The Soap Box — September 2, 2013 at 5:10 am

Productivity Schmroductivity


by Lisa Yauch-Cadden, MS CCC-SLP

“You need to get your productivity up”.
“Your productivity is way down”.
“Speech Efficiency needs to improve”.
“We need to fill these gaps in your schedule”.
“You’re spending too much time with your patients”.
“We have to do more with less.”

And the list goes on….

I know there is not one clinician out there who has not heard these words and been totally frustrated by them. Within all of these quotes is the assumption that we are doing something wrong; that we do not know how to do our jobs and that we are wasting time and money. In all my years as an SLP, providing direct care and supervising others, from new grads to seasoned clinicians, I would say that this is rarely the case. Most of the time, nay nearly all of the time, we are working in the service of our patients, and if you, like me are the only clinician at your site, I would say that except for lunch and bathroom breaks (and sometimes not even those) you are spending all of your your time in the service of your patients.

The problem of course is defining what is “productive time”? Most often, it is considered “direct” time with the patient, which according to Medicare is the face to face time we spend with the patient. This of course would be a fine tracker of productivity, if Medicare (and everyone else) didn’t require that we document our time with the patient, according to their guidelines (of course), so that they will not look back retrospectively and deny our servicies. It would also be a fine indicator of productivity if we didn’t have to deal with pesky things like doctors and doctor’s orders and families and referring clinicians and other team members, and patients who get sick and can’t/won’t participate. If we worked in a vacuuum with patients that came to us on a conveyor belt, we could just go from patient to patient and be 100% productive. That would be grand….And it would be wrong.

That is because patients are people and they deserve respect. They deserve our time and our thought and our planning and our follow through. As we all know, a treatment session isn’t just our time with the patient. It is the chart review and the materials preparation and the face to face time and the documentation and the billing and the call to the family, physician or fellow clinician. It should involve collaboration and teamwork. All of that is skilled service. If we don’t do it and do it well, then, while we may have been very efficient, we haven’t been very effective.

And that is why I say productivity schromuctivity. Because it all counts! It’s all important. You can put any productivity standard out there that you want, but if all those things don’t happen, you won’t get paid anyway. The patient won’t make progress and we will find ourselves further marginalized in healthcare, as payors decide that treatment doesn’t benefit the patient.

So, what to do? Well, first things first, determine who is appropriate for services and treat the patient to the best of your ability. Do the right thing. Document appropriately. And at all times advocate for your patients and yourself. Most often, when “efficiency” is down, it is because someone decided to stop counting something that needs to be done or decided that it should take less time to do something than it actually does. Most often the people that decide these things are not clinicians. People often quote the “7 minute” rule to demonstrate built in “down-time” or “indirect time” with Medicare patients. Well this would be fine if built in down-time was recognized across all payors and if notes (daily, weekly, monthly,etc.), team communication, etc., only took seven minutes and if you could always wrap up or extend your sessions to capitalize on those 7 minutes. In my experience, this is rarely the case.

Furthermore, the least expensive care for the patient is at the bedside. We should be advocating for more therapy hours not less to improve levels of function and patient independence, in order to decrease burdens of care and chronic hospitalizations. Our patients at every level, need more, appropriate, state of the art therapy, not less. If we cease to advocate for ourselves and our patients, we will find that we will have no problem being efficient, because there will be no one left for us to treat.

Your thoughts?

About the author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at

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