I have had a few interesting off-line discussions regarding home-health PT. I'll try to summarize the main points here:
- A common question is "how much does it pay?" It depends, as you can be paid by the billable hour, by the visit, or straight salary (I am in this last category). Pay by the "billable hour" seems to have the highest rate (a person told me that he got an offer for $80/hr, in an average cost-of-living area); however, the downside is you only get paid when you are directly treating the patient. Driving to/from the patient's place, calling up the MDs, documentation time, etc, is considered non-billable and so isn't paid. Pay by the visit, or "by points" means just that: you get a flat rate for each visit made. Currently the rate seems to be $45-$55/point, again in an average COL area. One regular visit equals one point, and a Medicare eval -where you have to fill out the dreaded Oasis form- commonly counts as 2.5 points. Accumulating 30 points/week seems to be the average requirement. And lastly, being on salary means you get $X per year. Salary offers seem to be in-line with average new-grad offers, $60 to $65K/yr.
- Mileage: it can vary quite a bit, from $0.25/mile to $0.535/mile (which is the IRS rate for 2017; it was $0.54 for 2016). From what I have seen, mileage and pay rate are the two ends of a teeter-totter: if you get a high mileage rate you'd most likely be offered a slightly lower visit rate, and vice-versa. Mileage from your house to your first patient, and from your last patient back to your house, doesn't count as those 2 trips are considered your normal commute.
A few things to keep in mind if you are offered a HH position:
- Unless you are on salary, get a really good feel for how many points or visits you are expected to make, and can realistically make, per week. Most places will say they have more business that they can handle, but if you can only scrounge up 15 visits/week, you can kiss that new Tesla S good-bye. And while there may be plenty of patients to be seen, the distances between patients will also affect your availability. For ex, yesterday I drove 68 mi to see 1 patient. So have a clear idea of your territory and the traffic conditions. If I were a HH PT in the Northern Va area, I would want a really really really compact area - I can remember taking 2 hrs to go 10 mi on the beltway there (I used to live in Fairfax county). Another thing to keep in mind is when you can see the patients: most people like to be seen between 10 am and 4 pm, so even though you may have enough patients on paper, you may not be able to get to them.
- Have a good understanding of how you'll be compensated for missed visits. Patients can be flaky, and may not be home when you show up - even if you have called the previous day to confirm. Will you be paid the mileage to drive to that house, and will you get any point credit (e.g, 0.2 or 0.25 point)?
- Mileage reimbursement can add to your paycheck, provided you don't have a gas-guzzler. And keep your car in tiptop condition; I check my oil, coolant, brake fluid, steering fluid, tire pressure and take a careful look under the body (esp the boots around the CV joints) religiously every weekend. If your car breaks down on a little-traveled country road in the boonies, it may be a while before a tow truck shows up. Check your car insurance and add towing coverage if you don't already have it, or get AAA. I had a breakdown once but luckily it was in a midsize city, even though most of my patients are in the surrounding rural areas.
- Even if the offer seems generous, don't forget to take a good look at the benefit package. To each his own, but I would want decent PTO, health and dental insurance and 401k matching. You never know when something bad is going to happen; believe me, I speak from personal experience.
- Check out the company's reviews on glassdoor.com and indeed.com. Reach out to your classmates and colleagues and try to find someone who has worked for that specific company before. The more information you can gather, the better the decision you'll make.
I hope others who have experience in HH will add to this thread.
