You could write a book about “employee vs. contractor” pros, cons, legality, and operational efficiency. In fact, there are books written about that very subject. There are also lawyers who specialize in employment law who advise companies about how to structure their staffing around those two broad categories of staff. While accreditation organizations won’t delve into the legalities (that’s for the lawyers to do), accreditation standards DO in fact address both categories of staffing.

Contracted staff are typically paid on a fee-for-service basis rather than an hourly, weekly, or monthly wage. For instance, an organization might elect to bring on a contracted respiratory therapist to provide clinical visits. The RT performs a clinical visit when one is needed and gets paid a specific dollar amount per visit. An organization can utilize contracted staff as opposed to employees for just about any position or job duty. Advantages to the organization include the fact that there are no taxes withheld and the contracted staff member does not typically get any kind of additional “benefit” such as vacation time, sick time, etc. Another advantage is that the contracted staff member gets paid strictly to do whatever the task is they brought on to perform. Thus, if a clinician is getting paid by the visit, and there’s only a few visits in a given time period, the organization only pays for the visits performed.

This scenario is often a “win/win” for both the contractor and the organization, but it is not without downsides for both parties. The organization has significantly less control over a contracted staff member as opposed to an employee. The contract is usually a side job for the contractor, who might have other customers or even a full-time job that they need to work around. Still, it’s a good way for a company to provide some service without bringing on full time staff and all the expenses and issues that employing a work force entail.

From an accreditation perspective, the accrediting body and the surveyor who inspects the organization will want to see evidence that contracted staff are oriented and trained to the organization’s procedures. There should be a very clear and comprehensive agreement or contract that outlines what services will be performed, how the contractor will be paid, and who’s responsible for what tasks, duties, and reporting. Ongoing competency assessment is important for any contracted patient care such as clinical visits or equipment set up/instruction. A written policy should be in place that describes all the appropriate requirements for contracted staff.

HR 3 is the HQAA standard that describes the requirements for these staff members. HR 3 is a standard that might not apply to an organization (if you don’t utilize contracted staff). But if you do have any contracted staff on board, you’ll want to pay close attention to the standard and make sure your organization is complying.

A punch list of items to check regarding HR 3 would include:

• A written policy is in place describing all aspects of requirements, paperwork, and documentation for contracted staff (this will be an item you will be asked to submit into the workrooms when applying)
• Any staff member that is providing service on a fee for service basis has a contract or agreement in place that contains a list of responsibilities, what the organization’s role is and what the contractor’s role is in patient services or care, how the contractor will be compensated, how the contractor will be trained or oriented to the organization, how ongoing competency will be assessed, and any other pertinent data about the contracted staff/organization relationship. The agreement should specify the term of the contract—in other words, how long the contract is in place and how it is renewed.
• The organization should maintain a contract file. Think of it as a personnel file for contracted staff (who aren’t personnel). This is where the documentation of any training and competency assessment is maintained. It is also where the actual signed/dated agreement should be maintained. Expect to show the file to surveyor.
• If the contracted staff member is a clinician and being utilized by the organization in a clinical role, make sure you have a current copy of their RT, RN, or other clinical license. This includes orthotic, pedorthic, and prosthetic fitters.

During application for accreditation, expect to be asked if you provide any care using contracted staff. If you do, you’ll be prompted to submit a written policy and a sample contract/agreement. During the survey visit, the surveyor will want to verify your compliance with the standard and will most likely follow up by reviewing your contract file or files. In addition, they may want to talk to the contracted staff member. During that conversation, they will verify what the contracted staff member is doing for your organization, how they communicate with the office, and how they were trained.

Contracted staff can be a useful, efficient way to solve staffing issues. If your organization goes this route, know that giving contracted staff assignments and tasks to do on your behalf doesn’t absolve you from responsibility to provide patient care and education in a manner that meets all accreditation standards. Keep contracted staff “in the loop” the same way you would for any full and part time employees. Always remember that you have the ultimate responsibility for anyone providing any kind of service on your organization’s behalf.