Productivity in Hospice?

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    Upper management once again is pushing the productivity quota on the Hospice nurses again. I understand the agency has the business side of things, but with the kind of work that we in hospice do, you can not put a quota on the amount of visits or Start of Cares that one does in a day. If hospice is being paid per dium by Medicare, why does this even matter?
  2. 10 Comments so far...

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    I'm wondering if we work for the same hospice, lol. Mine is doing this too. Upper management obviously have no clue what we take care of on a daily basis. My "eight" hour days have turned into at least ten! I'm not sure why this is happening. I would think they would know that this will lead to burn-out quickly. Good luck to you. Maybe someone else has an answer on here as to why this would be happening....
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    I have been doing some brief research online, and really have only come up with one indicator that may be the impetus to upper management pushing this agenda of productivity. The CMS has started rolling out the Obamacare plan/Health Care Reform, ie.FY 2013. I'm not sure how to interpret the language of the Health Reform, but it speaks to Productivity adjustments in Medicare and so forth. Terms such as "market basket updates" and "productivity adjustments" is all greek to me and Im sure anyone attempting to intepret the damn thing. The terms are soo nebulous that one can not even define what the terms even means~! Therefore allowing management to play their cards any way they want. Any thoughts??
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    What is your productivity? I went to the conference in San Diego and I was very surprised at how low productivity was for many hospices, compared to what I am often doing. I do not necessarily feel overworked, but I have to be firm about working 40 hour weeks. Our productivity is 25 visit credits a week. This works out to 5 routine visits or about 4 inpatient visits or 2 admits per day. We are paid per visit- being productive is not a big deal to me because I make more the more productive I am, but it seems pay per visit is getting less common. It is unusual that I do less than 30 visit credits per week, and I am probably closer to 35 most weeks.
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    The productivity in my company is that RN's see at least 20 patients per week, which is roughly 5 visits per day. I work in the facilities and often, this can be difficult to achieve especially on days I have a recert to do, or driving to 5 different places. We also recently started on EMR, so factor in time for managing electronic/computer issues. I spend way too much time somedays trying to solve computer issues let alone time to assess the patient, deal with family, input the visit, print out the visit, and then on top of it schmooze with the higher-ups in the facility in order to continue getting referrals. I swear, some days I feel like I'm in a commissioned sales job.
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    Also, forgot to mention, I'm on salary, so no extra pay for me. I usually end up working 50 hours per week...for free
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    We're starting to track productivity too... we just had a few layoffs, so we are all scrambling to get our "numbers" up. UGH!!! I hate that productivity is tied to patient care. I would think the word "productivity" should be saved for factory work!
    Selene006 likes this.
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    Our hospice monitors prouctivity also, most do. Sometimes it is warrented because for all of us who work our rears off, there are some who slack, provide less than standard care, who want to be paid to shop for groceries in the middle of their work day, who state on their timesheets that they are "at the office" fot 2 hours every morning, yet you have to beg and threaten every week to get a single note from them, and very late on top of that. Those employees make it really hard on everybody that is honestly trying to do a good job.
    comfortrn likes this.
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    Our productivity is based on the percentage of time with patients vs. time in the office or traveling. We have to have 50% face to face patient time. This is usually doable if you have 4 to 5 visits a day and try to keep the travel in a circle, which I usually am able to do. But 2 of us routinuly drive over 75 miles a day even with the circle and we are in a pretty congested area, so traffic can be a problem. I also learned that when doing an admission, which is about 4 hours of paperwork after the initial assessment, to "charge" that paperwork time to the patient. We also have started to write more narrative notes when we are pulled off the road into a parking lot to spend time on the phone, either a long phone call with a family member or multiple calls, in order to be able to "charge" the time to the patient and get credit for it.

    They refuse to let us charge the time we are doing notes for IDT as anything other than office time, even if they require the forms to be done every two weeks (and each form takes up to 10 minutes per patient to do.)

    But I will say that we get "Atta Girl" when we are above 50% and a little frowny face when we don't. There doesn't seem to be anything punitive about it. (at least so far...I just had my eval and there was no mention of the weeks I didn't meet the 50%)
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    my location has tried to change the way we are paid for mileage, saying they won't pay us for anything they can't bill for-such as delivering briefs, or chux....has anyone else heard of this? I'm still driving and fuel is still near $4/gallon and i get 30 miles per gallon......


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