Contractors
Several agencies, one car: scheduling as a home health contractor.
Each agency sees its own visits and builds its part of your day as if it were the whole of it. Only you can see Tuesday as one day. How to run a week across several agencies without double booking or zigzagging.
A lot of home health is done by people who are not on any one agency's payroll. Per-visit and PRN nurses, physical and occupational therapists, speech-language pathologists, aides and hospice clinicians take referrals from two, three or four agencies at once, often as 1099 contractors. It is a good arrangement for many of them: more control over the week, a better per-visit rate, and no single employer deciding the caseload.
It also creates a scheduling problem that no agency can see, because each one sees only its own visits. This is a practical guide to running one week across several agencies: where it goes wrong, how to keep it straight, and what to keep for the mileage and the tax return.
The day nobody else can see
Agency A's scheduler knows about Agency A's four visits on Tuesday. Agency B's scheduler knows about Agency B's three. Neither knows the other exists, and each builds its part of your day as if it were the whole of it. So the only person who can see Tuesday as one day — seven addresses, two sets of time windows, one car — is you.
That produces a predictable set of failures:
- Overlaps. Two agencies each offer a 10:00 start of care, and you find out when the second portal sends a reminder.
- Criss-crossing. Agency A's visits are in the north of the territory and Agency B's in the south, so the day zigzags to honour two schedules that were never meant to be combined.
- Three portals, three phones' worth of messages. Each agency has its own EMR, scheduling screen and way of telling you a visit moved. A change can land in any of them.
- Different deadlines. One agency wants notes the same day, another within 48 hours. Missing one can delay your pay from that agency.
Why the drive matters more on a per-visit rate
A salaried clinician's drive time is, at least in principle, part of paid work. A per-visit contractor is usually paid for the visit and nothing else: the minutes between patients are yours, unpaid, and so are the miles unless an agency's contract says otherwise. That changes the arithmetic of accepting a referral. A visit that pays well but sits forty minutes away from the rest of the day may earn less per hour than a lower-paying one around the corner.
| Question | Why a contractor asks it |
|---|---|
| Where is it, relative to the rest of my day? | The drive is unpaid time; distance is part of the rate. |
| What is the time window? | A fixed 8:00 on one side of town can dictate the whole morning for every agency. |
| How often, for how long? | Twice a week for six weeks commits a slot in every one of those weeks, across all your agencies. |
| Does the agency pay mileage? | Some do, many do not for contractors. Ask before accepting, not on the first invoice. |
Our Windshield Tax calculator puts a rough figure on what the driving costs you in fuel, wear and unpaid hours, which is useful when deciding whether a far-away referral is worth taking.
Running one week across several agencies
Keep one calendar that is yours
Not four agency schedules and a memory. One place — paper, a phone calendar, a spreadsheet, an app — where every visit from every agency lands, labelled with which agency it came from. Treat the agency portals as inputs to it, not as the schedule.
Give each agency a territory, if you can
The biggest saving available to a multi-agency contractor is geographic. If Agency A mostly sends referrals in one area and Agency B in another, try to hold certain days for certain areas — Monday and Thursday north, Tuesday and Friday south — and tell each agency which days you take their referrals.
Fixed windows first, then cluster, then sequence
Build each day the same way whatever the agency: place the visits with real clinical windows, group the rest by neighbourhood, then thread the day in one direction. The method is in how to plan a home health route by hand; the only difference here is that the visits come from more than one source. Our note on time windows covers which windows are clinical facts and which are preferences.
Answer every offer against the whole week
Before saying yes to a new referral, look at your own calendar, not the offering agency's view of you. Reply with the days that actually fit. It is also worth being clear with each agency about how many slots you hold for them, so nobody is surprised when you decline.
Keep a mileage log per agency
Date, start and end address, miles, purpose, and which agency the visit was for. It is what you invoice from where an agency does pay mileage, and it is the record the tax rules generally expect where it does not.
Mileage and tax, briefly and carefully
This is not tax advice, and the rules depend on your situation. In the US, self-employed people can generally deduct business driving, either at the IRS standard mileage rate or by actual expenses, and the IRS expects a contemporaneous log. Driving between patients is typically business mileage; whether the first and last trip of the day counts often turns on whether your home is your principal place of business. The current rate and the rules are at irs.gov (search "standard mileage rate" and Publication 463); a tax professional can tell you how they apply to you. For employees rather than contractors, see our piece on mileage reimbursement.
Whether you are genuinely an independent contractor is a separate question, and not one the label on a contract settles. Federal agencies and states apply their own tests, and state law varies. If an agency controls your schedule, your methods and your territory the way it would an employee's, that is worth asking a qualified adviser about.
If you are weighing tools, our honest comparison of home health scheduling apps notes which are built for the agency and which for the clinician — a difference that matters a great deal when you work for more than one. The broader case is in what home health scheduling software has to do.
Questions people actually ask
Can a home health nurse or therapist work for more than one agency?
Often, yes — many per-visit and PRN clinicians do, particularly as independent contractors. Check each contract for exclusivity or non-compete terms, and check your state's rules, which vary. Employees may also have policies about outside work.
How do you keep track of visits from several home health agencies?
Keep one calendar of your own where every visit from every agency lands, labelled with its agency, and treat each agency's portal as an input to it. Checking a new offer against that calendar, rather than against the offering agency's view, is what prevents double booking.
Do home health agencies pay mileage to independent contractors?
Some do and many do not; it depends on the contract. Ask before accepting referrals, and keep a mileage log per agency either way — it is what you invoice from where mileage is paid, and the record the tax rules generally expect where it is not.
Can I deduct mileage as a 1099 home health clinician?
In the US, self-employed people can generally deduct business driving at the IRS standard mileage rate or by actual expenses, with a contemporaneous log. Whether the first and last trips count depends on your circumstances. This is not tax advice; check irs.gov and ask a tax professional.
How many agencies should a per-visit clinician work with?
There is no right number. More agencies means more referrals to choose from and less dependence on one, but also more portals, deadlines and scattered geography. Many contractors find two or three agencies with distinct territories easier to run than several overlapping ones.
Is there a scheduling app for home health contractors with several agencies?
Most home health scheduling software is sold to agencies and sees only that agency's visits. A clinician-side app that holds every agency's visits in one plan is less common. Obillions labels each client with its agency and plans the week across them; it does not sync with agency EMRs and is in private testing on iPhone.
Obillions
A voice agent for a day of visits. You say what changed and the day re-plans itself: the order, the drive times, and who nearby could take the hour a cancellation just freed. Nothing changes until you confirm, and your voice and photos never leave your phone.
In private testing now. A public TestFlight comes next, then the App Store.