Shift to paraprofessionals saves system $500,000
Exercise physiologists, athletic trainers added
A Kansas City, MO, hospital system’s outpatient services have saved more than $500,000 annually over the past two years by hiring paraprofessionals instead of relying on agency therapists to fill staff vacancies. Health Midwest, a 13-hospital system, created a skill mix of 50% professional staff and 50% paraprofessional staff, says Janet Brooks, RPT, outpatient coordinator.
Two years ago, almost all the staff at the system’s outpatient centers were physical therapists and occupational therapists. Now, certified occupational therapy assistants (COTAs), physical therapy assistants (PTAs), certified athletic trainers, and exercise physiologists make up about half of the staff at the outpatient centers.
Using agency staff could cost anywhere from $35 to $60 an hour, whereas exercise physiologists and certified athletic trainers are paid a fraction of that amount, Brooks says.
Most of the paraprofessional staff in the outpatient centers have a four-year degree or are licensed physical therapy assistants or certified occupational therapy assistants, she says. The system used techs primarily for transporting people, and when the system shifted to unit-based rehab on the inpatient side, most of the tech positions were eliminated.
Changing times
Three years ago, the system was forced to rely on agency staffing because a shortage of physical therapists and occupational therapists made it difficult and time-consuming to fill vacancies. The shortage has abated somewhat, which makes it easier to find qualified staff, Brooks says. Today there are about 100 staff who give hands-on treatment in the outpatient centers. "We know we can’t rely on agency staff. It’s not cost-effective. We’re still looking at the skill mix. What was ideal three years ago is not ideal today."
As managed care severely limits lengths of stay in outpatient rehabilitation programs, Brooks is considering changing the staff mix to two therapists for each paraprofessional.
"We are constantly monitoring the skill mix as our market changes. We want to find the most effective skill mix that will allow us to keep our good outcomes. We’re looking at both pieces," she says.
Managed care restricts some patients to only three or four visits, making it imperative that they be treated by a highly skilled professional in order to get the best outcome.
"It’s difficult to assign patients to less-skilled staff when you have only a few visits to manage a case," Brooks explains. "Decreased utilization has made us look at staffing patterns again since we don’t have as much time as we used to."
Standardized training helps
All of the new paraprofessionals go through training in Health Midwest’s standardized methods of treatment and documentation. All modalities, exercises, transfer skills, and gait training are among the subjects covered.
Members of the professional staff have attended inservice programs to learn how they can use paraprofessionals to assist them without compromising quality of care. "It helped our staff accept and deal with people with different backgrounds. They learned that the paraprofessionals needed some on-the-job training, but they had a strong educational background," Brooks says.
Same jobs = same tasks everywhere
The Health Midwest management staff also have standardized how each level of staff is used at the each facility. For instance, all the athletic trainers are used for the same tasks systemwide.
"We looked at the different skill levels and what people could do. But we keep in mind that every clinic is going to be a bit different and that what works at a big clinic is not going to work at a smaller clinic," Brooks says. Her staff created standardized job titles, job descriptions, and performance appraisals across the system.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content