Friday, May 12, 2017

Wait...You Can Pull Off Over 90% Productivity??

If this is you and you are an Occupational Therapist, please speak now or forever hold your peace in this mastery of an unheard skill.

New value-based OT evaluation codes were released in January and some occupational therapists claim they are able to meet 90% productivity (and higher) when being asked to accomplish this at some settings! Can you believe it?

I am scratching my head at the confusion...this is so 2016 shenanigans.

We have been reminded that we get the permission to go back to our roots of what occupational therapy truly is, as well as being able to have the say of:

HOW LONG we spend with clients for evaluation sessions

AT WHAT COMPLEXITY LEVEL we evaluate them at (based on the complexity of their case) and....

no other non-OT person has the right to make this decision.

(and if you are a OTA, hang in there with me, this applies to you too!)

I was curious about the claims I read in social forums related to pulling off 90% + I explored the break down (seen below) for the time allotted in a typical day to do evaluations and/or treatments for clients in a post acute setting:

8 hours in a shift (480 minutes)

90% productivity met would be 432 minutes in a shift which would equal 7.2 hours

For California therapists: add on two mandatory 10 minute breaks to that - now we are hitting 452/480 minutes in the shift leaving us with 28 minutes to do a few un-billable things:


1. SELF CARE: water and pee ( or #2) breaks

2. EDUCATION and information gathering where the client is unable to be present:

This could be discussing education or occupational performance with:

The client's nurse who is running around the floor getting medication for their other patients

The doctor who is not in the building

Other disciplines working directly with this client who is not immediately present in the room at exactly the time you are having your session or caregiver/family involved.

3. SUPERVISION AND GUIDANCE: of OTAs you supervise...and for the OTA themselves:

-the time for the OTA to be able to ask for guidance
-the time to provide feedback to the OT supervising them regarding upgrading and downgrading (or meeting) goals
-the time to receiving the coaching they are allotted as well

am I missing any scenarios?


4. DOCUMENTATION and INTERPRETATION OF ASSESSMENTS that cannot be completed when you have your hands on treatment with your client

If you are able to physically master documentation on an IPAD while doing ADL treatment in a bathroom... or in the patient room while treating them, you MUST share your secrets with us. As OTs we have impressive talents including adapting devices and their user-ability.

...I wonder how this so when the patient requires contact guard assist for standing balance while progressing their dynamic access to grooming at the sink side

...or needs MAX redirection cues for safe participation in lower body dressing at the edge of the bed

...or needing to monitor their vitals while the client takes that rest break.

...or is impulsive in their movements during a cooking activity at stove top/ meal prep and needs the therapist to have two hands ready at any moment

...or that hands on assist for that safe shower transfer training

...or they have an aspiration risk that needs our eyes on them for the whole meal they are being trained to feed themselves with.

...or it's their first time handling that razor to shave themselves for grooming and their cognitive awareness isn't quite up to independent standards.

Other additional things like transporting a patient to and from our evaluation/treatment space of choice (when this is not conducted in the client's room), clean up of materials and etc can likely be delegated right?....hmmm not sure if there is a designated rehab aide in all settings yet but, having an assistant is helpful when we cannot do it all.

Here's the flip side...

(I am all about seeing each side of the coin and I do forewarn you on the real talk):

1. SELF CARE: I see the burnout and lack of self compassion for my occupational therapists who are my students, colleagues and clients of mine.

They are conforming to a non-OT rule to the way of evaluation, practice and treatment. Sure there is business to be done, we HAVE to get paid to put food on the table and a roof over our's and our family's heads... and I am not even talking about this being about having "no other choice." It is to point out that some disregard themselves as even being human, imperfect and doing their best...and that human I speak of (you!) must come first to truly serve your clients.

2. CARE FOR COLLEAGUES: we want them to be their most successful in assisting their client and decrease their burnout as well. They flourish from our guidance and training to facilitate our client's access to their life occupations. Take that time to say "how are you?" "How can I help?" Connect with their human self.

3. CARE FOR CLIENTS/PATIENTS: Their occupations are at the center of our practice ...

and yet, are they getting their value's worth for the evaluation, practice and treatment we provide them?

Is it truly client-centered....a life occupation based practice...

...or is it a day at the rehab gym?

(is it me or have many client's taken up the hobby of cone stacking, arm biking and T-band pulling?)

What do they (your client) want to get back to? Do they want to:

Care for their dog?

Spend social time with their grandchild?

Get back into their golf swing?

Write that letter to their best friend on the other side of the coast?

Put on their make up every morning?

Pull the weeds from their garden?

Wipe their tuchus on their own despite being incontinent so they can live with their children at home and not worry about them cleaning up after themselves?

Play their favorite instrument again?

Make it to their Mah-jong game on time?

This is why I love and live off my copy of the Occupational Therapy Framework because I know if I get lost, there will always be it's guidance in getting back to my client's occupations.

I am also super grateful for my California State and National occupational therapy associations because they not only advocate on behalf of me to do be able to do my job...

They keep me in the loop about resources to use to defend my intention in everyday practice, as well as provide the up-to-date info impacting our profession AND when I need to step up and act to protect it

(and, and... let me tell you this much):

we need to protect our profession even when, and especially when, things are going right.

So here is some real talk ;) :

1. Go easy on are productive when you are with your clients working toward their occupation based goals.

AOTA provides you with a copy of an occupational profile template to use with your clients to accomplish this.

2. Stay true to your value-based evaluations in choosing accurate codes to best serve your client

Didn't get formal training at your site for this?!

Here is the OT evaluation worksheet I compiled to help you figure out the formula of what code to choose for which patient (not every client or diagnosis fits all).

3. Ask yourself when your gut instinct cries and screams at you:

"what other resources are out there that can help me shift from defeat of ethical dilemmas to champion mode?"

Here is an additional document to use in defending your case to administrators of facilities/ parties that say you should do it differently than you have decided clinically (when you in fact, are in the right):

Consensus Statement on Clinical Judgment in Health Care SettingsAOTA, APTA, ASHA

My closing thoughts about this high productivity? I go for the goal of being 100% productive:

 when in an actual session...

From the time I enter a client's presence, to the end of that session, I am accomplishing one goal: 

understanding their occupations to their fullest, jam packing my assessment and intervention with therapeutic use of self and seeing them flourish on their own to access what is meaningful to them.

REMEMBER: productivity does not equate billable time; make either effort occupation based.

Two things I kindly ask of you:

1. Leave your comments below on ways you feel productive in a one-on-one session by answering this question:

When it comes to OT, what makes your heart sing?

2. Share this with your fellow OT colleagues as we don't know what we don't know and sharing the resources is mandatory so they too can do what they do best in practice.

Thank you for stopping by,


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  1. well, the only way I am 90% productive is ... work off the clock! I am unable to process information aka concentrate in a group of my coworkers and their patients in the rehab gym. I'm a COTA and my heart is in ADLS and IADLS and therapeutic use of self. I was feeling totally burnt out... and then I got a spark again while listening to Mandy Chamberlins pod casts and searching blogs like yours. I know my working off the clock isn't helping the greater good,,, but I know I give my patients 100% productivity and that's all I can worry about. I will ask my colleagues who put the Christmas tree up themselves and cook or prepare for our private potlucks!... why are we at least engaging the patient in these activities? Perfect balance activity is placing ornaments on the Christmas tree (as long as the patient is wanting to participate in it) they are missing their family and the celebrations why not have them help us? And that's just ONE example of what goes on in the rehab gym while our patients are doing rote exercises and activities!
    thank you for lighting my fire

    1. I appreciate you Debbie! For being occupation based. For being client centered. For being community centered! I do ask of you to give yourself care because you deserve Occupational balance. Do this by getting noise cancelling headphones to type your documentation and getting out on time. Invite your coworkers out for a hike or other activity after work when you all can still see the sunshine :) ps: you are more than welcome!! Thank you for being a part of my OTtribe!!!