Point-of-service: Friend or foe?

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Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L
As a manager, I used to love to promote point-of-service, or POS. As a therapist, I used to despise POS. How could I have such a love-hate relationship with POS? Well, let's start with identifying what it is.

Point-of-service is a term we use in this industry to define completing any non-billable tasks during billable time. An easy example is, completing your progress note throughout your treatment session with a patient. Companies have loved this idea for years because why allot two hours for paperwork, when it could be reduced in half if completed during treatment times?

As a manager, I loved the idea because it promoted better efficiency and productivity. As a therapist, I despised the idea because "How could I concentrate on my patient when I'm distracted writing notes?" Well, nowadays, I tend to think of POS as friend rather than foe. What changed my opinion? The new regulations from the Centers for Medicare & Medicaid Services.

With the onset of change-of-therapy (COT), observation periods and essentially treating all of our patients individually, I believe point-of-service is almost a saving grace to survive the day. We have so many patients to treat, meetings to attend, screens to complete, billings to enter, notes and evaluations to write, and so on. I need to work as efficiently as I can to even think about leaving on time in an eight-hour day.

So, to promote more point-of-service, think about logistics. If your rehab department is using individual handheld devices or still using paper forms, POS should be easy. If you complete your notes and/or billing on a computer, think about accessibility. It is not acceptable to leave your patient in the gym while you lock yourself in an office for 10 minutes to write a note. However, can you relocate the computer to an easily accessible area in the gym? Do you have laptops that can be set up directly next to the patient or brought to patient rooms? Completing a progress note during point-of-service may actually help to improve the quality of your documentation. You can talk directly with your residents about their progress, goals, discharge plans, etc., and involve them in the process.

It will help to better inform them of their progress and rehab potential and may enhance better carry-over and motivation. It is billable time for "therapeutic rest periods" or we may be able to complete the POS task while the patient is engaging in activity that only requires supervision (such as some exercises).

The days of concurrent therapy and group therapy have gone, but the days of individual treatment and point-of-service (multi-tasking) have started to resurface.

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Rehab Realities is written by Shelly Mesure, MS, OTR/L. She is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide.

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