Practice Answer: Working as an OT through Mable: what should I check before accepting a job?
Clear answers to common questions about occupational therapy practice in community aged care and Support at Home.
Platforms such as Mable can provide Occupational Therapists with another way to connect with older people seeking services under Support at Home.
The hourly rates can also look attractive.
But before accepting a job, it is important to understand that the hourly rate is only one part of the arrangement.
If you are working as an independent contractor, you are operating as a health professional and a business. The individual agreement may place responsibilities on you relating to documentation, invoicing, insurance, incidents, privacy, record keeping and other aspects of service delivery.
The specific requirements will depend on the agreement you are being asked to accept, so OTs should review the terms attached to each engagement rather than relying only on the information displayed in the job listing.
Here are some of the things worth checking.
1. What will you actually be paid?
Start by distinguishing between the agreed service rate and the amount you will actually receive.
For example, a platform may display an agreed rate of $160 per hour while the amount payable to the independent support worker or clinician after platform fees is lower.
Also check:
whether the rate includes or excludes GST
whether different rates apply at different times
whether there are platform or service fees
whether a flat rate applies to particular services
what expenses you are expected to absorb yourself.
The advertised hourly rate should therefore not be the only number you use when deciding whether a job is financially worthwhile.
2. What work is actually included in that rate?
For an OT, the face-to-face assessment is only one component of providing the service.
Depending on the referral, your time might include:
reviewing the referral and available information
travelling to and from the person's home
completing the assessment
clinical reasoning and research
contacting suppliers or other professionals
communicating with the care partner or provider
completing the OT report
completing additional provider documentation
invoicing and administration
responding to follow-up questions.
Check the agreement or service request carefully to determine which of these activities are billable.
If an assessment is allocated 3.5 hours including the visit and report, for example, you need to determine whether that is realistically sufficient for the type of assessment being requested.
3. What is your effective hourly rate?
This is a useful calculation for any independent OT:
Amount you actually receive ÷ total time you spend completing the job = effective hourly rate
Imagine an OT receives $504 for an assessment.
The work ultimately takes:
1 hour travelling
1.5 hours completing the assessment
2 hours preparing the report
30 minutes completing liaison and administration.
That is 5 hours of work.
$504 ÷ 5 = $100.80 per hour effective rate.
That is before considering your own business costs such as insurance, registration, professional development, software, accounting, superannuation, leave and tax.
This doesn't necessarily mean the job isn't worthwhile. It simply gives you a more realistic figure to make that decision.
4. Is travel covered?
For community OTs, this can substantially change the economics of a referral.
Before accepting the work, clarify:
Is travel time billable?
Is mileage reimbursed?
Is there a maximum amount of travel that can be claimed?
Does travel need prior approval?
Is travel included within the allocated assessment time?
Don't assume that because travel is clinically necessary to provide a home-based service that it will automatically be paid.
5. What exactly are you agreeing to deliver?
Understand the expected deliverable before commencing the assessment.
For example:
“OT assessment” can mean very different things to different people.
Clarify whether you are being engaged to provide:
an initial functional assessment
an AT assessment
a home modification assessment
a specific prescription
an assessment and written report
recommendations for further assessment
liaison or implementation support.
Also establish what documentation the provider requires.
Your clinical report may not necessarily be the only documentation required under the agreement.
There may also be requirements relating to progress notes, service reports, check-in/check-out systems, incident documentation or other provider processes.
6. What happens if the scope changes?
Community OT assessments do not always follow the pathway anticipated at referral.
You might arrive expecting a straightforward equipment assessment and identify that the person requires:
further assessment
an equipment trial
supplier involvement
additional measurements
complex home modification assessment
further liaison
another visit.
Before completing additional work, understand the process for obtaining approval.
Some agreements require additional services or changes to the original service specification to be approved before they can be funded.
This makes scope management an important part of independent practice.
When the clinical need changes, don't automatically assume the funding approval changes with it.
7. What are the invoicing requirements?
Read this section carefully.
An agreement may specify:
how quickly invoices must be submitted
who the invoice must be addressed to
information that must appear on the invoice
supporting documentation that must be attached
when payment will occur
circumstances in which payment may not occur.
This is particularly important under Support at Home because provider claiming requirements can influence how and when services must be invoiced.
Independent OTs should have a reliable process for invoicing promptly rather than allowing invoices to accumulate.
8. What happens if the client cancels?
Your own cancellation policy does not necessarily operate in isolation.
Check the actual agreement for:
the required notice period
when a cancellation fee can be charged
whether the provider's conditions override your standard cancellation terms
what happens if the overall service arrangement is terminated.
This matters particularly when you have reserved several hours for an assessment and associated documentation.
9. What governance responsibilities are you accepting?
Independent contracting is different from working as an employee within an established allied health service.
Depending on the agreement and your role in the service-delivery arrangement, there may be requirements relating to:
professional registration
worker screening
professional indemnity insurance
public liability insurance
privacy and confidentiality
complaints and feedback
incident management
Serious Incident Response Scheme requirements
record keeping
retention of clinical records
infection prevention and control
responding to suspected abuse or neglect.
Don't assume the platform or Support at Home provider takes responsibility for every governance requirement.
Read the agreement to establish what responsibility remains with you as the contractor.
10. What does the indemnity clause say?
This is one of the less exciting parts of a contract, but it is worth reading.
An indemnity clause deals with circumstances in which you may become responsible for losses, claims, damages or costs arising from your work or from a breach of the agreement.
The wording can vary considerably between contracts.
It is also worth checking that your professional indemnity and public liability insurance are appropriate for the way you are practising.
If you do not understand the liability you are accepting under a contract, obtaining appropriate professional, insurance or legal advice may be warranted.
11. Who owns the clinical relationship?
Check what the agreement says about communication with the consumer and their Support at Home provider.
For example, there may be requirements to:
provide information or reports to the provider
notify the provider about particular changes or incidents
allow an authorised representative to participate in aspects of the service
notify the provider if the consumer approaches you about receiving services through a different arrangement.
This is another reason not to assume that accepting a referral through a platform is equivalent to receiving an ordinary private-practice referral.
A useful check before clicking ‘accept’
Before accepting an OT job through Mable or another contracting platform, you should be able to answer:
What am I being asked to do?
How much time will it realistically take?
Which parts of that time are billable?
What will I actually receive after fees?
Is travel paid?
What documentation is required?
How is additional work approved?
When and how do I need to invoice?
What happens if the client cancels?
What compliance and reporting responsibilities sit with me?
What liability am I accepting?
If any of those answers are unclear, that is something to clarify before accepting the work, rather than after the assessment has been completed.
The key takeaway
Platforms such as Mable can provide OTs another referral stream and flexible opportunities to deliver services independently.
But a high hourly rate does not automatically equal a high-paying job.
The better question is:
What am I actually agreeing to provide, what responsibilities am I accepting, and what will I earn for the total time required to deliver it properly?
That is the mindset shift from simply accepting a referral to operating as an independent Occupational Therapist.
If you are interested in learning more about running a sustainable aged care business as an OT, keep an eye out for our upcoming webinar on the topic:
This Practice Answer provides general educational information for Occupational Therapists and is not legal, financial or insurance advice. Platform, provider and individual agreement terms can vary. OTs should review the terms applicable to their own engagement and obtain appropriate professional advice where required.
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