how are inpt physiatrists paid?

[oreosandsake]

sorry for the vague question, but this post is not a question of how much an inpt physiatrist (sci, tbi/stroke, peds) gets paid, but rather i am asking how.

for instance, I have heard of jobs where the physiatrist is an employee of the hospital - i guess in this sense, you take care of all the rehab pts that get assigned to you, plus/minus doing clinic as part of that salary.

this question stems from hearing about jobs where a physiatrist has been hired to take care of the "X number of beds on the rehab floor of a hospital" for X annual dollars.

there must be other models than this.

how do inpt physiatrists bill? I have never heard of a hourly wage (such as a hospitalist or ER doctor), but maybe this exists as well.


I guess I never thought about how the performance of the patient recruiters, and administrative staff keep a flow of patients into a rehab hospital - wondering how that affects income, since a physiatrist does not go out and "recruit" his patients such as a dermatologist/cardiologist might via advertising, etc.

ex: A rehab floor I heard recently has been having "low census" with inpt population of around 8-10 patients. if the normal census is higher, will the low census affect the attendings salary?

on a related note, i think i read somewhere that when medicare shifted towards DRG's in the 80s (?) that rehab was not included (limited) by this, and thus rehab floors became big revenue generators for hospitals... which I believe has now changed, and besides CMS wanting to cut back on costly things, I'm not sure exactly how else this has changed.

so, my second question is: how do rehab hospitals get paid by insurers/medicare? is it a lump sum for a diagnosis - "stroke," geographic median inpt stay, "12 days" with modifiers...

or do they pay by the day... or pay by the services rendered? (OT and PT saw the pt, but not SLP)

Also - if an inpt physiatrist injects botox/phenol for spasticity, is this billed seperately? i.e. does he/she get paid extra when procedures are performed?

I hope these questions makes sense... 😕

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[lobelsteve]

Mostly with checks, some direct deposit.

Occasionally with chickens or other farm animals.
Often, tips in the form of baked goods and fresh vegetables are greatly appreciated.

 

[PMR 4 MSK]

Start with the easiest scenario - a rehab doc independently seeing patients on the rehab floor. Not a hospital employee or contracted. He gets paid by submitting CPT codes with appropriate diagnosis codes to the insurance company, mostly Medicare. Most of the codes are E&M - 992xx - daily visits, consults, new patient H&P, D/C summary, etc. In this case, the pay is not high compared to doing procedures and EMGs, but overhead is minimal so it can be profitable.

The hospital bills the insurance seperately with medicare based on a complicated formula, different than regular hospital DRGs. It is related to diagnosis, severity, functional level and levels of need for therapies and nursing staff. For private insurance, they often negotiate a daily rate.

Other scenarios exist, such as an employee can be straight salary where the hospital pays the doc and he assigns all billing to them. There may or may not be incentives and/or bonuses involved.

You can also be contracted for a scenario in-between.

 

[axm397]

Most inpatient physiatrists also do outpatient clinics - so it's a combination of inpatient and outpatient billing/collections. There are many ways a physician might get paid - based on collections minus overhead, RVUs, straight salary, based on billing, etc. Procedures - depends on what procedure - some are "bundled" with the inpatient stay and others are not. Also, if you do inpatient consults, that pays separately as well.

I know quite a few private practice physiatrists who have a primarily outpatient practice (MSK, general rehab, EMG/NCS, etc) with a small number of beds to cover - round in the morning (+/- midlevel), am clinic, see consults during lunch, clinic in pm, do admissions. Also, can take "medical directorship" which comes with administrative responsibility and pay.

 

[copacetic]

dont some physicians also do medico legal work to augment their incomes?

 

[SSdoc33]

.

I know quite a few private practice physiatrists who have a primarily outpatient practice (MSK, general rehab, EMG/NCS, etc) with a small number of beds to cover - round in the morning (+/- midlevel), am clinic, see consults during lunch, clinic in pm, do admissions. Also, can take "medical directorship" which comes with administrative responsibility and pay.

this sounds like pure agony to me, but to each his own......

 

[PMR 4 MSK]

dont some physicians also do medico legal work to augment their incomes?

Yes, it can range from chart reviews and IMEs to selling your soul to insurance companies and lawyers.

 

[RUOkie]

Most inpatient physiatrists also do outpatient clinics - so it's a combination of inpatient and outpatient billing/collections... Also, if you do inpatient consults, that pays separately as well.

I know quite a few private practice physiatrists who have a primarily outpatient practice (MSK, general rehab, EMG/NCS, etc) with a small number of beds to cover - round in the morning (+/- midlevel), am clinic, see consults during lunch, clinic in pm, do admissions. Also, can take "medical directorship" which comes with administrative responsibility and pay.

dont some physicians also do medico legal work to augment their incomes?

This is exactly what my practice is. 90% outpatient, EMG/NCS, MSK medicine, I am the primary work comp doc for the 3 largest employers of my town. Then I do consults/rehab admissions/management in the hospital as a favor to a group of docs who are my primary referral sources. That way they send me the EMG's at the office.

I refuse to do ANY administrative work for the rehab unit, and refuse to take a salary from them (although I do from a LTAC) because of a bad past history with the administration.

Oh, I am also a med director of a home health company.

 

[Jitter Bug]

When I did inpatient it was as a hospital employee and was paid on production only by RVU's-the hospital negotiates with the physician group every year (long agonizing number crunching committee battles) to decide how much cash to pay for each RVU. You see the patient, write down your codes, which each has an affiliated RVU (usually loosely based on the CMS RVU but also decided by the hospital) and then multiply by this year's agreed upon cash value, and that is your salary.

Most inpatient docs also have other aspects of practice that provide a buffer for the days when bed census is low. (clinics, consults, EMG's etc)