COTA and PTA productivity targets: why assistants can get the higher number, and when that stops being fair
The reasoning holds only if assistants are protected from the non-billable work the therapist's lower target allows for.
COTA and PTA productivity targets can be higher than therapists' targets because evaluations, plans of care and supervision sit with the therapist. COTA stands for certified occupational therapy assistant, and PTA for physical therapist assistant.
Each employer sets these targets, and they vary.
The reasoning behind a higher assistant target can hold up. It also depends on four conditions, each of which you can test in your own job with two weeks of minute tracking.
The reasoning
Evaluations, re-evaluations, plan-of-care development, discharge planning and supervision sit with the therapist. These tasks take time, much of it non-billable, and they cannot be skipped.
An assistant's day, in the clean version of this model, is treatment. Fewer non-billable tasks leave more of the paid day for billable work, and a higher target follows.
What the gap allows for, in minutes
Example: a paid day of 480 minutes, with a therapist target of 85% and an assistant target of 90%. These targets are examples, not published figures.
| Role (example) | Target | Billable minutes needed | Non-billable minutes allowed |
|---|---|---|---|
| Therapist | 85% | 0.85 × 480 = 408 | 480 − 408 = 72 |
| Assistant | 90% | 0.90 × 480 = 432 | 480 − 432 = 48 |
In this example the assistant has 24 fewer minutes a day for all non-billable work. The gap is fair only if the assistant has at least 24 fewer minutes of that work to do.
The conditions assistant productivity targets depend on
Assistants are protected from non-billable work. In practice an assistant may take on chasing equipment, coordinating with nursing, family education and transport. They may also set up and clean treatment areas and write documentation for a shared caseload. None of that is in the billable column.
The caseload is more straightforward. An assistant's caseload may not be simpler. An assistant can carry a high-volume caseload with more patients a day and shorter treatment slots. More patients means more transitions between them, and each transition is non-billable time.
Supervision time is counted on both sides. Supervision meetings, co-treatment for competency and case discussion take time from the therapist and the assistant. If the therapist's target allows for it and the assistant's does not, the assistant carries a shared cost alone.
The documentation load is lower. Daily notes still have to be written. In some electronic records systems an assistant's daily note takes as long as a therapist's.
How to check PTA productivity in your own department
Track two weeks of non-billable time by category: documentation, equipment, coordination, transport, supervision, setup and waiting. Record the minutes without comment.
Then ask a therapist colleague to do the same. If your non-billable load is about the same as theirs while your target is higher, the model behind the gap does not describe your department.
Example: the assistant in the table above tracks an average of 70 non-billable minutes a day. That leaves 480 − 70 = 410 billable minutes, or 410 ÷ 480 = 85.4%. At a 90% target, the assistant falls short every day while doing the same non-billable work the therapist's 85% target allows for.
A rehab director can act on a measured figure like this, because it points at how tasks are shared out. The guide to tracking your own minutes sets up the log, and the therapist productivity calculator turns a day's minutes into a percentage. The same arithmetic applies to an OT assistant using the occupational therapy productivity calculator or a PTA using the physical therapy productivity calculator.
Group and concurrent therapy in US skilled nursing
Under US Medicare Part A in skilled nursing facilities (SNFs), the definitions of group and concurrent therapy name the "therapist or assistant". An assistant can run a group of 2 to 6 residents doing the same or similar activities. They can also treat 2 residents concurrently with both in line of sight. Group and concurrent minutes together are limited to 25% of each resident's therapy minutes in each discipline, across the stay.
Group and concurrent sessions add scheduling and a note for every resident. If you are an assistant in an SNF asked to hit a high target while running these sessions, ask how the target was calculated. Also ask how group minutes are credited and when the target was last reviewed. The guide to group and concurrent therapy under PDPM explains the rules and the crediting methods.
Supervision time
Assistants work under a therapist's supervision. The rules for how much supervision, and what kind, depend on where you work and who pays. It can include direct observation, case review, co-treatment for competency and countersigning notes.
Supervision time is not billable for the assistant. In a well-designed system it is allowed for in the assistant's target. Where it is not allowed for anywhere, it lands as non-billable time on the assistant.
If you are an assistant, track supervision time on its own for two weeks. Notes are easy to remember writing. Twenty minutes on a Tuesday spent waiting for a therapist to come and observe is easy to forget.
The career cost
A higher target with no protected non-billable time leaves an assistant the least room for mentoring, case discussion, continuing education and department projects. Over several years, an assistant without that time has less to point to when senior roles are filled.
A department can build a small protected allowance into the assistant target for this. Example: 30 minutes a week of protected time in a 5-day week of 480-minute days is 30 ÷ 2,400 = 1.25% of paid time. That is about one and a quarter percentage points.
What a fair assistant target looks like
A fair target gap has three properties. The non-billable duties that justify the therapist's lower target are held by the therapist. The non-billable duties that fall to assistants are counted somewhere, not assumed away. The gap is reviewed when caseload patterns change, instead of being inherited from whoever set it.
The target should describe the job as it is done. The guide to setting a productivity target shows how to build a target from the day. The guide to productivity targets by setting covers the published figures, which are for US speech-language pathologists, not assistants.
Questions to ask at interview
- What is the assistant target, and what is the therapist target?
- Which non-billable duties sit with assistants here?
- How is supervision time allowed for in the assistant target?
- What is the department's actual assistant average?
Suppose the assistant target is higher and the answer to the second question is "the same as everyone." Then the target and the reasoning behind it do not match. It is better to know that before you accept the role than six months in.