Productivity Evaluation

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Ollie123

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Have posted about clinical productivity and compensation before. Am curious to hear from others in hospital-based systems where they measure clinical productivity, but you also likely have less freedom to dictate things like policies, caseload, etc.

I'm not going to hit my RVUs for the year. Today is a good example given I scheduled 7 and am going to see 2-3. I normally try to schedule 8, but obviously it doesn't always happen. Clinic policy is we don't charge for last-minute cancellations (not my decision). Scheduling happens through a centralized system and I don't really have much freedom to dictate my caseload within that to try and pick/choose populations with high show rates (which I wouldn't necessarily feel great about doing anyways but hey, gotta work within the system). I try to walk a line between emphasizing the need for regular attendance without being so dictatorial as to impact rapport.

I'm sure others have been in similar situations and am curious how they handled it. Truthfully, I doubt its going to "hurt me" per se. I'm mostly research, am doing great on that front, and I seriously doubt anyone will care two licks if I come up slightly short on the clinical front. Nonetheless, failing to meet goals bugs me;) Is 6/day an unreasonable expectation for a moderate-severity clinic that takes insurance? They also set our hours of operation so I couldn't schedule outside 8-6 even if I wanted to (and I'd give up seeing patients entirely if they try to make me book 10/day). All I can think to do would be to expand my caseload so I'm cramming folks in where they fit and frequently not weekly. If that is what needs to happen I'll deal, but it doesn't sit well with me ethically.

Thoughts? Encountered similar problems? How do you handle?

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A liberal one (have to make it in at least every 4 weeks). It helps somewhat, but this is an issue across patients so it only gets one so far.

I think part of the issue also comes from the fact that it is a moderate severity population and generally high functioning. I get a fair amount of people that travel for work, etc. Few of these in a given week and I'm not able to schedule enough. I could overbook myself, but then I'm not necessarily seeing folks weekly who probably should be. Tricky balance!
 
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One place that I worked had a fairly stringent policy - 3 strikes within a year (no show, or canceling less than 24 hours in advance with exceptions for illness/emergencies) and you're out (not sure if that was permanent or just back of the waiting line for sessions, or a certain number of months, or what). I thought it was maybe too strict, but on the other hand, we had what I thought was an extremely low no-show rate for therapy sessions.
 
Sounds like a lot of this is out of your control, so I think you probably do need to have more active patients than you do openings in order to fill your time. Do your patients require weekly treatment?

I have only 4 hrs/week of time dedicated to clinical work, but have about 6 active cases at any given time. Not everyone needs/wants weekly treatment, and some increase or decrease frequency depending upon need and where they are in the course of care. This works pretty well for me, and my patients don't have much difficulty getting time in my schedule.

I'm pretty sure that the other providers in my clinic (who are full-time clinicians) do this, as well. I think it's just about striking the right balance, which can be tough - but doable.

Though I did chuckle a bit when you talked about your moderate severity patients having difficulty making it to their appointments because of things like work travel. I work almost exclusively with people who present with severe psychopathology - treatment attendance is no better, given the many barriers to care they face. So I guess it's a challenge no matter what!
 
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6 a day is perfectly reasonable. I schedule 8 and usually average a bit better than six. My colleague schedules 10 and gets at least 8! I find that when patients perceive benefit that helps keep them coming back and I put more energy into those patients. The rule of don't work harder than the patient applies here. It also can help to schedule out more sessions with the more reliable patients so that you don't get schedule filled up with people who won't show.
 
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Thanks all, this was helpful. Weekly treatment would probably be "ideal" for many of my folks but probably not "necessary." Given the constraints, I may just need to give up the notion of one patient per slot and go every other week with some folks who I otherwise might not have. I like the idea of scheduling out further with more reliable folks as it definitely happens where I "squeeze someone in" and they end up no-showing/cancelling at the last minute and the person who might otherwise want that slow misses out.

I also think part of the issue is my own time constraints. Clinic is a dedicated day for me and in a separate location from my main office. Given I'm overwhelmingly busy on non-clinic days, I refuse to rebook people the same week if they miss since it would mean an extra ~40 minutes out of my day back and forth to the clinic. Eventually we're hoping to reconsolidate into one space. I'm hoping that helps too since I could be a little more flexible with scheduling.

Though I did chuckle a bit when you talked about your moderate severity patients having difficulty making it to their appointments because of things like work travel. I work almost exclusively with people who present with severe psychopathology - treatment attendance is no better, given the many barriers to care they face. So I guess it's a challenge no matter what!

I should probably clarify. First - definitely a challenge no matter what! I'm used to working more severe pathology too...I think I'm just more used to troubleshooting attendance issues in that population. I'm very comfortable trying to address barriers to care (though obviously depending on the nature of them I may or may not be successful). I'm entirely uncertain what to do in these situations though, since I obviously want to support productive/active behaviors....but a caseload where 1/3 people get called out of town at the last minute several times a month absolutely kills my numbers! Going every other week doesn't even seem to help since is often unpredictable and they are just as likely to cancel their every other week session...
 
Caveats: I am ridiculously aggressive in negotiations, have a history of not playing well with others in institutions, and have many fall back positions which make that possible.

1) There are some professional guidelines on productivity described on some of the list serves. The one I read recently was very very low and included complex vs noncomplex caseloads.

2) I find it is helpful to know what you are bringing in when dealing with admin. I'm guessing your clinical work brings in more than your overall compensation. And your research likely brings in more than it pays out. Especially if you include things like of your research is used to get donations. If you could put a decent number to how much you brings in from that stuff, a competent business person would be happy to work with you. For example, if you could point out that your research is mentioned in brochures and phone calls that brought $400k in donations last year.

3) there's some compromises you might be able to make between your schedule and their needs: tele psychotherapy, groups, reviewing files, etc.
 
I'm entirely uncertain what to do in these situations though, since I obviously want to support productive/active behaviors....but a caseload where 1/3 people get called out of town at the last minute several times a month absolutely kills my numbers! Going every other week doesn't even seem to help since is often unpredictable and they are just as likely to cancel their every other week session...

So it's not just that clients have work travel, but also that a good chunk of them have last-minute work travel - that's a bummer for all around! I imagine that they also get frustrated when they have to cancel and then get rebooked a week or two later. I wonder if there's a way, for those clients with unpredictable schedules, to hold a few spots on your clinic day for those clients and then book those on a nearer-term basis than through the central office - e.g., you see clients on Wednesdays, clients who often have unpredictable work schedules don't get booked for a "regular" time but call you by the end of day on Monday if they'll be available that Wednesday to meet, and then you can slot them in at that time. Just one consideration, depending on how many clients have that issue.
 
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