S11 E2 - Balancing Billables: What Works for OTs and Practices?

A billable target only tells part of the story. The time needed to complete a report, the travel involved in a caseload and the support available to an early career OT all affect whether expectations are realistic.

Fair billing and practical time management sit alongside broader questions about growing a practice beyond its owner. Examples from Freedom Solutions and Freedom Wheels also explore how tailored equipment can help people return to activities they love.

Report-writing expectations need to reflect the work

A practice owner’s usual report-writing time may not be a fair benchmark for every therapist or assessment. Fixed limits based on how quickly the owner believes they could complete the work can overlook the participant’s circumstances and the complexity of the assessment.

Experience also affects efficiency. An early career OT may need considerably longer to complete a report, but there is a distinction between time reasonably charged to the participant and additional time spent learning.

Clear expectations need practical support behind them. Showing therapists how to structure reports, use templates thoughtfully and streamline their work gives them a way to improve, rather than simply being told to write faster.

What actually counts towards a billable target?

An example of an early career OT being asked to achieve 25 billable hours each week, with billable travel excluded from that target, raises questions about how performance expectations are calculated.

Some practices count travel at a reduced rate because it generates less income. However, this can create additional workload when therapists need to find more billable activity to meet their target, particularly in regional areas with long distances between appointments.

Understanding how a practice earns income is part of working in the private sector, but targets need clear explanations and realistic workload planning. Clustering appointments and reviewing the mix of travel, therapy and report writing can help identify where expectations become difficult to meet.

Accurate time recording starts with managing interruptions

Time spent on client work can be difficult to reconstruct when reports are interrupted by phone calls, emails and other tasks. Relying on memory makes it harder to distinguish the work completed for each participant.

Timekeeping sheets, tracking software or a simple kitchen timer can help record actual work accurately. Pausing when attention shifts elsewhere also prevents unrelated activity from becoming mixed into the time recorded for a report.

Protecting concentration matters too. An inbox-hiding browser extension provides one example of how to search for an email without being distracted by new messages and leaving the original task unfinished.

Growing a practice means growing the team

A service built around one therapist’s reputation can become difficult to expand. If clients expect the owner’s particular approach, bringing in another OT involves more than handing over appointments.

Nikki reflects on Action OT’s tenth anniversary, recalling a first referral that involved a Saturday home visit and a report for a man with a brain injury who could not afford an out-of-pocket payment. Only a small Medicare rebate covered the work.

Moving from those beginnings to a team-based service requires confidence in the skills of other therapists. Developing staff and communicating the value of the whole practice helps the service become less dependent on one person.

Planning an exit starts before you need to leave

A busy practice does not necessarily operate independently of its owner. Whether the business can keep running when the owner takes time off is a useful question, particularly when decisions and referrals still depend on them.

Selling can also have implications for templates and resources an owner hopes to use in future work. Alyce’s reflection on closing her practice and moving into The OT Coach illustrates how plans for the next stage of a career can influence which exit option makes sense.

Assuming a sale will be available when personal circumstances suddenly change can leave owners with limited options. Considering an exit earlier creates more time to review staffing stability, dependence on the owner and what would be included in a potential sale.

When standard equipment cannot support a meaningful activity

Freedom Solutions’ fiftieth anniversary provides an opportunity to reflect on the collaboration between OTs and volunteer engineers. One example discussed involved developing a tray table when commercially available options would not fit a client’s power wheelchair.

Another involved a man who could no longer strum his guitar after a stroke. An adapted device allowed him to return to playing, with further modifications expanding how he could use it.

The OT’s contribution is to identify the functional requirements and understand what the person wants to do. Working with an engineer can then help turn those requirements into a tailored solution when standard products are unsuitable.

Adaptive bike trials involve more than learning to ride

Freedom Wheels clinics support children and adults who have never ridden, outgrown suitable equipment or experienced changes in their function. A young girl riding for the first time and saying, “I doing it”, captures what access to suitable equipment can mean.

Different equipment can address different barriers. Examples include wider stabilising outriggers and a pedal-assist trike trialled by a man with multiple sclerosis who wanted to ride with his wife but experienced fatigue. A new folding trike also prompted discussion about transport, given the difficulty of moving larger trikes without a van or trailer.

These assistive technology trials have a different purpose from bike skills sessions. In the clinic model described, the participant’s own therapist remains involved in the assessment and recommendation, while the clinic provides equipment knowledge and facilitates trials.

Key takeaways
• Report-writing expectations should account for assessment complexity and therapist experience, with practical support to build efficiency
• Participants should not be expected to fund the additional time an early career OT needs for learning
• Clarify how travel contributes to billable targets and consider its effect on the therapist’s actual workload
• Record client work as it happens and pause time tracking when interruptions shift attention elsewhere
• Growing a practice requires developing the team and reducing dependence on the owner
• Consider exit options early, including how a sale could affect resources intended for future work
• Tailored equipment and adaptive bike trials can support participation in activities that standard products cannot accommodate

Links
ARATA Australia Assistive Technology Conference. Register here: https://aatc2026.com