Updated: May 23, 2020
This article will present two sides and SPOILER – no solid conclusion! Don’t worry, it’s very informative and worth the read!
Point of Service Documentation (POS) In skilled nursing settings, therapists are told they need to complete POS documentation. Point of Service documentation is a fancy name for doing your documentation while you are “treating”/providing interventions to your client. It helps increase your productivity. Productivity rates are typically high in SNF and do not provide much allotted time to complete documentation without doing it during your client’s session. Additionally, non-productive time that is given doesn’t count for all the call bells you may answer, time you spoke to the nurse, finding wheelchairs, using the restroom, etc. Quality of care suffers if you don’t have time to do any of those basic tasks. Can you be ethical AND do point of service documentation? (& productive?!) IT’S A HUGE ISSUE.It’s a source of ETHICAL TURMOILforMANYtherapists out there. If you join any Occupational Therapy skilled nursing Facebook group, you will see a TON of questions asking:
“How can I get better at it?
– “Am I being ethical?”
“What exactly am I billing for anyways?!”
“I’m a new grad and NO ONE told me or taught me that this was a thing! Should I resign?”
And – You will see FIGHTS.Fights about whether POS documentation is possible. Whether it should be done. And – You will see name calling.One side is calling anyone with a high productivity that is ABLE to handle POS documentation, “unethical.” The other side doesn’t appreciate the shadeand argues that point of service documentation can be a valuable part of a treatment session. They provide tips and tricks for making it work and stress the importance of properly educating the client and making them aware of their progress, reiterating goals frequently, and keeping accurate data. Background You Need Before We Explore Both Sides Productivity Productivity is known as billable time. Billable time is the amount of time that is spent providing direct patient care. The more productive time, the more money the rehabilitation company can bill insurance for. What does 90% productivity look like? Most of us work an 8-hour day. So…we will use 8 hours for this example.
8 hours = 480 minutes
90% of 480 minutes (90% productivity of an 8-hour day) = 480 x .90 = 432 minutes of productive time; 480-432 = 48 minutes of unproductive time/documentation time/additional getting stuffz done time.Good luck!
For this example, let’s say we have 9 patients today. Calculate productive time left divided by number of patients (432/9) = 48 minutes time with each patient
Time needed to walk and find each patient – let’s approximate 4 minutes (I’d say this is low!) For this example, we are seeing 9 patients, therefore 9 x 4 minutes = 36 minutes. We now have 12 minutes of non-productive time left. (48 – 36 = 12 minutes)
You must sign-in and check the charts for any change in medical status, check with the nurse for interdisciplinary communication purposes. Let’s give you 2 minutes per patient. 9×2 = 18 minutes. You are now at NEGATIVE 6 minutes.
You also must document your sessions. Let’s allow for 3 minutes per patient. 9x3minutes = 27 minutes. You are now at NEGATIVE 33 minutes. We have to get our notes done, so maybe we just skip our 30-minute lunch.
We are also co-signers for our beautiful OTA/COTA practitioners. Don’t forget to read all their notes, contact them if something needs correction.
So, IS THIS a POSSIBLE example that works? Let’s try again and rearrange things so they work. 7 patients = 0 minutes finding people (maybe transport delivers patients to you) + 14 minutes talking to nurses +21 min documentation = 35 minutes of non-productive time needed out of 48 minutes available. (13 minutes of bathroom/water time) 5 patients = 20 minutes finding people + 10 minutes talking to nurses + 15 minutes documentation (3 min per note) = 45 minutes of non-productive time needed out of 48 minutes available. (3 minutes of spare time) Obviously, this calculation changes based on productivity percentage, number of patients, the actual number of minutes the patient has (each patient differs & my example puts everyone at the same time) and the amount of time it takes you to type up your documentation and do other things (put your bag away in the morning, print your schedule, find wheelchairs, find nurses, find equipment, transporting patient, clocking in, out, for lunch, bathroom breaks, etc.). It doesn’t take intoaccount for any unforeseen events – what if your patient has an emergency? What if you need to use the restroom? BUT here’s a BIGGIE for me! NEWSFLASH:This calculation DOES NOT take into account any billing concerns! Billing Concerns During Your Sessions You cannot bill for documentation, but YOU CAN document while SKILLED service is occurring. (Of course, there are many skills we provide that demand our full hands-on attention and you cannot document while doing them.) To restate