National Standard Productivity

[mukluk2]

Is there any kind of national standard for productivity? If not, where did your agency get their metric?

Our agency is currently counting every visit no matter what type as 1 unit, and 1-120 miles as 0 units, 120-239 miles as one unit, and >240 miles as 2 units.

A typical day one to two times a week is 150-170 miles, a SOC, and ROC, a recert, an oasis discharge, and one regular visit. Other days are not quite as bad, but still much more than the 5-6 units as calculated by the metrics other people have posted for their agency.

Anything you can provide that would help us nurses have a conversation with our management so that we aren't drowning as badly would be much appreciated.

[BarrelOfMonkeys, BSN, RN]

My agency uses PPV, not points. Though I’m unsure where they get their metrics for even that. ?

[Kaisu]

Start of Care is 2 points, Recert is 1.5 points, regular visit 1 point, unless more than 2 cares are required, for example, wound care and ostomy care, still 1 point, add a wound vac and now it is 3 cares and becomes 1.5 points. 60 miles is a point and fractions are calculated. Productivity expectation is 25 points a week. Very doable. Great job.

[NRSKarenRN, BSN, RN]

There are various compensation models and productivity standards based on type of agency: profit, non-profit, urban, suburban, rural; some have mileage adjustments. Periodically state Home Health Association meetings will query agencies re productivity standards (Urban vs rural agency) and provide information to members. Sharing info between local agency's can be viewed as violating federal antitrust regulations so called wage-fixing agreements. From previous posts allnurses members 5-6/day appears average- that was my average with 35 patient caseload..

Compensation Models in Home Health

2014: Fazzi State of the Industry Report- Fazzi Associates

What are the Industry standards regarding productivity? see page 21

[fsudmbRN, ASN]

I am PPV and we have the same basic rubric as Kaisu.... SOC- 2 units, ROCs, recert, and DC's are 1.5, routine visits are 1. Any visit over 90 minutes are 1.5. We dont get units for miles though... we get paid for each mile. Full time for us is 30 units a week.

[GapRN]

federal law says 30+ hr/wk is full time and >40/wk is OT.

It is industry standard to call HH nurses exempt employees but this is just fraud if you have any hourly pay, even if you are primarily PPV.

every job I have had (x4) says I should work about 60 hours per week for full time status. But they say "when you get some experience you can finish in 40."

That is true if you swallow your integrity and start looking at home health as a game of Get VS, Drive to Next Pt, Commit Fraud in Documentation.

My last job said SOC had equal value for my full time status as RV! My contract could theoretically expect me to work 120 hr to be full time. But they don't pay OT

/RANT We got a pay cut for private SOC because they bill less. Oddly, for some reason the BRN doesn't seem to say I have less responsibility if I am taking care of private patients. Oddly, for some reason we pay medline the same amount for these private Pt's supplies. Oddly, for some reason I would feel guilty if I put 75% effort into a private case. Not odd at all: they cut labor costs, and refuse to even discuss it. /ENDRANT

BUT

If they hire you full time and say "you're not getting enough points" they can have you sign something that says you are part time (but why would you sign?!), or they can fire you. But they don't have nurses knocking down their door so...

SO

To hell with their metrics. Stop working after 40 hours unless you get over time. And I include on call in that too.

[tjean5377]

wow. just. wow. New England here. 2 units SOC/RoC. 1 unit recert, 1 unit SN visit. mileage 66cents per mile, productivity over full time (30 units in 40 hours) $13 above visit rate ($46hr visit rate) record time/phones $36/hr. $3 shift diff for evening, beeper on top $14/hr. what you are describing is insanity. I can efficiently due 1 SOC and 4 revisits perhaps 5 revisits if quickwounds. WE DO NOT do SOC and ROC with revisits unless an admissions nurse they don't case manage. An SOC can be witha recert we know with 3 other revisits but that is stretching it. I can do 7 revisits and an SOC on a day but its a 12 hour day. I realize I don't have anywhere NEAR the mileage you do. What your describing alone without mileage is INSANE.

[Svit, BSN, LPN, RN]

TN is here. Points system. 25 per week full time. 0.75 points regular visit, 1.25 ROC, 1.5 resumption, 2.25 SOC, 0.40 c per mile gas reimbursement

[RNseekingstandards]

@NRSKarenRN, BSN, RN 

Hello, thanks so much for the info you provided! The second link will not open though. Is there anywhere I can access sone kind of national standard on the productivity point scale used for HH nurses?

I'm a RN in Ohio. Unfortunately everywhere I look seems to be a different point system. 

[GapRN]

There is NO standard. If someone says there is, they're selling you something. Did you read the first link? That garbage was written for the benefit of investors. The pro's/cons of staff payment are all prioritizing profit. Page 2 talks about exempt status w/out mentioning CA case law finding HH non-exempt. Not that it matters since they openly ignore this. Look at bottom of page 5: 'does per visit pay reduce quality? study says no." What sort of nurse makes such an extreme scientific statement w/out citing references? "Extreme claims require extreme evidence" - Carl Sagan

Points are arbitrary and are not capable of reflecting your actual labor done. some RV can be longer than some SOC. Do you want to be the sociopath who unloads the 1 hr wound pt on unsuspecting peers, or the sucker that follows the pt? I say this shouldn't be a choice we even need to make. What little meaning these metrics have can easily be washed out by a boss playing favorites. A SOC can be 1 hr or 4 and I can make a pretty good guess if you show me the H&P. On the plus side, if your sole goal is to make money and you like to schmooze the boss, you can work this system to your advantage. You'll sleep fine if you're that sociopath I mentioned.

OMG P 6 is just straight up accounting on how owner can profit in HH.

Oh! middle of P7 "To make room for more patients on caseload,
staff incentivized to decrease visits per episode."  This is flat out stating that LESS PATIENT CARE is a GOOD THING.

I can't read that psychotic filth anymore. Give your self a moment to define "more/less productive staff"in terms of this industry document, and then in terms of a compassionate HCP and ask yourself why you went into nursing.

Here's a web site that might help you to write a definition for a reasonable productivity point scale... or just scrap it and go hourly.

https://guide.unitworkers.com/how-to-talk-to-your-coworkers-about-unionizing/

 

Edit: I think this is geographically specific, but my agency bills about $540/SN visit. I see $100 - $150 of that +federal milage (sometimes) at my per visit rate. It seems that some of our federal employees think we are worth more than that, which may explain the insane medicare documentation requirements vs the time our employers allot us to accomplish our work. I am of course assuming here that an 8 hour day w/ OT should be the liability you assume when getting a FT job. TOTAL NON-SEQUITUR: My boss bought a mansion in the CA hills 3 years after opening our agency.

[BBP42]

I work for 2 home health agencies in CT. Both have a 30 pt per week full time salaried expectation. One agency gives 3 points per soc or roc, 2 for recert and 1 for revisit. The documentation at this agency is much more time consuming. The other agency gives 2 points per soc roc or recert and one per visit but due to easier charting a full day takes a lot less time including all documentation. They also pay a little less on average.

[SpiritRN73]

GapRN said:

federal law says 30+ hr/wk is full time and >40/wk is OT.

It is industry standard to call HH nurses exempt employees but this is just fraud if you have any hourly pay, even if you are primarily PPV.

every job I have had (x4) says I should work about 60 hours per week for full time status. But they say "when you get some experience you can finish in 40."

That is true if you swallow your integrity and start looking at home health as a game of Get VS, Drive to Next Pt, Commit Fraud in Documentation.

My last job said SOC had equal value for my full time status as RV! My contract could theoretically expect me to work 120 hr to be full time. But they don't pay OT

/RANT We got a pay cut for private SOC because they bill less. Oddly, for some reason the BRN doesn't seem to say I have less responsibility if I am taking care of private patients. Oddly, for some reason we pay medline the same amount for these private Pt's supplies. Oddly, for some reason I would feel guilty if I put 75% effort into a private case. Not odd at all: they cut labor costs, and refuse to even discuss it. /ENDRANT

BUT

If they hire you full time and say "you're not getting enough points" they can have you sign something that says you are part time (but why would you sign?!), or they can fire you. But they don't have nurses knocking down their door so...

SO

To hell with their metrics. Stop working after 40 hours unless you get over time. And I include on call in that too.

CAN I GET AN AMEN?!?!?! I hav been in home health for 12 years and FINALLY stopped charting off the clock. I refuse! It's illegal.  And for this I am "difficult" or low productivity. BS! NURSES! YOU HAVE GOT TO STOP WORKING FOR FREE!! NOWHERE ELSE IN THE MEDICAL FIELD DO NURSES WORK UNPAID ROUTINELY!! And then if you refuse to you are branded. This is never going to change unless WE change it. They need you more than you need them right now. You know it's true. So know your worth and stop working for free. Change needs to be forced.