Pay for Residential Gig

[Fabio001]

I've debated posting my predicament here for several months, but I find myself in need of guidance and perspective.

I previously posted about a side-gig I have with an RTC. I described the details in a separate thread some months ago, quoted below. My current predicament is that I want to increase my rate, but also that the way I bill, which is essentially fee for service (FFS), doesn't feel right to me.

For some background, I'm a fellowship trained C&A psychiatrist and have a side-gig with a residential treatment center managing their 40 residents. I charge $300 per month for each patient I manage (which is all of them) which includes a monthly follow-up visit, and $600 for intakes. I am debating asking for $750 for intakes. The intakes I do are likely more involved than what you do; I spend an average of 30 minutes reviewing testing beforehand, 30-40 minutes interviewing the patient and their therapist, and 15-45 minutes on the phone with their parents. The intakes are the most challenging and lowest paying part of my job, and I wouldn't do them for $600 if I wasn't able to rake in the bucks through providing ongoing management afterward.

Part of what's motivating me here is a handful of clients they've accepted recently, with the understanding that they'd only be in the program for a few months until they turn 18; this puts me in the position of having put a ton of work into completing my evaluation, but then being unable to profit off the ongoing management, which I feel is much more generously compensated.


I see three options.
1) continue FFS model but increase my prices
2) switch to a flat management fee with no FFS
3) devise some sort of hybrid, to allow for flexibility

With that said, what makes the most sense? If it were entirely up to me, I think I would increase my total compensation by charging something like a $300 management fee for each kid, then on top of that, each follow-up visit I would charge $150. This would allow more flexibility in visit frequency as I could be compensated for seeing kids as often (or inoften) as they need, rather than seeing each kid once a month by default, which is how it currently is set up. I could then charge $750 for the intake, which could include management for that first month or have a pro-rated management fee added into it.

My questions: What's typical for the industry as far as models for paying for psychiatric coverage? Does the above seem appropriate as far as my rate, or does it seem high/low? What else should I be considering? In the other thread where I mentioned this, I was surprised at some of the reactions as far as my compensation; particularly the sentiment that I should be charging more. My hope is to remedy that with a new proposal.

Thank you sincerely,

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[smalltownpsych]

I would think that being paid extra to see kids more frequently could make alot of sense. If this is a private pay setup, they could pass that cost on to the parents. As a clinical director of these programs, I would say that having a good psychiatrist work more closely with the team and figuring out a way to compensate them well for that would be my goal. That being said, in most settings that is not their priority. I am also curious as to what the industry pays for this as my goal is to create this. In fact, I'm not too far away from being able to have the program that could be the place for those kids when they do turn 18.

 

[Merovinge]

It's hard to say without knowing what is happening for those 40 residents and what goes into it. Traditional RTC models require/have MD visits at least weekly and often have a total LoS of around 4-6 weeks (insurance driven RTCs), so you are discussing a fairly different setup where the management seems to be more behavioral and might be cash pay?. I think it's going to be hard to have many people with similar experience because this is a niche area (RTC is already niche, RTC that is working on a monthly visit w/ MD is very niche).

 

[nexus73]

Do you see each patient just monthly? Are you on call and responding to crises? Having to get on the phone with concerned, sometimes difficult, guardians? I don't have experience in this setup, but if it's basically an intake and then once a month check in without much in between the current setup sounds pretty reasonable. You're getting paid a little over $100K/year for basically one day a week of followups at 10 patients that one day (how long are you follow up visits?). I'd certainly encourage you to increase the rate for intakes if possible, given the amount of time you're spending. Plus the extra fee for visit beyond the once per month sounds very reasonsable, BUT you gotta make sure the $150/visit is enough. It might be low enough they just want you to see everyone twice a month, which basically cuts your rate in half for the second visit, 3rd visit, 4th visit... I suggest charging the same $300 for additional visits per month if the market will bear it, assuming this is a boutique residential program it's possible parents will be happy to pay for the option of more frequent psychiatrist involvement.

 

[Fabio001]

Do you see each patient just monthly? Are you on call and responding to crises? Having to get on the phone with concerned, sometimes difficult, guardians? I don't have experience in this setup, but if it's basically an intake and then once a month check in without much in between the current setup sounds pretty reasonable. You're getting paid a little over $100K/year for basically one day a week of followups at 10 patients that one day (how long are you follow up visits?). I'd certainly encourage you to increase the rate for intakes if possible, given the amount of time you're spending. Plus the extra fee for visit beyond the once per month sounds very reasonsable, BUT you gotta make sure the $150/visit is enough. It might be low enough they just want you to see everyone twice a month, which basically cuts your rate in half for the second visit, 3rd visit, 4th visit... I suggest charging the same $300 for additional visits per month if the market will bear it, assuming this is a boutique residential program it's possible parents will be happy to pay for the option of more frequent psychiatrist involvement.

I see each patient once a month for a 20 minute visit. In addition to the 20 minutes, I average about 10 minutes of administrative time, so 30 minutes of work. I am essentially on a very light form of call for the remainder of the month, but the average is around 4-5 issues per month for the entire facility. These typically involve some new behavioral or side-effect related concern or a pharmacy issue; the sort of thing that might take 10-20 minutes to address depending on whether I need to draft an email to parents. There is no expectation that I am responding to emails or texts within a certain time-limit, but I try to respond within 24 hours which I think lines up with the programs expectations.