How many times have you been to the doctor and they basically ignore you to type on the computer while you just sit there?

It can be infuriating if it happens every time you have an appointment. Unfortunately, this is a common situation enabled by point of service (POS) documentation.

As occupational therapists, we have been told to do POS documentation more and more to help achieve our productivity standards. I’ve even written about incorporating POS documentation into treatments to improve productivity in one of my earlier articles titled “Practical Advice for Achieving Productivity.”

But the more I practice giving quality occupational therapy treatment to my patients, the more I wonder:

  • Is point of service documentation really adding value to our patients?
  • Is it just satisfying the needs of our facility’s unrealistic productivity standards?
  • Is spending more of our time with the patient documenting leading to poorer treatment plans?
  • How can we maintain decent productivity but still give our patients the best care we can?

This post offers a few words of advice to these pressing questions.

What is Point of Service Documentation?

If you haven’t yet heard of this, point of service documentation means that you complete your documentation while you are treating your patient. In other words, you document at the same time that you treat a patient.

The reason why this assists your productivity is that it cuts down your documentation time after your treatments.

If you complete most of your documentation during treatments, you will generally be done with your day sooner and thus cost your company less money in wages.

Sadly, it sometimes seems like healthcare companies’ main mission is cutting costs. Because of this, they will encourage you to get as much of your work done during treatments as possible.

Is There a Catch?

The main drawback to point of service documentation is that it takes away from your attention paid to patients. Less attention generally equates to a poorer treatment session.

point-of-service-ot-bored

When you’re writing a note, you can’t fully focus on your patient. When under pressure for high productivity, therapists will give their patients simple exercises like putting them on the UBE/arm bike or NuStep to write their notes.

The patient might need activity tolerance retraining, but instead they’re slowly pedaling away while the therapist is busy writing notes.

Many of our patients need hands-on attention, especially during ADL retraining. If you’re providing a good ADL retraining session, you probably won’t be able to really get into your documentation.

One exception that does sometimes work is during showering with a higher level patient as long as you’re still within arm’s reach if needed. Even then, it can still be worrisome during bathing tasks if the patient slips and you were writing notes instead.

Other treatments like hands-on neuro re-ed treatments or transfer training also are not conducive to documenting. As a rule of thumb, if you’re providing good, effective treatment you probably won’t be able to document at the same time.

How to Involve Your Patient During Point of Service Documentation

If you absolutely must spend the last few minutes of your treatment writing your note, you can include your patient in the documenting.

When I do work on a note during my treatment, I will oftentimes discuss with my patient what I’m writing and inform them of their progress thus far.

It’s also a good opportunity to educate them on why they’re doing the intervention you’ve chosen. This can lead to increased patient satisfaction in the long run since a lot of therapists don’t necessarily take the time to discuss this.

A good point brought up by an OT in one of my many OT Facebook groups was this:

If your patient is significantly cognitively impaired, reviewing your notes with them might not be a good tactic. The patient could be engaged in something more therapeutic than listening to a recitation of their goals as you document.

I generally don’t spend more than five minutes discussing goals and progress while documenting during the treatment unless the patient is safe and engaged in their appropriate intervention.

Another good point from Advance Healthcare Network’s Physical Therapy Medicare Advisor in the article “Point of Service Documentation” is that…

“Discussing progress with the patient, teaching the patient about the disease process, obtaining information from them that relates to our treatment that day, as well as performing observation and assessment is skilled therapy and should be included in the time billed. However, having the patient just sit there while you are reading what you are typing is not skilled treatment.”

I couldn’t have said it better myself.

When Point of Service Won’t Work

As an example, if you have an impaired neuro patient you should be providing hands-on treatment.

With insurance companies getting more and more strict, the patient likely only has a few days or a few weeks of occupational therapy, so definitely don’t short-change them on their minutes. Consider saving the documentation for these patients for after the treatment is over.

While your productivity might be affected, it’s not worth skipping on giving your patient the best treatment they can get in the very short therapy time frame they have.

I say this in the nicest way possible:

Don’t be that therapist that just sticks the patient on whatever piece of equipment  or gives the patient a pointless activity and neglect them to do notes.

This is one of my biggest pet peeves as a therapist if you couldn’t tell!

Be Careful About Using POS Documentation

The general takeaway I want to give is that if you’re going to attempt point-of-service documentation, make sure it is appropriate to do so.

Ensure your patient is safe and that you are incorporating them in the documentation process. As you gain experience, you’ll quickly be able to recognize when it is appropriate to use point of service.

When I have a day of hands-on patient care and have no time to do point of service, I honestly don’t let myself stress about it even if my productivity is horrible.

We all got into this career to provide our patients with the best care we can give them. This is something to remind yourself on those bad days when you’re worried about the “numbers.”

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I hope this post clears up any questions you may have about POS, especially if you’re a new clinician. 

I would love to hear if you have any other tips for successful point of service documentation. When has it worked for you? When has it been impossible to complete?

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6 comments

  • OTgirl December 26, 2017   Reply →

    Point of service documentation is truly difficult if you’ve based your career on providing your patient with the best opportunity to succeed towards regaining their mobility. I have practiced for nearly 30 years and I am so grateful for the period of time in which I was blessed to practice. I am truly challenged by this current practice of point of service documentation in which you are expected basically neglect the true needs of the patient to assure your documentation is done during the time your hands should be on your patient. I’ve witnessed so many patient’s hanging on UE exercisers, hand grippers, pegs and pegboards while their potential to gain stability is neglected because the therapist is preoccupied with documenting. POS also delays patient progress because more aggressive treatments are not able to be attempted. It is even more frustrating, because these managers would never even fathom that there is anything wrong with this practice.

  • Sab January 12, 2018   Reply →

    I agree, but even the managers are under the pressure of the companies.

  • Carol Myers February 7, 2018   Reply →

    Point of service is rarely possible if you are providing truly “skilled” therapy. Putting a patient on a bike (stationary/arm) is NOT skilled therapy because anyone can do it. With more involved patients, hands on is a must for safety and instruction. Per Medicare, documentation is NOT a billable service (although it takes skill) so purely speaking, POS is fraud. Most rehab companies believe that if you are with a patient, whether he/she is engaged POS is legitimate but this is not true. Most of the time patients are not engaged because our attention is on our documentation and not them. It takes me longer to try and document while I am with a patient, then waiting after when I am not distracted to complete a good note. One of my supervisors told me I could take a charts into patients’ rooms during an evaluation and bill for chart review time because the patient is present. Char review is NOT billable whether it’s done outside or inside the patient’s room. These rehab companies are crossing the line into fraudulent and unethical practices/

  • Donna Fine February 27, 2019   Reply →

    I think POS documentation is only sometimes appropriate for a daily note. for a weekly note or an updated plan of care you can’t be treating and on the computer at the same time. To do so Nd huge inurance for minutes of treatment when the minutes were spent documenting is fraud in my opinion. I was asked to do this on my first and perhaps my last traveling PT assignment. I verbally refused to do it.. for my ethics my pay was docked. What has happened to my profession.

    • Sarah Stromsdorfer, OTR/L March 3, 2019   Reply →

      I completely agree and find it really frustrating/unethical that therapists are being pushed to bill weekly notes as treatment time in some settings, particularly SNF settings (although there are still ethical ones out there!) I’m so sorry you had this experience and that it soured your travel therapy experience. What I’ve personally found is that working for non-profit hospitals, particularly in acute care, there can be less pressure on productivity and point of service. If you would be open to a travel acute care position, I would recommend trying that out!

  • A BOT March 3, 2019   Reply →

    I’ve been a therapist for 32 years. POS documentation is the worst thing that has ever happened to this profession. On the days that I’ve given my best therapeutic interventions and went home feeling like a “real” therapist and good about what I was doing, were the days that my productivity percentages were horrible. On the days that I managed POS documentation and went home feeling like I’d “done good” for the company, were the days that I felt like I’d given mediocre therapy. There are very few circumstances where the documentation is actually therapeutic. How are you to educate a patient while typing? Therapy is hands on. You cannot merely tell a patient what they should be doing while typing on a computer. You need to be showing them. Sorry to say, I’m becoming increasingly disgusted with this practice and find it very unnerving that therapists are being lulled into believing this is billable therapy. Everyone is so afraid of losing their jobs that they’ll compromise what is right with what makes the most profit for the company. I’m tired of upper management’s attempts at brainwashing me into believing that this is okay. I know better. I was practicing OT when some of these upper management individuals were still in diapers. New grads don’t know better because this is how they’re being trained. I find it disgusting that management doesn’t even seem to care about retention of good therapists. They’d rather use them, burn them out and move on to the next new hire. Now they’re talking about artificial intelligence providing therapy with the therapist remotely controlling several sessions at one time. Are you kidding me? I’m so glad that I’m closer to retirement than just beginning my career.

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