With recent NDIS reforms and more changes underway for Aged Care, businesses within the private sector are feeling the crunch more than ever. For some businesses the ability of their staff to hit billable targets is essential to the viability of the business. It’s not just a matter of maintaining a profit, but actually being able to keep the doors open.

But I’m hearing more and more about clinicians who aren’t able to meet their billable target, even when the expectations are what most would consider reasonable (i.e. 60% or less of their working time). For some companies it is costing them tens of thousands of dollars to keep a staff member employed when not hitting targets goes on for months.

So, what do you do if you employ a clinician who is struggling to meet their target? What if you are that clinician who is struggling, but you’re not really sure why? This article will give you 8 things to consider, reflect on and take action.

1. Is the target realistic and achievable?

This should be the first question. There is no golden number for what is ‘reasonable’ as it depends on the caseload complexity and repetition, whether it is mobile or clinic based, and how much admin support is on offer. It should also vary depending on the clinicians’ years of experience. The question to ask is, “Are other clinicians able to consistently hit the target, or is everyone struggling?” If everyone is struggling, it could be the target is unrealistic, but maybe not (keep reading!). For more details on KPI considerations, check out this article.

2.       Do they know what is billable or non-billable?

It’s easy enough to get confused if you jump into any sort of discussion forum, or try to interpret the sometimes vague terms and descriptions in places like the NDIS price guide. Many businesses do things slightly differently, and they can all be doing it correctly. Consider whether you have given your clinician a very clear list of billable and non-billable tasks – like, actually print it out and stick it to their desk! This will remove any doubt that may be leading to underbilling. Also consider if they are doubting how long they should bill for a task, especially if they are learning. Providing guides or benchmarks can be helpful too.

3.       Do they value every part of the OT process?

Sometimes we do a quick phone call or email but don’t charge for our time, because it was “just a quick check-in or follow-up…” But we should ask – did it need our OT brain to do that check-in? Did we give advice or make a clinical judgement about what to recommend or do next? Did we document the service we provided? Was that “quick follow-up” an essential part of the OT process, such as a phone call to ensure the shower chair actually fit and was working? If you answered yes to any of these, you should be billing for those minutes. Think about it – a week with 5 or 6 of those ‘quick’ check-ins adds at least an hour to the billable work completed.

4.       Do they feel guilty about charging someone when funds are low?

Unfortunately one of the drawbacks of being a health professional in the private sector is that a caring nature and being disciplined with billing appropriately don’t always go hand in hand. Sometimes we put in extra hours and don’t bill fully for our time because we know the client doesn’t have much funding remaining. The difficulty is if we do this too often, the client and the funder start to develop an unrealistic understanding of how long it actually takes to do a decent job. In the end clients get allocated less funds and we have less to work with next time. There will always be a place for pro bono work, but this needs to be a business decision. If you are an employee, it’s not your call to decide what work you do for free, especially if your employer is paying for your time while you provide that free labour.

5.       Are they scared they’ll be accused of overcharging and being greedy?

To be honest, given the raw deal clinicians have been copping from the media, it’s probably a fair concern to be worried about this. But the thing about being an employee, is that it’s not your call how much to charge, or what services get billed for; it’s a business decision. If you are an employer who feels this is what may be holding back a clinician from billing appropriately, reassure them that any complaints or concerns will be redirected to you; it won’t be on the clinician to handle these conversations. There is still a chance they may be the initial target though, so provide some training and support to help them feel prepared to handle those tricky conversations.

6.       Can they handle the admin side of billing?

Think about how user-friendly your system is for inputting and tracking billable hours. Does it take forever to login or load? Does it frequently glitch and lose data? Did you actually provide appropriate training so they know any shortcuts or the benefits of using a mobile app rather than the desktop version? Don’t assume that quick whirlwind tour you gave day 1 is still sticking in their brain. Ask them if it’s easy. Get them to show you what they’re doing. Sometimes those 5-10 minute tasks aren’t being captured because the clinician feels it’s too much effort to input the data. Provide training, or consider outsourcing some of the billing to admin staff. Don’t let inefficient systems cost you.

7.       Are they getting through their work efficiently?

The previous tips were focused on either errors or decisions regarding what to bill for. This one focuses on how productive they are in their day. Are they utilising their time appropriately, or getting bogged down in non-billable tasks that should have been delegated to admin? Or are they keen to learn, but doing way too many deep dives into topics that aren’t essential to know about then and there, and that perhaps should have been moved to their unpaid time as a personal choice for professional development on a topic of interest rather than necessity? Getting them to log exactly what they are doing for each minute of the day, or at least in 10-15minute blocks for a few days, could help you get to the bottom of it. It’s not about doing this day-in and day-out to micromanage someone. It’s about helping them make good choices about where to prioritise their time in a way that aligns with the job they are getting paid to do.

8.       Do they understand how much they are hurting the business?

The private sector is a stressful place for all OTs, and no employer wants to add unnecessary stress to their employees by making them share the business financial burdens. But when an employee who isn’t hitting their billable target comes and asks for paid time off to do a course (that doesn’t really have any relevance to their caseload), or asks for a pay rise because they’ve been here for 12 months now…sometimes a reality check is required. Not to scare them or make them feel bad, but to reinforce the impact that underbilling can have. Tiny profit margins are falling further. Businesses are closing. The threat is real. And while the responsibility is on business owners to manage the risk, those that survive are the ones where the whole team is invested in making the business a success. This includes pulling their weight and billing for tasks we should be billing for. Even when we don’t want to.

What else would you add to the list? Are there other reasons you think may be contributing to a clinician underbilling – either intentionally or unintentionally? If you’re a clinician who struggles to hit a billable target but you’re not sure why, did any of these resonate with you? If they did, tell your employer! These insights will be valuable so they can help provide the support you need.

If you’ve found a way to help a clinician feel more confident and comfortable to bill for the true value of their time, resulting in a win-win for the clinician and business (and also a win for the client long term when the true cost of providing a high quality service is not undersold), I’d love to hear your ideas.

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