Is $80 for 30m f/u basically charity?

[Fluidity of Movement]

---

Members do not see this ad.

My doctor is nearing retirement and they are in solo pp in their own free standing building, doing face to face visits.

Unsure if they own it but certainly possible. They also have a receptionist there year round at least part time.

It's $195 for 1h initials and $80 for 30m f/u, cash only.

They don't work crazy hours typical 8-5 or less.

Is this person basically just doing God's work here by charging so little? They are extremely selective of their patients though which is understandable.

But it seems to me like they may be clearing what, 100k a year max? Less? I guess if they own the building that could be a huge factor. Theyve been there for 12-15 years or so.

I didn't want to ask them about it since I haven't seen them in a long time, but very curious.

 

[Stagg737]

That's low, but certainly not charity. Average 99213 reimbursement from CMS is ~$90. While psych should almost always hit 99214, there are a lot of people out there underbilling substantially and mostly billing 99213s. If he lives in an area where people are on the lower economic spectrum, that may be all they can afford for cash only. However, doing some basic math...

At 30 minute f/ups 6 hours a day, that's 12/day. At $80/fup x 12 is $960/day or $4,800/wk. Work 45 weeks a year and that's $216k/yr. They probably take home between $150-180k pre-tax depending on their overhead and how much they pay their receptionist. That's pretty low for psych, but still a great income for someone who is older and about to retire, especially if you're picky about who you see and are only seeing "easy" patients.

 

[Fluidity of Movement]

They probably take home between $150-180k pre-tax depending on their overhead and how much they pay their receptionist.

So it probably is around 100 or less actually in the bank?

 

[littlefred]

They may have lower mortgage payments (or no payments at all) and live frugally enough to not care?

 

[Celexa]

I agree, it's below market but not charity.

 

[comp1]

$160/hour is still some pretty good pay depending on the area. It's not amazing, but it's not charity. If it was charity then McDonald's workers are truly doing the Lord's work...

 

[TexasPhysician]

That is very low. If money is no longer important, it sounds great.

 

[forchinet121]

Yes this is charity no question about it

 

[FlowRate]

FWIW at least one insurance in my area pays $120 ($100 insurance, $20 copay) for 99213.

 

[Stagg737]

So it probably is around 100 or less actually in the bank?

Depends. If he owns the property and only pays the receptionist $25k/yr, then overhead is probably <$40k. So $176k pre-tax times 0.7 and take home is $123k. Keep in mind the median psychiatrist salary is around $280k, ant $216k isn't that low. That's actually higher than my base salary for this year (though my job has a significantly different structure which should gross closer to $250-270k).

You're looking at this incorrectly though, you don't have the information to calculate his actual net income, just his gross hourly rate which is probably ~$160/hr. Even that isn't really solid without knowing his no-show rate, number of f/ups vs intakes, total hours worked, etc. While $160/hr is not good in psych, it's certainly not charity and is actually more than some employers pay.

 

[wolfvgang22]

I doubt he's seeing 12 patients per day. Probably more like 6 patients per day. That's what I would do if I was near retirement and charging below market rates. Why grind if the house and car are paid off and the kids are gone? See only patients you can enjoy helping.

 

[Sushirolls]

I have some insurance that pay ~$80-90 for a 99213.
I nipped out one that paid that low and the others are in my cross hair to nip out.
In due time those will be gone. Thankfully, they are minor % of the practice.

If ~$160/hr were the rate for my practice, with which I still had to pay my practice overhead, I just wouldn't bother. I'd do something else. Just not worth it at that rate.

 

[Merovinge]

I doubt he's seeing 12 patients per day. Probably more like 6 patients per day. That's what I would do if I was near retirement and charging below market rates. Why grind if the house and car are paid off and the kids are gone? See only patients you can enjoy helping.

I think it's better to set a higher cash rate and then have sliding scale options so that people understand your worth and directly appreciate what you are doing. If you just set rates like a hairstylist, any new patient or person talking about your practice runs the risk of significantly devaluing the work you do.

Now if he's old and has a mature panel of patients, isn't taking anyone new, and said eff-it, 50%-75% sale for the rest of my career, than absolutely a cool move to wind down a career.

 

[Fluidity of Movement]

I'm a new pt, lol. Well I saw them a long time ago. Ten years or so. Before I moved.

They are mid 60s and almost 40 years of practice so im very fortunate. Seems to be fully booked up still.

 

[Bartelby]

It sounds to me like this psychiatrist is charging enough for some extra spending money, not with a goal of effectively running a business. That seems totally fine after a decades-long career, as others pointed out though this would not be a model that would be at all competitive with a typical employed role.

As Stagg pointed out it's $216k gross IF you actually see and collect for six hours of follow-ups five days per week consistently. Subtracting out expenses would likely put you at about half or potentially less of what you would earn in an employed position cranking out 32 billed hours of 30-minute follow ups each year.

 

[clozareal]

There's a 70+ year old psychiatrist in my area who stopped charging patients to be seen in the past few years because she couldn't keep up with billing and documentation, but isn't taking any new patients. She was seeing patients weekly or biweekly for decades and is trying to scale down her practice, which is why a patient came to me.

 

[Stagg737]

I doubt he's seeing 12 patients per day. Probably more like 6 patients per day. That's what I would do if I was near retirement and charging below market rates. Why grind if the house and car are paid off and the kids are gone? See only patients you can enjoy helping.

If he's had the practice for decades he could have a patient list that's 90% or more stable patients who like seeing him for their med refills. I had a few patients in residency who didn't need to be seen by a psychiatrist but liked having one available and would check in every 6 months for their med refills. Most of the time the actual appointment portion would be done in less than 10 minutes and we'd chat for 10-15 minutes while I charted and ordered their meds. If he uses paper charts, even easier. $160/hr is low for a physician but still pretty incredible for most people. If he's got an old school attitude where patients become like an extended family, then spending the day getting paid to chat with friends and write a few scripts seems like a nice life.

I realize there's a lot of issues with that, but I've met more than one PP doc who felt that way and ran their clinic in a somewhat similar manner.

It sounds to me like this psychiatrist is charging enough for some extra spending money, not with a goal of effectively running a business. That seems totally fine after a decades-long career, as others pointed out though this would not be a model that would be at all competitive with a typical employed role.

As Stagg pointed out it's $216k gross IF you actually see and collect for six hours of follow-ups five days per week consistently. Subtracting out expenses would likely put you at about half or potentially less of what you would earn in an employed position cranking out 32 billed hours of 30-minute follow ups each year.

If you're in a cash-only PP that's been established for over a decade and can't collect on six hours of f/ups per day, I'd say you're doing a pretty terrible job running that practice. He could pull in a ton more if he wanted to, but if he's just coasting to retirement, letting his next egg build for a few more years before cutting back or completely retiring, and loves his patients/job, then why would he need to?

 

[randomdoc1]

For 15 min and low complexity it's not too far left. But longer and depending on complexity, that's definitely on the low end. Especially since so many qualify as 99214 now and it's easily over $100 for the 99214.

 

[Bartelby]

If you're in a cash-only PP that's been established for over a decade and can't collect on six hours of f/ups per day, I'd say you're doing a pretty terrible job running that practice. He could pull in a ton more if he wanted to, but if he's just coasting to retirement, letting his next egg build for a few more years before cutting back or completely retiring, and loves his patients/job, then why would he need to?

True, what I was more getting at is that 32 hours (billed and collected) of 30-minute follow ups is a pretty serious workload. He may have a practice of stable long-term patients that makes it pretty chill, but in terms of productivity this would be a really productive practice, not the kind of practice I imagine if I imagine myself earning 160k take-home.

 

[allantois]

There's a 70+ year old psychiatrist in my area who stopped charging patients to be seen in the past few years because she couldn't keep up with billing and documentation, but isn't taking any new patients. She was seeing patients weekly or biweekly for decades and is trying to scale down her practice, which is why a patient came to me.

I'd give up documentation before giving up billing lol

 

[Shikima]

That's low, but certainly not charity. Average 99213 reimbursement from CMS is ~$90. While psych should almost always hit 99214, there are a lot of people out there underbilling substantially and mostly billing 99213s. If he lives in an area where people are on the lower economic spectrum, that may be all they can afford for cash only. However, doing some basic math...

At 30 minute f/ups 6 hours a day, that's 12/day. At $80/fup x 12 is $960/day or $4,800/wk. Work 45 weeks a year and that's $216k/yr. They probably take home between $150-180k pre-tax depending on their overhead and how much they pay their receptionist. That's pretty low for psych, but still a great income for someone who is older and about to retire, especially if you're picky about who you see and are only seeing "easy" patients.

So, I gotta ask about documentation for slinging Prozac to the stable ones. What does the documentation look like for this type of a scenario to achieve a 214 every single time?

 

[forchinet121]

So, I gotta ask about documentation for slinging Prozac to the stable ones. What does the documentation look like for this type of a scenario to achieve a 214 every single time?

MDD, GAD, continue Prozac 20 mg

 

[Stagg737]

So, I gotta ask about documentation for slinging Prozac to the stable ones. What does the documentation look like for this type of a scenario to achieve a 214 every single time?

Forchinet got it. If really want to justify you can say "continue prozac 20mg daily to maintain stabilization of mood and anxiety symptoms". Insurance/CMS doesn't care about actual clinical reasoning, as long as it checks the boxes.

 

[Stagg737]

I'd give up documentation before giving up billing lol

Right? In a cash only practice you don't even have to use an EMR. You can use paper charts and do a ridiculously basic SOAP note with check boxes for the HPI if all your patients are stable. I rotated with a cash only PP attending who did largely psychotherapy who did this. Would use a wrist monitor for vitals, jot a few notes down in subjective, then diagnoses and meds for the A/P portion and close the folder at the end of the appointment. Super laid-back practice and had a net income well over $200k. Only part I would hate was giving out paper Rxs, but might be worth it for a practice like that.

 

[clozareal]

Right? In a cash only practice you don't even have to use an EMR. You can use paper charts and do a ridiculously basic SOAP note with check boxes for the HPI if all your patients are stable. I rotated with a cash only PP attending who did largely psychotherapy who did this. Would use a wrist monitor for vitals, jot a few notes down in subjective, then diagnoses and meds for the A/P portion and close the folder at the end of the appointment. Super laid-back practice and had a net income well over $200k. Only part I would hate was giving out paper Rxs, but might be worth it for a practice like that.

Yep. Unless you offer a superbill. Then you have to document for insurance as an out of network provider.

 

[Mad Jack]

Even a nurse practitioner that takes cash-only around here charges $250 for a 45-minute follow-up and $375 for a 90-minute initial eval. Definitely way below market.

 

[annoyedpsychiatrist]

most my patients are 99214s and easily >100 for reimbursement, so yeah 80 seems low unless he has a caseload of 700 people on zoloft 25mg

 

[Stagg737]

Yep. Unless you offer a superbill. Then you have to document for insurance as an out of network provider.

Still, you can just do a basic SOAP note, no?

 

[Sushirolls]

You chart for 3 reasons:
Billing / Insurance
Medical patient care and conveying treatment etc
Liability CYA

Doing cash and not caring about insurance, only 2 of those matter.

 

[clozareal]

Still, you can just do a basic SOAP note, no?

I mean all you have to document for MDM is number/complexity of problems, amount/complexity of data reviewed, and risk of complications/morbidity/mortality of patient management. You don't need anything else in there for insurance purposes. Add on a couple of medicolegal defensive documentation, then you're golden.

Even less complex: just document duration of appointment at the end, don't worry about MDM nonsense, and code based on time. Insurances might not think that monthly 99215s for an hour appointment is "medically necessary" every month when half an hour can do, but out of network reimbursements are supposed to be not guaranteed and icing on the cake since how they determine reimbursements is arbitrary anyways. The patient's financial priorities are none of your business, but how much they value you and pay you is.