New Admin Behaviors?

[TerraceHouse]

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Recently, a lot of my inpatient colleagues have been venting to me about leadership/admin increasing average daily census each doc sees to more than 20 pts per day, mandating docs stay until 5pm despite having all meetings/notes/work done earlier, etc etc and just feels like more boldness in encroaching/micromanaging docs such as even trying to get docs to extend LOS even when it's unnecessary... at least it feels like I'm hearing more of this than before.

Can anyone attest to this for those who work inpatient? How to go about if this happens?

I know many docs work outpatient but I recall outpatient having its own stressors like no shows/having to crank volume to get similar pay, etc.

 

[shoomer]

A lot of this is institution dependent, and knowing how stable a place has been over time from people who have been there. I can't speak to how common it is, but the only way to have real negotiating power is if you can threaten to leave and then follow through on that threat if needed.

 

[Sushirolls]

If the Big Box shop is PE owned, higher odds.

*Critical Care Access Hospitals (25 bed places in middle of nowhere towns) can have 10 beds devoted to psych, for a unit beyond their 25 bed limit. Could be an opportunity for a 2 doc duo to petition a community with one to push for community funding, grant funding, etc to build a 10 bed unit and then be hospital employees servicing it. One way to guarantee a ceiling to volume. Just tossing that out there.

 

[comp1]

Well, I'm thankfully not working for a private hospital and am completely salaried at my inpatient job. I certainly wouldn't want it any other way. 20 patients is obviously not appropriate. Tour of duty is normal, but they should be able to keep you busy during that tour of duty. If they're not keeping you busy with consults or new admissions, I agree that just making you sit around is not good management. In terms of extending lengths of stay, I don't get that. Admission and discharge is more profitable for any psych hospital than a progress note and everywhere around here has waiting lists of patients waiting to get in. So no, I don't see that.

 

[psych_0]

If my hospital forced me to stay until 5pm I'd be looking for a new job.

 

[Stagg737]

Well, I'm thankfully not working for a private hospital and am completely salaried at my inpatient job. I certainly wouldn't want it any other way. 20 patients is obviously not appropriate. Tour of duty is normal, but they should be able to keep you busy during that tour of duty. If they're not keeping you busy with consults or new admissions, I agree that just making you sit around is not good management. In terms of extending lengths of stay, I don't get that. Admission and discharge is more profitable for any psych hospital than a progress note and everywhere around here has waiting lists of patients waiting to get in. So no, I don't see that.

I'll push back on this a little since this is definitely a VA thing. Are there inpatient hospitals that require docs to stay to a certain time? Sure. Is this standard? Absolutely not. I know exactly zero inpatient psychiatrists outside the VA for which this is true other than 1 or 2 who also cover the ER, and even some of them go home and see ER consults via telehealth during their shift. Even the academic center I'm at and the other major one across town this is not true.

If they're keeping someone busy with consults or other paid/included admin duties I agree that's one thing. But the whole present for the "tour of duty" is just a BS powerplay by administrators.

Not common, but there are some places where there just isn't a population to fill inpatient beds consistently. Admins may push to extend stays if there's no patients in waiting to keep census numbers up. More likely admins want to extend LOS for patients with specific insurances that reimburse at higher rates. Acadia Healthcare has gotten in trouble for this multiple times and have had multiple federal investigations leading to federal and civil settlements directly related to this.

Acadia Healthcare Company Inc. to Pay $19.85M to Settle Allegations Relating to Medically Unnecessary Inpatient Behavioral Health Services

Acadia Healthcare Company Inc., a Delaware corporation with its principal place of business in Franklin, Tennessee, has agreed to resolve allegations that it violated the False Claims Act and related state statutes by knowingly billing for medically unnecessary inpatient behavioral health...

www.justice.gov

 

[Merovinge]

I don't understand, did your colleagues all undergo bilateral orchiectomy? Demand for psychiatry remains very high in almost every part of the country...

 

[ObsequiousAplomb]

I don't understand, did your colleagues all undergo bilateral orchiectomy? Demand for psychiatry remains very high in almost every part of the country...

Honestly these power play moves by admin always make me think they are trying to get the psychiatrists to quit so they can be replaced by NPs who are happy to take a salaried, 9-5 that pays $150k base with $30k "bonus" for the mandatory call.

 

[Sushirolls]

^^^ding ding. That's a big one.

 

[mistafab]

I would just say that this should have been taken care of by the docs themselves prior to signing their contract. It is common practice to negotiate your patient caps, over cap compensation, how "averages" are calculated for patient volume... etc etc. You have a lot of power here because it is the easiest time for you to walk away.

I'm doing some inpatient work and not having this issue. You don't have a lot of recourse here if it isn't in your contract. Got to suck it up, make a stink about it, or leave.

 

[Merovinge]

I would just say that this should have been taken care of by the docs themselves prior to signing their contract. It is common practice to negotiate your patient caps, over cap compensation, how "averages" are calculated for patient volume... etc etc. You have a lot of power here because it is the easiest time for you to walk away.

I'm doing some inpatient work and not having this issue. You don't have a lot of recourse here if it isn't in your contract. Got to suck it up, make a stink about it, or leave.

Absolutely, at the IP unit I worked at, people had a daily Cap. Admin tried to argue this was a monthly average cap and all the docs said that's not how a cap works. They ended up paying a price per head over the cap including a higher rate for new admits vs follow-ups which significantly improved annual salaries given how busy the time was when I worked there (10-20% pay raises for the attendings).

 

[TexasPhysician]

I wouldn’t call this new.

The job of admin is to increase profit for the system. This means pushing physicians to do more for less.