Additional Revenue Streams

[vanfanal]

Hi. I've been doing lots of research into psychiatry lately. I have an elective scheduled for the summer, but it will be primarily inpatient based.

I was wondering if someone could tell me if there's any scope for additional revenue streams in a general psychiatry practice? My parents are small business owners, so I've always had an interest in running a business. From what I understand though, there are no procedures in psychiatry, so what's the scope for additional revenue streams beyond seeing new patients, med checks, and psychotherapy?

Any advice would be appreciated.

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[vistaril]

Hi. I've been doing lots of research into psychiatry lately. I have an elective scheduled for the summer, but it will be primarily inpatient based.

I was wondering if someone could tell me if there's any scope for additional revenue streams in a general psychiatry practice? My parents are small business owners, so I've always had an interest in running a business. From what I understand though, there are no procedures in psychiatry, so what's the scope for additional revenue streams beyond seeing new patients, med checks, and psychotherapy?

Any advice would be appreciated.

one of the things really limited to psychiatry incomes(and what don't get fully from salary surveys) are the limitations in additional revenue streams relative to say....internal medicine practices. I will admit that neurology also has some of the same limitations(but not to nearly the same extent).

an internal med practice can be collecting revenue from tons of additional passive services that psychiatrists can't. For example labs. Just do client billing. For a 4-5 man IM outpt group, that is a bunch of extra money right there.

 

[Leo Aquarius]

one of the things really limited to psychiatry incomes(and what don't get fully from salary surveys) are the limitations in additional revenue streams relative to say....internal medicine practices. I will admit that neurology also has some of the same limitations(but not to nearly the same extent).

an internal med practice can be collecting revenue from tons of additional passive services that psychiatrists can't. For example labs. Just do client billing. For a 4-5 man IM outpt group, that is a bunch of extra money right there.

Is this why two-thirds of PCPs express dissatisfaction with their income or the number of hours they must work to earn what they want? Tons of passive revenue streams? 67% dissatisfaction rate with revenue? Either the studies are wrong, you're wrong, or 67% of PCPs are dumber than you. Which is it?

 

[Leo Aquarius]

Primary care providers are hurting namely because health insurance continues to cut reimbursements to the doctors. I found this article on how to create additional revenue streams for PCPs, and most of the pointers can apply to psychiatrists as well. The fact that they had to write this article should tell you most PCPs are hurting. To Vanfanal, give this a read and imagine applying any or all of it to psychiatry. There are a lot of options for additional money. Good luck!

http://medicaleconomics.modernmedic...ap-new-revenue-streams?id=&pageID=1&sk=&date=

 

[shan564]

Hi. I've been doing lots of research into psychiatry lately. I have an elective scheduled for the summer, but it will be primarily inpatient based.

I was wondering if someone could tell me if there's any scope for additional revenue streams in a general psychiatry practice? My parents are small business owners, so I've always had an interest in running a business. From what I understand though, there are no procedures in psychiatry, so what's the scope for additional revenue streams beyond seeing new patients, med checks, and psychotherapy?

Any advice would be appreciated.

ECT, TMS, and one of the variety of other procedures in development. Also forensic consults. And eating disorders. And there are lots of cash practice opportunities.

But the way that people usually make a lot of money in psychiatry is by building a multi-provider practice. People often start by hiring a therapist or two, and gradually expand to hiring some salaried psychiatrists, which allows you to make a bit of a margin on top of what they bill in exchange for the responsibility of running the business. Many of us aren't interested in the business side of things, so if you like dealing with that stuff, then you can earn a pretty solid premium. Definitely not my thing, but I know people who have made a lot of money doing that.

 

[whopper]

Be a consultant for a primary care practice or GI clinic that treats HCV with interferon. GI docs are scared to deal with the psychiatric bad outcomes that could happen with Pegasys.

 

[Leo Aquarius]

Be a consultant for a primary care practice or GI clinic that treats HCV with interferon. GI docs are scared to deal with the psychiatric bad outcomes that could happen with Pegasys.

I've got an outpatient who has Pegasys-induced depression. Nobody's given me special training on how to treat him. I'm learning as I go and trying to read about it. But now that you mention it, I might be interested in being such a consultant sometime in the future. That Interferon is pretty harsh stuff. By the way, you're right. My patient's GI doc isn't addressing this aspect of his mental health and threw him my way and I'm just a PGY2.

 

[vanfanal]

Thanks @Leo Aquarius, @shan564, and @whopper. I do believe that I'll end up managing a practice some time in the future, which is why I was wondering about additional services. It's a shame that psych cannot add any procedures, but maybe things will change.

 

[whopper]

Pegasys is very lucrative for GI doctors. While a medstudent, I did a rotation at a GI clinic where the attendings were attached to the hospital where I was going to do psychiatry residency. Those GI doctors were begging me to join them after I graduated and told me upfront they would pay me very well to 1-see their patients 2-do screenings, decision making for antidepressants to prevent interferon-induced depression, 3-be their go to guy if one of their patients was psychiatrically decompensating.

I couldn't take them up on the offer because I did fellowship and moved away from that area. I recall eating at a restaurant, coincidentally seeing those GI docs while they were having a party, they invited me (and my then new wife) over to their table and they reiterated the offer even though it was 4 years after they had me as a student telling me they were still desperate for a psychiatrist, ordered me and my wife a $200 dinner each, which I kept refusing because I already knew my answer had to be no (and a damned shame cause I liked those guys a lot.)

I did read a published article on interferon and depression but it's about 10 years old now. Someone at Emory (forgot his name) was intensely studying this phenomenon. Just do a pubmed and you'll see a lot of hits but what it boils down to is...
1-HCV patients are usually at high risk for depression even without treatment (often are IVDA abusers among other demographic factors)
2-do a depression scale and thorough history, then consider if they should get treatment
3-if interferon will be used, consider antidepressant treatment as a preventative measure while bearing in mind other things can happen such as mania or psychosis
4-consider use of Modafanil due to extreme fatigue usually cased by interferon that appears to be independent of of the depression caused by the interferon
5-Monitor these patients and track their progress (or worsening) with further scale evaluations
6-have back-up strategies already planned out with the GI doctors on how they get can a hold of you if their patients are decompensating and what to do with those patients

 

[michaelrack]

Is this why two-thirds of PCPs express dissatisfaction with their income or the number of hours they must work to earn what they want? Tons of passive revenue streams? 67% dissatisfaction rate with revenue? Either the studies are wrong, you're wrong, or 67% of PCPs are dumber than you. Which is it?

I think you are both (Leo Aquarius, Vistaril) partly right: 1 . Many of the dissatisfied PCP's could be employees that don't get to participate in passive rev streams and 2. passive rev streams in primary care are getting less lucrative/harder to do- insurers are cutting down on lab reimbursement and forcing docs to send their pts to certain labs

 

[vistaril]

Is this why two-thirds of PCPs express dissatisfaction with their income or the number of hours they must work to earn what they want? Tons of passive revenue streams? 67% dissatisfaction rate with revenue? Either the studies are wrong, you're wrong, or 67% of PCPs are dumber than you. Which is it?

I think the answer leo is that you need to stop paying so much attention to these superficial surveys(which you often don't even interpret correctly) with in many cases ridiculously low provider participation. And which almost certainly don't include passive streams. Instead of doing that, why don't you go to a large and well run/high volume outpt IM group in your area and flirt with the office manager and then offer to buy her drinks. And then while doing so, ask some questions about things like their lab contracts. You have a lot of money at stake there controlled by the physicians and the service requested has a lot of bidders for it and its viewed as a commodity. Figure it out. As gov rod blagejovich famously said- "This is a f'ing valuable thing, I'm not just going to give it away for f'in nothing". And they usually don't.

 

[dl2dp2]

flirt with the office manager and then offer to buy her drinks...

You are making a sexist assumption here that OP is a male... Regardless, the scheme wouldn't work because the office manager usually knows very little anyway. On the other hand, if you want to make millions as a psychiatrist, the best way *is* to run a large group practice. There's no obvious recipe pathway to do that, and a lot of it depends on geography and local practice environment, but it's not rocket science either.

The biggest problem I see in getting passive stream is that a lot of information is proprietary. For instance, how much does any insurance actually reimburse for a 99213? And why is this information so hard to find??? And why does it take 6-8 months to credential for an insurance panel? It's hard to estimate the income and expenses when you don't have a good sense of how much money you'll make. Institutional players are protected and at competitive advantage precisely for this reason.

 

[michaelrack]

You are making a sexist assumption here that OP is a male... Regardless, the scheme wouldn't work because the office manager usually knows very little anyway. On the other hand, if you want to make millions as a psychiatrist, the best way *is* to run a large group practice. There's no obvious recipe pathway to do that, and a lot of it depends on geography and local practice environment, but it's not rocket science either.

The biggest problem I see in getting passive stream is that a lot of information is proprietary. For instance, how much does any insurance actually reimburse for a 99213? And why is this information so hard to find??? And why does it take 6-8 months to credential for an insurance panel? It's hard to estimate the income and expenses when you don't have a good sense of how much money you'll make. Institutional players are protected and at competitive advantage precisely for this reason.

Some office managers know a lot

 

[vistaril]

You are making a sexist assumption here that OP is a male... Regardless, the scheme wouldn't work because the office manager usually knows very little anyway. On the other hand, if you want to make millions as a psychiatrist, the best way *is* to run a large group practice. There's no obvious recipe pathway to do that, and a lot of it depends on geography and local practice environment, but it's not rocket science either.

The biggest problem I see in getting passive stream is that a lot of information is proprietary. For instance, how much does any insurance actually reimburse for a 99213? And why is this information so hard to find??? And why does it take 6-8 months to credential for an insurance panel? It's hard to estimate the income and expenses when you don't have a good sense of how much money you'll make. Institutional players are protected and at competitive advantage precisely for this reason.

lmao...the office manager of a large IM practice would almost certainly know the details on their lab contracts. They may not have been the point person in negotiatiating their cut, but they have to wash the money. Sheeesh....

The best way to make millions as a psychiatrist is to make 200k as a psychiatrist and then inherit a bunch of beach front properties and rent them out to get to 7 figures......As an internist, it's also very hard to hit 7 figures, but much more realistic to get to say 5-600. Because if you do really high volume, have your hands in a lot of different pots, etc you can get to 700k or so in the right areas counting all streams.

 

[vistaril]

You are making a sexist assumption here that OP is a male... .

absolutely....and most likely a spot on assumption as well.

 

[OldPsychDoc]

Some office managers know a lot

...and most know better than to go on a date with vistaril.

Sometimes I think I've entered a time warp with that guy.

 

[vistaril]

...and most know better than to go on a date with vistaril.

Sometimes I think I've entered a time warp with that guy.

time warp....not a bad thing come to think of it. Perhaps we'd at least get to spend more time with our patients then.

 

[Frazier]

My parents are small business owners, so I've always had an interest in running a business. From what I understand though, there are no procedures in psychiatry, so what's the scope for additional revenue streams beyond seeing new patients, med checks, and psychotherapy?

Consulting (business side of things)
Hiring midlevels to extend practice
Owning the building and charging rent to other providers
Clinical trials
Rehab facility
TMS
ECT
Giving talks
Writing articles
Writing books
Blog
Open a med spa (botox/dermal filler/etc)
Open a franchise
Etc.

As you can see -- there is a wide range of possibilities -- some have low barriers to entry, others being high.

Some of the above require a bit of skill (i.e. if you aren't a powerful speaker, no one would pay you to give a talk regardless of your message) or luck (i.e. even if you are a great writer, there is the real chance that none of your books will be wildly successful).

Others seem to not make immediate sense. A med spa? "Could a psychiatrist even do those types of treatments? Would anyone go to such a spa?" Apparently so -- I went to school with a kid that works at his father's dentistry practice. He does botox and dermal filler treatments...and from what I hear, a lot of them. It is all about reputation. If the kid has a rep for good results wielding botox, people don't care that the initials after his name are "DMD". At least you have a head start by having "MD" after your name on the med spa's website.

"Open a franchise"?! I can imagine a *certain predictable poster* on here coming in and replying with "What? Are you crazy? That isn't special to a psychiatrist. A cashier at a department store could open a franchise!" ...Not exactly. Good luck to that cashier at the department store in having the requisite level of assets and ability to attain the line of credit needed to pursue such a venture.

Essentially, you are limited by your creativity, motivation, acumen and [sadly] dumb luck.

From what I hear, as a psychiatrist you have the benefit of being able to often control your schedule and hours. If you only want to dedicate 30 hours to your clinical practice and another 30 hours per week to some other revenue-generating pursuits -- it is doable (and wise to diversify income streams). Good luck to some of the other specialties that work 60 hours per week regularly -- much harder to find those 30 extra hours each week to diversify income.

 

[vistaril]

[QUOTE="Frazier, post: 15300813, member: 294471
Others seem to not make immediate sense. A med spa? "Could a psychiatrist even do those types of treatments? Would anyone go to such a spa?" Apparently so -- I went to school with a kid that works at his father's dentistry practice. He does botox and dermal filler treatments...and from what I hear, a lot of them. It is all about reputation.[/QUOTE]

do you honestly not see the difference between a dentist doing botox and a psychiatrist doing botox? I'm not saying botox is brain surgery, but between dentistry and psychiatry......which one of those two fields is more based on putting small needles into small spaces? Of all the non-derm/non-plastics people to do botox, dentistry makes as much sense as any. Most people outside of both medicine and dentistry can easily see that.....

 

[Frazier]

do you honestly not see the difference between a dentist doing botox and a psychiatrist doing botox? I'm not saying botox is brain surgery, but between dentistry and psychiatry......which one of those two fields is more based on putting small needles into small spaces? Of all the non-derm/non-plastics people to do botox, dentistry makes as much sense as any. Most people outside of both medicine and dentistry can easily see that.....

Nope. When someone says "dermal filler" to the layman walking down the street, they don't say "Oh, yes! I should go get that at my dentist's office!"

It is about reputation and salesmanship -- plain and simple.

The DMD sold the patients on the idea and had pleased customers after smoothing out those crow's feet -- and such as marketing goes -- word of mouth is the most powerful.

If the psychiatrist-owned med spa got rave reviews -- the type of customer that would go to the spa for services would be much more influenced by her friend Sally's results [the results that she is showing on her face] than what the doc's initial's are.

Doesn't matter so much for the degree. DMD. MD. That's the point: if you are trained and certified to offer safe treatment with excellent results -- go for it.

For someone as pragmatic(?) as yourself -- it is surprising to see you not understand that.

 

[vistaril]

Nope. When someone says "dermal filler" to the layman walking down the street, they don't say "Oh, yes! I should go get that at my dentist's office!"
.

your fallacy is that people on the street don't view botox and similar things as in those terms to begin with. People know what botox and restylene and the like is and what they are for, and they view is as injecting stuff with needles into small pockets in their face, lips, whatever. And if you ask people on the street whose training jibes with injecting things into small pockets in peoples lips and face, they will dentists and not psychiatrists.....

I'm aware of some dental practices who make good money off things like this. In psychiatry it is much much rarer...for a reason.

 

[Frazier]

your fallacy is that people on the street don't view botox and similar things as in those terms to begin with. People know what botox and restylene and the like is and what they are for, and they view is as injecting stuff with needles into small pockets in their face, lips, whatever. And if you ask people on the street whose training jibes with injecting things into small pockets in peoples lips and face, they will dentists and not psychiatrists.....

I'm aware of some dental practices who make good money off things like this. In psychiatry it is much much rarer...for a reason.

Your fallacy is that people on the street don't view dentists as offering cosmetic skin treatment. Also, you are putting psychiatrists in too tiny of a pigeon hole.

Last time I checked, psychiatrists are physicians first and foremost. They are physicians that happened to specialize in psychiatric illness and mental health.

If we are playing free association with the words "dentist" and "physician", I think about teeth and oral health in regards to the former. [The fact that you perhaps first think of needles and "injecting stuff" is interesting. Do you have cavities? ]

Also, yeah, I am willing to bet if you walk down the street and ask 10 people what "restylene" is [or what it is for] that at least 7 of them will have no idea. Those other 3 people would be aligned with the market in some way -- whether it be they are patients themselves, had a family member/friend get it, or saw it on a TV spot.

I have a feeling you are trying to warp the point in such a way as if the question was: "Which is a patient more intuitively going to go to for botox? The dentist office or the psychiatrist office?"

That is not even close to what was originally stated.

The idea was med spa. And whether a dentist or the psychiatrist runs the med spa -- if they get good safe results -- the customers will seek service and leave happy.

 

[TexasPhysician]

[QUOTE="Frazier, post: 15300813, member: 294471
Others seem to not make immediate sense. A med spa? "Could a psychiatrist even do those types of treatments? Would anyone go to such a spa?" Apparently so -- I went to school with a kid that works at his father's dentistry practice. He does botox and dermal filler treatments...and from what I hear, a lot of them. It is all about reputation.

do you honestly not see the difference between a dentist doing botox and a psychiatrist doing botox? I'm not saying botox is brain surgery, but between dentistry and psychiatry......which one of those two fields is more based on putting small needles into small spaces? Of all the non-derm/non-plastics people to do botox, dentistry makes as much sense as any. Most people outside of both medicine and dentistry can easily see that.....[/QUOTE]

I actually once met a psychiatrist with a thriving med spa.

 

[Frazier]

I actually once met a psychiatrist with a thriving med spa.

Glad to hear they exist.

Was a bit worried about deja vu when I first started reading your post, until realizing that the quote was messed up -- with vistaril's post showing up as your own.

 

[dl2dp2]

absolutely....and most likely a spot on assumption as well.

I think you are wrong...>50% of new psychiatrists are female. Furthermore, a lot of that <50% who are male are not heterosexual. So your "advice" is a bit micro-aggressive there. Since it IS the Internet, I'm gonna go ahead and call you out on that one.

 

[OldPsychDoc]

I think you are wrong...>50% of new psychiatrists are female. Furthermore, a lot of that <50% who are male are not heterosexual. So your "advice" is a bit micro-aggressive there. Since it IS the Internet, I'm gonna go ahead and call you out on that one.

Don't bother interjecting facts from the real world into Vistaril World.

 

[PikminOC]

Does anyone have experience hiring therapists? I would be concerned about liability as the local papers sometimes have stories about therapists sleeping with their patients.
I don't like anything that increases my malpractice risk.

 

[vistaril]

I think you are wrong...>50% of new psychiatrists are female. Furthermore, a lot of that <50% who are male are not heterosexual. So your "advice" is a bit micro-aggressive there. Since it IS the Internet, I'm gonna go ahead and call you out on that one.

and? I'd bet that female psychiatrists and gay psychiatrists are far more likely to have a female office manager as well.

 

[vistaril]

do you honestly not see the difference between a dentist doing botox and a psychiatrist doing botox? I'm not saying botox is brain surgery, but between dentistry and psychiatry......which one of those two fields is more based on putting small needles into small spaces? Of all the non-derm/non-plastics people to do botox, dentistry makes as much sense as any. Most people outside of both medicine and dentistry can easily see that.....

I actually once met a psychiatrist with a thriving med spa.[/QUOTE]

of course....there are 25k or so psychs out there. Im sure a few do things like that. But Im sure there are more dentists who do it.

 

[dl2dp2]

and? I'd bet that female psychiatrists and gay psychiatrists are far more likely to have a female office manager as well.

Yes, but they are far less likely to benefit from your not so covertly sexist "advice" to "flirt with the office manager and then offer to buy her drinks" in attempt to "ask some questions about things like their lab contracts." I don't see any reason for any psychiatrist to have to play games in establishing a successful business. Get credentialed. Hire allied professionals. Gather patients. It's not rocket science. Getting some kind of lab contract via shady business practices need not be part of this.

IMHO, the bogus idea that you need an inordinate amount of business acumen to run a psychiatry practice is especially egregious because it discourages women and minority psychiatrists to establish practices because they think they don't have the appropriate qualification and/or are afraid of the "business aspects". Generally speaking, in this country, starting a private practice is extremely easy in psychiatry. If you take insurance, you'll fill within a month. But of course, we are talking about different things. You want to make millions "passively" by just sitting there. Obviously it's not possible, and it doesn't matter how much brainstorming and fantasy botox you would like to do. And it doesn't matter if you are a psychiatrist or an internist. You can complain all you want that you didn't win the Powerball, but no one is going to cry a river.

 

[vistaril]

Yes, but they are far less likely to benefit from your not so covertly sexist "advice" to "flirt with the office manager and then offer to buy her drinks" in attempt to "ask some questions about things like their lab contracts." I don't see any reason for any psychiatrist to have to play games in establishing a successful business. Get credentialed. Hire allied professionals. Gather patients. It's not rocket science. Getting some kind of lab contract is NOT part of this.

huh? i think we're talking about different things here. I was pointing out how other specialties(like outpt IM groups) had more revenue streams than us....and lab contracts are a big one. Of course you can establish a successful practice in mh if you do the things you suggest. Just as you can establish one in pretty much area. None of that takes away from my initial point that these passive revenue streams that we don't have are a big deal in other fields....

 

[dl2dp2]

huh? i think we're talking about different things here. I was pointing out how other specialties(like outpt IM groups) had more revenue streams than us....and lab contracts are a big one. Of course you can establish a successful practice in mh if you do the things you suggest. Just as you can establish one in pretty much area. None of that takes away from my initial point that these passive revenue streams that we don't have are a big deal in other fields....

Well okay, what do you want to do about it? Nothing. You just want to whine. And be provocative. Your attitude is really misaligned.

 

[greenlion]

I personally know an OBGYN that quit academia to open up a med spa. Has his MD plastered everywhere meanwhile an RN is the one who actually administers botox. He "developed" some sort of cream too.

*cue the dermatologists yelling about encroachment*

 

[clusterF]

I also know a psychiatrist who hit a nerve while doing botox and got sued/lost.

But med spa/weight loss/smoking cessation in connection with other providers can be useful.
I am trying to do something like that with GI, plastics and and PCP.
Suboxone and sleep are also good ways.

 

[Armadillos]

All of Vistarils theorizing about these additional revenue streams available to IM/FM was probably a lot more relevant 15 (or even 10) years ago, in my area over 50% of the IM/FM practices have been taken over by hospitals and I don't think a single new physician owned general FM/IM practice has started in the last 5 years, despite an explosion of chain "doc in the box" setups and IM/FM practices owned by a hospital group.

 

[shan564]

Well okay, what do you want to do about it? Nothing. You just want to whine. And be provocative. Your attitude is really misaligned.

You've fallen into the vistaril trap. Don't worry, I've done it many times myself too, and I keep doing it again despite knowing when/where it's there. The best thing to do is just ignore everything he says. Especially when the ignorance of the post speaks for itself. I sometimes reply when he says something that almost sounds correct, since there's a risk of people actually believing it... in those situations, I find that it's best to abort the discussion when he says something ridiculous.

 

[d2305]

Suboxone pays well, and the patients show up every month.

 

[Atom bum]

Suboxone pays well, and the patients show up every month.

It just requires the low price of your immortal soul.
No big deal.

 

[clusterF]

Suboxone is a very helpful medication. Where's the beef?

 

[Atom bum]

Well...Living in an area of the country where everyone and their mom is on suboxones...I have a few problems with it.
1. This naloxone malarkey. The stuff is injected more than it is used as it should be.
2. Any type of doctor can get a license to rx. Down the street is a clinic run by an ob/gyn.
3. Is it any better than methadone? Methadone sure is cheaper. Every. Single. Patient. I saw in the clinic was on Medicaid. We might as well pay for the cheaper drug.
4. It's a cash cow, see point number two. Docs open sub clinics to make cash. 300 bucks a month for the visit, then the patient gets free meds. You have repeat clientele that are addicted to your service, literally. The ob with a clinic has some wishy washy group "counseling" that really doesn't take much effort and sure as **** isn't helping anyone.
5. It's a cash cow for diversionists as well. The free meds are split in half. Sell half and take the other. They can easily make back the 300 and then some all while getting free opiates.
6. Ask a patient trying to quit and they will tell you suboxone is tougher to quit than any other opiate. If course this is anecdotal, but all the patients I saw on subs said this to be true.

Of course some people are getting help, and some clinics are legit. Don't expect this cash cow to last forever.

 

[Armadillos]

1. This naloxone malarkey. The stuff is injected more than it is used as it should be.

Huh? Am I reading this wrong?

 

[michaelrack]

3. Is it any better than methadone? Methadone sure is cheaper. Every. Single. Patient. I saw in the clinic was on Medicaid. We might as well pay for the cheaper drug.
.

Good point. However, there are a lot or restrictions on the prescription of methadone

 

[Atom bum]

Huh? Am I reading this wrong?

Sorry it was poorly worded. I'm just saying people inject suboxone all the time despite the manufacturers claims that the added naloxone discourages this.

 

[Indodo]

Why would you shoot up suboxone with that half life?

 

[vistaril]

Well...Living in an area of the country where everyone and their mom is on suboxones...I have a few problems with it.
1. This naloxone malarkey. The stuff is injected more than it is used as it should be.
2. Any type of doctor can get a license to rx. Down the street is a clinic run by an ob/gyn.
3. Is it any better than methadone? Methadone sure is cheaper. Every. Single. Patient. I saw in the clinic was on Medicaid. We might as well pay for the cheaper drug.
4. It's a cash cow, see point number two. Docs open sub clinics to make cash. 300 bucks a month for the visit, then the patient gets free meds. You have repeat clientele that are addicted to your service, literally. The ob with a clinic has some wishy washy group "counseling" that really doesn't take much effort and sure as **** isn't helping anyone.
5. It's a cash cow for diversionists as well. The free meds are split in half. Sell half and take the other. They can easily make back the 300 and then some all while getting free opiates.
6. Ask a patient trying to quit and they will tell you suboxone is tougher to quit than any other opiate. If course this is anecdotal, but all the patients I saw on subs said this to be true.

Of course some people are getting help, and some clinics are legit. Don't expect this cash cow to last forever.

I agree with a lot of this, but I don't think it's common to get $300 cash per followup visit. Hell, I know I disagree with others in here on the revenue potential in fields like outpt IM, but if it were really possible to easily get 300 bucks cash for suboxone followup visits, then more internists and such would be doing it.

Here the market is a mix between people who take insurance(and just bill it is a followup visit like any other to insurance) and those that are cash. Bt the cash places are usually between 75 and 130 dollars for followups(more for intakes). The difference in the cash places and insurance places is that the insurance/Medicaid places are usually full and the insurance places don't allow the pt to be on other controlled substances(stims and Xanax really) whereas most of the cash places have to

 

[Atom bum]

I agree with a lot of this, but I don't think it's common to get $300 cash per followup visit. Hell, I know I disagree with others in here on the revenue potential in fields like outpt IM, but if it were really possible to easily get 300 bucks cash for suboxone followup visits, then more internists and such would be doing it.

Here the market is a mix between people who take insurance(and just bill it is a followup visit like any other to insurance) and those that are cash. Bt the cash places are usually between 75 and 130 dollars for followups(more for intakes). The difference in the cash places and insurance places is that the insurance/Medicaid places are usually full and the insurance places don't allow the pt to be on other controlled substances(stims and Xanax really) whereas most of the cash places have to

The cash only place here, where I was for a few days, is 300$ per visit. It is the only clinic in this particular town and everyone knows how easy it is to get suboxone from it, so it stays busy. The psychiatrist has over 100 patients that make monthly visits to see his hired therapist. They take monthly drug tests which includes xanax screening.

I really don't think this is going to last. Methadone isn't prescribed because of all the regulations on it despite it being cheaper. Suboxone filled the gap, but soon it will also face lots of regulations and hopefully the cheaper drug will return.
Just my 2 cents. I'm probably wrong.

 

[vistaril]

The cash only place here, where I was for a few days, is 300$ per visit. It is the only clinic in this particular town and everyone knows how easy it is to get suboxone from it, so it stays busy. The psychiatrist has over 100 patients

unless he gets around the cap by prescribing suboxone for pain mgt and not ort, he can't do this because 100 is the cap.

I also don't know what kind of 'town' only has 1 suboxone provider/clinic. I'm not exactly living in a metropolis now, and we have 40+ easy in the area. I know of very small towns an hour or so from here who have 3-5.....

 

[dl2dp2]

1. This naloxone malarkey. The stuff is injected more than it is used as it should be.
2. Any type of doctor can get a license to rx. Down the street is a clinic run by an ob/gyn.
3. Is it any better than methadone? Methadone sure is cheaper. Every. Single. Patient. I saw in the clinic was on Medicaid. We might as well pay for the cheaper drug.
4. It's a cash cow, see point number two. Docs open sub clinics to make cash. 300 bucks a month for the visit, then the patient gets free meds. You have repeat clientele that are addicted to your service, literally. The ob with a clinic has some wishy washy group "counseling" that really doesn't take much effort and sure as **** isn't helping anyone.
5. It's a cash cow for diversionists as well. The free meds are split in half. Sell half and take the other. They can easily make back the 300 and then some all while getting free opiates.
6. Ask a patient trying to quit and they will tell you suboxone is tougher to quit than any other opiate. If course this is anecdotal, but all the patients I saw on subs said this to be true.

There is not that much money to be made treating Medicaid patients, even if you are trying to run a mill like that. From a public health perspective, suboxone is very clearly superior to continued use of shorter acting opiates, primarily because of decreased risk of overdose and HIV infections. Large scale trials showed that suboxone is easier to discontinue than opiates, but you are right anecdotally it can also be difficult to ween in some patients. The relative benefit of methadone vs. buprenorphin is an area of active research.

For Medicaid patients, the primary goal is harm reduction. Diversion of bup is IMHO vastly better than being trapped in a cycle with shorter acting opiates.

Again, if you REALLY are gun-ho about getting passive income (read: getting wealthy without work) in psychiatry, treating Medicaid patients is not going to get you there. Private insurance reimbursements for psychiatry and psychology are very similar to Medicare rates, and Medicare rates are public data. Check it out.

http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Check 99213, 99214 with add on codes 90833 90836

Then check the psychology codes
90832 90834

Median salary for psychologist 2012 $69,280 per year
Median salary for psychiatrist 2012 $182600 per year
Do some calculations on how much you'd make if you run a large group. Yeah. That's how. Case closed.

 

[vistaril]

Check 99213, 99214 with add on codes 90833 90836

Then check the psychology codes
90832 90834

Median salary for psychologist 2012 $69,280 per year
Median salary for psychiatrist 2012 $182600 per year
Do some calculations on how much you'd make if you run a large group. Yeah. That's how. Case closed.

there are already large groups that see lots of medicaid/are patients for those codes....they are called local community mental centers and they are hardly the pictures of wealth creation.....that's why they usually have to be subsidized as well. Oh, and they are bundle billing as well for extra revenue(something you coudlnt do in another setting).

If seeing a bunch of medicaid psych patients in an outpt setting was so profitable, outpt psychiatrists would gladly accept it.

 

[F0nzie]

Also need to factor in no shows. If I have an addict scheduled at 8am there is a 90% chance I will be listening to pandora.