Future practice, business style

[azumzz]

Hey everyone, I am interested in psych and was wondering what you think about the business goal I have. Disclaimer: it is super duper underdeveloped but I just want to know if my idea is feasible.

I'm hoping that after psych residency (maybe a little later in case i feel like i need more experience), I can start my own private practice as a sole proprietor.

Now here is ther part I am not sure about: After I have gained the necessary experience, saved enough for a bigger office, and have many people calling for my services, I also want to employ or contract independent psychologists or LSCW's so that they can provide therapy to the patients I help with medications. If anyone has had any experience with this set-up, can you please tell us about what you thought, and the pro's and con's?

Thanks

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[midweststudent1]

Hey everyone, I am interested in psych and was wondering what you think about the business goal I have. Disclaimer: it is super duper underdeveloped but I just want to know if my idea is feasible.

I'm hoping that after psych residency (maybe a little later in case i feel like i need more experience), I can start my own private practice as a sole proprietor.

Now here is ther part I am not sure about: After I have gained the necessary experience, saved enough for a bigger office, and have many people calling for my services, I also want to employ or contract independent psychologists or LSCW's so that they can provide therapy to the patients I help with medications. If anyone has had any experience with this set-up, can you please tell us about what you thought, and the pro's and con's?

Thanks

Just google psychiatrists in all the big cities...this is done all over the place. In a small town near where I'm from there's one psychiatrist and like 10 "psych NP's". It's terrifying, but true. He also has LSCWs and psychologists and I be the gets a cut from the billing from every single person in thAt place ...since it's a fairly rural area, he's also peoples only option.......$$$$$

 

[Shikima]

Be sure there are psychologists on staff to conduct neuropsych testing too.

 

[vistaril]

Hey everyone, I am interested in psych and was wondering what you think about the business goal I have. Disclaimer: it is super duper underdeveloped but I just want to know if my idea is feasible.

I'm hoping that after psych residency (maybe a little later in case i feel like i need more experience), I can start my own private practice as a sole proprietor.

Now here is ther part I am not sure about: After I have gained the necessary experience, saved enough for a bigger office, and have many people calling for my services, I also want to employ or contract independent psychologists or LSCW's so that they can provide therapy to the patients I help with medications. If anyone has had any experience with this set-up, can you please tell us about what you thought, and the pro's and con's?

Thanks

this is fairly common, and sometimes works the other way too(a therapist or group of therapists can own a MH practice and employ the psychiatrist). In these situations it is often more advantageous to be the employee, depending on what your goals are and the setting.

That said, I think a lot of people on here drastically overstate how much more profitable bringing in lcsws and lpcs and such to the practice can be. it's often done more to meet a need of the practice(and enable you to serve as a better practice to refer to) than any sort of income expanding tool. because think about it- if you bring these people on as salaried you are exposing yourself to a ton of expense and risk- expense that you may not make up and break even on. And if you eliminate that and put them on as ICs where their compensation is tied to their collections(very common), they are going to get a good portion of their collections to the point that you are essentially just using 'your percent cut' to defray some of the overhead(and some of that overhead they are going to be adding to anyways with their presence).

A model where the therapists, psychologists, psychiatrists, etc all bill individually and yet all share in the expenses of the practice is probably the most favorable one for most psychs in outpt settings. A model where the psychiatrist collects all the lpcs collections as their own but also assumes all the overhead *and* slots them into a salaried role with benefits and all the tax consequences as a result is probably the least favorable one in most situations.

 

[vistaril]

Be sure there are psychologists on staff to conduct neuropsych testing too.

?? the vast majority of small outpt practices don't have psychologists on staff to conduct neuropsych testing- simply because it isn't any more expensive to just refer it out to a group in town that does neuropsych testing. it's not like you cant get NP testing if you don't do it in house.

 

[F0nzie]

Hiring people...*shudder*

 

[OldPsychDoc]

Hiring people...*shudder*

Does open a whole new can o' worms, doesn't it?

 

[erg923]

Be sure there are psychologists on staff to conduct neuropsych testing too.

I am a psychologist, and even I have to say that this seems quite unnecessary for an average outpatient psychiatric practice. Unless your focus is on geriatric psychiatry or neuropsychiatry, what would be the rationale here? This does not seem cost effective vs referring out either.

Psychological testing by a staff psychologist would likely be quite useful (but certainly not even close to every case) for occasional psychiatric differential diagnosis, personality pathology, ID/MR or LD concerns, treatment planning, etc. But none of that requires a neuropsychologist/neuropsychological evaluation.

 

[Shikima]

I am a psychologist, and even I have to say that this seems quite unnecessary for an average outpatient psychiatric practice. Unless your focus is on geriatric psychiatry or neuropsychiatry, what would be the rationale here? This does not seem cost effective vs referring out either.

Psychological testing by a staff psychologist would likely be quite useful (but certainly not even close to every case) for occasional psychiatric differential diagnosis, personality pathology, ID/MR or LD concerns, treatment planning, etc. But none of that requires a neuropsychologist/neuropsychological evaluation.

Speaking from my personal viewpoint, I've noticed I get a lot of referrals for geriatric but also ADHD symptoms. NeuroPsych testing is an extensive process which is helpful in eliciting differences prior to blindly prescribing medications.

The reason I suggest having it available is that the billing can be quite lucrative if one is interested in private practice, much like hiring midlevels as they can create revenue for you directly.

 

[erg923]

Speaking from my personal viewpoint, I've noticed I get a lot of referrals for geriatric but also ADHD symptoms. NeuroPsych testing is an extensive process which is helpful in eliciting differences prior to blindly prescribing medications.

The reason I suggest having it available is that the billing can be quite lucrative if one is interested in private practice, much like hiring midlevels as they can create revenue for you directly.

Re: ADHD

Attention tests are very important for discovering what a person can and cannot do. However, for purely diagnostic purposes, cognitive tests of attention should at most play a very limited role, perhaps nudging a diagnostic decision one way or the other in cases that are on the threshold of that diagnosis.

Lets talk empirically: Individuals with ADHD, on average, tend to score slightly lower on tests of working memory, processing speed, and verbal fluency than on tests of visual–spatial reasoning, fluid reasoning, and crystallized intelligence. However, most people with ADHD do NOT have this particular profile and most people with this profile do not have ADHD. In the end, a diagnosis of ADHD cannot be ruled in by any particular cognitive profile, nor can any particular cognitive profile rule it out. Although it is possible for researchers to learn quite a bit about ADHD from small-to-modest mean differences in test performance, attention tests do not improve individual diagnostic accuracy very much and thus are generally not clinically indicated.

I have poured over this research for a large insurance company (as as consultant) for several years now. Thus, one could plausibility view my opinion as "biased." I would encourage a review of the peer reviewed literature in this area. Reasonable persons can disagree, I understand. There are complex differentials where this is called for, no doubt. I do not feel this is common scenario, however

 

[xlithiumx]

Re: ADHD

Attention tests are very important for discovering what a person can and cannot do. However, for purely diagnostic purposes, cognitive tests of attention should at most play a very limited role, perhaps nudging a diagnostic decision one way or the other in cases that are on the threshold of that diagnosis.

Individual with ADHD, on average, tend to score slightly lower on tests of working memory, processing speed, and verbal fluency than on tests of visual–spatial reasoning, fluid reasoning, and crystallized intelligence. However, most people with ADHD do not have this particular profile and most people with this profile do not have ADHD. In the end, a diagnosis of ADHD cannot be ruled in by any particular cognitive profile, nor can any particular cognitive profile rule it out. Although it is possible for researchers to learn quite a bit about ADHD from small-to-modest mean differences in test performance, attention tests do not improve individual diagnostic accuracy very much and thus are generally not clinically indicated.

This!! ADHD remains a clinical diagnosis. Testing can be a useful hurdle to screen out drug seekers who may not be willing to jump through the hoops. Otherwise, ADHD testing is of limited clinical utility.

 

[vistaril]

Speaking from my personal viewpoint, I've noticed I get a lot of referrals for geriatric but also ADHD symptoms. NeuroPsych testing is an extensive process which is helpful in eliciting differences prior to blindly prescribing medications.

The reason I suggest having it available is that the billing can be quite lucrative if one is interested in private practice, much like hiring midlevels as they can create revenue for you directly.

Of course there is revenue to be generated, but unless you are such a MASSIVE practice that you are going to have a psychologist skilled in this to do it on salary(which is going to cost a ton), you aren't going to be keeping most of the money(vs them being in contract) Our psychology colleagues actually expect to keep most of the dollars for something that they do exclusively, just as we do when we work on contract for groups owned by other types of providers(lcsw or psychology owned groups)

And I don't disagree that there are indications for np testing. ADHD is almost never one of them IMO.

 

[Shikima]

Thus the crux of my message has been glossed over quite readily. It was a statement on business acumen to lend support for those considering private practice as it is a business after all; not a free clinic.

 

[vistaril]

Thus the crux of my message has been glossed over quite readily. It was a statement on business acumen to lend support for those considering private practice as it is a business after all; not a free clinic.

Yes, and part of business acumen is trying to run a psych practice as lean as possible. Ask erg what he would work for if he were to be on salary- I bet it's not cheap after everything is considered.

 

[Shikima]

Yes, and part of business acumen is trying to run a psych practice as lean as possible. Ask erg what he would work for if he were to be on salary- I bet it's not cheap after everything is considered.

Erg is on salary at the VA. Beyond that I'll let him speak for himself and I make no assumptions.

 

[vistaril]

Erg is on salary at the VA. Beyond that I'll let him speak for himself and I make no assumptions.

Since he is on salary at the va(and gs guides are public info), no assumption is needed. His salary before all the goodies are considered is probably between 8o-115k depending on what stage of his career he's in. Now add all those goodies in(subsidized defined benefit retirement, subsidized good health insurance, subsided disability, etc) and then add all the employer expenses beyond that(employer taxes for ex) and that's a pretty decent idea of what it would cost to start to consider bringing erg on salary for a private practice. Iow, even much more than that 80-115k.

So yeah it would be nice to have access to all that np money. But it would be even nicer to not have an incredibly expensive salaried employee on the books and just refer out to a local group.

 

[Shikima]

Since he is on salary at the va(and gs guides are public info), no assumption is needed. His salary before all the goodies are considered is probably between 8o-115k depending on what stage of his career he's in. Now add all those goodies in(subsidized defined benefit retirement, subsidized good health insurance, subsided disability, etc) and then add all the employer expenses beyond that(employer taxes for ex) and that's a pretty decent idea of what it would cost to start to consider bringing erg on salary for a private practice. Iow, even much more than that 80-115k.

So yeah it would be nice to have access to all that np money. But it would be even nicer to not have an incredibly expensive salaried employee on the books and just refer out to a local group.

Your business chi is far too strong. Keep on truckin' with your current employment. You've got it all figured out!

 

[vistaril]

Your business chi is far too strong. Keep on truckin' with your current employment. You've got it all figured out!

No need to be sarcastic and dismissive- my overall point is that margins in psych tend to be pretty close to what the inidividual providers are going to generate after expenses(in a decently run clinic).

Iirc you work at the va, which is obviously not bound by this reality(amd that's not a bad thing- it is what it is....but it's a fair statement that the va mh depts would obviously not be a model that would survive in the real world)

 

[erg923]

Dr. Erg requires relocation assistance, sign on bonus, productivity bonus, and catered luches every Friday.

Neuropsychology clinics within hospitaks are not typically known for producing much revenue. They do, but its not much. I do not understand how an average and relatively small psychiatric practice could keep a neuropsychologist busy full time. It's just not indicated that much on that population. Half time contractor or refer out.

 

[Shikima]

Dr. Erg requires relocation assistance, sign on bonus, productivity bonus, and catered luches every Friday.

Neuropsychology clinics within hospitaks are not typically known for producing much revenue. They do, but its not much. I do not understand how an average and relatively small psychiatric practice could keep a neuropsychologist busy full time. It's just not indicated that much on that population. Half time contractor or refer out.

The testing in a private practice settings is typically fit into the schedule in addition to talk therapy - this is how it presents in my minds' eye. For example, testing is done Wednesday morning only or some other silly similar schedule. But in of itself isn't lending towards practice of doing the service, rather offering the service in the community which also will draw referrals for other reasons. Particularly if you produce a quality product.

The large picture of private practice is, all revenue generated is revenue generated as overhead costs in Psychiatry are relatively static (Offices in a building, Billing/Collections, etc). The same philosophy can be said for having midlevels on staff along with LPCs/SWs. Could also include IOP into the picture for revenue generation. No one product or service line will the dominating revenue generator rather the cumulative effects from all contributing.

And for Vistaril, I have been in private practice for the past 1.5 years and also work at the VA.

 

[erg923]

The testing in a private practice settings is typically fit into the schedule in addition to talk therapy - this is how it presents in my minds' eye. For example, testing is done Wednesday morning only or some other silly similar schedule. But in of itself isn't lending towards practice of doing the service, rather offering the service in the community which also will draw referrals for other reasons. Particularly if you produce a quality product.

The large picture of private practice is, all revenue generated is revenue generated as overhead costs in Psychiatry are relatively static (Offices in a building, Billing/Collections, etc). The same philosophy can be said for having midlevels on staff along with LPCs/SWs. Could also include IOP into the picture for revenue generation. No one product or service line will the dominating revenue generator rather the cumulative effects from all contributing.

And for Vistaril, I have been in private practice for the past 1.5 years and also work at the VA.

Most neuropsychologists have little interest in therapy. Thats why they are neuropsychologists....

 

[whopper]

I've had a lot of experience with this type of thing. Odds are there will be SEVERAL other mental health providers begging for a psychiatrist.

The problem won't be finding other providers outside of psychiatry to work with you. The problem will be working with others that are compatible with you. I worked at a place where the majority were psychologists and counselors. Their usual patient was a guy who didn't like his boss and needed to whine about it to a therapist.

Fine. Nothing wrong with that. But when I had the suicidal patient, they didn't know what to do and would overreact or under-react to the situation. They didn't know how to handle such patients and thought we could handle things we couldn't or referred to me completely BS cases.

Just as an example, one of the local hospitals discharged patients way too early that were still suicidal and this office I was at, in an attempt to get more patients, took up all of these horror-wreck cases from the hospital. We were just a private office with no case manager. Private practice IMHO should not be dealing with most patients with a GAF below 50. Those patients should've either not been discharged or discharged to a partial-program. I told the office manager this and he didn't get it.

 

[PistolPete]

Whopper, how do you suggest to "weed out" these types of MFT's/psychologists that can't work with you? You can only gather so much from an interview.

 

[F0nzie]

Whopper, how do you suggest to "weed out" these types of MFT's/psychologists that can't work with you? You can only gather so much from an interview.

After 1.5 years of pp and meeting other psychologists in the community, I finally found the right psychologist for our practice. She is a new grad, has a great personality, and knows her evidenced based therapies. Finding her was like finding a pot of gold at the end of the rainbow. We make our own coin and she makes her own coin. Nothing is shared other than referrals.

 

[smalltownpsych]

Whopper, how do you suggest to "weed out" these types of MFT's/psychologists that can't work with you? You can only gather so much from an interview.

Past history is the best predictor of future behavior. Therefore, I look really carefully at the types of training experience in the CV. That tells me if they took the easy road or the more severe cases. Especially important, IMO, is inpatient experience. If they haven't seen some of the more severe cases, then they will be more likely to not know how to handle them. For example, many of the the MA level therapists in the community will send every patient who cuts to the ER for us to evaluate. On the one hand I am fine with that because it gives me the opportunity to conduct a solid risk assessment and provide a higher level of care when necessary, on the other hand many of these patients could easily be managed on an outpatient basis using a modicum of DBT knowledge. In any event, when I was hiring therapists, I avoided any that had too much "soft" experience and that worked out well most of the time.

 

[PistolPete]

Got it, thanks smalltownpsych.

 

[PistolPete]

After 1.5 years of pp and meeting other psychologists in the community, I finally found the right psychologist for our practice. She is a new grad, has a great personality, and knows her evidenced based therapies. Finding her was like finding a pot of gold at the end of the rainbow. We make our own coin and she makes her own coin. Nothing is shared other than referrals.

Sounds like the best mix: both essentially practice independently, although perhaps under the same roof and refer to each other.

 

[smalltownpsych]

After 1.5 years of pp and meeting other psychologists in the community, I finally found the right psychologist for our practice. She is a new grad, has a great personality, and knows her evidenced based therapies. Finding her was like finding a pot of gold at the end of the rainbow. We make our own coin and she makes her own coin. Nothing is shared other than referrals.

I hope that you share info about concurrent patients. That is another benefit of having a shared office space is the chance to coordinate care or from a more negative stance to share the burden of particularly difficult cases.

 

[F0nzie]

I hope that you share info about concurrent patients. That is another benefit of having a shared office space is the chance to coordinate care or from a more negative stance to share the burden of particularly difficult cases.

Yes we do. Definitely a plus.

 

[whopper]

Whopper, how do you suggest to "weed out" these types of MFT's/psychologists that can't work with you? You can only gather so much from an interview.

There really isn't a good way to do it.

Here's what I told my office. 1-Do not advertise to take up patients from hospitals where they've developed a rep for discharging too early. Some units will not discharge too early. You will have to figure this out on your own because every locality will differ. 2-If you do take up patients from a hospital, aside that there should be some trust with the social workers there that they are giving you an appropriate patient, you can personally talk to them or given them a specific criteria list. 3-Specifically tell the unit's social worker if you get an inappropriate referral you will likely not take any more of their patients.

Here's a list I recommended the office to use. They of course blew me off.
1-We will not see the patient immediately after discharge (Several dump jobs they tried to get them to immediately see me, thus setting up a defensive practice of "we didn't see the guy last" if there was a bad outcome
2-The patient must be free from indicators of dangerous behavior for X amount of days
3-Patient should be able to communicate with the doctor in a coherent manner
4-Do not take anyone that's in need of acute and emergency care. Ask upfront what the main problem is from the patient that they want treated and how severe it is. When a person calls to schedule a new appointment, the receptionist should openly state, "If you are suicidal you need to go the hospital now and do not schedule an appointment with us at this time. We likely will not be able to provide the suitable level of care needed."

Most referrals you will get from a psychologist or other mental health provider won't be horror cases in an acute emergency sense because they usually aren't seeing a psychologist for treatment first. It's really getting them fresh from a hospital where I've seen the worst cases.

If you've worked inpatient before, you know then that most insurance companies and Mediare/Medicaid will tell a unit they will stop paying for the patient's stay at a specific time even if the patient is in need of further treatment. Some places will discharge the patient right after the payment stops even if the patient still needs treatment. Don't take up these types of patients. You will be taking a dangerously hot potato that you touched last.

 

[PistolPete]

There really isn't a good way to do it.

Here's what I told my office. 1-Do not advertise to take up patients from hospitals where they've developed a rep for discharging too early. Some units will not discharge too early. You will have to figure this out on your own because every locality will differ. 2-If you do take up patients from a hospital, aside that there should be some trust with the social workers there that they are giving you an appropriate patient, you can personally talk to them or given them a specific criteria list. 3-Specifically tell the unit's social worker if you get an inappropriate referral you will likely not take any more of their patients.

Here's a list I recommended the office to use. They of course blew me off.
1-We will not see the patient immediately after discharge (Several dump jobs they tried to get them to immediately see me, thus setting up a defensive practice of "we didn't see the guy last" if there was a bad outcome
2-The patient must be free from indicators of dangerous behavior for X amount of days
3-Patient should be able to communicate with the doctor in a coherent manner
4-Do not take anyone that's in need of acute and emergency care. Ask upfront what the main problem is from the patient that they want treated and how severe Tis. When a person calls to schedule a new appointment, the receptionist should openly state, "If you are suicidal you need to go the hospital now and do not schedule an appointment with us at this time. We likely will not be able to provide the suitable level of care needed."

Most referrals you will get from a psychologist or other mental health provider won't be horror cases in an acute emergency sense because they usually aren't seeing a psychologist for treatment first. Tis really getting them fresh from a hospital where I've seen the worst cases.

If you've worked inpatient before, you know then that most insurance companies and Mediare/Medicaid will tell a unit they will stop paying for the patient's stay at a specific time even if the patient is in need of further treatment. Some places will discharge the patient right after the payment stops even if the patient still needs treatment. Don't take up these types of patients. You will be taking a dangerously hot potato that you touched last.

Thanks so much!

 

[jettavr6]

Here's what I told my office. 1-Do not advertise to take up patients from hospitals where they've developed a rep for discharging too early. Some units will not discharge too early. You will have to figure this out on your own because every locality will differ. 2-If you do take up patients from a hospital, aside that there should be some trust with the social workers there that they are giving you an appropriate patient, you can personally talk to them or given them a specific criteria list. 3-Specifically tell the unit's social worker if you get an inappropriate referral you will likely not take any more of their patients.

Here's a list I recommended the office to use. They of course blew me off.
1-We will not see the patient immediately after discharge (Several dump jobs they tried to get them to immediately see me, thus setting up a defensive practice of "we didn't see the guy last" if there was a bad outcome
2-The patient must be free from indicators of dangerous behavior for X amount of days
3-Patient should be able to communicate with the doctor in a coherent manner
4-Do not take anyone that's in need of acute and emergency care. Ask upfront what the main problem is from the patient that they want treated and how severe it is. When a person calls to schedule a new appointment, the receptionist should openly state, "If you are suicidal you need to go the hospital now and do not schedule an appointment with us at this time. We likely will not be able to provide the suitable level of care needed."

This is excellent!

 

[Shikima]

There really isn't a good way to do it.

Here's what I told my office. 1-Do not advertise to take up patients from hospitals where they've developed a rep for discharging too early. Some units will not discharge too early. You will have to figure this out on your own because every locality will differ. 2-If you do take up patients from a hospital, aside that there should be some trust with the social workers there that they are giving you an appropriate patient, you can personally talk to them or given them a specific criteria list. 3-Specifically tell the unit's social worker if you get an inappropriate referral you will likely not take any more of their patients.

Here's a list I recommended the office to use. They of course blew me off.
1-We will not see the patient immediately after discharge (Several dump jobs they tried to get them to immediately see me, thus setting up a defensive practice of "we didn't see the guy last" if there was a bad outcome
2-The patient must be free from indicators of dangerous behavior for X amount of days
3-Patient should be able to communicate with the doctor in a coherent manner
4-Do not take anyone that's in need of acute and emergency care. Ask upfront what the main problem is from the patient that they want treated and how severe it is. When a person calls to schedule a new appointment, the receptionist should openly state, "If you are suicidal you need to go the hospital now and do not schedule an appointment with us at this time. We likely will not be able to provide the suitable level of care needed."

Most referrals you will get from a psychologist or other mental health provider won't be horror cases in an acute emergency sense because they usually aren't seeing a psychologist for treatment first. It's really getting them fresh from a hospital where I've seen the worst cases.

If you've worked inpatient before, you know then that most insurance companies and Mediare/Medicaid will tell a unit they will stop paying for the patient's stay at a specific time even if the patient is in need of further treatment. Some places will discharge the patient right after the payment stops even if the patient still needs treatment. Don't take up these types of patients. You will be taking a dangerously hot potato that you touched last.

I'm going to take this post up with my partners at the next meeting we have to address similar issues. Excellent insight and you've managed to articulate it well.

 

[Indodo]

Hiring people...*shudder*

What is the big deal?
Many psychiatrists hire support staff like billers, secretaries etc.
Why is hiring another psychiatrist/therapist/midlevel that much different.

 

[F0nzie]

What is the big deal?
Many psychiatrists hire support staff like billers, secretaries etc.
Why is hiring another psychiatrist/therapist/midlevel that much different.

Never tried. Maybe I should when I have more time on my hands. Help stimulate the economy.

 

[clusterF]

In California, with some government exceptions, only physicians can hire other physicians. Hospitals have tried very hard to get this overturned. I think it is the one of the few things that has kept CA physicians salaries competitive.

 

[Leo Aquarius]

Wait, I thought hospitals hire physicians too. Isn't that how hospitals exist?

 

[brainmedicine]

can Neuropsychiatrist do Neuropsych testing or neuropsychologists only? Is it a good pay from the insurance?

 

[Shikima]

Wait, I thought hospitals hire physicians too. Isn't that how hospitals exist?

I'm supposing in CA that there is some physician health organization associated in tandem with the hospital corporation which does the hiring.

 

[erg923]

can Neuropsychiatrist do Neuropsych testing or neuropsychologists only? Is it a good pay from the insurance?

It's not a standard part of any residency or medical fellowship that I know of, so, ethically, no. That said, a circus clown can bill 96118 and get paid. Doesn't mean he knew what he was doing.

 

[Mad Jack]

Wait, I thought hospitals hire physicians too. Isn't that how hospitals exist?

Usually there is an affiliated physician group that does the hiring, in my experience. Few physicians are employed by hospitals in my area directly, but a great number of them work for medical groups that are owned by the hospital in all but name.

 

[Indodo]

http://www.healthleadersmedia.com/c...nia-Hospitals-Fight-for-Right-to-Hire-Doctors

 

[Leo Aquarius]

So when an anesthesiologist tells me (as one did recently) "The hospital cut my income 10% this year", that cut was done by business people not physicians most likely right? I mean it's the hospital administrators who hire and manage physician incomes? I'm digressing...

 

[Therapist4Chnge]

Neuropsychology clinics within hospitaks are not typically known for producing much revenue. They do, but its not much. I do not understand how an average and relatively small psychiatric practice could keep a neuropsychologist busy full time. It's just not indicated that much on that population. Half time contractor or refer out.

1. The hospitals that actually focus on neuropsych billing (e.g. getting pre-auth, trying to get a decent payor mix and actually get paid for some cases, etc) and not just RVUs...they can do okay. If they are part of a speciality Memory Clinic or similar, then they can do higher volume work.

2. As for how psychiatric referrals will make it work...that is a harder sell. I guess it can happen, but it is probably easier to do w. peds or geriatrics...but that scenario is very difficult (for billing and just day to day stuff).

FWIW...I don't take referrals from any outside psychiatrists and I only accept a referral from one of our psychiatrists if I talk w. the referring physician first and think that it is an appropriate referral. I have a good rapport with most of them and we don't dump patients on each other, so usually when they call me it is a good referral.