Reimbursement for PA vs NP

[Yoyomama88]

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Any idea on average rates of reimbursement for CPT codes for either mid-level provider?

 

[splik]

It is 85% for medicare and many private insurers of that of the physician rate, except in states like Oregon where there is "parity" for NPs. For Medicaid it is between 70-100% of the physician rate depending on states. The absolute numbers of course are wildly variable depending on location, payor, and negotiated rates.

 

[Yoyomama88]

It is 85% for medicare and many private insurers of that of the physician rate, except in states like Oregon where there is "parity" for NPs. For Medicaid it is between 70-100% of the physician rate depending on states. The absolute numbers of course are wildly variable depending on location, payor, and negotiated rates.

So do less than 50% of the work to become a psychiatrist but make 85% of what a psychiatrist makes? Not bad 🙂

 

[splik]

So do less than 50% of the work to become a psychiatrist but make 85% of what a psychiatrist makes? Not bad 🙂

well this is widely variable. In employed positions PAs tend to make less than NPs in psych based on what I've seen. NPs can make in the low hundreds to 200k+ in employed positions. As contractors they may make a lot more hustling. In private practice some do cash only. We had an NP working for us who charges $500/hr in their private practice.

 

[PikminOC]

So do less than 50% of the work to become a psychiatrist but make 85% of what a psychiatrist makes? Not bad 🙂

More like 25 percent of the work
And their malpractice and actual liability are much less too. They are held to mid-level standard and have a collab doc to take the hardest hit as the deepest pocket

 

[Splenda88]

More like 25 percent of the work
And their malpractice and actual liability are much less too. They are held to mid-level standard and have a collab doc to take the hardest hit as the deepest pocket

Sound like it's a win-win for NP... ~10% of physicians' education (school'ing') with 50-100% pay parity.

 

[nexus73]

Sound like it's a win-win for NP... ~10% of physicians' education (school'ing') with 50-100% pay parity.

My friend is a medical director at a health system's psych clinic and the NPs are basically on nursing contracts, but get paid an NP salary. This means breaks and lunch and overtime...all the stuff an RN should get as an employee, the NPs get this, but none of the doctors do.

 

[AD04]

My friend is a medical director at a health system's psych clinic and the NPs are basically on nursing contracts, but get paid an NP salary. This means breaks and lunch and overtime...all the stuff an RN should get as an employee, the NPs get this, but none of the doctors do.

Wow. Are NPs better at negotiating than doctors?

 

[Sushirolls]

Yes, that's why we need to flood the market with MD/DO grads.
1) end step/level 3 requirements to obtain a medical license in all states.
2) grant full unrestricted independent licensure for MD/DO graduates simply at medical school graduation and levels/steps 1 thru 2.
3) A fresh grad MD/DO is far superior to an ARNP or PA-C. We flood the market with MD/DO grads that take over all these midlevel positions. Why would any entity hire a PA-C or ARNP over a fresh independently licensed MD/DO?
4) Yes, residencies will be more competitive for all specialties now that there is an ever expanding pool exceeding the available slots, but that is okay.

The cheaper paid concept of a midlevel isn't going away, therefore let's own it and claim it with Physicians.

 

[birchswing]

Yes, that's why we need to flood the market with MD/DO grads.
1) end step/level 3 requirements to obtain a medical license in all states.
2) grant full unrestricted independent licensure for MD/DO graduates simply at medical school graduation and levels/steps 1 thru 2.
3) A fresh grad MD/DO is far superior to an ARNP or PA-C. We flood the market with MD/DO grads that take over all these midlevel positions. Why would any entity hire a PA-C or ARNP over a fresh independently licensed MD/DO?
4) Yes, residencies will be more competitive for all specialties now that there is an ever expanding pool exceeding the available slots, but that is okay.

The cheaper paid concept of a midlevel isn't going away, therefore let's own it and claim it with Physicians.

What do you see as the benefit of the freshness? I understand not wanting someone with senility, but is being green a good thing?

 

[heartsink]

What do you see as the benefit of the freshness? I understand not wanting someone with senility, but is being green a good thing?

I don't think he's emphasizing the "freshness" as much as the comparison of the base of knowledge and training a fourth year medical student has compared to an NP or PA.

Its actually a genius idea -- imagine if we removed the requirement of completed residencies for a medical graduate to be hireable; medical students that immediately wanted to continue on and become physicians would continue the process as normal and apply/match/etc, but medical students that were content being "mid-levels" for a while (or needed more experience/research to be competitive for their specialty) could immediately begin practice, replacing NPs/PA's with superior funds of knowledge and experience.

 

[Splenda88]

I don't think he's emphasizing the "freshness" as much as the comparison of the base of knowledge and training a fourth year medical student has compared to an NP or PA.

Its actually a genius idea -- imagine if we removed the requirement of completed residencies for a medical graduate to be hireable; medical students that immediately wanted to continue on and become physicians would continue the process as normal and apply/match/etc, but medical students that were content being "mid-levels" for a while (or needed more experience/research to be competitive for their specialty) could immediately begin practice, replacing NPs/PA's with superior funds of knowledge and experience.

It's something I have been advocating in SDNN for a while, but you have a bunch MD/DO docs who said it's not a good idea because they don't want to 'devalue' the MD/DO degree... like it's not already devalued by NP organizations and the been counters who are looking to screw us.

 

[PikminOC]

Wow. Are NPs better at negotiating than doctors?

Nurses are unionized. And there are alot more of them

 

[psychacad]

I don't think he's emphasizing the "freshness" as much as the comparison of the base of knowledge and training a fourth year medical student has compared to an NP or PA.

Its actually a genius idea -- imagine if we removed the requirement of completed residencies for a medical graduate to be hireable; medical students that immediately wanted to continue on and become physicians would continue the process as normal and apply/match/etc, but medical students that were content being "mid-levels" for a while (or needed more experience/research to be competitive for their specialty) could immediately begin practice, replacing NPs/PA's with superior funds of knowledge and experience.

The reason why there's a market for NPs in the first place is because there aren't enough MDs to cover the necessary need. This is largely due to efforts by physicians themselves to keep the supply tight for high $$.

Having MDs practice after med school won't change any of that. The crushing majority of graduating med students still pursue residency. You'll just have fewer residency-trained doctors.

We have two options really: 1) expand available residency spots and/or med school spots 2) deal with the reality of mid-level providers and continue to refine a niche in medical practice.

I would go with 2. I am not favorable to 1 because the standard of acceptance into medical school is already dropping.

P.S: BTW, residents pretty much function like mid-level providers. We're better off arguing that they should be paid similarly to NPs with improved rights, lol.

 

[Sushirolls]

There are enough docs to cover the need. Get rid of my charting for lawyers, get rid of my charting for billing. Allow me to chart only for clinical need, I could see 3x as many patients, easily.

India, specialty docs charge ~$25 for the visit, lasts 10minutes, notes are literally on a piece of printer paper hand written, see A LOT of people per day.
This model could even work in the US, simply get rid of those other documentation needs, and put the onus back on patients to follow your recommendations. "do xyz, next!" Rather than viewing patients as incapable of personal responsibility and needing reminders, and being chased down by the 'system' to induce treatments for DM, HTN, etc.

 

[nexus73]

There are enough docs to cover the need. Get rid of my charting for lawyers, get rid of my charting for billing. Allow me to chart only for clinical need, I could see 3x as many patients, easily.

India, specialty docs charge ~$25 for the visit, lasts 10minutes, notes are literally on a piece of printer paper hand written, see A LOT of people per day.
This model could even work in the US, simply get rid of those other documentation needs, and put the onus back on patients to follow your recommendations. "do xyz, next!" Rather than viewing patients as incapable of personal responsibility and needing reminders, and being chased down by the 'system' to induce treatments for DM, HTN, etc.

also lawsuits are virually non-existent in India, so just practice good medicine and not work about CYA.

 

[clausewitz2]

There are enough docs to cover the need. Get rid of my charting for lawyers, get rid of my charting for billing. Allow me to chart only for clinical need, I could see 3x as many patients, easily.

India, specialty docs charge ~$25 for the visit, lasts 10minutes, notes are literally on a piece of printer paper hand written, see A LOT of people per day.
This model could even work in the US, simply get rid of those other documentation needs, and put the onus back on patients to follow your recommendations. "do xyz, next!" Rather than viewing patients as incapable of personal responsibility and needing reminders, and being chased down by the 'system' to induce treatments for DM, HTN, etc.

IIRC you are seeing people mainly for 20 minute medication-focuses appointments. You are suggesting you could deliver adequate care in 10 minute long appointments. How, exactly?

They do this in India because there is a stupidly small number of specialists for a huge number of people. My attendings who trained in India would tell stories about coming to clinic in the morning and there being a line of 100 people waiting to be seen.

What kind of meaningful care does an outpatient psychiatrist provide at that point that a psychotropic vending machine does not?