Help! Baffled by 'pay per visit' offer

  1. I recently applied as a home health case manager and received a phone call last night saying she would call tomorrow with an offer. The company in Kansas City Missouri pays per visit. I am not sure how to convert my requested annual salary to a per visit number! I have tried dividing annual salary down to daily pay but I'm not sure if visits will be made 5 days a week 52 weeks in a year, so I am worried about accepting their offer not knowing.
  2. 4 Comments

  3. by   elimayrn
    Also how are "pay per visit" RNs compensated for meetings, inservice, on-call hours etc? I will be going from a hospice case manager on a salary to Home Health case manager so this is a big decision for me!
  4. by   Libby1987
    It always worked out for me to be paid 1.5 times my hourly for a revisit (shortest billable visit) and 3 times my hourly for an admission visit (most time consuming visit). Other visits were weighted accordingly. Meetings etc were paid hourly. Hourly was at the lower end of the local Mon-Fri straight hourly acute hospital pay. Orientation was paid hourly. On call was a flat rate (slightly higher than 1 hr of pay per night) and any visits were paid at my visit rate.

    If you're efficient and organized as well as live in your patient territory, it can work out better than straight hourly (it did for me). I had to claim 9hrs of PTO to equate my usual daily per visit pay.
  5. by   elimayrn
    Thank you for your reply. That makes sense. Am not understanding the PTO example you gave. Is this to make up for too few visits?
  6. by   Libby1987
    Quote from elimayrn
    Thank you for your reply. That makes sense. Am not understanding the PTO example you gave. Is this to make up for too few visits?
    No. Because I was what is called highly productive (not excessively where it impacted my practice). 5 revisits at per visit pay was close to the equivalent of 8 hrs. Actually 5.13 revisits was the exact equivalent. Because I averaged 6 revisits per day at per visit pay, I needed to claim 9 hrs of PTO for the equivalent of my average day's pay.

    The acuities have changed so much but those of us who learned on lower acuity patients could find it more lucrative to be paid by the visit once we became efficient. That definitely comes with experience and the per visit pay was an incentive to amp up our organizational skills and reduce waste. Unfortunately others abused it and just "racked up the visits". Professional integrity is essential.

    As the acuities increased, those who are efficient could still do well on per visit pay but it is a hard place to start out. The down side of hourly is that there is less incentive to increase your efficiencies and regardless of your pay structure, efficiency in home health (or any job) is a better work experience. Some hourly staff will come by it naturally as they are inherently wired for it and those who aren't will struggle with productivity expectations and unfortunately, in some cases patient care is impacted. Patient care can be impacted by either if professionally integrity is absent.

    There are other factors of course like drive time and office inefficiencies but those can impact impact all pay structures. In theory, with the hourly structure and productivity expectations, those with short drive times need to make up for those with long drives for fairness and balance.

    I've seen companies who take advantage of their per visit staff staff and I've seen hourly staff take advantage of their employer. But from a career home health nurse perspective, a year or 2 of per visit experience will benefit practice.