Per-Visit Pay
Per-visit pay is a compensation model in which home health field clinicians earn a set rate for each completed visit rather than an hourly wage or salary. Rates are tiered by discipline and visit type, with comprehensive assessment visits such as start of care paying more than routine visits. It is the dominant pay model for field staff at many agencies because it ties labor cost directly to visit volume.
How per-visit pay rates are structured
Agencies set a rate table by discipline (RN, LPN, PT, PTA, OT, SLP, aide) and visit type. A routine skilled nursing visit anchors the scale. Start of care, resumption of care, recertification, and discharge visits pay a premium because they include a comprehensive assessment and OASIS documentation that can take two to three times as long as a routine visit. Most agencies build documentation time into the visit rate rather than paying it separately, and layer on additional payments for mileage, case conferences, supervisory visits, in-services, and on-call shifts. The rate table is effectively the agency's labor cost model, so it gets benchmarked against local competitors and revisited when market pay moves.
Why agencies use it
Per-visit pay converts field labor from a fixed cost into a variable cost that rises and falls with census. Under the Patient-Driven Groupings Model (PDGM), revenue arrives per 30-day payment period based on visits delivered, so matching pay to visit volume protects margin when census dips. Productive clinicians often prefer it too: high performers who manage their own schedules can out-earn salaried peers. The tradeoff is income volatility. When referrals slow or a caseload empties out, per-visit clinicians feel it in their paycheck immediately, which is why low census periods are when per-visit agencies lose staff to hospitals and salaried competitors.
Wage-and-hour and quality risks
Per-visit pay creates real compliance exposure if it is administered casually. Common problem areas:
- Overtime: nonexempt per-visit staff must have all hours tracked, including documentation and required drive time, with overtime paid on the correct regular rate
- Off-the-clock charting: unpaid after-hours documentation is a frequent wage claim in home health
- Minimum wage: long visits or heavy documentation can push the effective hourly rate below legal floors
- Quality pressure: paying only for completed visits can quietly reward rushed visits and thin documentation
Agencies should get classification and drive-time policies reviewed under state law, not just federal rules.
What a fair per-visit plan looks like
A defensible plan starts with visit weights that reflect real total work time, including documentation, not just time in the home. It pays explicitly for non-visit work such as case conferences, in-service training, and preceptor duties instead of treating them as free. It offers a guaranteed minimum or hybrid arrangement for new hires and for clinicians in territories being built up, so income volatility does not drive early turnover. And it is paired with time tracking that lets the agency reconcile per-visit earnings against actual hours worked, which is both a wage-and-hour safeguard and an honest measure of whether documentation load is eating the rate.
Frequently asked questions
Do per-visit clinicians get overtime?
It depends on how they are classified, and misclassification is one of the most common wage-and-hour claims in home health. Many agencies treat per-visit field staff as nonexempt, which means tracking all hours worked, including documentation and required travel, and paying overtime on a properly calculated regular rate. Agencies should review classification under both federal and state law.
Does per-visit pay include documentation time?
Usually yes, the visit rate is intended to cover the visit plus its documentation. The agency should say so explicitly in its compensation plan. If documentation regularly pushes total hours high enough that the effective hourly rate falls below minimum wage or triggers unpaid overtime, the agency has legal exposure regardless of what the plan says.
Which visit types pay the most?
Comprehensive assessment visits: start of care, resumption of care, recertification, and discharge. These include OASIS data collection and take far longer than routine visits, so most rate tables pay a meaningful premium for them. Rates also vary by discipline, with therapy evaluations similarly weighted above routine therapy visits.