I am so mad !!! We are going per visit !!!

caliotter3 · Mar 28, 2007

Sorry to hear about this change and how it will affect you. It usually turns out that there is someone who suffers for the transgressions of the many.

CseMgr1, ASN, RN · Mar 28, 2007

i am so angry !!!!!!!! :angryfire
my wonderful hh company has decided to go per visit. :angryfire they say we can make more money but i've been there before. :angryfire we're no fools. :angryfire .they are only interested in putting $$$ in their pocket. :angryfire the problem is that many of the nurses spend too much time with the patients and then too much time charting and they have overtime on every paycheck. their productivity stinks. i have no problem keeping routine visits to 30 mins, evals to 1 hour to 1 & 1/2 hours and keeping my charting to a reasonable time. i have called back and suggested that continue as we are doing now but put a cap on the length of the visit that you can claim for a particular kind of visit and also put a cap on the length of charting. if it takes you longer, you're just out of luck.
:angryfire :angryfire :angryfire :angryfire :angryfire
this stinks! i am so mad!

i hear you. home health's shift from quality to quantity was one of many reasons why i left it for good in 2006, after almost 19 years. it just wasn't worth the hassle anymore.

floridanurse65 · Mar 28, 2007

It happened to me and for a while I was making a killing. I'd never made so much money. Then the census dropped drastically for about 2 months and I had to leave. None of us were happy. Several others left after me. I tried another company and had the same results. I put my notice in last week and I'm starting at a hospital on the 9th. Not what I wanted to to, but my mortgage company likes to get paid for some reason. I sincerely hope things work out for you.

Morgan314 · Mar 28, 2007

Is this the same thing as "fee for service?" That's what our company is talking about doing.

Jolie, BSN · Mar 29, 2007

i am so angry !!!!!!!! :angryfire
their productivity stinks. i have no problem keeping routine visits to 30 mins, evals to 1 hour to 1 & 1/2 hours and keeping my charting to a reasonable time. i have called back and suggested that continue as we are doing now but put a cap on the length of the visit that you can claim for a particular kind of visit and also put a cap on the length of charting. if it takes you longer, you're just out of luck.
:angryfire :angryfire :angryfire :angryfire :angryfire
this stinks! i am so mad!

i understand your frustration, and agree that your suggestion seems reasonable. problem is, federal labor laws won't allow it to be done. as long as workers are paid on an hourly basis, the company must pay them for every minute they work. this is the same issue that comes up in hospitals when employees who are consistently slow are "encouraged" to clock out and then finish their work. it's just not legal.

DutchgirlRN, ASN, RN · Mar 29, 2007

Is this the same thing as "fee for service?" That's what our company is talking about doing.

Yes fee for service is the same critter! I hope it works out for you. It seems more and more companies are doing this. Put more money in their pockets. Seems the reason our office is going per visit is because our productivity is off. It's 2 out of 6 nurses causing the problem. I say get rid of them. The other 8 branches are not going to per visit. We're being asked to take a decrease in pay to keep the company salvageable. I want to ask, ok who else in this office is taking a decrease in pay? Is this not a team effort? So who else is a part of the team? The MSW? The DON? The Clinical Supervisor? The QA nurse? I bet none of them are taking a cut???? :angryfire I just may have to ask...

Cattitude · Mar 29, 2007

Yes fee for service is the same critter! I hope it works out for you. It seems more and more companies are doing this. Put more money in their pockets. Seems the reason our office is going per visit is because our productivity is off. It's 2 out of 6 nurses causing the problem. I say get rid of them. The other 8 branches are not going to per visit. We're being asked to take a decrease in pay to keep the company salvageable. I want to ask, ok who else in this office is taking a decrease in pay? Is this not a team effort? So who else is a part of the team? The MSW? The DON? The Clinical Supervisor? The QA nurse? I bet none of them are taking a cut???? :angryfire I just may have to ask...

I WOULD ask but I am a PITA. Now I understand your frustration. I know you have posted before that you are usually done with visits by early afternoon and then have time to chart.

Now will you have to fill up your day with more visits?

My agency too screams about productivity. Sometimes my patients don't need weekly visits so I don't know what they expect me to do. Argghhh.

DG, I hope you can figure something out so this still works for you.

Jolie, BSN · Mar 29, 2007

We're being asked to take a decrease in pay to keep the company salvageable. I want to ask, ok who else in this office is taking a decrease in pay? Is this not a team effort? So who else is a part of the team? The MSW? The DON? The Clinical Supervisor? The QA nurse? I bet none of them are taking a cut???? :angryfire I just may have to ask...

I encourage you to ask. It is a fair question.

DutchgirlRN, ASN, RN · Mar 31, 2007

I haven't asked yet but I am going to. We were told on Wednesday that we were going per visit and that we were the only branch out of 9 because of low productivity. It's 2 particular nurses who are abusing the system. (3-4 hours for an admission, puhlease and never can do a visit under 90 minutes, yeah right) anyway, we felt as though we were being punished for the actions of those 2 nurses. I said fire them and leave us alone. Then yesterday we learn that the entire agency, all 9 branches, are going per visit effective April 2. So far one branch had all the nurses walk, another branch had several nurses walk and in our small branch of 6 nurses, so far one has walked. I can't blame her. She has been there a long time and built up her hourly with raises and merits. She just got a big raise 2 weeks ago and now suddenly she's making the same as everyone else, lost her raise entirely! The nurse who's basically a new grad and been there only 2 months is now making the same as she. I don't blame her at all and feel really bad for her. She rightfully feels as though she been sucker-punched.

I have decided to ride it out for a while. We learned yesterday that if a visits mileage is 24 miles+ we automatically get an extra $15 for that visit. We still get mileage reimbursement as well. I thnk two other nurses are going to walk as well. The day after we learned the news all the nurses except me and one other called in sick. Interestingly the nurse who takes 3-4 hours on admits and wants to always do nothing but admissions now all of a sudden wants to do nothing but plain visits. Thankfully admin sees her for what she is and has said they will be more than fair to me and she's going to get leftovers. I am still frustrated. But I'm going to give it a fair shake. This is one company who has prided itself on looking out for it's employees. This really stinks. The admin in our office is sickened over it as well, they haven't slept for several nights. At least I know they're feeling the pain as well.

Cattitude · Mar 31, 2007

Oh you agency will learn a LOT of things. Especially when your 90 min per visit nurses suddenly start getting them done in 30-40! It's amazing how fast those admissions will get done too.

Just be careful with your own visits. I know you said previously I think you did around 4 a day. If you need to increase that for $, do it slowly. I know that when I did Fee for service i could do 7-8 visits per day. BUT I didn't have to case manage them either. That makes a lot of difference. Also when your patients know you they want to chat. That tends to make visits lengthy too. You know that.

Hang in there, see what the changes bring. How much are they paying per visit? Here in NY it is $53 for a regular visit and I think $62 for a recert and ROC/SOC. I know its probably more here but so is everything else, housing, gas, etc.

DutchgirlRN, ASN, RN · Apr 1, 2007

$37 for regular visit, $52 for any visit requiring an RN (eval visit). $15 premium for more than 24 miles one way to visit. 1/2 usual rate for non billable visits. After hours and weekends 1 and 1/2 times the regular rates. We still get mileage and cell phones. Right now were seeing 3-4 patients per day. We are moving up to 6 per day, 5 if an eval visit is included.

I agree, I think the "slow" nurses (those abusing the system) will suddenly have a noticeable improvement in their productivity. If they don't, which I seriously doubt, then they will leave because they are losing money. Two in particular are known to abuse the hourly system. One figures she'll now be making less than the HHA because of how long everything takes her.

It will be interesting Monday to see what's going on. I expect more nurses will have walked without any notice. The only thing I dread is having to take more frequent call due to less nurses in the rotation.