The Whispering of Pay Per Visit for Hospice

Recently I have heard some whispering around pay per visit for hospice visits. This is mostly coming from organizations that have a skilled home care business where pay for visit is an option. As you might imagine, this is causing quite a rise in eyebrows in the hospice community. What are your thoughts?

Hospice Pay Per Visit

As the quest for enhanced productivity and performance in hospice organizations are being looked at, obviously, the management of our labor pools is at the top of the list. Home care nurses are paid on a per visit bases. So some management folks are asking “why not look at pay for visit for hospice nurses?”

Some of the people I have spoken with feel that applying a pay for visit to a hospice model of care flies right in a face of the hospice philosophy. Managing a hospice case load with a variety of patients at different stages of end-of-life requires longer and more intense visits for some patients/family than other. Most home care patients and visits are more predictable in terms of the care plan and path where this is not necessarily so with hospice patients.

The theme I discovered from hospice executives I have spoken with is that if you force a hospice nurse to make a “quota” of visits that the unintended consequence and subsequent outcome will lead to patients and families being “short-changed” on the care, attention, and services necessary to provide the best patient care. I agree with this thinking.

The other concern from hospice executives is that by opting for a pay for visit model the nurse turn-over will increase. Nurses who may be required to do on-call, admissions, etc. will burn-out. In communities where it is difficult to recruit and retain hospice nurses, a pay for visit model could make it extremely difficult to meet the demand for nurses.

The other issue related to a consideration of a pay for visit model with hospice nurses is how to handle the pay for visits related to GIP and Continues Care visits. The four-levels of care require a variety of staffing patterns. Applying a pay for visit model to a multi-level care approach would be challenging.

Do you have any experiences with hospice nurse pay models? What are your thoughts on a pay for visit hospice nurses model?

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