The Pay Per Unit (PPU) model has turned licensed therapists into piece laborers. It is exploitative, unethical, and unsustainable. It reduces clinicians to billing machines instead of allowing us to function as healthcare professionals.

We, the undersigned therapists and supporters of ethical rehabilitation care, demand an immediate end to this broken model. The PPU system ties our pay directly to the number of units we bill, not the total time we work or the total care we provide. It completely ignores the non-billable, legally required, and medically necessary work we do every day.

Under the PPU model:

• Documentation and skilled time that is legally and medically required is often not compensated, despite being a critical part of skilled care. If therapists are legally required to complete documentation for compliance, risk management, and continuity of care, they should be compensated for that time. To not pay for it is both unethical and exploitative.
• Therapists are unpaid for care planning, communication with families, coordination with nursing, and walking between patients.
  
• Patient care suffers as clinicians are incentivized to bill more units rather than provide individualized, appropriate interventions.

The model creates a toxic, high pressure environment that promotes burnout, shortcuts, and fraud.

Pay us for our time worked. Pay us from the time we clock in until the time we clock out. Anything less is wage theft.

Stop taking advantage of therapists.

Many of us have already left multiple jobs or even the profession because we cannot ethically, morally, or mentally survive under this system. We urge contract therapy providers, long term care facilities, and outpatient clinics to replace PPU pay with:

• Hourly pay models that compensate for total clinical responsibility
• Hybrid structures with guaranteed base pay
• Compensation for all required non-billable work

We call on national organizations such as AOTA, ASHA, and APTA to take an official stance against the PPU model and support efforts to end this exploitative structure.

Therapists deserve better. Patients deserve better. Let’s end the PPU model and restore integrity to rehab care. We must act now to protect our profession, those we serve, and our future.