LTAC privileges, anyone?

[DrBodacious]

In my community hospital, there is a separate "hospital within a hospital" that is sort of a combo inpatient rehab and LTAC facility. It takes up a wing on 2 floors of the hospital. A lot of what they do is vent weaning. They have approached me to apply for privileges at the facility. Another ENT doctor in town does have privileges there.

They kind of gave me a sob story about how they really need more help to manage their trachs. I am almost certainly going to get consulted for trachs and trach complications, neither of which I particularly want.

This is a private, for-profit, hospital, and they don't have any kind of call stipend they are offering me. (They did say that it wouldn't cost me any yearly fee to have privileges there (yay!).) I would think if they want someone to cover the trachs and trach decannulations, they should be prepared to fork up some doh.

They also gave me a line on how it would be great to have continuity of care for the patients I do trachs on in the big hospital who end up in the LTAC. Frankly, rounding for 4-5 days on the postop trach is good enough for me for continuity of care. If the patient needs an LTAC after that(for their head bleed or end stage COPD, etc), I appreciate the fact that someone else gets to pick up any daily trach managment from there.

Does anyone else have privileges at an LTAC? If so, do you get a call stipend or some other reimbursement? Am I a heartless bastard for not wanting to spend my time running in to the LTAC in the middle of the night to help with a trach decannulation on a 400 pound pickwickian patient?

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[OtoHNS]

That sounds miserable. I wouldn't do it unless they paid a hefty stipend.

 

[Pir8DeacDoc]

I try and limit the number of trachs I do. I'm a jerk maybe, but the general surgeons are in the hospital all the time and rounding on people. I am in my office on the other side of town and try and limit my inpatient duties. I've done a handful in my time here over the last year. I'm happy to help on the super fat patient or revision trach or whatever. But a straight ahead trach, I'm more than happy to let the general surgeons have that work. I'd say before they rope you in to that mess, they'd need to pay you. The fee you get for doing the procedure isn't worth the pain.

 

[DrBodacious]

Thanks for the comments, OtoHNS and Pir8DeacDoc. One of the biggest problems with inpatient care for me is that the documentation required to support coding is a pain. I guess I am just whining about documentation requirements, but I hugely prefer my clinic routine to scrounging up a level 3 H&P and documenting it just to get paid for putting someone's trach back in.

If anyone has any knowledge of stipends that are offered from such facilities, please share. Frankly, I can't even think of a number that would make it worth while, though.

 

[resxn]

I do probably 90% of the trachs at my main hospital. I don't want the general surgeons doing them, but my office is literally 30 steps from the hopsital so it's not a big deal. However, I would NOT get privileges at LTAC. There's almost zero money in a trach change. There is some if you do a flexible scope on them at the same time, but will they have a scope for you or will you need to bring your own. It's 100% not worth the rounding dollars to round on them all day. It's also 100% not worth the time to document to go through a decannulation protocol. It's also 100% not worth your time for the accidental decannulation that will be happening there. You'll get called for every mucus plug, bloody sputum, pain, ache, or anything to do with the trach. Even at zero global days following a trach, I don't think this is worth it at all without getting paid.

You are not an heartless MD for not doing it. They are heartless for not providing revenue. What'll you do when you sign up, get no pay, and then all of sudden they get bundled payments and the LTAC admin says, "yeah, thanks for your help, but we think we're only going to pay you $20 for a visit" instead of the $60 you were making. Oh and don't forget how many trachs you do for free for the non-insured. You want to clean a trach that the nurses call you about at 0200 for free?

Blah. Medicine is a business now more than ever and it's only getting worse. Any physician who still practices as though it's not will summarily be screwed.