Realistic neuropsych workload expectation?

[NeuroP877]

---

Members do not see this ad.

.

 

[Therapist4Chnge]

Overworked AND those productivity bonuses are trash compared to the added revenue you produce. While 10 Dementia or pre-surg evals are different than 10 TBI evals, I suspect it’s mostly longer/more complex cases than easy cases, so having 10 is likely excessive.

 

[WisNeuro]

Depends on the bennies.

 

[WisNeuro]

How good is that match?

 

[AcronymAllergy]

That definitely seems on the high end for workload, but you're also above the median pay for early-career neuropsychologists, especially if you're in the 1-5 years of practice group (you're at almost +1 SD there) and, as you say, you're at 40 hours/week. I'd say if you had 100% psychometrist support, it might not be horrible, but you're probably worth more to the hospital. At less than 100% support, yeah, that's a lot.

But I'm also wondering about your billing numbers. You say you're on pace for 3200-3500 RVUs. If assuming 450 evals/year (10/week, 48 weeks/year, with some no-shows worked in), assuming I didn't completely space on my math, you're sitting at <8 RVUs per eval. I haven't looked at RVU values in a few years, but that still seems low.

Are the 10 evals/week based on explicit expectations, or instead are you seeing that many because that's what you need to see to hit RVU targets?

 

[szymk1sm]

That definitely seems on the high end for workload, but you're also above the median pay for early-career neuropsychologists, especially if you're in the 1-5 years of practice group (you're at almost +1 SD there) and, as you say, you're at 40 hours/week. I'd say if you had 100% psychometrist support, it might not be horrible, but you're probably worth more to the hospital. At less than 100% support, yeah, that's a lot.

But I'm also wondering about your billing numbers. You say you're on pace for 3200-3500 RVUs. If assuming 450 evals/year (10/week, 48 weeks/year, with some no-shows worked in), assuming I didn't completely space on my math, you're sitting at <8 RVUs per eval. I haven't looked at RVU values in a few years, but that still seems low.

Are the 10 evals/week based on explicit expectations, or instead are you seeing that many because that's what you need to see to hit RVU targets?

In line with this post:

My dept was previously 3500 wRVUs for full time clinicians working 48 weeks / year (regardless of whether you had psychometrist support - we average ~75% tech support). This averaged out to 7 half-day evals / week. General outpatient clinic at AMC (geri mixed with medical / neurological conditions). No training or teaching requirements per se. Starting salary was $100k (recently bumped up to $120k), Supposedly wRVUs decreased this AY to 3000 (so likely 5 or 6 half-day evals / week).

So I too am questioning your billing / wRVUs per case if you're seeing 10 evals / week. Might be worth seeking some guidance on this (happy to send you what I do if you PM me) to see if you can see 1 or 2 less cases / week but still meet your wRVU goals? You doing all that work and only being there 40 hours / week is impressive BTW.

 

[WisNeuro]

That definitely seems on the high end for workload, but you're also above the median pay for early-career neuropsychologists, especially if you're in the 1-5 years of practice group (you're at almost +1 SD there) and, as you say, you're at 40 hours/week. I'd say if you had 100% psychometrist support, it might not be horrible, but you're probably worth more to the hospital. At less than 100% support, yeah, that's a lot.

But I'm also wondering about your billing numbers. You say you're on pace for 3200-3500 RVUs. If assuming 450 evals/year (10/week, 48 weeks/year, with some no-shows worked in), assuming I didn't completely space on my math, you're sitting at <8 RVUs per eval. I haven't looked at RVU values in a few years, but that still seems low.

Are the 10 evals/week based on explicit expectations, or instead are you seeing that many because that's what you need to see to hit RVU targets?

I haven't looked at RVUs since I've been PP, but I wonder if that number does not include the psychometrist rvus.

Edit: looks like 96132 - 3.71, 96132 - 2.83, 96116 - 2.70

 

[PsyDr]

1) I'm a workaholic, and even I think this pace is insane.
2) You're grossing them $320k/yr, unless you have some billing errors, or you are doing weird test batteries.
3) Unless you are always writing reports in an hour, and never have a low productivity day, or you never get sick, you're writing a LOT of reports from home. I would minimally come up with some back up plan, for when those productivity dips.
4) Those RVUs make no sense, based upon your intakes alone.

 

[AcronymAllergy]

1) I'm a workaholic, and even I think this pace is insane.
2) You're grossing them $320k/yr, unless you have some billing errors, or you are doing weird test batteries.
3) Unless you are always writing reports in an hour, and never have a low productivity day, or you never get sick, you're writing a LOT of reports from home. I would minimally come up with some back up plan, for when those productivity dips.
4) Those RVUs make no sense, based upon your intakes alone.

This is what I keep coming back to as well. Even for a relatively straightforward Medicare-based adult outpatient neuropsych eval, I'd expect to get around ~$800. But I don't think 3200-3500 RVUs comes anywhere close to reflecting that, even accounting for not including testing codes.

At the RVU rates WisNeuro provided, it looks like you're averaging less than 1 unit of 96116, 1 of 96132, and 1 of 96133 per eval. Which doesn't seem to make sense, even if you're ridiculously efficient in your work.

 

[szymk1sm]

Thank you everyone for these responses. They have been pretty eye opening and validating.

I gave a pretty conservative estimate for the wRVUs because I wanted to be sure not to exaggerate. There was also a ramp-up period with the position so I did not initially start at 10 evals/week. There is the occasional week where I have 9 or 8 evals, but very rarely is it less than that. Realistically, I am looking at 4000+ wRVUs generated, but I do have a good bit of upcoming PTO planned as well. Also my understanding is my system does not count psychometrist codes (96138/96139) into our wRVUs, but I am not 100% sure if that is correct or typical.

The explicit expectation is around 10 evals a week, but our wRVU productivity target is about 3000. The productivity target though is purely for determining if we qualify for the productivity incentive.

I do not have a lot of control over my clinic work flow. A lot of these evals are forced to be half day evals by the design of our clinic. On some cases though if it is a younger or more complex patient they are full day evals where I only do 1 eval that day. The modal experience though is 2 half day evals/day + 1 feedback.

Some additional food for thought:

If you're generating 4000 wRVUs, but the expectation is 3000 wRVUs - what is your productivity incentive? Is the discrepancy between your required wRVUs and your actual wRVUs beneficial for you in terms of incentive pay?

I make an additional $18-27k / year in incentive pay, as I exceed my wRVU targets (so the model you're doing would motivate me b/c i would make more money) -- also note I'm mostly research, so my wRVUs are 20% of the full-time clinicians amount. With my dept's current incentive pay model, you would make an extra ~$32k / year with an excess of 1000 wRVUs / year.

I also run two half-day evals where I do interview, testing, and feedback all in the same day - regardless of patient age / condition - and regardless of whether I have a tech or not. If you're not doing that, would consolidating everything into a single day help with time management? Are you getting any writing days in your week?

We also don't get wRVU credit for tech codes (96138/39).

 

[szymk1sm]

The productivity incentive is directly proportional to how much we exceed the wRVU target by, so I do get paid more depending on how much I exceed it. It’s determined by a combination of a few metrics though besides wRVUs, so it is hard for me to estimate exactly how much it’ll be. I have been at the position for almost a year, so it won’t be until the year end when I would see how much I get from the incentive.

Unfortunately my clinic has been pretty resistant to any sort of changes in work flow. I imagine I could maybe do more same day feedbacks, but at least personally I don’t have a preference one way or the other for feedback timing. I do not get any writing days or options for a condensed work week. I feel like I am managing, still producing quality work, and all my patient satisfaction metrics are great. It’s just more of a question about how sustainable this all is, and from everything I have been reading in this thread it sounds like it is not realistically sustainable long-term without some sort of change.

Agreed...

and part of what is unique to neuropsychology over other providers is that we can bill for our writing time - so your clinic (ideally) should not be scheduling you patients 5 days / week, 2 slots per day. There is no accounting for billable writing time w/in that week and thus, the potential expectation is that you're taking that writing time home. I'm sure I'm preaching to the choir here, but that may be something to consider bringing up to your team.

 

[AcronymAllergy]

Agreed...

and part of what is unique to neuropsychology over other providers is that we can bill for our writing time - so your clinic (ideally) should not be scheduling you patients 5 days / week, 2 slots per day. There is no accounting for billable writing time w/in that week and thus, the potential expectation is that you're taking that writing time home. I'm sure I'm preaching to the choir here, but that may be something to consider bringing up to your team.

Well, there could be writing time if there were 100% psychometrist support. But without that, yeah, you're not doing any writing if you're doing your own testing for 2 patients/day, every day.

 

[PsyDr]

Thank you everyone for these responses. They have been pretty eye opening and validating.

I gave a pretty conservative estimate for the wRVUs because I wanted to be sure not to exaggerate. There was also a ramp-up period with the position so I did not initially start at 10 evals/week. There is the occasional week where I have 9 or 8 evals, but very rarely is it less than that. Realistically, I am looking at 4000+ wRVUs generated, but I do have a good bit of upcoming PTO planned as well. Also my understanding is my system does not count psychometrist codes (96138/96139) into our wRVUs, but I am not 100% sure if that is correct or typical.

The explicit expectation is around 10 evals a week, but our wRVU productivity target is about 3000. The productivity target though is purely for determining if we qualify for the productivity incentive.

I do not have a lot of control over my clinic work flow. A lot of these evals are half day evals by the design of our clinic. In a perfect world, I would prefer for some of them to be full day evals. On some cases though if it is a younger or more complex patient they are full day evals where I only do 1 eval that day. The modal experience though is 2 half day evals/day + 1 feedback.

are you not billing for time spent interpreting and writing? You still get to bill for your time interpreting psychometricist data.

 

[AcronymAllergy]

Sorry maybe I didn’t explain the level of psychometrist support well! I fortunately am not testing all of my patients. Out of 10 evals in a week, I would say I’m usually testing 3-4 of them myself. The other 6-7 are tested by a psychometrist. Some weeks I test a little more myself and others a little less. I very much agree though that I feel I do not get a reasonable amount of writing time.

Sorry, I did read that in your previous post and didn't mean to imply you don't have any psychometrist support. But even with only partial support, it's tough to find the time to write reports for 10 patients/week, especially if that support is sporadic (i.e., you can't plan around it).

Also, to add on to what PsyDr said, definitely be sure to bill all time you're spending interpreting and thinking about the case. In my experience, this is something many neuropsychologists underestimate.

I do think it's reasonable to not receive credit for psychometrist testing time/codes. But when that help is scattered around, it makes your report writing much less efficient.

 

[NeuroP877]

Thank you all so much. I am aware that data interpretation is part of 96132/96133, but sounds like there is certainly the possibility that I am not fully capturing my time based off of the estimates in here. If I want to be able to make the case that my workload is high I need to make sure it is being appropriately and accurately captured in my billing. I really appreciate you all and having this forum as a resource.