Patients per hour. What’s your speed limit?

 

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The topic of one-on-one care vs a double-booked/overlapping/>1 care model is one of great emotion and opinion in the physical therapy community.

So, I am a huge fan of the one-on-one treatment model and it really seems to suit me.  Bias warning, I am drawn to this style of care.  This model is not pushed or addressed in school other than to say that most out-patient ortho clinics are >1 treatment model providers.  My experience has been as follows: I was a PT Tech in a clinic for two years that saw 3 pt/hour/PT and I have interned in a clinic with one-on-one care and am currently in a clinic that does 2-3 pt/hour/PT.  I recently posted on Twitter about not feeling I could ask as much from my patients in a >1 care model, since I was wasn’t giving them as much of myself.  I felt (and still feel) that if a patient comes in and I give them divided care, and not my full attention, that I could only expect the same in return from them.

I got some responses that were quite positive for the >1 model of treatment and it got me thinking about some of the pros and cons.  First off, I was happy to get the insights since I may be in a situation in the future (actually, as I am now in this internship) where I am practicing under the double-book model. Also with future health care regulations and changes, a double-book model may be the only way to operate and I want to be able to think positively about it.  So let’s take a look…

The >1 treatment model: So, some of the positive things about this model are certainly staying busy, as a clinic and provider, and being able to keep the doors open.  It is better to give divided care in order to help people, than to have to close your business and not help anyone.

Another great point that was made was about multiple patient interactions.  Often patients can be motivational to others; for example a TKA that is 8 weeks out being treated along side a patient that is 2 weeks out.  This can build a nice experience for both of them.  This community idea could work very well with certain patients.  A point was made that some patients may seek this >1 treatment as well.

To the make all that happen, it was also suggested that the DPT “own their schedule.” In other words, have the flexibility and control to know how to layer your patients correctly and maximally.  You have got to know that the patient with a CVA cannot come in with the one who needs chronic pain neuroscience education, right?  I assume this means that the clinics that they PTs work in allow either one-on-one or >1, depending on the patient.

There is a model out there that involves 30 minutes one-on-one with a hand-off to a PTA/ATC for the duration to complete exercises.  I am not speaking about billing practices here, but this model seems to benefit the patient pretty well.  It allows the PT to assess/re-assess and treat the individual for a nice time frame, give that attention and pay that attention while still seeing more patients to keep the business doors open and/or put chrome rims on the minivan, etc.  My ‘big-buddy’ from ODU, a DPT now, is about to go into this model… I’m going to ask for a report in a few months on how it is working for him.

Some points were also made that their outcomes were no different in a one-on-one care vs >1 care setting. I do not have any reason to doubt this objectively, although deep down I feel that this could not be the case, I may be wrong.  Perhaps the ROM values were the same, but was the customer satisfaction?  The long-term patient loyalty?  I don’t know, but it’s worth thinking about.

I think these points are good to hear since a majority of clinics follow a >1 treatment model, chances are you will be exposed to this in one way or another.

The one-on-one treatment model: So, a negative I have heard about the one-on-one model is that you loose tons of money when a patient cancels.  Now, on the surface this sounds correct, although I have experienced the opposite.  Patients are less likely to cancel in this setting due to the high level of attention and value provided.  If the patient sees value in showing up, they show up.  Also the front desk has a lot to do with this, so when a slot does open up, it is filled with a patient who may want to be seen earlier, etc.  I have seen this issue become back-burner with proper customer service and value.

When seeing a patient in a one-on-one context you don’t miss as much.  I view treating multiple patients like texting and driving.  Yeah, it mostly works out OK, but you miss a lot of information, and sometimes that info is very important.

As a profession, across he board, we are proud to be the providers that spend the most time with the patient.  We can all spout off the statistic that physicians spend an average of 3 minutes with the patient, and we as PTs get the opportunity to really get to know and hear the patient.  So why would we want to cheapen this time aspect of what makes us so special? We should maximize this facet, it is really refreshing from a patient standpoint and is something we need to promote, not demote.

You are also allotted time to deliver proper patient education, not just “don’t forget about your HEP” as they walk out the door.  Patient’s want to know ‘why.’  Why everything.  Even if they are not actively asking, it always works better when people know why they are doing something.  You now have time to explain why an exercise is being done, why it hurts when they do this or that, why something is not working, etc.  This knowledge of ‘why’ is a real key to compliance/adherence to an HEP, which is overly important in patients achieving their goals.

Fantastically we are given the chance to show the value of PT.  Yes your documentation is legal and correct and says that you gave adequate care during your double booked session, but the patient was there, they know, and they talk.  An insurance company is not touting your business to the public as “always provides good care.”  No, it’s the patient who talks about you… to every single person they meet and tell their aches and pains to.  What do patients say about the double book experience?  I don’t know, lots of them love their PTs, but I also can imagine how that conversation goes if the patient talks with someone who has come off a one-on-one treatment plan of care.

From a PT standpoint; one-one-one means 1 note to write while billing those 4 units during the hour.  I prefer this over 2 notes to write and billing 4 units per hour.  Do you think there will be more or less patients with Medicare coming through your doors?  For selfish reasons I like more patient interaction, less computer-time.  I prefer time with people, building a Therapeutic Alliance. I also feel as though I have been trained in a valuable skill set (more to come, no doubt) and I want the chance to use them.  It’s only fair to us as PTs that we take the time to do our job.

From a patient’s standpoint I can surely say that a health care provider spending time listening and interacting with them is cherished.  This is the type of environment I would send my mother or myself  into.  (Now, one-on-one with a PT that has lost passion and doesn’t care anymore will certainly not help. An awesome PT seeing 2pt/hr will be better in this case… just saying: all things being equal, give a good PT the chance to do his/her job, give them the environmental context, the time.)

Let’s not even start to talk about the use of techs in a clinic.  Do you think that the use of techs (in any capacity that you choose to imagine…) helps the patient start to respect us as PTs more?  Respect our profession more, our skill set more? Do you think that they want to pay for a Doctor of Physical Therapy to help them along in their recovery? Will they support us by voting to help us out on our initiatives in state and federal matters? I guess I’m trying to lead you in a direction here… I’m seeking community interaction between PTs and patients/future patients.  Let’s not waste the face time allotted to us! (don’t get me wrong: PTs don’t stand alone.  A successful clinic functions as a team, we are all important in delivering care to people: front desk -billing-PTA-PT, etc)

Hands down, one-on-one is a better customer service model and a better business plan (all this is my thoughtful opinion, not a judgement on your business plan).  “Build it and they will come.”  In other words, don’t worry about the units, worry about the patient.  Be the best you can, so you can help the most. It is the experience of therapy along with outcomes that matter.  Treat ’em right, trust me, it will be noticed, it will stand out, you will do better than you think. (that’s a lot of awesome phrase right there!)

Please leave thoughtful comments below.  I know there are valid points on either side.  As I’ve said before: PTs a lucky, we don’t have to live in someone else’s box, we can make the treatment environment that we want. What do you want?

Questing for the best,

Matt D

 

 

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9 thoughts on “Patients per hour. What’s your speed limit?

  1. Great piece!

    I fully agree w your rationale for 1on1 model; however, I don’t see why your reasoning can’t be achieved in a double book environment.

    You may “miss” less in double book model as 2 clinicians are delivering care to a pt during a 1 hr tx session; more eyes on on pt.

    1on1 model has fewer moving parts than double book model.

    Why would customer service improve w 1on1 model? I can see how product could be enhanced w 1on1 but if 4 people (front desk, PT, PTA/ATC, tech) are making that pt feel important valued and welcomed rather than 2 (PT & front desk) you could argue customer service may be better in double book model.

    Double book model w techs can improve efficiency of PT. I agree that it can also water down your product (if not done properly), but some stuff that a PT does during the day does not require a PT degree. A PT PTA/ATC model can be somewhat compared to a MD nurse/PA model. Or a surgeon functioning out of 2 OR rooms simultaneously. Techs (and PTAs/ATCs) can really set up the PT to deliver his “A-game”: clean, print, customer service, messenger, etc.

    1on1 does have fewer moving parts, but there are many factors to a good business plan.

    I have been involved w 1on1 models that only see pts for 30 or 45 minutes. What if that model was changed to 30-45min 1on1 w 15-30min w an extender? Would that water down the product or provide opportunity to improve product, business efficiency, and customer service?

    Thanks for writing this piece!

    Like

    • Thanks for the feedback Nick! Yes indeed, no doubt you make some great points. If there is passion for care behind decisions then the outcomes are often workable. If everyone on the team has the same goal, the same drive, I can imagine that working well. I suppose I just want my time with the patient.. as you said, maybe 30 minutes is enough. I do like the idea about designated one-on-one time with some extra extender-type time at the end. I do not feel that would cheapen the product at all. I just have not seen that yet.
      My favorite part about big constraints and problems is that the solutions are so cool. So I am happy that this is kind of a difficult topic… It’s like camping equipment: the limitations and constraints are so high (must be light, portable, small, ergonomic, etc) and the answers are so cool: light weight stoves, thermarest sleeping mats, ultralight tents, etc.
      Thanks for the ideas and interaction… I know there are great answers out there.

      Like

  2. Love this post, Matt! I think that as the healthcare profession is changing and consumers are drawn to a more customer-service based clinic, a 1on 1 model could actually turn out to be more beneficial. I see both sides for sure, and I agree with all of the points you made here.

    Like

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