CAP question...

[psychfun]

My question is about Adult v/s Child Psychiatry in PRIVATE PRACTICE only.

I have been told that CAP pays more than Adult psychiatry .... how does this work out? Are depression/bipolar/psychosis better reimbursed for pedi population v/s adults? Can ADHD be billed at a higher rate?

I can understand how SALARIED position might be higher given the acute shortage, however, the higher pay (if any) in private practice?

Again, trying to think ahead of time whether fellowsip is worth it....I like working with adults and child population both....

Thanks for your time!
PF

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[Doc Samson]

My question is about Adult v/s Child Psychiatry in PRIVATE PRACTICE only.

I have been told that CAP pays more than Adult psychiatry .... how does this work out? Are depression/bipolar/psychosis better reimbursed for pedi population v/s adults? Can ADHD be billed at a higher rate?

I can understand how SALARIED position might be higher given the acute shortage, however, the higher pay (if any) in private practice?

Again, trying to think ahead of time whether fellowsip is worth it....I like working with adults and child population both....

Thanks for your time!
PF

acute shortage = able to practice cash only (no insurance) = setting your own hourly rate = better pay than insurers will give you

 

[psychfun]

Yes, I can see that in the cash-only scenario; however, do the insurance companies also reimburse higher for same diagnoses? And is cash-only prevalent commonly?

Thanks,
PF

 

[pingouin]

Insurance companies reimburse psychiatric and psychotherapy appointment based on provider licensing credential (MD> PhD> LCSW) and type of appointment, not by diagnosis code. An MD who bills an hour of medication managment + therapy for an adjustment disorder diagnosis will be reimbursed at a higher rate than a PhD who bills an hour of therapy with a borderline PD patient. There's no special license for CAP, so they get reimbursed at the same rate as a general adult psychiatrist.

Doc S' comments ring true for my region of the country- the need is so great that the CAPs can develop their practices however they want. I talked to one a few years ago who told me the insurance companies were actively recruiting her to be on panel but refused to negotiate with her on contracted rate. She told them "You need me more than I need you", they still wouldn't do it, and she walked- and now has a thriving cash-only child practice with a 2 month waiting list.

 

[psychotrope]

acute shortage = able to practice cash only (no insurance) = setting your own hourly rate = better pay than insurers will give you

which i get in certain high density areas in the northeast, california, etc......i guess there they have the population and concentrated wealth to support self pay patients.

But some of the medium sized southern cities I've lived in had multiple child psychiatrists and none of them(at least the ones I knew) were self pay types. And yet they all made a good bit more than adult psychiatrists.....so I'm curious about the OP's question too.

Is it that(for CAP's who take insurance vs adult psychs who take insurance) medchecks for your typical ADHD/ODD 7 year old are quicker than the average adult outpatient psychiatrists med checks and thus they do higher volume?

 

[nancysinatra]

Is it that(for CAP's who take insurance vs adult psychs who take insurance) medchecks for your typical ADHD/ODD 7 year old are quicker than the average adult outpatient psychiatrists med checks and thus they do higher volume?

How could you properly treat a 7 year old for anything with a quick "med check?" How do even you DO a quick "med check" on a 7 year old? How many 7 year olds do you know who answer questions about side effects and symptoms in the same rapid fire way adults do?

And besides that, is this even the treatment for ODD? Wouldn't that be kind of like an adult psychiatrist having a panel of nicely responding, compliant ASPD patients and doing "quick monthly med checks" on them like they were adjusting their synthroid or something? Seeing as ODD --> CDO --> ASPD? Forgive me for laughing I just think it's funny. But, of course, maybe I'm wrong and med checks are the exact way to go...

 

[masterofmonkeys]

How could you properly treat a 7 year old for anything with a quick "med check?" How do even you DO a quick "med check" on a 7 year old? How many 7 year olds do you know who answer questions about side effects and symptoms in the same rapid fire way adults do?

And besides that, is this even the treatment for ODD? Wouldn't that be kind of like an adult psychiatrist having a panel of nicely responding, compliant ASPD patients and doing "quick monthly med checks" on them like they were adjusting their synthroid or something? Seeing as ODD --> CDO --> ASPD? Forgive me for laughing I just think it's funny. But, of course, maybe I'm wrong and med checks are the exact way to go...

don't get me started on med checks in child psych. I have often said that if I somehow get told that I will HAVE to do med checks as a routine thing, I will insert one of my many guns into my mouth and pull the trigger. Repeatedly.

 

[psychotrope]

How could you properly treat a 7 year old for anything with a quick "med check?" How do even you DO a quick "med check" on a 7 year old? How many 7 year olds do you know who answer questions about side effects and symptoms in the same rapid fire way adults do?

And besides that, is this even the treatment for ODD? Wouldn't that be kind of like an adult psychiatrist having a panel of nicely responding, compliant ASPD patients and doing "quick monthly med checks" on them like they were adjusting their synthroid or something? Seeing as ODD --> CDO --> ASPD? Forgive me for laughing I just think it's funny. But, of course, maybe I'm wrong and med checks are the exact way to go...

I don't have any opinion one way or the other as Im not interested in child.....and I even have less knowledge/experience than opinion.......

but that's the reality of the situation. Most 7 yo pts with an "established dx" of odd also have adhd, and are on some stimulant. The child psych brings them and the mother in the room for a very short period of time(maybe 2-3 minutes), the mother answers a few questions, and then the child psych either keeps the med the same or makes a little change........

that's the world of private practice outpatient psych, at least with the 10 or so I know doing it(and accepting insurance).

 

[psychotrope]

don't get me started on med checks in child psych. I have often said that if I somehow get told that I will HAVE to do med checks as a routine thing, I will insert one of my many guns into my mouth and pull the trigger. Repeatedly.

curious...what venue/payer system do you plan to work in then?

 

[billypilgrim37]

don't get me started on med checks in child psych. I have often said that if I somehow get told that I will HAVE to do med checks as a routine thing, I will insert one of my many guns into my mouth and pull the trigger. Repeatedly.

If there wasn't such a tremendous shortage of people who can write prescriptions for children, I might agree. But depending on where you are, the need for someone thoughtfully following children for whom a thorough assessment has already suggested that x medications are appropriate to treat symptom X to goal Z, the med check does provide a pretty useful service. I understand the reticence: you want your interactions to be therapeutic, you don't want to make a lot of money w/o providing value, and you want to feel there is some depth for your work. There is certainly a role for frequent short medication checks in child psychiatry, and a thoughtful provider can make these brief interactions therapeutic, even if plenty of providers are too lazy to do so.

 

[psychotrope]

How could you properly treat a 7 year old for anything with a quick "med check?" QUOTE]

it's not an ideal world.....I guess "quick" is a term that means different things to different people.

I've worked with child psychs in an outpatient setting that spent 45 seconds on average with the pt and their parent during a med check. I've also worked with child psychs who spent more than 8 minutes on average with the pt and their parent(s) during a med check......

 

[maranatha]

How could you properly treat a 7 year old for anything with a quick "med check?" QUOTE]

it's not an ideal world.....I guess "quick" is a term that means different things to different people.

I've worked with child psychs in an outpatient setting that spent 45 seconds on average with the pt and their parent during a med check. I've also worked with child psychs who spent more than 8 minutes on average with the pt and their parent(s) during a med check......

I have a very hard time believing anyone is doing 45 second med checks, let alone 8 minutes. If you're correct, those psychiatrists should not be practicing as that simply bordering on malpractice.