Per Diem vs. Salaried

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    I am a clinical nurse supervisor in a small home health agency in a large city in NC. I'm curious as to how other home health agencies pay their full time nurses, either per diem or salaried, which works better, and why do you think so? The home health agency I used to work for paid nurses on a salary basis, and this one that I work for now pays on a per diem basis. Personally, I feel salaried nurses work out better because they are obligated to come to the office, whereas per diem nurses feel it's a huge hassle to come into the office. I have read literature that says most HHA are getting away from per diem with PPS, as it's not feasible enough. Any comments would be appreciated.

    Lenora Ramsey, RN, BSN
    Clinical Nurse Supervisor
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    Hi Lenora, I have been involved with a committee for the last 3 months debating those very questions, my agency had been per visit, not per diem, and prior to PPS it wasn't a bad system, the company made money as well as the nurse, now that has all changed since reimbursement is now capped and if you have too many visits per patient, your agency is going to be out of business in a heartbeat, so the whole point now is to work smarter, and spend more time each visit to get that patient independent and discharged as soon as possible, (same as DRG's)the per visit system will not work any longer in lieu of PPS, my agency has developed a plan to go salary, with a flexible model based on points. At least that's what is being proposed to HR, it should be in effect by April, although, I will not see this work to fruition, I have had to find employment elsewhere due to a drastic pay cut for me personally with the salary model, I am going back to hospital nursing after 10 years in the field, which I did love,(NOT THE PAPERWORK THOUGH!) but the salary I would make now can not come close to what I made per visit, since I was a high productivity nurse, I had been making 47,000-53,000/year and my pay will drop to 41,600/year. Unfortunately I need to maintain the same income. Good luck! NN


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