could someone explain pay per visit and why agencies are doing this?

Traveler · Mar 10, 2005

I have worked in home health for four years in the Southeast for two different agencies. I have always been paid per visit and prefer it that way. At my current job that is the only option. At my last job some nurses were hourly and some were per visit. I don't know if it saves the agency money or not. I suppose the per vist pay encourages increased productivity by less time in the office socializing, getting to the business of the visit and not just "visiting", and encouraging speed in paperwork. For me in the field, some days I make less than I would make at the hourly rate and some days I make more- it evens out in the end though. One thing I think the agencies need to be very careful about is to make sure that the per visit staff spends the appropriate amount of time with the patients and also does follow through as needed. I think that the per visit pay could mean that some nurses would cut corners. Because I prefer to do my paperwork at home and work far away- I tend to see more patients then the full time salary/hourly nurses do, but I spend 3-4 hours on paperwork at home each night that I work. Our salary/hourly nurses do as many visits as I would do if I were to work an eight hour day. I think that much of this comes from the management. Where I used to work (and quit) the hourly/salary nurses would spend too much time with the patients (not on direct care- just gossiping to kill the time), would play around in the office not doing much, and take as much time on their paperwork as they could. This was because the overall morale of the office was not good. Another thing to consider on a per visit pay scale is the distance/travel time between patients. Where I am now, the patients are relatively close together. I saw eight today and drove 60 miles. The most time from one patient to the next was 25 minutes. Where I used to work, it was not uncommon to drive an hour between patients and well over 100 miles/day (sometimes up to 200) For that, I was paid at an hourly rate for any travel time over 30 minutes between patients: If it took me an hour to go from one patient to the next one I was paid the per visit rate plus thirty minutes of hourly time. But again, I think a lot of the productivity and overall work environment comes from the director and the company.

London Turtle · Mar 10, 2005

Our company started pay per visit about a year ago. I don't like it because I cover a 4 county area. And these counties are large. If all my patients were fairly close together it would be great, but because they are mostly far apart from each other, mostly rural and country roads, my pay check has decreased considerably. It does save the company money...mine!

Traveler · Mar 13, 2005

Are you receiving excess travel time in your pay that I talked about in my last post? If not, you should. When you have such a large area to cover (I know what that is like. At my last job I lived on the south end of our coverage area. When I was on call and had to go make a visit on the other end of the coverage area, it took me 2.5 hours.) But then I was paid two hours of excess tt to get there and the same back. You really need to plan your visits well. Sometimes the scheduler has no idea where people live- just their frequency. Try helping her in making your schedule so you have patients all along your route and aren't in Timbuktu again the next day.

London Turtle · Mar 13, 2005

Are you receiving excess travel time in your pay that I talked about in my last post? If not, you should. When you have such a large area to cover (I know what that is like. At my last job I lived on the south end of our coverage area. When I was on call and had to go make a visit on the other end of the coverage area, it took me 2.5 hours.) But then I was paid two hours of excess tt to get there and the same back. You really need to plan your visits well. Sometimes the scheduler has no idea where people live- just their frequency. Try helping her in making your schedule so you have patients all along your route and aren't in Timbuktu again the next day.

I make my own schedule. And plan my visits so I'm not going any farther than i have to. But there are always exceptions, and I've spoken to my supervisor anytime I have to go out of my way, I'm denied for any extra pay. I have asked frequently, but always get turned down. So it makes me feel like I'm asking for something special above and beyond what the other nurses are getting. I don't think that most of the nurses are traveling this much, but I don't really know for sure. Another factor is if the visits take longer than usual. I have 2 in home patients--long term, that are diabetics that take 5 insulin injections a day, I fill 35 syringes for each of these patients plus a med tray, not to mention an assessment and anything else that comes up, so both these visits are very long. There is another nurse that does alot of driving to get to the office. I drive 68 miles and she drives 80 I think, and we were having a nurse meeting and talking about the excessive mileage, and she was told that maybe she should go find her another job. I hate being so far away from my patients charts, and try to get into the office once a week, but that doesn't always happen. I know that this company has set these rules and it would surprise me if they helped us out with this problem.

alintanurse · Mar 13, 2005

I think HH agencies are doing pay per visit for all the reasons previously stated--it saves them money. If you see a patient 30 min. away then they save an hours worth of pay! If the visit takes you an hour in the home and an hour of paper work plus travel time then you are the one that takes the monetary hit. I would rather be paid hourly than pay per visit, because of the high acuity of the patients in home care. That's just my opinion.

London Turtle · Mar 13, 2005

I think HH agencies are doing pay per visit for all the reasons previously stated--it saves them money. If you see a patient 30 min. away then they save an hours worth of pay! If the visit takes you an hour in the home and an hour of paper work plus travel time then you are the one that takes the monetary hit. I would rather be paid hourly than pay per visit, because of the high acuity of the patients in home care. That's just my opinion.

I SO agree w/ you. But the majority of nurses I talk to like the per visit pay and I can only figure their patients are close together or they work real fast. I think per visit pay encourages sloppy nursing. If your hurrying, watching the clock your more likely to forget or miss something. Your might be less likely to give your patient time to talk about whatever is going on with them. I have always tended to be detailed in my nursing. My first year's eval w/ this company my supervisor said I was too thorough. And at that time we were payed by the hour, but our time was kept track of to measure productivity, my productivity was usually lacking, whereas another nurse who worked in my area had wonderful productivitly. Later, after she left the agency, i picked up her patients and every one of them told me that much of the time she didn't take their v/s, made errors in their med tray, and would be in and out like a whirlwind. I know from f/u in her patients charts, her charting was minimal. Our supervisor knew what she was doing and let her get by with it, and it would have only made me look bad to c/o, so I pretty well kept my mouth shut. I've checked with other agencies and like Isearl said this is the trend for home health, and it does appear that they are all going to pay per visit. Our agency has already been in trouble with the state, so you'd think they would do every thing they could to keep their act clean, but obviously the money talks. I don't want to change jobs, I don't want to work at any other kind of nursing. I've been in HH so long I'd be like a fish out of water to do any thing else. Besides that I Love HH nursing.

alintanurse · Mar 13, 2005

You're right about sloppy nursing and watching the clock, and let's face you're gonna watch the clock if you're paid per visit. I've told the agency I work for that I only will see patients who live in town,they weren't too happy but I don't want to be on the losing side as far as my paycheck is concerned. London turtle--I also am very thorough and follow through on obtaining whatever my patients need. But like you said,money talks and I'm not sure these qualities are as appreciated as making the almighty dollar by seeing more and more patients.

Traveler · Mar 14, 2005

I think it really depends upon the individual nurse and the expectations of the leadership if the nurse paid per visit would practice "sloppy nursing." Where I work it would not be tolerated at all. But I have seen some nurses hurry with the patients because of the almighty dollar. Like I said, I think it works out in the end. Some days I make way over what I would on an hourly basis and some days I make way under. But, I am going to spend as much time as I need to with my patients. In home health it is very important to do a thorough assessment, teaching, and any interventions and then leave. We all know that this is very hard to do in home health. Many patients would love for us to stay all day and it is very hard to get out of the home when the visit is done. I think per visit encourages nurses to be productive in their visits.