Starting a HHCA AND WANT TO DO IT RIGHT!

[jaxmedco]

Hi All,

I am based in Jacksonville, FL and myself and a business partner are in the process of starting a HHCA. I am doing my due diligence on the industry and what NEEDS to change in the industry (I know this opens the flood gate ). We are not going to be one of these fly by night agencies; I can assure you of that as we are well capitalized.

To give a little background on myself; I am very familiar with running a national vendor network and how the employee vs sub-contractor relationship works as I owned a business for 8 years in the mortgage industry that was very successful...prior to the downfall in 2008. I realize that the in order for everyone to be happy there is a fine balance between what the HHCA charges and what they pay to the RN. Also, please realize that I am only doing pre-operation research at this time and the company will be employing at a minimum a RN, MSN as our Chief Medical Officer / Director for further guidance.

I do have a couple of questions regarding the industry that I am hoping the collective audience here can help with:

1. We will begin operations in a small territory based in Jacksonville, FL and the other 4 other surrounding counties that we are to be licensed in. Taking this demographic into consideration, what would you say a low end and high end hourly rate would be for a RN's services?
   
2. I have read on a couple of posts here regarding case management. It appears that many of you are your own case managers; meaning that you case manage your own "hands on" patients. Is that accurate and an accepted practice?
   
3. Can someone please advise how the per visit vs. per hour scenario works? I assume that the per visit scenario is based on the fact that you know you will be there for x amount of time and it is a flat rate whereas the per hour is just that?
   
4. We will provide both personal care as well as health care services. I already know that RN's did not go to school to clean houses and dishes , that being said, I don't really want to hire someone who has no certification whatsoever to be in a patients home. What type of credentials do YOU believe should be required?
   
5. I know from research that Medicare and Medicaid are the major sources of payment in the industry. How do you handle working for HHCA's since the pay scale is lower with these types of sources?
   

Feel free to provide any feedback or comments.

TIA for your time!

[caliotter3]

Since medicare and medicaid are the usual payors, people who work in hh are typically used to lower wages. For extended care cases, the LPN rate of pay usually prevails, as RN level cases are less common. Agencies will typically rate these cases at the LPN rate of pay but may show deference to RNs that do extended care by paying them two or three dollars an hour more out of their discretionary funding.

For your nonmedical care, I would recommend HHA or CNA as the minimum certification goal. You can hire noncertified caregivers to be companions, but these people should be paid less (as a matter of practice) and should be required to obtain the CNA and HHA certification within a year of hire. If you get the authorization to provide this training yourself, there should be no problem in meeting this goal for all employees.

You can find threads where the per visit versus per hour pay scenarios are discussed. You could actually offer both, once you have set your criteria. You can't be paying somebody for a 40 hour work week who is not meeting a minimum quota. You will want to limit your hourly visit employees who are paid hourly because you will want to have enough available work to justify that payroll cost on a regular basis.

Don't know the pay scale for that geographic area. You want to pay well enough to attract and retain good employees, yet maintain your profit or operations margin. Maybe start asking around, even cold calling other agencies.

[BabaLouRN]

It's a "dog eat dog" world out there!!