Welcome to Part 2 of this 2-Part series on how physical therapists and occupational therapists can get started working prn home health and why they should consider doing so.
To recap, in Getting Started in PRN Home Health Physical/Occupational Therapy – Part 1, we learned why working prn home health is a realistic option that should be strongly considered as a potentially lucrative side hustle for physical therapists and occupational therapists.
Now we will learn the terminology unique to the home health setting that can often act as a deterrent from attempting to work in home health.
We will also discover how to best decide which home health company to work for.
Let’s get started.
IMPORTANT TERMINOLOGY IN THE HOME HEALTH SETTING
This section serves to give insight into some of the home health terminology commonly utilized.
1. Therapy Staffing Company
A therapy staffing company is a home health company that has therapists working for them to treat patients. These therapists can include physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assists.
An agency is a home health company that provides patients to the home health staffing companies. Agencies are typically comprised of case managers and nurses. Some agencies do have physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assists on staff who can evaluate and/or treat patients.
3. OASIS Visits
OASIS stands for Outcome and Assessment Information Set. There are two types of OASIS Visits: Start of Care (SOC) and OASIS Discharge. These visits are typically performed by a nurse, but a physical therapist or an occupational therapist can be asked to do them instead.
- Start of Care (SOC)
A start of care visit opens the patient’s case and acts as an evaluation visit. These visits include reviewing and taking inventory of medication, immunization history, and general medical history in addition to a physical therapy or occupational therapy evaluation. A start of care visit can also include wound assessment and care, but when wounds are involved then oftentimes a nurse will perform the start of care visit.
- OASIS Discharge
An OASIS Discharge closes the patient’s case. It requires a review of the patient’s medical status in addition to the physical therapy or occupational therapy discharge evaluation.
The term frequency is used to describe how often you are seeing the patient.
It is typically written in short-hand using a number, followed by the letter “w,” followed by another number. The first number is how many days per week you are seeing the patient, the letter “w” represents the word “week,” and the second number is how many weeks the frequency will last.
For example, a frequency of 2w3 would represent seeing the patient for 2 visits per week for 3 weeks. 2w3 is verbalized as “2 times per week for 3 weeks.” A more complex frequency of 1w1 3w2 1w1 would indicate one visit for the first week, 3 visits for the next 2 weeks, and then 1 visit on the last week.
5. Agency Case Manager
A case manager helps manage the different disciplines and various medical needs of the patient.
Oftentimes, the case manager is also a nurse. As mentioned earlier, the case manager works for the agency and not directly for the therapy company you work for. In the home health setting, the case manager can be an important person to have a good working relationship with.
For example, when you complete an evaluation or SOC visit, it’s the case manager that must approve your suggested frequency. When you want to request more visits, it’s the case manager who must get these visits approved. If you have a medical question regarding the patient’s status, guess who you would want to talk to?
6. Agency Care Coordinator
The care coordinator works for an agency and ensures that patients are assigned to the appropriate clinicians.
Now that you’ve gotten a handle on some of the terminology common to home health, it’s time to figure out which home health companies to consider working for.
HOW TO PICK A GOOD HOME HEALTH COMPANY TO WORK FOR:
Not all home health companies are the same. When deciding where to work, there are many factors to consider.
1. Your Rates
You’re taking on this second job largely for the additional income, so how much you get paid is of great importance.
Your rates are negotiable before signing a contract. When negotiating a higher rate, the following factors are often given consideration:
- Experience as a physical therapist or occupational therapist in general
- Willingness to expand into a new geographic region
- Experience utilizing that company’s documentation system
- Having prior experience in the home health setting
After you’ve worked for that company for about 1 year, you should consider yourself more established and attempt to renegotiate your contract for higher rates.
You can gain leverage by seeking out how much other companies may offer to bring you aboard. Just be careful not to price yourself out of a good job as some companies may prefer to prioritize giving patients to therapists they pay slightly less to increase the company’s profit.
2. Number of Patients/Consistency of Patient Referrals
The number of patients you see can outweigh how much you are paid per patient. In fact, keeping a full schedule is the best way to be financially successful in the home health setting – both for you and for the company you work for.
However, it is common that one company will not always be able to keep your schedule full. Therefore, working for more than one company can be a good strategy.
3. Size of Geographic Region
If you are not getting enough patients in the geographic region you’d like to stay within, consider expanding your geographic region. Another tactic can be to maintain your geographic region but take on working for another company.
If the company you are working for is making you travel quite a distance to see your patients when you were expecting to stay more local, the company may not have the business relationships to obtain patients in your desired area. This can be a good sign to consider working for a different company altogether or to help the company expand into your region.
4. Working with a Physical/Occupational Therapy Assistant
Working with a therapy assistant can either be something you prefer or something you’d like to avoid.
As in other therapy settings, therapy assistants cannot perform the initial evaluation or discharge visit. However, home health companies can attempt to save money by having a therapy assistant perform all of the follow-up visits.
The company will require you to co-sign the therapy assistant’s notes and you may or may not be paid for this effort. If you are paid, the amount tends to be negligible.
This setup can work well if your full-time job’s schedule makes it difficult to see home health patients consistently. However, a large portion of home health visits will be follow-up visits, so if you are looking to make more money, it can be best to perform all of these visits yourself.
If the home health company refuses to allow you to perform follow-up visits and you’d strongly prefer to do so, look for another company to work for.
5. Patient Type
It is common to find that a home health company obtains most of its patients in a certain setting. The patient populations include surgical patients (outpatient or inpatient), hospital discharges, homebound patients, and patients living in assisted living facilities.
This is not to imply that any of these populations is preferred over the other, but you may find that you prefer to work some of these groupings over others. For example, if your full-time job is in an acute care hospital setting, you may find that you are more comfortable seeing patients that were recently discharged from the hospital.
Of note, not all assisted living facilities are equal. They can range from commercially established chain brands to houses turned into an assisted living setting. Commercial assistive living facilities are typically more rule orientated so consider calling in advance to schedule your appointment, wear your ID badge, and allow time to sign in at the front desk.
6. Good Documentation System
Whereas most clinicians are focused on how much they are paid and how many patients they are seeing, using a documentation system that you are comfortable with can be priceless.
An ideal documentation system should be thorough enough to absorb all of the information you need but also allow you to remain efficient.
It should also include all of the necessary types of notes you may need to complete. For example, you should not have to utilize a completely different documentation system or, even worse, pen and paper just because the agency requests that you perform a SOC visit which their documentation system is not equipped to handle.
Ideally, the company that monitors the documentation system should also have technical support available so that if a problem arises it can be more readily addressed.
You may find that some companies use the same system so if you learn the system with one company, working for a second company that uses the same system can be a less stressful addition.
7. Getting Paid on Time
The company you work for should pay you on time as long as you complete all of your documentation on time.
The company may have a system in place where you are paid at the end of the week for the patients you saw that week, or you may be paid for an entire month’s work a couple of weeks into the following month.
Some companies may require you to email an invoice for the time period being paid whereas others may have all of this performed electronically.
On the other hand, if the company is requesting that you snail mail paper invoices to them and they subsequently snail mail you a paycheck, they may be behind with the times.
In any case, if you are consistently not being paid when the company states you should expect to be paid, or if you are consistently finding mistakes in the amount you are being paid, consider this a red flag and look for another company to work for.
8. Company Support
As with many other independent contractor jobs, you can find yourself out in the field and needing support from your company. The company you work for should be readily accessible and able to support your needs.
The structure of some companies may entail several different departments so that someone more familiar with your needs may assist you. Other companies may have only one person performing all of the jobs. You may initially think the former should allow for better support, but this may not always be the case.
As you work for that company, if you find any difficulties getting the support you need, talk to the owner of the company or someone in upper management and find out if there may be other channels of communication you were not aware existed.
For example, a company that may only have one person performing all of the support tasks may be difficult to reach by phone, but may also have the option of text messaging if your needs are more urgent. Just be sure to keep things HIPPA compliant.
Final Thoughts. . .
Do you already work prn in home health? If so, any other terms or aspects you think should be considered? Or are you thinking about working in home health and looking for further advice?
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