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Podiatrist working in nursing home salary

Discussion in 'Podiatric Residents & Physicians' started by bigstar21, 04.10.11.

  1. bigstar21

    bigstar21

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    Just curious but what is the starting salary of a podiatrist working JUST in a nursing home right after 3 year residency? I couldn't find a thread that really answers it. Thanks!
  2. dtrack22

    dtrack22

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  3. PADPM

    PADPM

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    I believe that there is the slightest possibility that dtrack22 is being sarcastic with his salary quote. Otherwise, I know of a lot of DPM's in private practice who would stop performing surgery and stop worrying about office overhead and start going to nursing homes to chip and clip!

    There aren't that many nursing homes that employ podiatrists. Most facilities simply either have a contract or a handshake to allow a group or several competing podiatrists to provide care for their patients. The majority of these facilities simply allow the doctor(s) to come to the facility on a scheduled basis and provide care and bill for their services independently. You provide service, you bill for your service.

    There are some facilities that will pay a doctor a set fee to come on a regular basis and the doctor comes to the facility and treats patients during those visits and the facility bills for the services. I have personally never encountered one of these types of facilities.

    I do know of one very large adult community that actually employs a DPM who has an office at the facility and must be available 40 hours +/_ weekly. The DPM provides care to nursing home patients at the facility, assisted living patients, rehab patients, independent living patients, etc. I believe the salary is around $100,000 for this particular facility.

    Recenctly, there have been advertisements in some of the podiatric journals for DPM's for hire by some "super-groups" who provide care for nursing home type facilities in several states. They contract with these facilities and provide podiatric services for dozens or hundreds of these facilities across several states. Their ads say that they hire part time and full time (they are hiring you, not the nursing home) and that full time docs can make up to $225,000. Some of the ads say that they supply a car, equipment, an assistant, etc. That seems like a very generous salary for this type of work, considering there are very few big ticket items you can bill.

    We interviewed a potential associate who looked into this for possible employment, and he told us that he was expected to see between 40-50 patients daily at these facilities and they were very aggressive with billing and ancillary services provided such as pushing vascular testing, ultrasound, etc.

    But to get back to your original question, I know of very few nursing home type facilities that actually "hire" a DPM on salary. The vast majority simply allow you to come to the facility, treat patients and bill for your services. There are companies you can work for that provide services to multiple facilities, and these companies WILL hire you for a salary.

    Please note that in the past I have been hired to review medical records for insurance fraud, and by FAR, the highest amount of fraudulent billing was generated by nursing home visits. So if you end up providing care at these facilities on your own or for another company, don't overlook the fact that your salary doesn't justify fraudulent billing.
    Last edited: 08.10.11
  4. 347932

    347932

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    Everything PADPM said.

    Also, you collect more for the same service by providing the service in your office, since the insurances don't consider that you have "overhead" if you're providing care in a facility.

    For example:
    In the office setting I get about $12 for "routine foot care" per patient.
    In the nursing home setting I get about $7 for "routine foot care" per patient.

    A 2nd level office visit pays about $60.
    A 2nd level nursing home "office" visit pays about $30.

    I would venture to say that MOST of my nursing home patients are "routine foot care" patients with the odd ulcer care and ingrown toenail/partial nail avulsion thrown in.
  5. dtrack22

    dtrack22

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    So a visit to a nursing home with routine foot care provided would gross $37 (give or take a few bucks) per patient?
  6. 347932

    347932

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    Nope. You can only charge visits for new patients, if there is something OTHER than nail care you're seeing the patient for, which requires a new order, OR once a year, Medicare allows an office visit as a "re-evaluation".

    So really, for your regular nail care patients you see every 2 and a half months, you're getting $7.
  7. 347932

    347932

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    Just as a total aside, nursing home care is really a labor of love. It's a necessary public service that makes me warm and fuzzy inside, since even though I don't get paid much to see these patients, they REALLY need it. Especially when you see the odd patient that has a horrible ulcer and you save a limb by alerting the staff to it's presence and also helping in the care of it.

    The bonus too is that if you're office is close by and the staff like you, chances are you will end up seeing the staff and their families in your office before long. Also, even when times are slow in your office (which they will be), the nursing home patients are guaranteed income. Maybe not a lot of income (depending on how many facilities you cover), but it is there and won't go anywhere.
  8. PADPM

    PADPM

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    I'm afraid that if this is how Kidsfeet is billing, he may have short-changed himself a significant amount of money over the years. I will also preface the fact that our office does a few nursing homes and follows the rules VERY closely and "plays by the rules".

    Let me clarify.

    When treating nursing home (or any office patient) for palliative care, there are several codes that are billable and here they are;

    11719 which is essentially the trimming of healthy, non dystrophic/non mycotic nails. This pays between $12-19 depending on locality.


    11720 which is the debridement of mycotic nails up to 5 nails. This can be approximately $24

    11721 which is the debridement of 6 or more mycotic nails. This pays in the range of $34


    11055 which is the trimming of a keratotic lesion. This pays in the range of $20 (I may be wrong)


    11056 is the trimming of 2-4 keratotic lesions. I believe this pays in the $40 range.

    11057 is the trimming of greater than 4 keratotic lesions. I believe this pays over $45.

    Now is when it gets tricky. You can bill several of these together WHEN appropriate;

    You can bill the following scenarios;

    11719 and 11720 together

    11719 and 11720 with ONE of the following 11055, 11056 or 11057

    11721 by itself

    11721 with ONE of the following 11055, 11056 or 11057

    You can NOT bill 11719 with 11721 and can NOT bill 11720 with 11721.


    Additionally, for the majority of these codes the patient must meet the guidelines of "class findings" such as decreased or absent pulses, decreased or absent hair growth, trophic skin changes, edema, temperature changes, etc., and must have a qualifying systemic condition such as PVD, diabetes, etc.

    So, as you can see, IF a patient has one or two mycotic nails and a callus or two, your LEGITIMATE billing for that patient is substantially greater than $7.

    And I believe it's safe to say that there are very few geriatric patients in these facilities who have 10 perfect toenails without some form of pathology/mycosis. Our office was even performing cultures to CYA on these cases to justify the billing.

    I'm afraid either Kidsfeet has underbilled and passed on a significant amount of money, or his patient population has greatly beaten the statistics by having perfect nails on every patient!!
  9. 347932

    347932

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    Wow...looks like I need to hit the books! Thanks for the info PADPM. Always learning on this site.
  10. Foot Doc

    Foot Doc

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    Those numbers had me checking medicare reimbursement as well.......I was hoping he was wrong. What a slap in the face to get paid $7 for medical care. Thats the gubment for ya'
  11. PADPM

    PADPM

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    Our practice does not dedicate a lot of time to nursing home care (maybe about 5-9 total man hours a week in a large multi-doctor practice), but we certainly would not spend any time in these facilities if our average reimbursement was 7 bucks per patient. At that rate I would rather provide gratis care to those really at need.
  12. podpal

    podpal

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    Many plans are paying a little under $6 per pt for repeat visits. Some plans are paying a little under $12 per pt for repeat visits. A small number of plans pay over $20 per pt per repeat visit.

    One would need to be independently wealthy or win lotto to be able to afford to do this job long term.
  13. PADPM

    PADPM

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    First of all, what is the definition of a repeat visit. I've been involved in this profession for a long time, and there is NO code for a repeat visit.

    You are supposed to code for whatever service(s) you provide. If you are there as a repeat visit to follow up for an ulcer, and that involves a debridement of the ulceration(s), you are expected to bill the new ulcer debridement code and of course document accordingly, including the size and characteristics of the ulcerations(s), type of debridement, instrument used to debridement, type of medication applied, type of dressing(s) applied, just to name a few things, as well as the follow up care.

    If you are there to provide repeat palliative are for a patient who qualifies due to a systemic disease such as diabetes/peripheral vascular disease, etc., and who also meets the class findings, most insurance carriers will pay for these services every 61 days. You are expected to bill the appropriate "nail" codes and/or trimming of keratotic lesion codes as explained in a prior post.

    You are NOT expected to bill a visit code at the same time as one of the above, unless you have provided a separately identifiable service for another problem.

    If you are treating a patient for a repeat visit to follow up for an infection, tinea pedis, etc., then you would simply be a "visit" code, and would bill the appropriate code according to the amount of time spent with the patient, the amount of decision making and how much was in your documentation, etc.

    But there is no "repeat" visit code.

    If you are treating nursing home patients and consistently getting reimbursed $6, $12, etc., and/or are billing for visit codes often, you are doing something wrong and need to take a course in proper billing.

    Believe me, I know of NO ONE who would waste their time for those fees unless they were independently wealthy and providing services out of the kindness of their hearts.

    As I stated before, if I was getting reimbursed those fees, I would rather provide gratis care to those really in need.

    Once again, I've read many of your posts and have read how you make no money, etc., etc., and this may be just one of the contributing reasons. Most of our nursing homes are serviced by subcontractors or associates for our office, and we would not be able to pay them if that's what they were billing. We don't tell them how to bill, but we do watch to make sure what they do is "kosher" and legal. If you have any questions regarding billing, PM me and maybe I can teach you how to earn a little more income legitimately. It appears you need help.
    .
  14. podpal

    podpal

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    To clarify for you. Repeat visit = nail care.

    Thanks for the offer. I may be looking for work at some point.
  15. PADPM

    PADPM

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    If you are/were receiving those low figures for your palliative care services, you may want to read one of my prior posts to explain why those figures are not consistent with what our practice or any practice I'm aware of receives.

    If you read the APMA news or other journals that have recently been advertising for DPM positions for nursing home work, they are offering relatively generous salaries and benefits. I'm confident that they couldn't offer those numbers if they were receiving the reimbursements you've mentioned.
  16. ramonfernandez

    ramonfernandez

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    True...

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