Hacker News Reader

Comment by iambateman | Hacker News Reader

My wife is a therapist. Her supervisors expect 80% efficiency (billable time) and her treatment to paperwork load is close to 1:1.

So literally her only option is to document while also treating.

she comes home and tells me that a patient asked for water and that creates a dilemma for her: go get water and lose productivity while treating your patient like a human OR reject their request and keep productivity high and avoid being scolded.

The problem is, obviously, good care is therapy AND getting water for your patient. They're humans not numbers. We're forcing medical professionals to only work within the scope of "billable" activities and that ultimately hurts the patient.

View on HN

My wife is a therapist as well. She has to clock out and do documentation on the evenings or weekends to meet productivity (documenting while treating isn't an option given her need to be hands on with patients). They also require her to overbook (i.e., book >100% productivity) so that she stays above 80% in the case of no shows. I get the logic behind it, but it really sucks for her when she doesn't get no shows.

They don't care if she gets overtime (so long as she meets productivity), so that's nice, but I really can't understand why they don't just go to salary or work with insurance companies to incorporate documentation into billable time. I can't imagine the patient experience would be hurt too much by shifting from 1 hour sessions to 45 minute sessions with 15 minutes of paid documentation. If anything, insurance companies should get better documentation and that should help them combat fraud while also improving care. Granted, I think the clinic my wife works at is almost entirely built around Medicaid reimbursement and Medicaid doesn't have many real incentives to reduce costs or improve quality of care.

These sorts of universal employee abuse problems are what unions are supposed to solve.

Seems like a big part of the problem is that paperwork is part of the process of treating patients, but apparently isn't billed. If it's a necessary part of treatment then it ought to be billed just like the rest, then there's no more conflict.

Healthcare (in the US) is a mess. Changing billing requirements means changing Medicare, Medicade and the VA...plus all private insurance which saves money when denying reimbursement.

Standardization has benefits in the existing system.

No doubt. Unfortunately this is one of those cases where identifying the root of the problem doesn't necessarily help you solve it.

For longer than our twenty years of marriage, my beloved has been in healthcare...I of course have not.

My gut tells me that standardization of what is and isn't billable solves a bigger problem than described in the above comment. My whole being tells me that changing the definition of billable time won't fix crappy workplaces run by bean counters.

And if I had to guess, classifying documentation as treatment is unlikely to improve patient care and outcomes.

My beloved has been a therapist for almost 30 years...it's an after work debrief I can relate to...and something I've learned not to try and fix, just listen.

Anyway, my gut tells me that sometimes getting water for a patient is good therapy and sometimes it is bad therapy. The same for documenting during a session. Depends on the person and their situation. Sometimes what people describe as their is the problem, sometimes the describing things as problems itself is more the problem. Good workplaces have a leadership culture that can and does distinguish between them.

Anyway, I don't expect to stop hearing variations on that theme any time soon.

She doesn't think that the small gesture helps the patient form a therapeutic bond with the therapist, and is part of treatment?

Doesn't matter what she thinks. Healthcare is controlled not by the health experts but by the money experts. Kinda like when a doctor must call insurance to approve a procedure because it is up to the insurance, not the doctor, to determine what procedures are medically necessary.

Reply on news.ycombinator.com