How to Justify Seeing Your Neuro Patients for an Hour... like a Boss

#iloveneuro....and I want to see my clients for an hour!

When we had our live kick off event, one of the first questions I was asked was how can we justify seeing our clients for longer in the climate of declining payment.    People who have been seeing their clients for hour long appointments are being asked to squeeze and see people for 45 minutes or 30 minutes and it often feels like the client’s best interest is the last thought.  There is talk of productivity, bottom line, cancellations, etc.   As a business owner, believe me, I look at all of metrics closely.  There is not one black and white answer to the treatment length question, but I do have lots of tips to get you started! I will start with my top 5:

1)   First—remember what is most important—the client in front of you!

Do all clients need a 60-minute treatment?  No.  I have a 93-year-old woman who really can only tolerate 45 minutes right now (and that is what works for her and her family’s schedule).   I have another client right now who does very well with a 30-minute appointment with me and then 30 minutes with a student.  The change in pace (and face) keeps him engaged for longer.  I have one client that truly started making great improvements in his function after he started in some group classes.  The lesson—be flexible and advocate for the length of treatment that the client in front of you needs.   Sometimes there is a compromise with your management—you see half or your clients for an hour and half for 45 minutes—only you make the decision based on what is the best for the client. 

2)   Understand your productivity standard and how you can master it.

I think most PTs hate the “P” word and I am right there with you.   I prefer to think in terms of maximizing the amount of clients that I can serve.  If your clinic has a long waiting list—this is even more important.  You do want to see as many people as you can and not let spaces go unfilled.   Some clinics expect you to be 75% productive—i.e. see 6 patients in an 8-hour day.  In my experience—that is a very generous productivity standard.  Let's remember that in some outpatient orthopedic practices PTs may see 16-20 clients per day!   So, if your clinic is pushing for you to see more clients per day—can you 1) get your documentation done within your session so that you can see a client instead of documenting at the end of the day? (Getting documentation done quickly in the neuro world is another passion of mine and another blog topic)  2) make a case for your current treatment hours?  Making a case depends on your understanding of the next two factors

3)   Understand how your clinic is paid. 
Payment—
another dirty P word—but so necessary! Do you know how your clinic is paid?   Here are a few basics in case you don’t know (I know that I did not until I was running a clinic):

a.     In an out of network environment—you are paid for the time you spend with a client—so there is no incentive to make a shorter appointment simply based on payment.  This is a huge reason why I run an out of network and cash-based clinic!

b.     If you are under contract—a lot of contracts reimburse a flat rate based on a minimum # of minutes with the patient (usually about 30 minutes), therefore, working with a client for increased time is a losing proposition.   It would be helpful to know the pay rates per minute and per session for your current clinic.  

c.      Medicare pays less with each successive unit reimbursed.  For example, the first unit is reimbursed at the full amount, the second at a less amount, the third even less, and so on.  So, also, the company is incentivized to provide shorter treatments.  Unless, of course, you can show that you can get the client better in less sessions this way.

4)   Understand your cancellation rateWhen I started my practice, people told me that it couldn’t be done successfully because “neuro patients cancel a lot”.    I set out to prove that wrong!  I have heard clinics and supervisors use this to implement shorter treatment sessions, so I challenge you to first know your cancellation rate.  And then commit to lowering it.  Could you potentially lower the cancellation rate by increasing the length of visit? Consider discussing this with your clients—the importance of the whole hour and how their arrival is so important to maintain the hour-long appointments.  Consider also a challenge to your supervisor—if you can lower the cancellation rate by a certain percentage—can you maintain hour-long sessions?    Again, this will be a topic of another blog post (how to lower that cancellation rate), but it is quite doable and it is literally worth $$.

5)   Is it time to start your own practice?  Perhaps you are already here and wondering how to do this, or you are thinking that you will NEVER own your own practice (I swore I would never own my own practice!)    But, if you have not been able to make a case in your current environment, maybe it is time to look for a different environment or start your own!

Finally, I like to put everything to the excel test (I love my spreadsheets!)—can you come out ahead?  Armed with the above information you can make some great predictions of income and expenses (and therefore profit) based on how you see your clients.  Sign up for our newsletter and  we will send out an excel sheet for you to play around with.  Start to plug in some numbers and see how you come out.  Then go and make that case to your boss—I think they will be impressed!   We want to hear success stories—so let us know how it turns out.

Until next time—keep your #iloveneuro spirit strong and keep changing lives!

Julie Hershberg PT, DPT, NCS