Below is a home health care conversation that developed in answering the above question:

Per visit! SYLVIA

Good question. Currently salaried which I used to prefer but as demands for more continue to rise I am not sure any more… I feel like my agency would not pay hourly at current rate for true time a take with clients. Anyone currently paid by visit? LORI

I am paid per visit. I do get more than an hourly rate however hitting productivity for the week is the key. Calling ahead to confirm with patients helps to keep down some cancellations. KRISTINA

Per visit because if the census fluctuates frequently in HHC and if you are hourly they still demand quotas even if they themselves don’t have the patients available and then they want you to use your vacation time to fill the gaps , so I would just rather get paid for what I do its easier. JANIE

Cancellations and census fluctuation make it hard to have predictable productivity measures. But whose problem is that? The therapist or the employer? DEVIN

Financially its both of their problems which is why per visit is the most fair for both parties. JANIE

I have men doing home care about 15 years and always paid per unit (eval or recert=1.5, admit or ROC=2, regular visit or DC=1) or salary for a certain number of units with extra per unit over quota. The PTAs tend to be paid hourly in my area which doesn’t make sense to me. WANDA

From a staffing stand point I would say it is more beneficial for both parties to be reimbursed per visit. There are pros and cons to both but I think it has a lot to do with the area, and the case load. If there is a solid case load and a reasonable distance between visits then either method would be sufficient. But with continuously fluctuating case loads by reimbursing per visit you are able to keep both sides honest and make sure you are not in a situation where you are paying out more money than what you are actually able to bill for. JEREMY

Obviously, drive time is non productive time. So it’s in the best interest of both the therapist, and the employer, to keep it as short as possible. What have you found to be a reasonable distance/ (drive time ) for the day? DEVIN

Usually I would see a 50 mile radius form a central office be the norm. If it is a high traffic area like Chicago, IL, you might only see a 25 mile radius. If it is a true home health route and it is what someone is doing full time/40 hours. 25 visits a week is about average to equal 40 hours of work. JEREMY

Thank you for your perspective and experience. Helpful to identify 50 mile radius and 25 visits per week. DEVIN

The market that the Home Health Care company works in can make a huge difference as well. In the Tucson and Phoenix areas I have seen some recent instances of a high quality HH company offer a base for 25 visits per week + extra per visit over quota + extra per visit that a PTA they supervise sees. It is written in their employment offers that they do not deduct from the Therapist if the patients are not available for them to see. Their local market and demand for service affords them this as the competition to hire PT, OT, and SLP providers is the only thing holding them back. JON

It would have to vary some by population density and percent of population over 65. I’m in an area with close to 4,000 people per square mile and over 18% over 65. Most HHCs here do either per diem or salary for 30 visits and extra for over 30. WANDA

Per visit takes a lot of management time off the supervisor but that really can lead to a downfall of the quality. I have seen agencies where the therapists were paid per visit and they average 10-14 patients a day. Upper management is happy with the revenue but everyone knows the quality sucks since visit times have been cut. If you go to per visit, you still have to manage your program. STEVE

Steve, that is a very good point. There are some that will try to over do visits and take advantage of the system. But with the constant productivity battles that seem to take place in a SNF, or LTC, I see a lot of therapist that are disgruntled that the are being forced to move away from quality patient care and have to be pressed for keeping numbers up. Home Health clinicians to focus on why they entered this industry, to help people, and not feel so pressured on productivity. One average if you are a registered discipline 5-6 visits with proper notes should be the norm, unless you have some visits that are literately a stones throw away. Since assistance do not have to to the extensive notes, they might be able to average a few more visits a day. So Steve, you are very correct it all stems back to how the program is managed. Greedy owners/managers in home health could easily make what seems to be a great shift in the industry to one that is less desired by those seeking therapy. JEREMY

Jeremy, very true when you said 5 to 6 might be the norm for PT and a little more for a PTA as reassessments take more time and can be unplanned and have to be met and a PT might not do as many visits as a PTA can in a day. KIRAN

Just curious…how many PTAs to PTs do you have and how many PT visits to PTA visits do you do on average? I realize state laws vary in the number of PTAs that may be supervised. Some managed care organizations are not allowing PTAs to perform services and this too may be a factor but just wondering if the paid per visit model vs. the paid by the hour model effects this. CARIN

We currently have 2 PTs and 2 PTAs. Full time 40hrs for PT is 30 visits/units but I’m 32hrs so 24 visits. The PTAs are expected to do 30-35 visits in 40hrs. There are a lot of highrise buildings where one might have several patients in walking distance so when there is no drive time, more visits are expected. WANDA