I currently am working full time in a home health agency and they are going nuts about productivity. they started out by saying that they wanted us to meet national standards and then said that it was not national standards, just what we need to do financially.  Most of us are feeling that the expectations are unrealistic.  They want us seeing 5 pts in an 8 hour day.  A lot of us are traveling for nearly 2 hours, it doesn't allow for much time to document (we use Palmwyse), make calls to doctors and case conference with other staff.  I'd love to know what other agencies are doing.

 

Kristen

Hi Kristen

I am also working full time in Home care in Delaware.  I've been in home care for 31 yrs. now.  20 yrs. in MA. I've seen alot of changes in those yrs. but find that working in home care now is harder than ever. Productivity is a huge issure here as well. They would like us to see 6 patients a day but after alot of complaining, have agreed to 28 visits a week. I used to comfortably see 6 to 7 patients a day and get all my paperwork done before the laptop. Since the laptop, I can hardly see 5 patients a day. To top it off, I have a PTA working with me that has made my day longer at times due to the discussions and supervisory visits needed. I usually travel about 90 min. a day.  It is city driving with alot of stop signs, lights and traffic. Our annual raise is based on productivity as well as other professional standards. Right now we have no Rehab. Supervisor so our pleas are going nowhere. I do believe the national standards are important to agencies for reimbursement , but if they don't take care of the people who are caring for the patients , they will lose us all.

Rosalind

Hi Kristen,

      I have worked as a PT for 16 years.  Always on the side in home health PRN.  Currently fulltime the past 4 years.  The average caseload in HH for a PT is 4 to 6 pts a day.  It depends upon how far one travels and if have an eval  to perform.  Always productivity requests are demeaning and WRONG.  A non therapist upper management personel has absolutely no idea what we do. I agree, since we have gone to the laptop, I spend hours inputting data.  I am not a typist.  In hospitals and outpt places I have worked, we used dictation which significantly speeded up the paper trail.  Until HH figures out that is the quickest way we can be more productive, they just will have to pay me to hunt and peck.  I feel ultimately it is up to us to set our schedule.  I am a productive employee, but also a reasonable commen sense man.  I do a good days work, for a fair days pay.  Some days I am busier than others, have meetings etc.  But my company has never pushed us therapists to increase productivity.  They realize we are professionals. I also realize I work for a great place!  Never underestimate your worth! Russ

My office is finally starting to think about weighting visits based on evals, SOC, discharges.  They keep asking for more out of us, and then are telling us to do it faster!!!  There are very few therapists in our agency who are reaching productivity (5 per day regardless of type of visit). Unfortunately they do not consider that we have meetings and this is figured right in to our productivity.  So if I work an 8 hour day and have a 3 hour meeting and only see 3 pts, I am way behind in my productivity.  I'm happy to have found this place to discuss home health issues.

 

Kristen 

I work as a home health PTA in west virginia.  i am a full-time, per diem employee.  so, the more productivity, the more $$ i make.  my quota is 6 per day, or average of 30 per week.  i get fussed at some when i don't meet the quota, but i can only do so much with the driving i do.  the company is not too bad at complaining about my work.  i drive anyplace they want with no complaint, and i guess they appreciate that.  i usually see an average of 28 per week.  the PT's i work with usually do the same.  we still do paperwork and have not started the electronic style yet.  the PT's stop at 30 per week max normally.  i guess i am not aware what the national standard is?

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becs, bs, pta

That is a lot of pressure. You should try an online documentation system like WebPT.com. That will allow you to visit more patients since you will be documenting less. It's web-based so you can take your laptop with you and breeze through the documentation. Perfect for traveling PTs.

We tuned up our productivity in home care with a target of 7 "equivalent visits" per 8 hour day, calculated as follows:

 Initial assessment visit RN   1.75 hrs

Recert visit RN      1.25 hrs

Resumption of care RN visit 1.25 hrs

IV therapy visit RN    1.25 hrs

Regular RN visit   .825 hr (50 min)

Wound vac RN visit    1.25 hr

Case management 2 per day (.25 hr)

PT visit 1.00 hour

Travel   Actual mileage / 45 mph

 

So you multiply the number of visits of each type by the standard, add the equivalent visit travel time and the target

is 7 equivalent visits per day.  (really that is 7 hours in an 8 hour day, pretty generous)

 

 

I work for an agency that uses contract therapists only, they have been unsuccessful at hiring anyone.  I started when we were doing notes on paper, now we are on laptop.  As the agency wants more documentation from us they just say it's part of the visit and there is no compensation for the time spent documenting things in other areas to make it easier for them and potentially the surveyor to find.  I have found the productivity discussions helpful as I would like to propose a "overtime" rate for greater than 30 "equivalent visits" a week.  As contractors we have just worked as long as it took to get the job done, including weekends  There was an extra fee we could charge them for the extra documentation but they have recently taken that away and state "it's part of your visit". Leaves one to wonder when the actual therapy is ever going to be considered the important part of the visit.    I am interested in knowing more about what is classified as the case management you mentioned above.   If anyone else is in the contract/per diem model verses the employee model do you find you are given more or less responsibility as the P.T.  ie doing the admissions, transfers, home health aide supervisions, etc, substituting for the traditional nurse role.

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C. Dudek

In our agency the PT's productiviyt is 5.5 a day and PTA's are 6. We do however take into consideration drive time and most of our staff averages no more than 20 minutes between visits. We are currently using laptops also.

Do you require 60 minute PT visits? Curious as some patients warrant an hour or longer - such as CVA's while some only warrant for example 40 minutes such as the typical deconditioned (weakness) patient whom cannot tolerate much more activity than that.

I have a similar problem. I work in Florida and our office covers the entire county we live in which is one of the largest counties in the southeast of the country. I range from 80 miles per day to 120 miles per day at times. Our treatments were transitioned to a points system in which we originally were required to meet 35 "points" per week. SOC's were 2 points, PT evals were 1.5 points, recertifications and resumption's of care were 1.5 points, discharge OASIS were 1.5 points, and treatment visits were 1 point.  Despite the additional "points" for evaluations and SOC's etc, it is still difficult to get 7 "points" per day in 8 hours due to the driving. I have friends in other areas that only drive 35 to 40 miles a day. Last year they lowered our points per week to 32 which was helpful but this year they have lowered our PT evaluations to only a point, basically no different than a PT visit. I find it unreasonable because if I had 6 evals to perform in one day I would have to see seven visits total to even clear my daily quota (6.4) which can't be completed in 8 hours with consideration of documentation and on average 90 to 120 minutes of driving. 

Updating you San Francisco Escort on this - they've San Francisco Escorts made it easier to find me.

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This is pretty amazing.  You budget your time really well.  Oh yeah, I'm also into health care but I'm still looking for a job.  I may try home care. 

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Concord Home Care

I am a DPT and I am currently interviewing with a few companies in Florida. Most of them are telling me there weekly productivity quota is between 30-32 "visit equivalents" for a FT position. My question is in regards to compensation for visits beyond this amount.  It is typical for a PRN rate to be offered for these visits beyond the quota? I would think this is something I should make sure is included….I’ve heard horror stories of companies scheduling an obscene amount of weekly visits and I want to make sure I’m compensated fairly? Any thoughts or personal experiences?

Basically, if you are a salaried employee- then extra visits that "fit in" to your schedule are within your already salaried week.  

I work in home health Pediatrics.  It takes me longer to write up an eval using the computer but that's because we still have a third of the paperwork that we used to have before, plus new forms that JCAHO decided we needed because it wasn't in a form, even though the information needed is in 2-3 places in the typed and computerized versions of our evals. Although what takes me the longest in the eval is typing in all the medications! 

When I started here 10 yrs ago, I was told that because of the paperwork and meetings that we were supposed to see 16-20 visits a week .  The higher ups keep trying to increase that and I've heard a minimum of 25 visits a week tossed in.   I can do 25 visits a week if all my kids are healthy and live in a relatively small area and if I can schedule them geographically close together.  However, that leaves me no time for evals, paperwork, meetings, phone calls, or to come into the office to sign all the generated paperwork. 

I am sure that my laptop would help speed things up once someone writes an excellent pediatric home health program so I can pick and choose, re enter the same thing I wrote last visit and make small adjustments as needed. If I didn't like playing with my kiddoes, I'd go beg for a job at a software company and develop one.  

:)

 

Thanks for letting me vent.   I hope the question about getting paid prn on top of salaried was answered.