Can anyone chime in on how the reimbursement rates look for mid levels in community practice? I've read 85% of what MD bills. Not sure how this is working on it everyday practice.
The 85% rule is no longer the case. Insurance pays the same no matter who sees them.
Are midlevels able to see a new patient, plan, write chemo with MD approval if MD is comfortable with this approach?
I guess, but no oncologist should be OK with this plan. And in the systems I've worked in, APPs are not allowed to start new chemo plans. Patients and referring docs should be sh****ng bricks if this is the standard anywhere.
How many patients per day do midlevels typically see ? I am assuming there is a range from the newly licensed to the 30+ year vet.
Not many. The APPs at my old job capped at 12 patients a day. The NP at my current job typically sees about half the patients I do in a given day. You'd be surprised at how little most NPs and PAs actually advance in their skills, comfort and abilities as they gain experience. I used to work with an NP who'd been in oncology for 6 years and still freaked out if she had to see more than 1 patient an hour.
How many midlevels are you normally overseeing any given day?
Define "overseeing". Both NPs and PAs in my state have independent practice rights. So unless they have a question, they typically do whatever they want. I don't have to sign off on any charts and I don't get "credit" for the work they do. So I don't "oversee" anything. Now, the NP is seeing "my" patients, so I always check her schedule and make sure there's not anything unusual going on that she might not be aware of. But it's not like with a resident or fellow, she's not running every case by me and getting me to sign off on it.
Now, keep in mind that the situations I described above are employed, community-based practices. In large academic/academ-ish practices, you might not even work on the same floor or the same part of the building as the APPs who see your patients sometimes. On the flip side, in a true, "eat what you kill" PP setting, if you want an APP to work with you, you are going to hire them and pay them, like, literally write them a check from your checking account every 2 weeks for the work they did, pay the employer part of their taxes, contribute to their 401K, etc (Note that the practice will actually write the checks, but it will come out of your pay). So in that case, you can collect everything that they bill and put it in your account which you will then use to pay the APP.
