Real PTO is a liability that shows up on the company's balance sheet. I'm sure they care if their manager tells them, "hey we need to reduce the amount of outstanding PTO and your department is dragging us down, fix it".
At least at my job it “comes out of my paycheck” and “budget” because my employees bill their time and all my KPIs are based on yadda yadda so yes short sighted managers could see it see it taking from both. Personally I’m not a numbers person and would rather concentrate on having a good team and producing a good product and let the numbers do what they do. I don’t even look at PTO requests and just approve them.