am i missing something to this RVU model?

[finalpsychyear]

I am close to signing a rvu based part time job through a local hospital which has no psych services. Now the hospital will pay me the same rate (64 per rvu) regardless of insurance. They are expecting that I see around 20 ish outpatients a day and that i bill 99213+90833 for the vast majority. The two days a week I will be doing this my hrs will be 8-6 so i can spend 20-25 min per patient. They also would like that i do some consults in the ER or inpt floor which i am ok with and everything is again based on the RVU model.

Once things get rolling, seeing 20 pts with low level therapy add on is 2.5 rvu x40 pts a week I think conservatively this comes out to 100 Rvus per week even if therapy isn't with everyone given the consults should push it close to that.

6400 per week for this 2 day gig... am i missing something that sounds like it is too good? I know hospital gets facility fees of course.

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[dl2dp2]

I think the issue is that you expect to fill 20 per day jam packed immediately, and they may not be able to for a while. But otherwise the numbers all sound about right. You won't gross 300k, but something 200-250k 1099 for 2 very heavy days of work is fairly typical in the community.

 

[nexus73]

I'm surprised the hospital wants you to bill psycho therapy codes.

 

[st2205]

I'm surprised the hospital wants you to bill psycho therapy codes.

Why wouldn't they? There's a big difference between employer not wanting you to do hour long therapy appointments and doing 90833 add ons to E&M visits.

 

[wolfvgang22]

Yeah, 99213 + 90833 is more RVUs than 99214 and takes the same amount of time and effort from where I'm sitting.

 

[finalpsychyear]

I think the issue is that you expect to fill 20 per day jam packed immediately, and they may not be able to for a while. But otherwise the numbers all sound about right. You won't gross 300k, but something 200-250k 1099 for 2 very heavy days of work is fairly typical in the community.

I filled my 2 day a week private practice in a few months without medicaid but I'm from the area so maybe that is why. The hospital has a dozen or so outpatient PCP's I know and their admin was saying a lot of them have signs in their waiting room saying they are not even prescribing SSRI meds. If i am taking some medicaid with the hospital based practice, I can't see a 2 day a week clinic not full in what 6 months being very conservative?

Also, my goal for the first year is to hit 200k which since I'll be doing some consults I feel is realistic hopefully even though the first 2-3 months may not be that busy.

I just think that is mad generating 200k for 2 days and it is W-2. Guess I will see what the reality is once i sign the dotted line and actually start.

 

[perox123]

Those will be very long 2 days. Personally I wouldn't be able to do that. Floor and ER consults could be quite unpredictable with regards to number and timing and I'm not sure how are you planning to incorporate this into full two days of outpatient practice. Wish you all the best!

 

[dl2dp2]

I filled my 2 day a week private practice in a few months without medicaid but I'm from the area so maybe that is why. The hospital has a dozen or so outpatient PCP's I know and their admin was saying a lot of them have signs in their waiting room saying they are not even prescribing SSRI meds. If i am taking some medicaid with the hospital based practice, I can't see a 2 day a week clinic not full in what 6 months being very conservative?

Also, my goal for the first year is to hit 200k which since I'll be doing some consults I feel is realistic hopefully even though the first 2-3 months may not be that busy.

I just think that is mad generating 200k for 2 days and it is W-2. Guess I will see what the reality is once i sign the dotted line and actually start.

I think your expectations are pretty realistic. Maybe not 300k in the first year...but it's feasible. I know of city hospitals in desirable areas paying $180 an hour for straight clinic coverage, so if you work 12 hour days for two days that's 200k right there. And that's 100% Medicaid. HMOs are paying 300k salaried. 3-6 months fill with commercial insurance should be NO problem anywhere in the country. In big markets, I'm starting to hear very entrepreneurial people filling CASH *general* (i.e. not child or some other subspecialty) half time practice in 6 months--don't know if your PP is cash or not...

Your problem is that you are *working too hard* lol. two days PP PLUS two 10-12 hour days in the clinic?! Psychiatry is a LIFESTYLE specialty. Please... don't ruin our reputation. What are you trying to buy a mansion or something? Is that a Tesla you are driving to work?

 

[finalpsychyear]

I think your expectations are pretty realistic. Maybe not 300k in the first year...but it's feasible. I know of city hospitals in desirable areas paying $180 an hour for straight clinic coverage, so if you work 12 hour days for two days that's 200k right there. And that's 100% Medicaid. HMOs are paying 300k salaried. 3-6 months fill with commercial insurance should be NO problem anywhere in the country. In big markets, I'm starting to hear very entrepreneurial people filling CASH *general* (i.e. not child or some other subspecialty) half time practice in 6 months--don't know if your PP is cash or not...

Your problem is that you are *working too hard* lol. two days PP PLUS two 10-12 hour days in the clinic?! Psychiatry is a LIFESTYLE specialty. Please... don't ruin our reputation. What are you trying to buy a mansion or something? Is that a Tesla you are driving to work?

Lol. Got loans to pay and working hard while I'm young just makes sense to me. Besides who knows 5-10 years what the landscape of medicine is. Plus 2 x 10 hour days plus the PP comes out to 33 ish hours. Im in PP (insurance based) and i work two 6-7 hr days without breaks which lets me sleep in and leave early.

I had a mentor who said under the right set up and efficiency, you should be making about 100k for each full day of work you do. This is gross mind you. This comes out to generating about 2k per clinic day.

 

[PistolPete]

I think your expectations are pretty realistic. Maybe not 300k in the first year...but it's feasible. I know of city hospitals in desirable areas paying $180 an hour for straight clinic coverage, so if you work 12 hour days for two days that's 200k right there. And that's 100% Medicaid. HMOs are paying 300k salaried. 3-6 months fill with commercial insurance should be NO problem anywhere in the country. In big markets, I'm starting to hear very entrepreneurial people filling CASH *general* (i.e. not child or some other subspecialty) half time practice in 6 months--don't know if your PP is cash or not...

Your problem is that you are *working too hard* lol. two days PP PLUS two 10-12 hour days in the clinic?! Psychiatry is a LIFESTYLE specialty. Please... don't ruin our reputation. What are you trying to buy a mansion or something? Is that a Tesla you are driving to work?

Which big markets, NYC? LA?

 

[Blitz2006]

I think the issue is that you expect to fill 20 per day jam packed immediately, and they may not be able to for a while. But otherwise the numbers all sound about right. You won't gross 300k, but something 200-250k 1099 for 2 very heavy days of work is fairly typical in the community.

What if the OP double books a few patients, and assumes a 25% cancellation rate. Easily hit 20 pts then right?

6400 x 48 weeks = 307k.

Is this realistic?

 

[splik]

double booking patients that dont exist is not going to help!

 

[dl2dp2]

Which big markets, NYC? LA?

Turns out, you are right for both! At the moment it's not very hard to make 300k, especially 1099, in either markets working 40-60 hours a week at a FACILITY driven job--there are "ongoing needs"--as long as you are not academic or extremely specific on location (oh I just HAVE to work at Cedar Sinai...no you do not). Now these are not "great jobs"...busy, sick people, etc. but you aren't working harder than a general internist in the same treatment setting, I can say that for sure.

What if the OP double books a few patients, and assumes a 25% cancellation rate. Easily hit 20 pts then right?

6400 x 48 weeks = 307k.

Is this realistic?

I don't know if it's "realistic". I know people who do it...usually in a clinic context. I know it's NOT realistic FOR ME. I can't live that life. lol. Tesla or not. I just can't.

 

[Merely]

Wait so if OP is making 200k for two days work at hospital then making 200k for two days work in his PP, does this mean he's making pretax around 400k for about 35-40 hours of work a week?

 

[finalpsychyear]

Wait so if OP is making 200k for two days work at hospital then making 200k for two days work in his PP, does this mean he's making pretax around 400k for about 35-40 hours of work a week?

No, the hours would be closer to 50-55 and i wouldn't make that amount for a few years theoretically speaking. Also add another 5 hours for admin work to that number for my PP. Unless you do insurance based PP no one has any idea how much time it really takes for pre auths, denials, etc.

 

[Jules A]

Also add another 5 hours for admin work to that number for my PP. Unless you do insurance based PP no one has any idea how much time it really takes for pre auths, denials, etc.

Nor do I want to know which is why we pay a secretary $20 an hour to do the admin stuff.