Physical Therapy Benchmarking

What is the most important PT/OT productivity benchmark?

If you are trying to gauge the productivity of physical and occupational therapists, we recommend using procedures (preferably weighted procedures) per provider work hour. This is the benchmark that most closely translates into profitability for two primary reasons. First, the vast majority of outpatient PT/OT is still paid on a per procedure basis, so more procedures typically equates to more revenue. Second, provider staff costs are the highest variable costs so more procedures generated per provider hour generally results in increased profits. You could measure procedures/gross compensation (and we do use this measure on a group basis); however, when you are measuring individual providers and comparing provider-to-provider, you can place everybody on a level playing field by measuring procedures/provider work hour.

Many PT/OT clinics measure provider productivity in terms of visits/day or visits as a percentage of available time. We find that the procedures/provider work hour metric is much more useful because visits/day is not necessarily a true indicator of productivity. For example, some providers see a relatively large number of patient visits/day, but are billing a relatively low number of procedures/visit because they are either not spending a sufficient amount of time with each patient or not capturing all of their appropriate charges. As a simple example, a PT provider who is seeing 18 visits/day and billing an average of only 2 timed procedures (or 30 minutes) per visit is billing 36 procedures/day which is the same as another provider seeing 12 visits/day and billing 3 procedures/visits. Both providers are generating the same amount of revenue from their 36 procedures/day, but the provider seeing 12 visits/day is able to spend more time with each patient, almost certainly has higher patient satisfaction and better outcomes, has less documentation time, and the lower number of visits is reducing the workload on the front desk and business office.

To measure procedures/provider work hour, you can simply use the total number of procedures as the numerator; however, because not every procedure involves the same level of effort, skill and revenue (e.g., initial evaluation as compared to e-stim), we typically recommend using a very simple weighting system. In this weighting system, initial evals and custom splints have weight of 3, re-evals have a weight of 2, all timed codes have a weight of 1, and modalities have a weight of 0.5 (with the exception of H/C packs which have a weight of 0.25. These weights are basically in proportion to work RVUs and roughly in proportion most payer rates. In addition, because all timed procedures have a weight of 1, a weighted procedure typically translates into 15 minutes of charges which is easy for providers to translate into every day reference and use. A simple Excel spreadsheet that has a column for each provider’s number of units by CPT code, a column with the weight for each CPT code, and use of the “Sum Product” function will quickly calculate each provider’s weighted procedures for a month or whatever period you choose. You can also use RVUs or work RVUs as the numerator, but PT/OT providers think in terms of 15-minute units, so we find that weighted procedures translates relatively easily into everyday use.

For the denominator, we use regular plus overtime hours for each hourly provider. For salaried providers, we use the regular hours they work each month up to a maximum of the FTE hours for the month because they do not receive overtime. For example, if a salaried provider is regularly scheduled for 8 hours/day and works 20 days during a month, we will use 160 hours for the denominator regardless of whether the provider may have actually worked more hours because this provider is not being paid for overtime.

For providers with significant administrative responsibilities, such as a PT Director, we typically deduct a fixed amount of time each month to recognize the fact that they are not available to treat patients every hour they work.  We will typically use an allowance of .75 hours/week for every FTE provider supervised by the PT Director.  For example, if a PT Director is supervising 6 FTE staff providers, we will typically use of an administrative allowance of 4.5 hours/week. In this example, if the PT director is working a 40 hour week, 35.5 hours is designated for patient care and used for the procedures/work hour measurement and 4.5 hours is used for administrative tasks.

We typically do not provide any adjustments for documentation time because we want to encourage therapists to document while they are treating patients and also available time from typical cancellations and no-shows during a day should allow PT/OT providers to complete documentation without blocking time.

The benchmark for weighted procedures/provider work hour in better-performing practices is 4.7. For example, a physical therapist who generates 790 weighted procedures during a month that she works 168 hours, is averaging 4.7 weighted procedures/hour. Because a weighted procedure roughly translates into 15 minutes of charges, 4.7 weighted procedures/hour translates into about 70 minutes of charges/hour. The charges exceed actual time during an hour because most patients can be overlapped to a certain extent.

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