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Are Your Home Health & Hospice Productivity Targets Realistic? · The Home Health & Hospice Profitability Podcast

• 0:02
  SPEAKER_01: Every home health and hospice owner knows the feeling.
• 0:05
  SPEAKER_01: Census is up, the team is working harder than it ever has, and the margin still isn't there.
• 0:10
  SPEAKER_01: Your host has spent a career finding out why.
• 0:13
  SPEAKER_01: Doug Walters is a CPA with a master's degree in taxation, and before that, a home health agency owner himself.
• 0:20
  SPEAKER_01: So he's lived the problem before he built a career solving it.
• 0:24
  SPEAKER_01: He founded Walters and Associates in 1999, and the firm has since served more than a thousand home health and hospice providers nationwide.
• 0:34
  SPEAKER_01: Medicare and Medicaid cost reports, hospice cap, outsourced CFO work, and Temex.
• 0:40
  SPEAKER_01: It anchors the Walters Family Companies, alongside Walters Billing Solutions, running revenue cycle and denials management for agencies, and Walters Strategic Advisors Managing Wealth for the Owners who built them.
• 0:54
  SPEAKER_01: Three companies, one obsession.
• 0:56
  SPEAKER_01: The profitability of home health and hospice.
• 0:59
  SPEAKER_01: Here's Doug Walters.
• 1:00
  SPEAKER_00: Welcome back to the Home Health and Hospice Profitability Podcast.
• 1:03
  SPEAKER_00: I'm Doug Walters, your host, and let's jump right in.
• 1:06
  SPEAKER_00: Let's talk about what is probably the biggest expense in your agency, your clinical team.
• 1:10
  SPEAKER_00: Most agencies know what they spend on clinicians, but what they often don't know is how much work one full-time clinician can reasonably complete in a week.
• 1:19
  SPEAKER_00: Maybe your target's 30 points, maybe it's five visits a day, maybe it's a caseload of 15, but where did that number come from?
• 1:26
  SPEAKER_00: That's the real question because if nobody can explain the math behind the target, there's a good chance it was inherited from someone else or simply became the way we've always done it.
• 1:35
  SPEAKER_00: So let's build the number from the ground up.
• 1:38
  SPEAKER_00: First, not all visits are equal.
• 1:39
  SPEAKER_00: A startup care can easily take three and a half hours once you include the drive, time in the home, documentation, orders, calls, and everything else.
• 1:47
  SPEAKER_00: A routine follow-up might take closer to 1.5 hours.
• 1:50
  SPEAKER_00: If your productivity system counts both as one visit, you're pretending three and a half hours of work and one and a half hours of work are the same thing.
• 1:57
  SPEAKER_00: That's why point systems can make sense.
• 1:59
  SPEAKER_00: A routine visit might be one point, a start of care might be two and a half, a resumption might be two, a wish it might be one point seven.
• 2:06
  SPEAKER_00: The exact point values aren't the important part.
• 2:08
  SPEAKER_00: The important part is that you're measuring workload, not just counting visits.
• 2:12
  SPEAKER_00: So what's one point worth?
• 2:14
  SPEAKER_00: Think of it as one routine visit from start to finish.
• 2:17
  SPEAKER_00: Not just the time in the home, the drive, the visit, the documentation, the calls, everything.
• 2:21
  SPEAKER_00: For most agencies, that might be around 1.5 hours.
• 2:24
  SPEAKER_00: Now we can actually calculate productivity.
• 2:27
  SPEAKER_00: Start with a full-time clinician at 2,080 hours per year.
• 2:31
  SPEAKER_00: Obviously, not all 2080 hours can be used for visits.
• 2:35
  SPEAKER_00: You have PTO and holidays, let's call that 200 hours.
• 2:38
  SPEAKER_00: You have meetings, training, competencies, system issues, and administrative work, maybe another 90 hours.
• 2:44
  SPEAKER_00: Then you have all the patient-related work that happens outside the visit, pronation, tracking down orders, prior offs, talking with physicians, talking with families.
• 2:53
  SPEAKER_00: That can easily add up to another 235 hours a year.
• 2:56
  SPEAKER_00: Subtract all of that, and you're left with about 1,555 hours actually available for visits.
• 3:03
  SPEAKER_00: That works out to around 33.8 hours a week, not 40, 33.8.
• 3:08
  SPEAKER_00: Now figure out how long a routine visit actually takes.
• 3:11
  SPEAKER_00: Maybe it's 45 minutes in the home, 20 minutes driving, and 25 minutes documenting.
• 3:15
  SPEAKER_00: That's 90 minutes or 1.5 hours.
• 3:18
  SPEAKER_00: Take your 1555 available hours and divide by 1.5, you get about 1,036 visits per year.
• 3:23
  SPEAKER_00: Spread that across roughly 230 working days, and you land at about four and a half visits per day.
• 3:28
  SPEAKER_00: That's around 22 visits per points per week.
• 3:31
  SPEAKER_00: Now you have a B target that actually came from somewhere.
• 3:34
  SPEAKER_00: And that is where things get interesting.
• 3:36
  SPEAKER_00: Let's say your agency currently expects 30 points a week.
• 3:39
  SPEAKER_00: At one and a half hours per point, that's 45 hours of work.
• 3:43
  SPEAKER_00: But your clinician has about 33.8 hours of so you're asking for 45 hours of work inside 33.8 hours.
• 3:49
  SPEAKER_00: That's an 11-hour gap.
• 3:51
  SPEAKER_00: That gap doesn't disappear, somebody absorbs it.
• 3:54
  SPEAKER_00: Maybe documentation gets pushed into the evening.
• 3:56
  SPEAKER_00: Maybe lunch disappears.
• 3:58
  SPEAKER_00: Maybe people start rushing.
• 4:00
  SPEAKER_00: Maybe your best clinicians eventually leave.
• 4:02
  SPEAKER_00: But somewhere the math has to balance.
• 4:04
  SPEAKER_00: That's why productivity isn't just an HR issue.
• 4:07
  SPEAKER_00: It affects operations, retention, staffing, and your bottom line.
• 4:10
  SPEAKER_00: Let's attach some dollars to it.
• 4:12
  SPEAKER_00: Say a fully loaded RN costs the agency$120,000 per year.
• 4:16
  SPEAKER_00: At four visits a day, that clinician completes about$920 visits a year, which puts your direct labor cost around$130 per visit.
• 4:24
  SPEAKER_00: At four and a half visits a day, the cost drops to about$116.
• 4:28
  SPEAKER_00: At five visits a day, you're around$104,000 and at$5.5, you're around$95 a visit.
• 4:34
  SPEAKER_00: So an extra five visits per day can make a meaningful difference.
• 4:38
  SPEAKER_00: But that doesn't not mean the answer is simply everybody needs to do more visits.
• 4:42
  SPEAKER_00: The goal is to find the highest productive level that is actually sustainable.
• 4:46
  SPEAKER_00: Because once you push past that point, the savings you think you're creating can show up somewhere else.
• 4:52
  SPEAKER_00: Turnover, overtime, rush documentation, poor patient experience, more recruiting, more training.
• 4:57
  SPEAKER_00: So yes, matters, but sustainably, productivity matters more.
• 5:01
  SPEAKER_00: Now let's talk about hospice because hospice agencies often look at productivity through caseload instead of visits.
• 5:07
  SPEAKER_00: But caseload is really just visits per day wearing a different hat.
• 5:12
  SPEAKER_00: Suppose a nurse averages about 1.8 visits per patient per week.
• 5:16
  SPEAKER_00: Take that caseload, multiply it by 1.8, and divide by 5.
• 5:20
  SPEAKER_00: A caseload of 12 works out to about 4.3 visits a day, 15 patients is about 5.4, 18 is about 6.5, and 25 patients comes out to about 9 visits a day.
• 5:30
  SPEAKER_00: That sounds a lot different than simply saying our nurses carry a caseload of 25.
• 5:34
  SPEAKER_00: That's why I like converting everything back into what the clinician's actual day looks like.
• 5:39
  SPEAKER_00: And even then, caseload alone doesn't tell the whole story.
• 5:42
  SPEAKER_00: Does the nurse also handle admissions?
• 5:44
  SPEAKER_00: Do they take call?
• 5:46
  SPEAKER_00: How far are they driving?
• 5:47
  SPEAKER_00: Do they have an admission team?
• 5:49
  SPEAKER_00: How complex are those patients?
• 5:50
  SPEAKER_00: A nurse with 12 patients and no support may have a harder week than someone with 16 who has a dedicated admission team.
• 5:57
  SPEAKER_00: So when someone throws out a number like 30 points, 15 patients or five visits a day, don't automatically assume it means anything.
• 6:04
  SPEAKER_00: Ask what's behind the number.
• 6:06
  SPEAKER_00: There are three big mistakes I see with productivity.
• 6:09
  SPEAKER_00: The first is setting the target higher than your own math supports.
• 6:12
  SPEAKER_00: If your actual capacity is four and a half visits per day, and somebody decides the goal should be six, you haven't increased capacity.
• 6:19
  SPEAKER_00: You've just created a gap.
• 6:21
  SPEAKER_00: The second mistake is treating points like they're the entire management system.
• 6:25
  SPEAKER_00: Points are useful for measuring workload, they can help with staffing, scheduling, coaching, and balancing territories, but they're just a measurement tool.
• 6:34
  SPEAKER_00: And the third mistake is chasing lower labor costs so aggressively that you create bigger costs somewhere else.
• 6:40
  SPEAKER_00: If pushing for more visits creates burnout, turnover, sloppy documentation, or unhappy patients.
• 6:46
  SPEAKER_00: You didn't save real money, you moved the expense.
• 6:50
  SPEAKER_00: So here's the takeaway.
• 6:51
  SPEAKER_00: You don't need a magic industry number, you need your number.
• 6:54
  SPEAKER_00: Start with 2080 paid hours, subtract a time that I realistically cannot be used for visits, measure how long your visits actually take from start to finish, then divide.
• 7:04
  SPEAKER_00: That's it.
• 7:05
  SPEAKER_00: Once you do that, you can finally answer a very important question.
• 7:08
  SPEAKER_00: Is your productivity standard actually achievable, or have you just been assuming it is?
• 7:12
  SPEAKER_00: One thing I'd recommend doing this week is taking your total visits and dividing them by your clinical FTEs.
• 7:18
  SPEAKER_00: See what productivity actually looks like today.
• 7:21
  SPEAKER_00: Because knowing what you want the number to be is one thing.
• 7:24
  SPEAKER_00: Knowing what the number really is is something completely different.
• 7:27
  SPEAKER_00: I'm your host, Doug Walters.
• 7:29
  SPEAKER_00: Thanks again for tuning in.
• 7:30
  SPEAKER_00: We'll catch you in the next episode.
• 7:36
  SPEAKER_01: Thanks for listening to the Home Health and Hospice Profitability Podcast.
• 7:41
  SPEAKER_01: If you enjoyed today's episode, make sure you subscribe so you don't miss what's coming next.
• 7:46
  SPEAKER_01: You can also follow us on social media for more insights, updates, and practical ideas for running a stronger home health or hospice organization.
• 7:54
  SPEAKER_01: And if you would like to learn more about how Walters can help your agency, visit WaltersAccounting.com, WaltersBilling.com, and Waltersadvisors.com.