Hospital Productivity: Why is there such a large range depending on state and hospital?​

From discussions on the acute care Facebook group to perusing the physical therapy reddit threads there seems to be such a significant variation in productivity expectations in the acute care hospital setting. But why is that? Why does one facility require a PT to only see X amount of patients a day, where others require you to meet a % productivity of say 50-80+% productivity, where others will give a unit requirement that can range anywhere from 16-32 units a day? Granted that higher end of the scale usually is for a 10 hour employee.

Quote from the APTA on productivity:

1. “The American Physical Therapy Association supports productivity standards that balance the patient experience and outcome, respect clinical judgment, adhere to the APTA Code of Ethics, consider the economics of care delivery models, and improve the work experience of the providers.

2. In a longitudinal study done on productivity of CIs in the acute care hospital environment, an institution in Florida expects 16 units per day at 20-minutes per billable unit for PT services

3. Survey done in 2015 by the chair of the academy of acute care task force on productivity, they found a wide range of measures being used to determine productivity and how productivity was defined in that facility, they also had 58% of those surveyed indicate their facility was using an outside consultant for productivity measurement and they were unaware of what facility their productivity requirements and numbers were being based on and compared to.

Similar to my facility, 26% of people also reported they have no functional measures they use to determine patient progress aside from objective numbers like ambulation distance and assistance levels.

This survey also stated that the billing you are inputting into the system is does not make money for the hospital except for “part B”, you are really just inputting cost values for your time.

Some interesting data they gathered from this survey is that ortho patients are both the highest cost patients to see and the patients seen most often compared to med/surg and neuro patients, but they are usually the patients with the lowest % functional change as well, so wouldn’t our time be better spent with the neuro patient which has arguably a similarly significant need for service early on and also has the lowest cost basis, a very high % functional change but was shown to be seen the least of these three categories.

My two cents on the topic:

1st cent- Why can’t there be more of a widely accepted, not necessarily universal, standard of care and productivity across hospital systems in regards to PT. Why is there allowed to be such a stark contrast in how PTs are expected to be able to perform in regard to productivity just based on where you work?

2nd cent- In an ideal world of physical therapy that we likely have thought of when thinking about going into healthcare and PT and what some of us may wish the job could become, why can’t we use our clinical judgement as a doctor of our practice to determine the time need and intensity need for each patient that we see, we spend as much time as is needed with each person and get through as many patients as possible in the span of your 8/10/12 hour workday and you know that you provided the most necessary and best possible care you could have provided for each patient rather than worrying about if you’re going to meet productivity or that you have to see X amount more patients to finish your day.