a ten hour day is expected to treat 12 patients a day. That employee would need at least 120 minutes minimum to complete documentation. However, the amount of time blocked on the schedule for documentation is only 30 minutes.
Members working in pediatrics share similar time needs for documentation. “If we are supposed to see between 7 and 9 patients a day to meet productivity, then we need at least 70 minutes to complete outpatient notes”. Pediatric evaluation appointments are even more complex, requiring at least 50 minutes to score the necessary assessments.
This time is not provided in their schedules.
Also, Inpatient therapists have similar time needs for documentation. They tell us that management claims the non-productive time of their day is for this documentation time, and also for the time they spend on patient care rounds and care conferences.
Members state that this is simply not true.
The non-productive time of their day is the time required to do their work to safely care for medically fragile patients – including necessary chart reviews and coordinating with nursing, respiratory therapists and physicians, in addition to completing documentation.
None of these tasks counts as billable time toward productivity.
The following OHSU rehab management suggestions to improve efficiency and productivity raise ethical and patient care concerns for our members. Each suggestions is followed by the members’ concern in italics.
- Document in the room or while with a patient to increase billable time. Documentation is not billable time, this is fraud.
- Limit chart review and clarification of precautions and restrictions with providers. This could lead to unsafe patient care
- Use students to increase number of patients seen per day and therefore productivity. In some cases this is fraud, potentially unsafe for patients and a disservice to student learning.
- Save parts of an assessment or evaluation for another day and charge separately for that time. “We’ve been told by management that we don’t have to do a formal assessment on the first day, but the issue is that the assessment needs to get done, and for the most part we need to know where the child is at baseline…assessing the child…is essential, especially when determining numbers of visits and appropriateness of services” This suggestion is unethical and could be considered “un-bundling” of services, which is fraud.
- Prioritize evaluations over treatments to increase productivity, making the budget more profitable/favorable. This is a disservice to those patients in need of intervention and follow-up care.
Previous articles have addressed the harm to our members’ well-being from OHSU rehab management’s productivity requirements and accounting system. Now, members are sharing the impact this system can have on patient care and services.
OHSU needs to prioritize employee and patient well-being over profit. Members and patients deserve better.