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Bill to ban pay-per-visit compensation for home health and hospice staff draws support and opposition
Summary
Senate Bill 1168 would extend the ban on per-visit pay beyond nurses to other home health and hospice clinicians. Proponents warned the pay-per-visit model causes burnout and harms patient care; provider groups warned the change would reduce access and conflict with Medicare capacity rules.
Senate Bill 1168 would prohibit compensating home health and hospice care staff on a per-visit basis, extending an existing prohibition that currently applies to nurses to include other clinicians such as therapists and social workers.
Supporters told the Senate Human Services Committee the pay-per-visit model incentivizes speed over quality and contributes to workforce burnout. “This bill fixes the pay per visit loophole and ensures that no clinician, whether a nurse or another professional, is compensated on a per visit basis,” said Senator Winsve Campos, a sponsor. Representative Travis Nelson, a registered nurse and co-sponsor, said the measure would shift compensation to hourly or salaried pay and remove productivity metrics that penalize clinicians for spending extra time with patients.
Nurses and clinicians described workplace conditions they said the bill would address. “Quotas have absolutely no place in health care,” said Nonika McAllister, a nurse who testified in support, recounting schedules that rose from four to six visits a day while support staff were cut, and describing long charting hours at night. Testimony cited rising hospice turnover — “reaching 26 percent in 2023,” according to Representative Nelson — and the effect of productivity systems that assign point values to visits.
Industry groups opposed the bill. Jamie Doherty of the Oregon Association for Home Care warned that banning productivity metrics would prevent agencies from planning capacity under Medicare’s conditions of participation and could reduce patient access. “Prohibiting these metrics means that agencies cannot accurately plan how many clients can be served, thus creating barriers to admitting clients,” Doherty said. Doherty and others said agencies use metrics to ensure they meet regulatory requirements and manage limited staff and margins.
Committee members asked whether stakeholders had negotiated alternatives; sponsors and opponents said further work was needed. The committee closed the public hearing and said the measure will be scheduled for a work session in the coming days. No vote was taken at the hearing.
