Anyone heard of U.S. Physiatry

[pmrrehabdoc]

Has anyone heard about or worked for U.S. Physiatry, I'm interested in learning what you guys think about them

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[RUOkie]

Has anyone heard about or worked for U.S. Physiatry, I'm interested in learning what you guys think about them

never heard of them, but their website makes it look like they are a SNF management group started by the former leaders at RehabCare who left after RehabCare was purchased by Kindred.

I would assume a similar management style to RehabCare.

but I could easily be wrong.

 

[Xardas]

I have not heard of them but I think the basic idea is this.. 'we can do the same thing at a SNF as we can do at inpt rehab' and you are the physiatrist. You'll do stuff like team rounds etc and see patients. The internist will be responjsible for medical care.

The idea is the PMR sees the rehab stuff and doesn't get bogged down by medical stuff and thus no phone calls for stuff like sleepers, colace etc.

You bill, collect, they get a cut of it. Its a volume based operation and since its a SNF you don't see them every day. I thnk they try and get you to see the patient 3 days a week (the most CMS allows I believe)

The idea works great in theory but there's a few inherent problems

1. You see everybody in the SNF or close to it. Ok you ask, what is the problem? Well, does everyone in the SNF need to see PMR? A lot of the patients I know who go to SNF probably don't need to see a rehab doctor let alone their primary more than once a week. Do you feel comfortable providing charges on someone that may not realy need it?

2. They get a cut. Yes, there is no reason you can't go to your local SNF and set up a relationship with them where you're the consultant.

3. I briefly considered doing this type of gig.. until I asked the question.. how do you get all the consults in place if the medical director (usually geri or IM) isn't there but once or twice a week? His response? 'Oh I write a verbal order in teh chart for all patients saying consult PMR since its an "understanding"!! Sounded pretty shady to me.

Like I said this is a company that I think has a good idea in principle but is using you to collect money for them. There is no reason any physiatrist can't go do this themselves.

 

[PhysiatristDoc]

US Physiatry is an interesting scheme. It is a small corporation that has ties to a huge corporation that acquires nursing homes. What US physiatry will do for you is give you subacute rehab contracts where you can go and be the rehab doc. These are not all state of the art facilities, to put it mildly. Part of the catch is you must use them to do your billing and they charge an astronomical amount for this service, about 3-4 times what is usual. They want you to use your own corporation name, pay for your own malpractice, etc. All they do is help you get the gig and take a percentage. They are having difficulty recruiting.

What do you call that?

 

[AndyDufrane]

US Physiatry is an interesting scheme. It is a small corporation that has ties to a huge corporation that acquires nursing homes. What US physiatry will do for you is give you subacute rehab contracts where you can go and be the rehab doc. These are not all state of the art facilities, to put it mildly. Part of the catch is you must use them to do your billing and they charge an astronomical amount for this service, about 3-4 times what is usual. They want you to use your own corporation name, pay for your own malpractice, etc. All they do is help you get the gig and take a percentage. They are having difficulty recruiting.

What do you call that?

SHADY

 

[pmrrehabdoc]

Odd, I heard they covered all this stuff

 

[Louisville04]

Odd, I heard they covered all this stuff

Make sure you get it in writing before signing up.

 

[Xardas]

Very interesting to hear.. this is a racket, and much worse than what a competitor of theirs asks for..

My personal opinion: SNF's will be getting the hammer soon too. They are accepting patients that are at supevision or mod I levels of function but b/c the family gripes about leaving mom or dad alone at home, they ask for SNF and SNF takes them.

Not too long before this gets stopped imo

 

[pmrrehabdoc]

who are their competitors?

 

[PMR2008]

I have not heard of them but I think the basic idea is this.. 'we can do the same thing at a SNF as we can do at inpt rehab' and you are the physiatrist. You'll do stuff like team rounds etc and see patients. The internist will be responjsible for medical care.

The idea is the PMR sees the rehab stuff and doesn't get bogged down by medical stuff and thus no phone calls for stuff like sleepers, colace etc.

You bill, collect, they get a cut of it. Its a volume based operation and since its a SNF you don't see them every day. I thnk they try and get you to see the patient 3 days a week (the most CMS allows I believe)

You are absolutely correct about all the above. Typically patients are seen once or at most twice a week. In my residency program about half the attendings were rehab directors of subacute facilities. We even had a dedicated "subacute" month and had a subacute unit in our free standing rehab hospital. Patients are never seen 3 days a week because the level of acuity is just not there. But CMS does allow consultants to see patients 3 days a week if needed.

The idea works great in theory but there's a few inherent problems

1. You see everybody in the SNF or close to it. Ok you ask, what is the problem? Well, does everyone in the SNF need to see PMR? A lot of the patients I know who go to SNF probably don't need to see a rehab doctor let alone their primary more than once a week. Do you feel comfortable providing charges on someone that may not realy need it?

Not everyone at the SNF needs to be seen, but all patients getting therapy should be seen. How often is of course up to the discretion of the consultant. You have to justify it with your notes. I strongly believe that every patient getting therapy has issues that needs a rehab consultants input. I work at a subacute facility and I can give you tons of examples of patients who have under treated pain, bowel/bladder issues, untreated neuropathy etc. Patients are barely seen by their primaries and they honestly don't have the time or knowledge to manage some of these complex rehab issues like spasticity, bracing, neuropathy, foot drop etc. In the facility I cover there are patients I will not see for 2 weeks and some I will see twice a week. I discuss patients with the nurses and therapist and see patients on an as needed bases. That is how all my mentors do it and they have been doing it for 15+ years without any problems.

2. They get a cut. Yes, there is no reason you can't go to your local SNF and set up a relationship with them where you're the consultant.

This can be done and has been done for many years. I for one do not like dealing with the admin, billing etc. Yes the company I work for takes a cut but there is never any pressure to increase productivity or see more patients. If any issues with insurance companies, credentialing or admin come up they take care of it. It also gives you the security of being part of a bigger organization. I have seen some solo physiatrist replaced by rehab consultants from these companies. Than again if you do a good job, maintain strong relations with the facility you should have no such issues.

3. I briefly considered doing this type of gig.. until I asked the question.. how do you get all the consults in place if the medical director (usually geri or IM) isn't there but once or twice a week? His response? 'Oh I write a verbal order in teh chart for all patients saying consult PMR since its an "understanding"!! Sounded pretty shady to me.

You can either have a standing order for a patient to be seen by a physiatrist if they are getting therapy or do it on a case by case basis. If physical therapy is having issues with a patient they can ask the PCP to put in a consult.

 

[PMR2008]

Odd, I heard they covered all this stuff

As a disclosure I do not work for U.S. Physiatry but for one there competitors. You can PM me for details. One of my friends from residency did end up joining U.S. Physiatry last year. As far as I know they offered her a salary package which included malpractice, insurance etc. She also had the option to join as an independent contractor where she would have to pay her own malpratice etc. The salary model is offered by all the companies but financially it makes more sense to be an independent contractor.

 

[PMR2008]

Very interesting to hear.. this is a racket, and much worse than what a competitor of theirs asks for..

My personal opinion: SNF's will be getting the hammer soon too. They are accepting patients that are at supevision or mod I levels of function but b/c the family gripes about leaving mom or dad alone at home, they ask for SNF and SNF takes them.

Not too long before this gets stopped imo

I would not call it a racket. Any physiatrist can go to a subacute facility and work as a consultant. What these companies are offering is peace of mind so that you don't have to deal with admin, billing, credentialing among other things. Some of these companies will take a larger cut and offer less support, while other are more hands on. In my opinion It is much easier to become the rehab director of a desirable facility with a high number of subacute beds and high ratio of post op ortho patients when you are part of a company that has a national presence.

SNFs have been under the hammer for the last 10-15 years and about 2% of SNFs close every year. As you are well aware because of the push to get patients discharged earlier inpatient hospital stays will get shorter and shorter. Where do you think these patients will go. On top of that It is becoming increasingly hard to qualify for inpatient rehab stay. Reducing readmission rates is one of the top priorities for hospitals and atleast in my area some medical directors are being asked to see SNF patients atleast once a week. These facilities understand the role of physiatrist in providing quality care and helping reduce readmission rates. The only change that is inevitable is that they will reduce the number of days allowed by medicare from 100 days to a diagnosis specific amount. This should not affect physiatrist. And don't forget that the peak year of baby boomers retirement will be 2023. In my opinion the future of Physiatry in subacute is stable for atleast the next 10 years.

 

[Louisville04]

I would not call it a racket. Any physiatrist can go to a subacute facility and work as a consultant. What these companies are offering is peace of mind so that you don't have to deal with admin, billing, credentialing among other things. Some of these companies will take a larger cut and offer less support, while other are more hands on. In my opinion It is much easier to become the rehab director of a desirable facility with a high number of subacute beds and high ratio of post op ortho patients when you are part of a company that has a national presence.

SNFs have been under the hammer for the last 10-15 years and about 2% of SNFs close every year. As you are well aware because of the push to get patients discharged earlier inpatient hospital stays will get shorter and shorter. Where do you think these patients will go. On top of that It is becoming increasingly hard to qualify for inpatient rehab stay. Reducing readmission rates is one of the top priorities for hospitals and atleast in my area some medical directors are being asked to see SNF patients atleast once a week. These facilities understand the role of physiatrist in providing quality care and helping reduce readmission rates. The only change that is inevitable is that they will reduce the number of days allowed by medicare from 100 days to a diagnosis specific amount. This should not affect physiatrist. And don't forget that the peak year of baby boomers retirement will be 2023. In my opinion the future of Physiatry in subacute is stable for atleast the next 10 years.

What peace of mind do they offer? It is very easy to get credentialed in a SNF. The peace of mind comes from being a consultant and not the admitting physician. You don't have to worry about being paged after hours for emergencies as well as non-emergencies.

Are you sure SNF's are closing at a 2%/year? It would seem they would be booming. Elective ortho cases (TKA, THA) are less likely to get authorization for an acute rehab stay. They end up going to SNF's. These patients usually have good insurance vs medicare or medicaid.

 

[PMR2008]

What peace of mind do they offer? It is very easy to get credentialed in a SNF. The peace of mind comes from being a consultant and not the admitting physician. You don't have to worry about being paged after hours for emergencies as well as non-emergencies.

Are you sure SNF's are closing at a 2%/year? It would seem they would be booming. Elective ortho cases (TKA, THA) are less likely to get authorization for an acute rehab stay. They end up going to SNF's. These patients usually have good insurance vs medicare or medicaid.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699923/
"One thousand seven hundred and eighty-nine facilities closed over this time period (1999–2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing"
There are many factors associated with SNF closures. You can read the details in the link. Hardly ever do ortho cases get authorized for acute rehab cases unless they are bilateral, associated with high BMI or have other comorbid conditions.
I suppose it is a lot easier to get credentialed at a SNF vs hospitals. The peace of mind I have is that someone else is assisting me get the best possible facility and beds, they contact the PCPs for me, set up note templates, talk to admin to make my job easier, do all the billing, contact insurance companies for denials etc. I am sure all of the above can be done. But if one is in a desirable area like Chicago most high volume facilities already have a physiatrist. In a small town technically you don't need anyone's help.

The following are the advantages at working at a subacute facility
1) Excellent work/life balance. Typical hours are 9-4. Most people work 4 days a week. No call and no weekends. You are the consultant so all medical issues are addressed by the primary care physician.
2) Relatively easy but extremely rewarding work. I have worked with all types of patient populations but by far my favorite are the nursing home patients and young athletes. Patients at the nursing home are extremely grateful and not demanding. Small gains are cherished while most pain patients want all the pain to disappear. Families appreciate a physician seeing the patient vs a NP or PA. Therapist appreciate the feedback you provide them. Admin appreciate the fact that you are not charging them high monthly stipends.
3) Low risk with extremely low malpractice. Your only overhead the cut the company will take or billing if you go solo. I barely ever prescribe opoids and if I change things I communicate with the PCP.
4) Flexibility of schedule. You can work as much or as little as you want. Since you are your own boss you can take time off when ever and as often as you want.

I think subacute works best for phsiatrist who like the patient population, want a work/life balance and are independent. I know quite a few young monthers who live the flexibility. You will get no prestige that comes along with working at a big hospital or group but the work is extremely rewarding, low risk and well paid. It can be monotonous but the company I am working for is helping me setup a day and a half of outpatient MSK clinic so I can keep up my skills.

 

[judasreznor]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699923/
"One thousand seven hundred and eighty-nine facilities closed over this time period (1999–2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing"
There are many factors associated with SNF closures. You can read the details in the link. Hardly ever do ortho cases get authorized for acute rehab cases unless they are bilateral, associated with high BMI or have other comorbid conditions.
I suppose it is a lot easier to get credentialed at a SNF vs hospitals. The peace of mind I have is that someone else is assisting me get the best possible facility and beds, they contact the PCPs for me, set up note templates, talk to admin to make my job easier, do all the billing, contact insurance companies for denials etc. I am sure all of the above can be done. But if one is in a desirable area like Chicago most high volume facilities already have a physiatrist. In a small town technically you don't need anyone's help.

The following are the advantages at working at a subacute facility
1) Excellent work/life balance. Typical hours are 9-4. Most people work 4 days a week. No call and no weekends. You are the consultant so all medical issues are addressed by the primary care physician.
2) Relatively easy but extremely rewarding work. I have worked with all types of patient populations but by far my favorite are the nursing home patients and young athletes. Patients at the nursing home are extremely grateful and not demanding. Small gains are cherished while most pain patients want all the pain to disappear. Families appreciate a physician seeing the patient vs a NP or PA. Therapist appreciate the feedback you provide them. Admin appreciate the fact that you are not charging them high monthly stipends.
3) Low risk with extremely low malpractice. Your only overhead the cut the company will take or billing if you go solo. I barely ever prescribe opoids and if I change things I communicate with the PCP.
4) Flexibility of schedule. You can work as much or as little as you want. Since you are your own boss you can take time off when ever and as often as you want.

I think subacute works best for phsiatrist who like the patient population, want a work/life balance and are independent. I know quite a few young monthers who live the flexibility. You will get no prestige that comes along with working at a big hospital or group but the work is extremely rewarding, low risk and well paid. It can be monotonous but the company I am working for is helping me setup a day and a half of outpatient MSK clinic so I can keep up my skills.

I'm not asking about your situation specifically, but generally how is the compensation when working for these companies?

 

[Louisville04]

I think subacute works best for phsiatrist who like the patient population, want a work/life balance and are independent. I know quite a few young monthers who live the flexibility. You will get no prestige that comes along with working at a big hospital or group but the work is extremely rewarding, low risk and well paid. It can be monotonous but the company I am working for is helping me setup a day and a half of outpatient MSK clinic so I can keep up my skills.

You make some very good points. I still think if you're motivated, you can cut out the middle man (US Physiatry).

I'm not asking about your situation specifically, but generally how is the compensation when working for these companies?

That all depends on what you consider good vs. bad compensation.

 

[PMR2008]

I'm not asking about your situation specifically, but generally how is the compensation when working for these companies?

I PM'd you the details.

 

[PMR2008]

You make some very good points. I still think if you're motivated, you can cut out the middle man (US Physiatry).
.

I agree. Obviously the people who started US Physiatry are also highly motivated. There is plenty of work around for everyone. Its not everyone cup of tea. With the recent reimbursement cut for EMGs, bundling of procedures, inevitable cut of ultrasound, high stress of inpatient rehab and strong desire of work/life balance I suspect more graduating residents will want to do subacute.

 

[ACLPCL]

On this note, has anyone heard of or had experience with Advanced Rehabilitation Care (ARC) which has a similar model and had a popular booth at the AAPMR job fair this year?

 

[AndyDufrane]

I referred one of my colleagues to one of these national SNF management companies, it seems like a rip off, she basically had to do all the credentialing stuff herself, has to pay her own malpractice insurance, and pay for her own dictation service, and also use their billing service which is rip off, and they take 30% off the top of her profits, but they did find the SNF facility, so she has been doing it for 6 months, don't think she is happy because she has to see at least 30-40 patients a day as that is the target set by the company, but if you cut out the middle man taking 30% of the top of your profits, she calculated she could see maybe 20 patients a day and make the same amount, so its essentially an parasitic relationship, just my 2 cents

 

[RUOkie]

damn. I would take a week, and code call nursing directors at SNFs in your area. I bet in one week prep time in a metro area would yield enough work to see 100-130 pts/wk.

 

[RUOkie]

damn. I would take a week, and code call nursing directors at SNFs in your area. I bet in one week prep time in a metro area would yield enough work to see 100-130 pts/wk.

 

[100YardDash]

One of my attending's brother works for US physiatry in Austin, Texas. Says he makes around 200-220k/yr, works 8-4 mon-fri, no weekends. Said it's an eat what you kill job so you can make more if your willing to put in the work. Says he is pretty happy. anyone else have any more info on these consulting jobs? thanks

 

[Straw Hat]

The following are the advantages at working at a subacute facility
1) Excellent work/life balance. Typical hours are 9-4. Most people work 4 days a week. No call and no weekends. You are the consultant so all medical issues are addressed by the primary care physician.
2) Relatively easy but extremely rewarding work. I have worked with all types of patient populations but by far my favorite are the nursing home patients and young athletes. Patients at the nursing home are extremely grateful and not demanding. Small gains are cherished while most pain patients want all the pain to disappear. Families appreciate a physician seeing the patient vs a NP or PA. Therapist appreciate the feedback you provide them. Admin appreciate the fact that you are not charging them high monthly stipends.

If you don't mind me asking how do you get into working with young athletes? Are there a lot of opportunities as a physiatrist or do you need to do sports med? I'm just pre med, done some reading but would love to hear more. Obviously my interests could change at this point but so far I'm very interested in this field. I'd enjoy working with patients of all ages but I'd also love to work with athletes as well since I played in college. You can pm me if you'd like. Thanks.

 

[PMR_doc]

One of my attending's brother works for US physiatry in Austin, Texas. Says he makes around 200-220k/yr, works 8-4 mon-fri, no weekends. Said it's an eat what you kill job so you can make more if your willing to put in the work. Says he is pretty happy. anyone else have any more info on these consulting jobs? thanks

200-220k for a 5 day week seems pretty low to me. That kind of job you can pretty much find anywhere.

 

[PhysiatryMan]

I read the post above and Andydufrane wrote:

"I referred one of my colleagues to one of these national SNF management companies, it seems like a rip off, she basically had to do all the credentialing stuff herself, has to pay her own malpractice insurance, and pay for her own dictation service, and also use their billing service which is rip off, and they take 30% off the top of her profits, but they did find the SNF facility, so she has been doing it for 6 months, don't think she is happy because she has to see at least 30-40 patients a day as that is the target set by the company, but if you cut out the middle man taking 30% of the top of your profits, she calculated she could see maybe 20 patients a day and make the same amount, so its essentially an parasitic relationship, just my 2 cents"

Is this still the case?

If they are basically a management company, why would anyone give them 30% for perpetuity? I'm not sure if I would want to give any more than 10% or a fee.
How do you get the consults to stay busy? Do they own the sites or guarantee that you will be busy if you don't get consults? If they don't own the sites, why should you be employed by them? Maybe it is possible to be salaried instead for say $300k/year to take out the risk? It seems a little risky to trust them, given the information above.
Can you leave if they don't live up to their end?

Thanks for any info.

 

[PMR2008]

I can help answer some questions. I have done this for 6 years now.
5-7% is typically billing, 5-6% is admin(secretary etc). So essentially these companies make 10-15% to help setup the practice. This includes placement, credentialing, templates, EMR, contacts, protocols, internal education/audits, help with external audits, assisting in hiring mid levels etc
Consults are received from the primary care team and therapy/nursing. These companies usually do not own the site but have contracts with local and national post acute companies and networks. I am unaware if any of the companies offer salaried positions but if they did it would be unusual.
PM me if you have more questions.

 

[PhysiatryMan]

PMR2008, thanks for this reply! I have been employed for the past few years and I am concerned about leaving my job and signing on with one of these national companies, only to be trapped in another contract.
You seem to be happy since you have been with them for the past 6 years. It seems like they helped you with your practice set up and give you administrative support. It makes more sense since they are really only taking 5-7% for billing and 5-6% for admin. I'm assuming that you are not still paying the other 10-15% for help with the practice setup.
How long did you have to pay that 10-15%? Was it only for a few months? 1 year? If that 10-15% goes away, it does not sound as bad as it seems!
Thanks for this info!

 

[PMR2008]

PMR2008, thanks for this reply! I have been employed for the past few years and I am concerned about leaving my job and signing on with one of these national companies, only to be trapped in another contract.
You seem to be happy since you have been with them for the past 6 years. It seems like they helped you with your practice set up and give you administrative support. It makes more sense since they are really only taking 5-7% for billing and 5-6% for admin. I'm assuming that you are not still paying the other 10-15% for help with the practice setup.
How long did you have to pay that 10-15%? Was it only for a few months? 1 year? If that 10-15% goes away, it does not sound as bad as it seems!
Thanks for this info!

I understand your fear. Which is why you sign up with a company with a long history, good reputation and national presence. Also have an attorney review the contract etc. The 10% is not just for practice setup. It is for ongoing support and expansion. I have expanded yearly since I started. Adding new faculties and midlevel providers etc. Also the percentage is negotiable every year so you might start off paying more but that changes.
Subacute it not for everyone and I understand that. The company I am a consultant for grew from 3 when I joined to 150+ PM&R providers and in 30 states. It is out of the startup stage and is well established now. PM me if you want more details.

 

[PhysiatryMan]

I did ask around and one of my old residents actually works for one of these companies and had a lot of good info! It is amazing the number of companies out their doing this! He explained to me how this is a big money maker for the companies who take a cut from the docs and is not nearly as enthusiastic about it as you but he enjoys it since he was able to renegotiate his contract. He actually considered leaving his company because he felt "stuck" with what he felt was an unreasonable percentage cut taken by his company after being with them for a couple years. He thought it was great initially, but he felt he built the practice even though his company said they would give him support. It did not happen after he signed the contract. He is happier now and they are no longer taking a high percentage and they provide his practice management while he continues to work at his subacute as an independent contractor. He warned me to stay away from a few companies if I decide to pursue this and informed me that some of the companies even shut down and open again under different names?? He read your responses and reinforces your advice to have a lawyer look over things do due diligence by talking to people both within the company and ask for contacts of docs who have left. I thought that was great advice. It sounds like this can work for some people and like you said, it isn't for everyone.

 

[PMR2008]

Certainly not for everyone but I love the flexibility. I used to do subacute 5 days a week but now have diversified the practice and spend 1 day in clinic, 1/2 day admin, 1/2 day medicolegal and 3 days subacute. Probably make about the same but I have less symptoms of burn out now. I would say there are 1-2 companies out there that have a good track record and are the largest in the country. With smaller companies there is always a risk of companies shutting down etc. Also I personally feel that it is easier to negotiate with a larger company since they really don't need the capital as much as smaller start ups. I would look into US Physiatry and IRC since they are both very well established and the leadership is composed of former AAPM&R leadership.

 

[sigmared]

The consults are ordered by primary team, RN, PT/OT, but how can you be guaranteed that you'll be receiving 30+ consults? What if you sign with one of these companies and you're only seeing 5 consults? It would be hard to pay the bills with that, and it's not like I can consult myself. How exactly can you make certain that you'll have a steady stream of consults coming in, reliably in the 30+ range per facility?

 

[PMR2008]

Every rehab patient is co managed by a few providers in the facility. Depending on the need and diagnosis the patient is consulted by the primary care team to see the psychiatrist, cardiologist, neurologist, nephrologist etc. Does not mean that every patient is seen by all the consultants but patients undergoing short term rehab are almost always seen by me. Hence having 30+ consults in a larger facility is not that hard. This is not a new concept but it is more necessary now since patients have higher acuity and length of stay is extremely short now versus 10 years ago. When I started 6 years ago it was normal for stroke patients to stay for 4-6 weeks but now it is down to 2-3 weeks. Bilateral knee replacement are staying for 7 days. The primary care need us more than ever. I help reduce readmission rates, optimize therapy, manage pain and help with discharge planning. Again it is a co management model and works really well.
You want to sign up with a company that can find you high end facilities who understand the model of care.

 

[USPhysiatry]

Good Afternoon Everyone. I work at US Physiatry and I am here to answer any questions you may have. Please feel free to reach out to me as I am here to help.