8 patients an hour?

Started by vistaril
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vistaril

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this isn't possible is it? Had a recruiter contact for me one purely outpt med mgt in a group of ~6 that pays well with 40 hrs a week and no call, but she said the practice expects is going to expect me to see followups on the average of 7-8 per hour? She states that have social workers that have already asked some of the key questions and gone over mood symptom/SI/AVH charts already with the pts, but still....8 an hour is 7.5 minutes per pt.....I'm fast, but I don't know if I am that fast.
 
With social work help I've seen an emergency psych doc bust thru 3-4 evals per hour, so I'm sure it's possible. The assembly line type of work would wear on you though wouldn't it? Is this group owned by a psychiatrist?

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If a patient had a bad outcome, I'm not sure that you could defend yourself by saying that you relied on what they said to the social worker instead of personally evaluating the patient. This
kind of setup sounds like it's asking for trouble to me.
 
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vistaril said:
this isn't possible is it? Had a recruiter contact for me one purely outpt med mgt in a group of ~6 that pays well with 40 hrs a week and no call, but she said the practice expects is going to expect me to see followups on the average of 7-8 per hour? She states that have social workers that have already asked some of the key questions and gone over mood symptom/SI/AVH charts already with the pts, but still....8 an hour is 7.5 minutes per pt.....I'm fast, but I don't know if I am that fast.
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I'd pass. That's TOO fast. I think 4/hr is a good, safe pace. 6/hr is probably the maximum any reasonable provider should go. More than 6 (10 min per pt) and I don't care who you are, you're probably sacrificing patient care.
 
That is really only possible if everything is working perfectly, with probably sub-optimal care. Insert just ONE crappy social worker, a patient in crisis (that didn't tell the social worker), and your whole day is shot.

I did coverage of a private hospital for a little bit on weekends previously, seeing 30-40 patients a day, essentially cross-coverage (brief check-in, "babysitting"), and that was tough. I was exhausted by the end of the weekend. In your scenario, 8pts/hr x 8 hours/day = 64 pt's/day. Recipe for burnout, apathy, and malpractice IMO. Especially if trying to do that 5d/week.
 
Oh, anything is possible. As someone told me, Pfizer them all and let God sort them out.
 
Our current billing codes are structured around actual face-to-face time with patients with the exception of 90862 which will be replaced by E/M codes:

The one specific we are able to provide about the changes is that code 90862, pharmacologic management, will no longer exist in 2013. Even now, it is appropriate to use a medical evaluation and management (E/M) code (i.e., 99212 or 99213) in place of 90862.)
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http://www.psych.org/practice/manag...reimbursement/changes-to-psychiatry-cpt-codes

As some of you know, E/M codes are not based on face-to-face time, but rather "complexity" which to me is still an elusive term. The two codes replacing 90862 are reimbursed at different rates: 99212 reimburses about $10-$20 less and 99213 reimburses about $10-$20 more (depending on your region). Hypothetically, if you were getting $40 per patient using 99212 and seeing 4 patients an hour you would bring in $160/hr. Account for 80% collections (no shows, insurance drops) and 40% in overhead, you're only making $76 an hour (which is not accounting for administrative time). Alternatively, if you were getting $70 per pt using 99213, you would be making significantly more at $134 per hour after collections and overhead. Double these two hourly rates if you were seeing 8 patients an hour and subtract the overhead for the 2 social workers.

IMHO all of this grind sucks and I could care less which codes will be replacing 90862. I don't want to feel like a factory worker on an assembly line. I am hoping reimbursements will change for the standard 20-30 minute med check/brief therapy and 45-50 minute med check/therapy to accurately reflect how our profession should be practicing. Until then, I will be holding off on the private practice dream or at least until more of my debt is paid off.
 
F0nzie said:
Our current billing codes are structured around actual face-to-face time with patients with the exception of 90862 which will be replaced by E/M codes:

http://www.psych.org/practice/manag...reimbursement/changes-to-psychiatry-cpt-codes

As some of you know, E/M codes are not based on face-to-face time, but rather "complexity" which to me is still an elusive term. The two codes replacing 90862 are reimbursed at different rates: 99212 reimburses about $10-$20 less and 99213 reimburses about $10-$20 more (depending on your region). Hypothetically, if you were getting $40 per patient using 99212 and seeing 4 patients an hour you would bring in $160/hr. Account for 80% collections (no shows, insurance drops) and 40% in overhead, you're only making $76 an hour (which is not accounting for administrative time). Alternatively, if you were getting $70 per pt using 99213, you would be making significantly more at $134 per hour after collections and overhead. Double these two hourly rates if you were seeing 8 patients an hour and subtract the overhead for the 2 social workers.

IMHO all of this grind sucks and I could care less which codes will be replacing 90862. I don't want to feel like a factory worker on an assembly line. I am hoping reimbursements will change for the standard 20-30 minute med check/brief therapy and 45-50 minute med check/therapy to accurately reflect how our profession should be practicing. Until then, I will be holding off on the private practice dream or at least until more of my debt is paid off.
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A typical psychiatry practice using E/M codes would likely bill predominately 99213 with occasional 99214's. That is what I bill in my sleep medicine practice.
 
The only way I'd be willing to dramatically cut time based on another person's evaluation was if that person had very very very good clinical judgment.

I've seen plenty of social workers with that judgment, I've seen plenty without. You only figure these things out after you've worked with them for at least a few weeks.

And even with such a great coworker, I'd still not cut it down to 8 an hour.

Only way I'd see people for such short periods of time if I already knew the patient well and they were stabilized, and then just wanted a refill.
 
michaelrack said:
A typical psychiatry practice using E/M codes would likely bill predominately 99213 with occasional 99214's. That is what I bill in my sleep medicine practice.
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👍

Learn how to document properly and you should easily be billing for 99213s even for the easiest patients. Personally since med management is how I'd like to end up practicing with minimal therapy I like this change. I do agree though that this will continue to encourage psychiatrists to move away from therapy unless they can get a pure cash clientele. So sort of bad news for people who are more interested in that portion of psych.
 
So, Vistaril... med check $50 X 8 = $400/hr.. So you would be bringing the practice $400 per hour, how much of that are you going to be seeing? If 4 patients per hour usually gets people about $125 in contract work, is your per hour pay going to be in the $200-250 range?
 
F0nzie said:
Our current billing codes are structured around actual face-to-face time with patients with the exception of 90862 which will be replaced by E/M codes:

http://www.psych.org/practice/manag...reimbursement/changes-to-psychiatry-cpt-codes

As some of you know, E/M codes are not based on face-to-face time, but rather "complexity" which to me is still an elusive term. The two codes replacing 90862 are reimbursed at different rates: 99212 reimburses about $10-$20 less and 99213 reimburses about $10-$20 more (depending on your region). Hypothetically, if you were getting $40 per patient using 99212 and seeing 4 patients an hour you would bring in $160/hr. Account for 80% collections (no shows, insurance drops) and 40% in overhead, you're only making $76 an hour (which is not accounting for administrative time). Alternatively, if you were getting $70 per pt using 99213, you would be making significantly more at $134 per hour after collections and overhead. Double these two hourly rates if you were seeing 8 patients an hour and subtract the overhead for the 2 social workers.

IMHO all of this grind sucks and I could care less which codes will be replacing 90862. I don't want to feel like a factory worker on an assembly line. I am hoping reimbursements will change for the standard 20-30 minute med check/brief therapy and 45-50 minute med check/therapy to accurately reflect how our profession should be practicing. Until then, I will be holding off on the private practice dream or at least until more of my debt is paid off.
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ummm....there will likely be changes in the future and they will likely be geared towards even more grinding......it's reality. If you want to make less money and not do the grind, thats cool too
 
BS81 said:
So, Vistaril... med check $50 X 8 = $400/hr.. So you would be bringing the practice $400 per hour, how much of that are you going to be seeing? If 4 patients per hour usually gets people about $125 in contract work, is your per hour pay going to be in the $200-250 range?
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we didnt talk specifics of money....
 
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As far as PP with therapy goes (if you're going the insurance route), check out the reimbursement rates for 90805, 90807, and 90809. Not Awful (90807 pulls about 105 here) for a 45-50 minute therapy and med appt. If you run a bare minimum practice, and theoretically charge something about what you're being reimbursed (I don't take insurance so I'm not certain that's legal), then there's already plenty of other codes that're usable.

On the flip side I could see an easy and rational argument for using 99214 for complex therapy and med cases on a regular basis.
 
vistaril said:
ummm....there will likely be changes in the future and they will likely be geared towards even more grinding......it's reality. If you want to make less money and not do the grind, thats cool too
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So I am under the impression that we will have to do more work to make comparable pay? I don't know what it used to be like old school: see one patient then=see 8 pts now in terms of reimbursement? THAT'S what I signed up for! I HATE cramming patient after patient and cramming note after note. I don't want to work like that. Its not fun. At ALL. In fact I LOATH(E) this. Psych isn't supposed to BE like that. I dont want to see more than3 pts max in an hour EVER! In an 8 hr day that's still 24 notes! ARRRRGH!!Who are these *******s that are ruining medicine?! Can't they be stopped? At least until I retire!? Waaah!
 
toothless rufus said:
So I am under the impression that we will have to do more work to make comparable pay? I don't know what it used to be like old school: see one patient then=see 8 pts now in terms of reimbursement? THAT'S what I signed up for! I HATE cramming patient after patient and cramming note after note. I don't want to work like that. Its not fun. At ALL. In fact I LOATH(E) this. Psych isn't supposed to BE like that. I dont want to see more than3 pts max in an hour EVER! In an 8 hr day that's still 24 notes! ARRRRGH!!Who are these *******s that are ruining medicine?! Can't they be stopped? At least until I retire!? Waaah!
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Whatever situation vistaril is getting himself into, it is not typical.
For example, our (large non-profit multi-specialty) group allows one to make a decent living seeing 3 revisiting pts/hour and 1 hour, well-supported intakes in a collegial environment. It's not a setting for someone who wants to be a entrepreneur or capitalistic robber baron, but it is a model of sustainable integrated care that others in the country would do well to emulate. (And that's just outpatient--reimbursement is substantially better in our inpatient world...)
Fear not, Toothless One. Though we cannot all be as amazing as dr. hydroxyzine, others among us WILL make a decent living, gain the respect of our patients and colleagues, and be able to respect ourselves when we look in the mirror the next morning.
 
toothless rufus said:
So I am under the impression that we will have to do more work to make comparable pay? I don't know what it used to be like old school: see one patient then=see 8 pts now in terms of reimbursement? THAT'S what I signed up for! I HATE cramming patient after patient and cramming note after note. I don't want to work like that. Its not fun. At ALL. In fact I LOATH(E) this. Psych isn't supposed to BE like that. I dont want to see more than3 pts max in an hour EVER! In an 8 hr day that's still 24 notes! ARRRRGH!!Who are these *******s that are ruining medicine?! Can't they be stopped? At least until I retire!? Waaah!
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well, if you are only scheduling 24 patients a day, you can probably makle a living doing that.....but it's not going to be a great one. You could get a job for a comm mental health center on salary and do that if you wanted....
 
vistaril said:
well, if you are only scheduling 24 patients a day, you can probably makle a living doing that.....but it's not going to be a great one. You could get a job for a comm mental health center on salary and do that if you wanted....
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Hydroxyzine's idea of "a living" is quite a bit different from most people's.

24 patients * $80 * 5 days a week * 48 weeks a year * .8 to remove 20% for collections and no shows * .7 to remove 30% for office overhead = $258,000 before taxes.

I'd call that a pretty darn good living. And those are conservative numbers. In my area, a mix of 99213 and 99214 would average closer to $90/hr not 80. And, you could do better than 30% overhead or take less than 4 weeks of vacation a year.

Either way...you can make a decent living seeing 24 patients a day in psych. Maybe not ortho numbers, but better than the 99%.
 
digitlnoize said:
Hydroxyzine's idea of "a living" is quite a bit different from most people's.

24 patients * $80 * 5 days a week * 48 weeks a year * .8 to remove 20% for collections and no shows * .7 to remove 30% for office overhead = $258,000 before taxes.

I'd call that a pretty darn good living. And those are conservative numbers. In my area, a mix of 99213 and 99214 would average closer to $90/hr not 80. And, you could do better than 30% overhead or take less than 4 weeks of vacation a year.

Either way...you can make a decent living seeing 24 patients a day in psych. Maybe not ortho numbers, but better than the 99%.
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It's a decent living, but only better than 98%.
 
all the $$$ talk aside 27 pt is still a lot in a day.

at least i think so as a pgy 3 who is pretty fast
 
This Vistaril guy would make an excellent career as a doctor of...the stock market (on the other hand maybe not, he could possibly lead it to crash)
 
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That's too many an hour to consistently deliver quality care. It can be done, but it reduces us to "prescription writers". I see that many an hour when I cover for others on call. It's appropriate then, but still not an ideal model for delivering quality care.
 
BC/BS reimburses $111.00 for a 90805 where I live. I schedule 2-3 per hour to account for no shows/late cancellations (which I then charge the patient for) and spend 20-25 minutes per patient.
The time frame defined in the code applies only to the psychotherapy portion of the visit. It doesn't matter how much time is spent on medical management in a given appointment.
It's easy to do supportive therapy while getting necessary information for a med check.
 
Dapplegrey said:
BC/BS reimburses $111.00 for a 90805 where I live. I schedule 2-3 per hour to account for no shows/late cancellations (which I then charge the patient for) and spend 20-25 minutes per patient.
The time frame defined in the code applies only to the psychotherapy portion of the visit.It doesn't matter how much time is spent on medical management in a given appointment.
It's easy to do supportive therapy while getting necessary information for a med check.
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So this change requires a "psychotherapy portion of the visit?" You can't do straight med management anymore? Says who? So annoying. I am constantly amazed how outside forces control what they have no busy being involved in. Is there a resource that adequately explains all this stuff?
 
I'm not yet familiar with 99212/99213, apparently the codes replacing 90862. These are not time codes and you can do 2, 4, 6, or 8 per hour if that's your preference. My point was I prefer the 90805 code, spend the time with a patient, and can still make plenty of money in the process. BC/BS reimburses about $76.00 for a 90862, so yes you can make more money doing only med checks. However, I've never been fired or had a complaint against me by a patient.
 
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