Help! Baffled by 'pay per visit' offer

elimayrn · Jan 10, 2018

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!

Libby1987 · Jan 10, 2018

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.

elimayrn · Jan 10, 2018

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?

Libby1987 · Jan 12, 2018

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.

love2banurse89, BSN, RN · Jan 18, 2018

I worked in home health in a rural area. Our standard visits were 30 minutes and the per visit pay was equal to a very competitive hourly wage. BUT there were times the drive time between patients dramatically brought down the average hourly pay. We did a lot of charting outside of visits and that also brings down the average hourly pay.

However, if your patients are fairly close geographically, per visit pay works out well! Some agencies will allow you to make your own schedule and so you can arrange patients to do the least driving; others won't let you do that.

Be sure to get a clear answer on pay for orientation, office time, meetings, etc.

Good luck!

kel*rn*bsn · Jan 23, 2018

I recently switched off of per visit to hourly after lots of fighting for it. I am so much happier and feel I finally compensated for my time. As,a per diem they would send me all over the place and very little continuity of care. So I would do a solid chart review and spend time with the pt, often referring back to my computer to verify order which slows you down, then have to finish charting at home. I was not compensated for researching pt prior to visit, travel time, documentation time, calls from care givers or doctors or whatever later that night or next day. It's a lot of little bits of time that all add up to an average of 2hrs per visit which translated to very low pay. You need to ask a lot of questions prior, ask about territory size, continuity of pts, can you bill hourly for extra work later or next day etc. Good luck

elimayrn · Jan 23, 2018

Thanks for all the information, it is very helpful! I definately see your point on improving patient care and efficiency.

elimayrn · Jan 23, 2018

I did accept the possition and will start Feb. 5th so we shall see! I have 3 years with hospice as a CM and 4 years with HH as an LPN. That should help.

OldDude · Jan 25, 2018

I did accept the possition and will start Feb. 5th so we shall see! I have 3 years with hospice as a CM and 4 years with HH as an LPN. That should help.

Congratulations! Just keep an eye on the math...Drive time, documentation time, fuel cost, premature wear and tear plus loss of value for your vehicle, certain "color" of scrub requirements, and other things that cost you but not the agency. "Pay for visit" is synonymous with "agency cost cutting." As stated above, if the visits are close together, geographically, and if the visits are there for you to do, it can be profitable. Home Health, in my neck of the woods, is a cycle feast or famine...too many visits to do in one day versus not enough visits to keep everyone working.

KelRN215, BSN, RN · Jan 26, 2018

There are times when pay per visit benefits you- like if you have several visits that are only a mile or 2 apart and the visits are straightforward. I had several patients when I was a visiting nurse that lived within a mile of each other and I could easily bang out 3 of them in just over an hr- weight checks, blood pressure checks, lab draws via central line, etc. On the other hand, if your patients live far away from each other or are complex/require longer visits, it will benefit your employer but not you to pay you per visit. When I started in home health, I had 20 hrs/week where I was paid hourly for in office case management and then I was paid per visit for the visits that I did. When I became full-time, I switched to salary 40 hrs/week but still got paid per visit for the visits I did outside of the Mon-Fri 8-4:30 hrs. We got a very low flat daily rate for being on-call but also got paid per visit for any visits/admissions we did on the weekends so I typically just did these visits myself if I was the supervisor on-call.

feelix, RN · Mar 15, 2018

The long and the short of it is, they put you on pay per visit to save money. There is no way anyone could do 6 visits a day, even if they do 2 admissions. If you are not cutting corners, 4 admissions is as far as math will go in a day. One hour at least for an admission visit, plus 2 hour of charting is 12 hours per day all inclusive.

If they are paying you even $100 per visit, which is rare, you make $300 per day if you see 3 patients. There is no guarantee you will get 3 patients a day. They will make the salaried person work first to recover fixed costs. You will be called only when no one else is available. You will be given the farthest assignments with most time spent travelling. They will not give you a portable laptop with wireless capability, so you will have to chart on paper and take all the paper work home. So you will probably never be able to do 4 patients a day and not have more than a couple of patients on the days you are called.

In short, you will make a fraction of the salary that full-time staff makes.