Sarah is a new clinician and just started her first job at a skilled nursing facility with an attached post-acute care wing. She is thrilled to have this job and excited to begin her new career in rehabilitation therapy. The first few months went really well as she got trained and acclimated to her job, but now she is facing increasing pressure to meet a productivity requirement of 90%. As each week passes, she feels less and less capable of her job because her manager is writing down her productivity percentage on a sticky note and leaving it on her desk each morning. Throughout the day, she struggles to find ways to increase her productivity. She finds that the only feasible way to do this is to fudge the number of minutes that she is spending with patients by billing for time she spends looking for them. This makes her feel slimy, but she doesn’t know how else to achieve 90% without clocking out for bathroom breaks and paperwork sessions. All of the other clinicians seem to be able to achieve it, so why can’t she? After a few months, she starts to dread going into work. Seeing the sticky note at her desk each morning makes her feel frustrated, resentful, and unappreciated. Fudging her billable minutes makes her feel like a fraud, and she starts to notice other slides in ethical decision making, such as ignoring an urgent call light or telling a family she doesn’t have time to talk with them because she knows she can’t bill for that time. She is starting to wonder if she made a mistake with this career choice. After work, she is turning to more and more coping strategies, including drinking more than she ever has each night, binge-watching TV, and venting about her job to whoever will listen. She does not feel that it’s safe to bring up the topic of productivity with her boss because anyone else who has tried to do so only has stories of how badly the conversation went. She feels stuck, ashamed, and burned out.

In this case study we will discuss:

• Productivity and where it came from.
• The landmark switch to PDPM.
• The residual crisis: Why productivity still exists in PDPM.
• Point of care documentation- the pros and the cons and why this isn’t a solution.
• Collective hands in the air: SNF brain drain, lack of cohesive solution, and... are unions the answer?
• 5 things therapists can do to push back and turn the conversation in a different direction.
• 5 ways leaders can communicate how they value employees beyond a productivity number.
• The future of rehab medicine and how we measure efficacy of clinicians: What we want to see if we could wave a magical wand.