Child psychiatrists in outpatient practice... time for evals?

[fiatslug]

As mentioned in the "What's your practice setting?", I'm a child-trained psychiatrist who has a pretty sweet working mama gig seeing adults in a partial hospitalization setting. I'm peeking around at opportunities out there that might involve a move back home, and (because I am so not ready to just hang out a shingle independently), looking at salaried jobs in child.

In fellowship, we had the luxury of drawn-out evals, taking place over several sessions (we'd only bill for one 90801, of course, but the actual process of the eval was usually stretched over 2-3 1 hr sessions)... in an insurance panel setting, I'm guessing you just get the one shot eval slot. I seriously don't know how you can do this in child--I can barely speed dictate my adult evals with 60 min for interview/30 min fur dictation, and child cases are SO much more collateral-heavy.

How does it work? I know I still have the relatively-fresh-out-of-training tendency to do the ridiculously detailed evaluation--in child training in particular, it seems to breed a fetish to "show your work" --but I just don't know how you can do it well and fast in 90 minutes (or god help me, an hour).

How do you structure your day? Do you see all child/adolescent cases or are there adults in there too (I'm assuming this salaried position would be child only/adol only)? How many evals do you do in a week? How many patients are in your practice at a time?

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[michaelrack]

In fellowship, we had the luxury of drawn-out evals, taking place over several sessions (we'd only bill for one 90801, of course, but the actual process of the eval was usually stretched over 2-3 1 hr sessions)... in an insurance panel setting, I'm guessing you just get the one shot eval slot. ?

my guess is priv prac is similar in actual evaluation, but that you bill 90801 for first visit and f/u codes for the 2nd/3rd sessions. this necessitates doing at least a skeletal/global eval on the 1st visit (covering all major areas) and coming up with prelim diagnosis/recs. Things are fleshed out on subsequent visits.

 

[dl2dp2]

I'm not sure if my opinion would be helpful but I talked to a couple of teaching attendings on the child service about this, and depending on the practice setting, it sounds like at least in a major metro, you can charge on top of whatever insurance reimburses for an extended initial eval, and the patient will OFTEN pay. Group practices don't really care one way or the other.

This brings a related point. With medicare rate for 90801 at @ $130 with only 80% reimbursement, how does one survive a pure medicare private practice?

 

[fiatslug]

my guess is priv prac is similar in actual evaluation, but that you bill 90801 for first visit and f/u codes for the 2nd/3rd sessions. this necessitates doing at least a skeletal/global eval on the 1st visit (covering all major areas) and coming up with prelim diagnosis/recs. Things are fleshed out on subsequent visits.

I would assume that, too--my worry is, if working for an employer (rather than in PP), would the employer "get" that? One of the reasons why I turned down a C&A job at Kaiser was the untamed firehose of intakes--two scheduled per day, until... you retire. No such thing as "not taking new patients" . That kind of thing is skeery to me.

sluox--I think that kind of charging is very common in higher COL areas in PP. Honestly, it's one of the things I wonder about with child PP--all of the uncompensated collateral time--do you inform parents of that up front, and say "I will be billing you for time most insurance companies don't reimburse, but I feel is essential to a thorough evaluation and ongoing treatment: contact with schools/teachers, other members of the child's treatment team, etc etc." ?? I mean, as a fellow I often attended IEP meetings to advocate for the child...

 

[Chimed]

I would assume that, too--my worry is, if working for an employer (rather than in PP), would the employer "get" that? One of the reasons why I turned down a C&A job at Kaiser was the untamed firehose of intakes--two scheduled per day, until... you retire. No such thing as "not taking new patients" . That kind of thing is skeery to me.

sluox--I think that kind of charging is very common in higher COL areas in PP. Honestly, it's one of the things I wonder about with child PP--all of the uncompensated collateral time--do you inform parents of that up front, and say "I will be billing you for time most insurance companies don't reimburse, but I feel is essential to a thorough evaluation and ongoing treatment: contact with schools/teachers, other members of the child's treatment team, etc etc." ?? I mean, as a fellow I often attended IEP meetings to advocate for the child...

Really?!? If that's true, there's no way I'd work for Kaiser. Having to pick up 2 new patients per day is insane. I'm starting to think about practice options right now. I keep going back and forth between seeking an academic career vs. PP. Both have big advantages and disadvantages. Fiatslug, you'll have to let us know how your search goes.