Inpatient private practice?

[Sea Otter]

If you were doing private practice inpatient rehab at an ARF, how many patients would you expect to see daily? I only have experienced the academic side through residency. I’m sure as you get more efficient you could see more patients but, in general, what would you expect? And is there a number that would feel like too many patients (due to either time or just work burden)? Thanks for your thoughts!

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[PMR2008]

25-30 for the busy/efficient docs. 15-20 is probably average+consults.

 

[RangerBob]

25-30 for the busy/efficient docs. 15-20 is probably average+consults.

25-30? Really? I’d be working ridiculous days. But I’d be making it rain with that many patients/day. That would bring in well over half a million in patient billings

 

[PMR2008]

I know at least 3 docs who work through the encompass health system formerly known as HealthSouth that see that many patients a day. I personally could not see that many acute patients a day.

 

[Piebaldi]

I know at least 3 docs who work through the encompass health system formerly known as HealthSouth that see that many patients a day. I personally could not see that many acute patients a day.

I agree with this. I have seen 20-21 and that was an exhausting day in terms of acute rehab, particularly with meetings, etc. For SNF yes upper 20's/30 is more doable.

 

[PMR2018]

Residents at my program cover 18 usually... and this is at a model systems program with mostly high cord patients on the SCI services and cranis/DOC on the TBI services. I could see how after becoming more efficient it would be possible as an attending to see 25 on a daily basis.

 

[Piebaldi]

Residents at my program cover 18 usually... and this is at a model systems program with mostly high cord patients on the SCI services and cranis/DOC on the TBI services. I could see how after becoming more efficient it would be possible as an attending to see 25 on a daily basis.

That's not the typical in residency, and no, it's not easy or normal to cover 25 acute inpatients on a daily basis - if you want to keep your hair and sanity.

 

[RangerBob]

18/day in residency is an awe fully high number. You can’t get any reasonable teaching in with that volume.

18 patients/day is a pretty healthy number as an attending. The docs in SF and LA (as independent contractors) are averaging $100-$120 per patient per day. 18 patients gets you $430k in patient collections per year if you work no weekends and take 4 weeks vacation.

That doesn’t even include director stipends, which can get into six digits.

If you’re already making that much, I dont personally see much reason to see more patients. Patient care and or my sanity would certainly suffer.

 

[PMR2018]

18/day in residency is an awe fully high number. You can’t get any reasonable teaching in with that volume.

¯\_(ツ)_/¯

 

[Ogliodendrocyte]

18/day in residency is an awe fully high number. You can’t get any reasonable teaching in with that volume.

18 patients/day is a pretty healthy number as an attending. The docs in SF and LA (as independent contractors) are averaging $100-$120 per patient per day. 18 patients gets you $430k in patient collections per year if you work no weekends and take 4 weeks vacation.

That doesn’t even include director stipends, which can get into six digits.

If you’re already making that much, I dont personally see much reason to see more patients. Patient care and or my sanity would certainly suffer.

Billing a progress note is 100-120$?? How does that work? Just genuinely curious where I could find that. And I'm glad people are saying 18/residency is unusual because I generally am at 10-12

 

[j4pac]

Residents at my program cover 18 usually... and this is at a model systems program with mostly high cord patients on the SCI services and cranis/DOC on the TBI services. I could see how after becoming more efficient it would be possible as an attending to see 25 on a daily basis.

Do you want to live like a high volume resident all your life? Some people live for that...but it’s important to know yourself

 

[RangerBob]

Billing a progress note is 100-120$?? How does that work? Just genuinely curious where I could find that. And I'm glad people are saying 18/residency is unusual because I generally am at 10-12

Progress notes (follow up visits) usually pay $70-$100–if they’re Medicare/private insurance. Medicaid much less. And those rates assume they pay their copay.

The average number I quoted averages everything together-admits, discharges, progress notes (of which quite a few can be level 3–especially if you’re taking time to counsel patients, team meeting days, etc), as well as state Medicaid and non-paying patients. Plus billing for ancillary services, when appropriate, like end of life discussions/advance directives, tobacco cessation, home health care certification, etc.

I’m not sure of great places to look up reimbursement-it varies by location. Where I work reimbursed less than SF or LA. My billers negotiate rates with private payers. Medicare says “this is what we’ll pay you.” As does Medicaid.

Of course, your billers usually charge a percentage of collections. So even if you averaged $100/patient/day, it might be closer to $92-$95 after their fee. Still, it sure beats what I got paid as a janitor.

 

[RangerBob]

¯\_(ツ)_/¯

Yeah, not much you can do about it. It’s rough.

On the upside, you’ll probably feel like being an attending and managing a full service isn’t all that bad. Your life would likely be better if you’re at a 14 bed unit.

 

[lejeunesage]

If you were doing private practice inpatient rehab at an ARF, how many patients would you expect to see daily? I only have experienced the academic side through residency. I’m sure as you get more efficient you could see more patients but, in general, what would you expect? And is there a number that would feel like too many patients (due to either time or just work burden)? Thanks for your thoughts!

I see 15 to 20 patients on average.
In residency, I saw about 12. And that's how many I saw when I first started after residency.
I remember interviewing at Indiana and learning that they saw 18. I politely smiled and thought: "nope!"
Today, 18 is my ideal. But I don't do any consults or clinic, and I don't have to staff with an attending.

Is there a number that's too many? Definitely.
I will very occasionally see 22 patients. But I don't like doing more than 20.
But it depends on who you are. Do you feel like you are providing adequate care to your patients?
Do you feel like you have an adequate work-life balance?

If I saw 12 patients, today, I'd basically be working 4-5 hours every day. I'd have more time to sleep, exercise, and devote to other intellectual pursuits. But I'd also earn a lot less.
I consider 15 to be a normal census. I'm not overworked. I still have time to do other stuff. I can start at 9 and be done by 3 or 3:30. And Team conferences don't make me want to shoot myself in the face.
At 18 patients, I'm busy. It's doable, but I'm starting to sacrifice work-life balance for money. These days, this might take me anywhere from 6 to 9 hours of work, depending on how many admissions I have, whether there are complications, and whether it's a team conference day.
At 20 and above patients, I start not being sure who my patients are. I have to constantly refresh my memory about what a few of them are there for. I don't like that. And team conference blows.

My advice is to start with 10-12 in your first couple of months and see how it goes. If you think you can handle a bit more, go to 12-14 and sit there for another couple of months. After about 6 months to a year, you'll have a better sense of what your ideal census is.

 

[Animi]

How much control do you have over your census? Guessing it might depend on your employer, but was wondering if there was a model in which you could. Thank you.

 

[PMR’s chill]

In the private world all of this will depend on the organization that manages the ARU and your internal medicine coverage. If the Organization that manages the ARU knows what their doing and you have solid internal medicine coverage you can see 15 patients and a handful of consults in a half day with no problem. If you don’t have those in place life will be hell.

 

[lejeunesage]

How much control do you have over your census? Guessing it might depend on your employer, but was wondering if there was a model in which you could. Thank you.

Plenty, especially if you're an independent contractor. Just make sure you let them know what your cap is from the get go. I would do this during the interview. Whether it's 12 or 15 or 18, let them know what you feel comfortable with.