Rvu question

[MedMan80]

hello all,

I’ve received an offer letter from a facility, mix outpatient and inpatient and call coverage (phone), they also are willing to do 75% of earnings over 5k rvu, I understand that the average psychiatrist does around 4500. How likely am I to get to >5k if assuming 12 outpatients a day (few new in there), and maybe 15 inpatients daily every fourth day or so? Im assuming call would not generate RVU as phone only..

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[dl2dp2]

You need to get a solid number. I've seen 99213 RVU from 0.65 to about 1.2. If the former, impossible. If the later, maybe.

In *general* for a facility driven job you'd want to just get a flat salary not contingent on RVU, then work there for a bit to get a "feel" before you commit to a full RVU model. OTOH, if this job is ideal for other reasons (i.e. location, etc) I'd just start and see what happens. Frankly I think most facility jobs are very similar to each other.

 

[MedMan80]

Thanks for the reply, they are offering a base and then the RVU is a bonus above 5000; just wanted a sense of if it would be achievable given the current loads they are proposing..also I have no idea about how much 75% of billings are, however it seems that Medicaid pays decently in this area....

 

[dl2dp2]

Thanks for the reply, they are offering a base and then the RVU is a bonus above 5000; just wanted a sense of if it would be achievable given the current loads they are proposing..also I have no idea about how much 75% of billings are, however it seems that Medicaid pays decently in this area....

I would have the expectation that you'll make base and not one cent more. Typically the advantage of this type of job is your ability to say no whenever you want, rather than make money up on billing extra. You can cancel clinic randomly or not see people, or just cancel appointments. Or show up 2 hour late. Nobody will care. This is why typically they either draw masochists or bottom feeders.

I have NEVER met a psychiatrist working for a facility who was able to bill enough RVUs in 40 hours a week to crack 500k. NEVER. In the private world, this is not common, but it's also not rare.

 

[hamstergang]

I’ve received an offer letter from a facility, mix outpatient and inpatient and call coverage (phone), they also are willing to do 75% of earnings over 5k rvu, I understand that the average psychiatrist does around 4500. How likely am I to get to >5k if assuming 12 outpatients a day (few new in there), and maybe 15 inpatients daily every fourth day or so? Im assuming call would not generate RVU as phone only..

I'm CAP solely outpatient, and I've averaged around 1 intake and 5 follow ups per day actually seen. I hit approximately 3300 wRVUs per year.

 

[nexus73]

hello all,

I’ve received an offer letter from a facility, mix outpatient and inpatient and call coverage (phone), they also are willing to do 75% of earnings over 5k rvu, I understand that the average psychiatrist does around 4500. How likely am I to get to >5k if assuming 12 outpatients a day (few new in there), and maybe 15 inpatients daily every fourth day or so? Im assuming call would not generate RVU as phone only..

5000 RVUs is a lot of work, but doable. If you work 48 weeks a year (4 weeks vacation), you need 104 RVUs per week, or 20-21 per day consistently to hit 5000/year. You MUST have the coding criteria down or you'll end up under billing.

15 inpatients if you bill all 99232 is 20.89 RVUs. If there is a mix of admit/discharge, therapy, your work will probably generate that many RVUs.
12 outpatient followups at 99214 is 18 RVUs. If you are doing therapy, it will be more.

5000 RVUs can be done, but may be a recipe for burnout.

 

[MedMan80]

Okay, so maybe I’ll ask for the bonus to be given at 4500 rvu? This would seem to be more fair.

 

[SmallBird]

Okay, so maybe I’ll ask for the bonus to be given at 4500 rvu? This would seem to be more fair.

That depends on the base! I think that incentive is going to be quite tough with this kind of setting so I’d rather negotiate the best base possible. I hope the base is > $250k.

 

[Horners]

I'm CAP solely outpatient, and I've averaged around 1 intake and 5 follow ups per day actually seen. I hit approximately 3300 wRVUs per year.

Excuse my naivety but assuming 1 hr for intake + 30 min f/u... that’s 3.5 clinical hrs a day. Why so little? Is it just slow? Or is this just a part time thing for you?


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[nexus73]

Excuse my naivety but assuming 1 hr for intake + 30 min f/u... that’s 3.5 clinical hrs a day. Why so little? Is it just slow? Or is this just a part time thing for you?


Sent from my iPhone using SDN mobile

Your assumptions are probably wrong

 

[hamstergang]

Excuse my naivety but assuming 1 hr for intake + 30 min f/u... that’s 3.5 clinical hrs a day. Why so little? Is it just slow? Or is this just a part time thing for you?

Depending on where in my job it's happening, intakes are 1.5 or 2 hours, so its 4 - 4.5 hours of clinical time per 7.5 hour day (they build 30 minute lunch into the 8 hours). It still doesn't feel like a lot, yet I always feel busy. Some of the other things that would take up time:
-2 team meetings per week as I work out of 2 departments/offices
-1 hour per week providing curbside consultation to a subspecialty clinic
-admin time for paperwork and phone calls (calling back parents, actually reaching out to schools and therapists)

There have also been a number of staffing/program changes for me over the past year which likely kept my clinical hours a little lower than they otherwise would have been.

I also think that a good deal of the leftover time is from no-shows or last minute cancellations. It's hard for me to use that time as efficiently as scheduled admin time. And with patients showing up late sp frequently, I can't use all my admin time each day. Still, it is a nice job. Not as crazy of days as I hear my private practice friends going through.

 

[MedMan80]

That depends on the base! I think that incentive is going to be quite tough with this kind of setting so I’d rather negotiate the best base possible. I hope the base is > $250k.

The base is decent, but I fully expect this type of operation to be pretty busy/shoestring..asked for a lower RVU for the bonus...will keep you guys updated

 

[Sushirolls]

5000 wRVUs for bouncing between inpatient and outpatient would get a nope from me. Needs to be 4000 wRVUs or less. Therapy add on codes would be necessary to approach the 4500 or 5000. Sure you could work more / harder to get that extra bucket of coal to hopefully pay off the company store, but if you take your vacation time (which you always should!!) you'll be struggling to pay the company store their 5000 wRVUs.

If you are working harder, or working more than median, you're sweat equity should be expended in your own private practice. The carrots employed jobs offer just aren't worth it. Or worse yet, they claim Fair Market Value rules and cap income at 75% of MGMA.

For folks playing by the wRVU rules, sit down, and review your numbers for an "average" month, and add up how much time you spent working. All work, phone calls, charting, patient care, emails, prior auths, everything. Then calculate out your true hourly pay rate, or your true wRVU conversion factor.

Time is your most precious commodity, know your worth, and work smarter not harder.