Nursing home and residential tx jobs?

[finalpsychyear]

I need some help. There are two facilities near me that are offering me some options as i build up my practice.

1) Nursing home with medicare/medicaid mix less than 5 minutes from my house : have about 30 dementia/alzheimers locked unit and another 20-30 patients on other units that they want me to round on at least 1x a month. There is already a medical director there. I would bill on my own which is fine so i'm guessing 50 pts x 60 dollar a visit.

2) Residential tx facility medicaid with dual diagnosis adolescent: about 54 kids from 13-17 years old avg length is 180 days. They want to give me 40 hrs a month to round on everyone but they pay per hour. Meeting tmrw but I'd guess it would be about $100 per hour for indep contracting? Plan is to eventually bill on my own since at a minimum they want everyone seen once but ideally more but we shall see. This place is 15-20 minutes from my house.

Are these both places that are no brainers to supplement a private practice or can someone with experience in these give me insight one way or another. Thanks!

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[Jules A]

I need some help. There are two facilities near me that are offering me some options as i build up my practice.

1) Nursing home with medicare/medicaid mix less than 5 minutes from my house : have about 30 dementia/alzheimers locked unit and another 20-30 patients on other units that they want me to round on at least 1x a month. There is already a medical director there. I would bill on my own which is fine so i'm guessing 50 pts x 60 dollar a visit.

2) Residential tx facility medicaid with dual diagnosis adolescent: about 54 kids from 13-17 years old avg length is 180 days. They want to give me 40 hrs a month to round on everyone but they pay per hour. Meeting tmrw but I'd guess it would be about $100 per hour for indep contracting? Plan is to eventually bill on my own since at a minimum they want everyone seen once but ideally more but we shall see. This place is 15-20 minutes from my house.

Are these both places that are no brainers to supplement a private practice or can someone with experience in these give me insight one way or another. Thanks!

They are very different populations do you have a preference? I love the RTC kids and wish they weren't doing away with them in my state. In my experience they are usually more behavioral, trauma, in-utero exposure etc. rather than true psych. If it is dual diagnosis I'd want to know what if any responsibility you might have for detox protocol or if that falls under the somatic provider because that will be time consuming and possibly a high liability area. I would also ensure the nursing and tech staff is sufficient and skilled as there is usually a high rate of after hours calls for seclusions, IMs, notification of physical altercations or self injury. If you are only required to see stable patients once a month and it is largely med checks with a few new evals per month 40 hours 54 patients is very doable. Most will probably be stable on their medication regimens and only require a few minutes of face time. Because many don't want to work with this patient population the psychiatrists in my area usually make in the range of $150-175 an hour for a part time position.

 

[Shikima]

I need some help. There are two facilities near me that are offering me some options as i build up my practice.

1) Nursing home with medicare/medicaid mix less than 5 minutes from my house : have about 30 dementia/alzheimers locked unit and another 20-30 patients on other units that they want me to round on at least 1x a month. There is already a medical director there. I would bill on my own which is fine so i'm guessing 50 pts x 60 dollar a visit.

2) Residential tx facility medicaid with dual diagnosis adolescent: about 54 kids from 13-17 years old avg length is 180 days. They want to give me 40 hrs a month to round on everyone but they pay per hour. Meeting tmrw but I'd guess it would be about $100 per hour for indep contracting? Plan is to eventually bill on my own since at a minimum they want everyone seen once but ideally more but we shall see. This place is 15-20 minutes from my house.

Are these both places that are no brainers to supplement a private practice or can someone with experience in these give me insight one way or another. Thanks!

I'd just contract with them as 1099 for an hourly rate, they keep the billings and cover your malpractice.
You'll find this much easier to negotiate, less time wasted in your future.

Putting hourly rate into perspective - roughly $120/hr is about 250k. Anything less, you're devaluing yourself.

 

[finalpsychyear]

I'd just contract with them as 1099 for an hourly rate, they keep the billings and cover your malpractice.
You'll find this much easier to negotiate, less time wasted in your future.

Putting hourly rate into perspective - roughly $120/hr is about 250k. Anything less, you're devaluing yourself.

The medical director spoke to me and said he wants me to also do some talk therapy in addition to the E/M visits with the 50 or so residents. Anyone know what cpt codes i use for nursing home e/m or residential facility? Do i just use the 90833 add on codes if there is at least 16 min of just talk therapy? thanks!

 

[michaelrack]

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[st2205]

The medical director spoke to me and said he wants me to also do some talk therapy in addition to the E/M visits with the 50 or so residents. Anyone know what cpt codes i use for nursing home e/m or residential facility? Do i just use the 90833 add on codes if there is at least 16 min of just talk therapy? thanks!

Yes.

 

[michaelrack]

I'd just contract with them as 1099 for an hourly rate, they keep the billings and cover your malpractice.
You'll find this much easier to negotiate, less time wasted in your future.

Putting hourly rate into perspective - roughly $120/hr is about 250k. Anything less, you're devaluing yourself.

even $120/hr is low; and I doubt they would be covering his malpractice, so that should be taken into account when setting the rate.

 

[Merovinge]

even $120/hr is low; and I doubt they would be covering his malpractice, so that should be taken into account when setting the rate.

Particularly if its 1099 where you will pay an extra roughly 9% in taxes vs employed pay.

 

[finalpsychyear]

even $120/hr is low; and I doubt they would be covering his malpractice, so that should be taken into account when setting the rate.

Yes. At least the child unit stated they did not cover malpractice. We haven't talked numbers yet but they want me to be there for 10 hours a week. Then they said they would be texting or calling me for other issues during the month... i'm thinking shouldn't I be getting paid separately as this essentially means i am "on call" in a way. Is this a standard for these places i mean they already have a separate medical director and i am just independently contracting with them for 10 hours a week but somehow obligated to answer and respond to various issues through text/phone?

 

[Jules A]

Yes. At least the child unit stated they did not cover malpractice. We haven't talked numbers yet but they want me to be there for 10 hours a week. Then they said they would be texting or calling me for other issues during the month... i'm thinking shouldn't I be getting paid separately as this essentially means i am "on call" in a way. Is this a standard for these places i mean they already have a separate medical director and i am just independently contracting with them for 10 hours a week but somehow obligated to answer and respond to various issues through text/phone?

It depends on whether or not you are considered the patients attending. If you are the attending the after hours calls will be part of your obligation and should be considered when you negotiate your rate. How often are you required to see each patient? At the job where I'm required to see all the patients on a weekly basis I bill a flat rate of 1h per patient per week which is more than sufficient to also cover the after hours calls which can be cumbersome. Many RTCs require the RNs to notify a provider any time a patient burps. I'd also investigate the whole therapy thing. I've never heard of that being financially viable in a RTC setting. They usually employ social workers or LCPCs to do therapy.

 

[Thruster]

similar jobs in my area (low paying, saturated) at least 150/hr and no less than 50-60 pp.

 

[finalpsychyear]

even $120/hr is low; and I doubt they would be covering his malpractice, so that should be taken into account when setting the rate.

Particularly if its 1099 where you will pay an extra roughly 9% in taxes vs employed pay.

It depends on whether or not you are considered the patients attending. If you are the attending the after hours calls will be part of your obligation and should be considered when you negotiate your rate. How often are you required to see each patient? At the job where I'm required to see all the patients on a weekly basis I bill a flat rate of 1h per patient per week which is more than sufficient to also cover the after hours calls which can be cumbersome. Many RTCs require the RNs to notify a provider any time a patient burps. I'd also investigate the whole therapy thing. I've never heard of that being financially viable in a RTC setting. They usually employ social workers or LCPCs to do therapy.

similar jobs in my area (low paying, saturated) at least 150/hr and no less than 50-60 pp.

I am so raw right now. Here I was thinking because most of these kids will have medicaid I would be lucky to get 100 dollars an hour. Yes, so they have 50 kids right now and the ceo wants me to see them minimum 1x a month but ideally to have me see them 2x a month while attending a team meeting weekly. You guys are right since I will be the attending I guess they can text me questions and issues anytime during the month so I"m essentially in a way "on call" for them 24/7.

Good to hear that 150/hr doing 1099 where they give me no benefits/no malpractice is THE MINIMUM i should be negotiating. Also, i think 40 hours to do 50 kids is fine but initially to go through their charts and what not it will be like 50 new patients for me. Eventually, if they want me to round 2x a month I think it will be fair that i bill those "2nd" visits on my own or they pay for more hours. Agree?

 

[FlowRate]

I am so raw right now. Here I was thinking because most of these kids will have medicaid I would be lucky to get 100 dollars an hour. Yes, so they have 50 kids right now and the ceo wants me to see them minimum 1x a month but ideally to have me see them 2x a month while attending a team meeting weekly. You guys are right since I will be the attending I guess they can text me questions and issues anytime during the month so I"m essentially in a way "on call" for them 24/7.

Good to hear that 150/hr doing 1099 where they give me no benefits/no malpractice is THE MINIMUM i should be negotiating. Also, i think 40 hours to do 50 kids is fine but initially to go through their charts and what not it will be like 50 new patients for me. Eventually, if they want me to round 2x a month I think it will be fair that i bill those "2nd" visits on my own or they pay for more hours. Agree?

It sounds to me like you are unsure of your options when negotiating a contract. You can pretty much ask for whatever you want.

I would personally negotiate an hourly rate and actually track my hours worked. Any phone call / text / email is minimum 30 minutes pay. If you are attending of record on dual-diagnosis kids and only there a few hours a week, that sounds a little risky. Medical director should be AOR.

 

[finalpsychyear]

It sounds to me like you are unsure of your options when negotiating a contract. You can pretty much ask for whatever you want.

I would personally negotiate an hourly rate and actually track my hours worked. Any phone call / text / email is minimum 30 minutes pay. If you are attending of record on dual-diagnosis kids and only there a few hours a week, that sounds a little risky. Medical director should be AOR.

Thanks for this information. I usually always let them say an offer and answer the "what are you looking for question"... with "whatever is fair". I will probably ask for 200 per hour... they are offering 10 hours a week. I guess i would take 150 but since i'm not experienced with these facilities I'm not sure if the Medicine director who is an FP would go for the AOR. Is that how it is normally done in the places you guys have seen?

 

[Jules A]

Thanks for this information. I usually always let them say an offer and answer the "what are you looking for question"... with "whatever is fair". I will probably ask for 200 per hour... they are offering 10 hours a week. I guess i would take 150 but since i'm not experienced with these facilities I'm not sure if the Medicine director who is an FP would go for the AOR. Is that how it is normally done in the places you guys have seen?

The two places I have worked did not have the medical director as AOR on any of the long term patients. Is it a true dual-diagnosis unit? If so does the FP handle detox management? You could also consider billing per encounter which is my preferred method in this type situation. I don't ever rely on an employer to tell me how much they will pay me I always go in with my requirements and see if they are willing to meet it.

 

[finalpsychyear]

The two places I have worked did not have the medical director as AOR on any of the long term patients. Is it a true dual-diagnosis unit? If so does the FP handle detox management? You could also consider billing per encounter which is my preferred method in this type situation. I don't ever rely on an employer to tell me how much they will pay me I always go in with my requirements and see if they are willing to meet it.

They do not do detoxes there and so the ceo told me that the kids arrive medically stable in that aspect. I have thought about billing on my own but i'm thinking it will be very low for a RTA facility maybe 40 dollars an encounter? Plus, it would be nice if i did 40 hours a week and got a fixed 6k paycheck.

 

[michaelrack]

To the OP; I suggest that in either setting you 1) bill patients for the services you perform and 2) get a stipend from the facility- this stipend could be in the form of a "provider fee", a "medical director fee", or both. You may also want to ask for a fee for "call coverage"- however the facility will probably want to bundle some of these together which is fine.
If you have the infrastructure (billing capabilities and are in network with most of the insureres the facility takes), then you definitely want to bill for your services, but you deserve more than that!

Note that even if the facility already has a medical director, you can be "medical director of psychiatry," or "medical director of adolescent services", etc

edit: for legal purposes, any fees discussed above are considered to be for non-billable services such as leading treatment teams, etc

 

[finalpsychyear]

To the OP; I suggest that in either setting you 1) bill patients for the services you perform and 2) get a stipend from the facility- this stipend could be in the form of a "provider fee", a "medical director fee", or both. You may also want to ask for a fee for "call coverage"- however the facility will probably want to bundle some of these together which is fine.
If you have the infrastructure (billing capabilities and are in network with most of the insureres the facility takes), then you definitely want to bill for your services, but you deserve more than that!

Note that even if the facility already has a medical director, you can be "medical director of psychiatry," or "medical director of adolescent services", etc

edit: for legal purposes, any fees discussed above are considered to be for non-billable services such as leading treatment teams, etc

Wow. Fantastic advice. Any idea what is reasonable for a "directors" fee bundled with the call coverage? I'm guessing 2-3k a month maybe?
The population is kids 11-17 so im guessing it is all medicaid insurances more or less.

 

[Merovinge]

I am so raw right now. Here I was thinking because most of these kids will have medicaid I would be lucky to get 100 dollars an hour.

So while medicaid does pay substantially less for outpatient than private insurance, they reimburse somewhat decently impatient AND they have far far fewer hops to jump through than private insurance. This is really good because it allows kids on medicaid to get reasonable inpatient care (their LOS can be much longer than private). My work is typically with this population and the pay at some of the private hospitals can even be better than some places that take care of a more affluent patient base (comparing 100% inpatient job vs 100% inpatient job).

 

[Jules A]

Not a clue how it is done where OP is applying but the RTCs I have worked didn't bill insurance for separate services. The providers were either paid salary or productivity and the facility was paid a flat rate by the insurance companies.