So can we talk money?

[F0nzie]

My buddy took a $200k gig for 5 beds.

...




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[SteinUmStein]

What are typical appointment lengths for outpatient positions like those? Flexible, or are they fixed 20 or 30 min RVs?

 

[Blitz2006]

The position I took pays you a flat amount per RVU generated. It has some nice benefits and such but with bonus it equates to $63/RVU, so you can do the math.

If I stayed here where I'm finishing residency you've got:

- $230k inpatient / outpatient mix, 30k sign on, something like up to $120k loan repayment (unclear on details), then about $48/RVU above 4,900. Call weekends are 3k (in addition to keeping RVUs) ~20 beds (average census 15-24). Kicker is overnight weeknight home call is $600 and is easy.

- $250k inpatient M-F no weekends. Crappy facility -- would never work here.

- $235k VA. Essentially no call. Also would never work here (it was my original plan until I actually worked in the clinic/VA).

- Something like $290 for a pretty easy military gig but it's all 1099.

- Where residency is at is like $210. Overall not bad job but as people have stuck around who trained here I don't think many people realize how much more you can get compensated outside the system.

Other places in the location I'm headed to were about $275 for inpatient stuff. My buddy took a $200k gig for 5 beds.

What region of the country is this? Big city, medium, rural?

 

[st2205]

What are typical appointment lengths for outpatient positions like those? Flexible, or are they fixed 20 or 30 min RVs?

The position I took you have as much flexibility as you want so long as you generate ~3,500 RVU/yr. I'm going to do 1 hr new patients and 30 minute followup. Some people are opting for longer than that.

What region of the country is this? Big city, medium, rural?

The place I'm currently at is Texas in medium sized cities plus some smaller areas (60-80k ppl). The place I'm going is a western state that's got a little over a million in the greater metropolitan area.

 

[Trismegistus4]

The position I took you have as much flexibility as you want so long as you generate ~3,500 RVU/yr. I'm going to do 1 hr new patients and 30 minute followup. Some people are opting for longer than that.

How does that translate to RVUs? How many RVUs does, say, a 99214 equate to? Does it vary widely? Is there any way to get any idea other than just asking the particular institution?

 

[st2205]

How does that translate to RVUs? How many RVUs does, say, a 99214 equate to? Does it vary widely? Is there any way to get any idea other than just asking the particular institution?

A 99214 is 1.5. 99213 is 0.97. Consider 90833 psychotherapy is another 1.5. Those values should hold across the board, unless you're in a system that's setting their own. The reimbursement per RVU will vary geographically but not by a very large amount.

 

[Shikima]

Oh RVUs, what a kind way of saying "sweat shop".
And I wonder why physicians are dissatisfied with the level of care they're giving.

 

[st2205]

Oh RVUs, what a kind way of saying "sweat shop".
And I wonder why physicians are dissatisfied with the level of care they're giving.

This cuts both ways. When you're reasonably compensated by them and not given unreasonable demands with them, you can provide good care without being rushed. For instance, I'll be making well above the mean working 4 days per week and not pressured to see 20 patients per day like many salaried jobs.

 

[thepoopologist]

For interest sake, do you know roughly what $ Kaiser in your area is offering?

Kaiser in Northern California offers a $300,000/year base salary with a $100,000 signing bonus. The signing bonus ties you there for 7 years.

Kaiser in Southern California offers a $220,000/year salary and an average of $80,000/year in retention and signing for the first three years. After 3rd year is partnership, and your base salary increases to about $300,000 a year. The signing bonus year 1 is $70,000 and ties you there for 2 years.

 

[SteinUmStein]

Do these kinds of outpatient positions (Kaiser and others) typically require call coverage or weekends? Does Kaiser require a certain patient schedule or RVUs?

 

[prominence]

Large managed care systems (i.e. Northwell) have a salary structure very similar to Kaiser (not surprisingly). These types of jobs tend to have a commute from Manhattan of about 40-90 minutes.

In NY, is anyone here familiar with how well Northwell hospitals pay board certified psychiatrists with 5+ years experience?

Do Northwell hospitals generally pay the same for inpatient vs. outpatient psychiatrists?

Are psychiatrists working at Northwell hospitals generally happy with their patient loads and work environments?

Any helpful insights would be greatly appreciated. Thank you in advance.

 

[PistolPete]

So conclusion to the story, I ended up accepting a state hospital position for $272,000 a year. The base salary increases by $10,000 when I pass my boards. I'll have 4-6% increases to my salary annually. There is a pension and 401k. I'll be running a 30 patient unit, with 1 note/patient/month. My team will include a psychologist, internist, and optionally a psychiatry resident and/or medical student. Schedule is four 10 hour days a week with no call. Vacation is 3.5 weeks a year. CME is 1.5 weeks a year.

Based on my job search this year, I think it is a buyer's market and will be for at least the next 2 years, provided one is

1. Thorough, i.e. asking multiple on the ground employees what the job is like
2. Negotiates for what they want (having leverage in the form of multiple other job offers always helps)
3. Exercises enough patience to not accept the first job offered, unless of course the first job offered is everything they want.​

Certain parts of the country pay more than others. Certain settings in psychiatry pay more than others. Results may vary.

Sounds like a DSH chronic-unit gig. Mind elaborating why you chose the state hospital system over Kaiser and over PP? All the best to you!

 

[JustAGuy]

I've only been to Napa State, and that place seemed dangerous as hell. Are all DSH jobs in California like this?

 

[PistolPete]

I've only been to Napa State, and that place seemed dangerous as hell. Are all DSH jobs in California like this?

Not sure. Heard that apparently Napa is supposed to be the worst, if not one of the worst, in terms of safety, but that's just rumor.

 

[splik]

I've only been to Napa State, and that place seemed dangerous as hell. Are all DSH jobs in California like this?

the population at the different hospitals vary and this affects the dangerousness (along with any management issues). Napa is mostly NGRI cases and highlights why all this stupid talk about "bringing back" the asylums is a terrible idea. A large proportion of these patients aren't mentally ill, they are malingerers and antisocials or psychopaths who have successfully exploited the system. meanwhile people who are actually mentally ill rot in prison. Coalinga is mainly sexually violent predators, so I would imagine it would be safer as a result though again, many/most are not mentally ill, unless you regard being a serial rapist ("unspecified paraphilic disorder") or pedophile, a mental disorder. A large proportion refuse to engage in treatment or have been instructed by their lawyers not to do so. Atascadero is mainly mentally disordered offenders (MDOs). These are criminals with severe mental disorders who have served their sentence but deemed to dangerous to be released and thus shipped into the state hospital system. So again, you can imagine it might be dangerous working with this population, but much less so than malingering NGRI patients (the more mentally ill they population, the less dangerous). Metropolitan hospital can't take the most dangerous patients, and they skew heavy on civil commitment cases which might make it "safer" but because the hospital is not built for the kinds of patients it gets it actually it has the 2nd most assaults after Napa. Patton also has a large proportion of NGRI cases and these patients are dangerous because of all the malingering antisocials.

here is a nice article comparing the risks at the different hospitals:
https://ww2.kqed.org/stateofhealth/...of-patients-assaults-on-staff-goes-untreated/

 

[PistolPete]

the population at the different hospitals vary and this affects the dangerousness (along with any management issues). Napa is mostly NGRI cases and highlights why all this stupid talk about "bringing back" the asylums is a terrible idea. A large proportion of these patients aren't mentally ill, they are malingerers and antisocials or psychopaths who have successfully exploited the system. meanwhile people who are actually mentally ill rot in prison. Coalinga is mainly sexually violent predators, so I would imagine it would be safer as a result though again, many/most are not mentally ill, unless you regard being a serial rapist ("unspecified paraphilic disorder") or pedophile, a mental disorder. A large proportion refuse to engage in treatment or have been instructed by their lawyers not to do so. Atascadero is mainly mentally disordered offenders (MDOs). These are criminals with severe mental disorders who have served their sentence but deemed to dangerous to be released and thus shipped into the state hospital system. So again, you can imagine it might be dangerous working with this population, but much less so than malingering NGRI patients (the more mentally ill they population, the less dangerous). Metropolitan hospital can't take the most dangerous patients, and they skew heavy on civil commitment cases which might make it "safer" but because the hospital is not built for the kinds of patients it gets it actually it has the 2nd most assaults after Napa. Patton also has a large proportion of NGRI cases and these patients are dangerous because of all the malingering antisocials.

here is a nice article comparing the risks at the different hospitals:
https://ww2.kqed.org/stateofhealth/...of-patients-assaults-on-staff-goes-untreated/

Interesting, thanks. Aren't those deemed NGRI generally confined to the state hospital system for life, though? You'd imagine that an antisocial/psychopath and his/her lawyer that was smart, would realize that prison would mean a decade or two sentence, perhaps even earlier parole, rather than a life sentence at the state hospital?

 

[splik]

Interesting, thanks. Aren't those deemed NGRI generally confined to the state hospital system for life, though? You'd imagine that an antisocial/psychopath and his/her lawyer that was smart, would realize that prison would mean a decade or two sentence, perhaps even earlier parole, rather than a life sentence at the state hospital?

antisocials/psychopaths aren't smart. certainly not the ones who get caught. and defense attorneys, particularly public defenders may prefer to have their client found NGRI which they might consider a successful outcome even if it means a longer sentence for the client. also in getting an insanity verdict, they put all their eggs in one basket and often ruin any chance the defendant would have at a reasonable plea (since you have to be found guilty first in order to be found NGRI bizarrely). it's not uncommon for those found NGRI to feel misled or aggrieved, when they spend longer in a hospital than they would have if sentenced to prison.

But no, if you're found NGRI you are not in the hospital for life (or shouldn't be unless you are really that dangerous) but will usually spend more time in hospital than you would have if sentenced. NGRI acquitees will hopefully make their way through the CONREP program in california, which is the conditional release program. If they successfully meet all the requirements, they may "graduate" from this program. It makes sense to go in for NGRI for capital crimes or crimes carrying a life without parole sentence, or a really long sentence. Hospital is obviously much cushier than prison, and these antisocials prey on the more vulnerable patients.

 

[dl2dp2]

In NY, is anyone here familiar with how well Northwell hospitals pay board certified psychiatrists with 5+ years experience?

Do Northwell hospitals generally pay the same for inpatient vs. outpatient psychiatrists?

Are psychiatrists working at Northwell hospitals generally happy with their patient loads and work environments?

Any helpful insights would be greatly appreciated. Thank you in advance.

It depends on the job, as Northwell is a huge system. However, as far as I know things are getting close to Kaiser level for facilities outside of Manhattan. Believe it or not Northwell and Kaiser often compete against each other for docs. I would say 250k base + incentives not uncommon for a typical O/P job. 300k possible for child/addiction trained. They also have to compete with city-wide jobs, as City Hospital systems are now paying $160+ per hour. I think it's fair to expect that a fairly chill job in the boroughs to pay ~250k+.

If you are gun-ho on Manhattan, you'd have to work harder to get to 300k, but I know plenty of people who can do this. Typically the arrangement is 40 hours a week at a facility (which really is more like 35 hours), which grosses you ~180k, then another 6-10 hour private practice.

 

[Blitz2006]

Kaiser in Northern California offers a $300,000/year base salary with a $100,000 signing bonus. The signing bonus ties you there for 7 years.

Kaiser in Southern California offers a $220,000/year salary and an average of $80,000/year in retention and signing for the first three years. After 3rd year is partnership, and your base salary increases to about $300,000 a year. The signing bonus year 1 is $70,000 and ties you there for 2 years.

These are some pretty impressive numbers, especially for California...

 

[prominence]

It depends on the job, as Northwell is a huge system. However, as far as I know things are getting close to Kaiser level for facilities outside of Manhattan. Believe it or not Northwell and Kaiser often compete against each other for docs. I would say 250k base + incentives not uncommon for a typical O/P job. 300k possible for child/addiction trained. They also have to compete with city-wide jobs, as City Hospital systems are now paying $160+ per hour. I think it's fair to expect that a fairly chill job in the boroughs to pay ~250k+.

If you are gun-ho on Manhattan, you'd have to work harder to get to 300k, but I know plenty of people who can do this. Typically the arrangement is 40 hours a week at a facility (which really is more like 35 hours), which grosses you ~180k, then another 6-10 hour private practice.

Sluox, thanks for the helpful reply.

 

[Shikima]

And if your lawyer was good enough, arrange for conjugal visits

These are some pretty impressive numbers, especially for California...

It's not that great considering the cost of living. Take a lesser number by 20% in the midwest, and you end up with more still - purely from a numbers game.

 

[SteinUmStein]

Anyone have guidance on how to compare outpatient positions with and without call? I've seen positions with some home call and occasional weekends that seem to offer more, but I haven't heard if there is a standard rate for overnight home call and for weekend coverage with these positions. Is there a typical rate or does it vary widely by region and specific position?

 

[FlowRate]

Anyone have guidance on how to compare outpatient positions with and without call? I've seen positions with some home call and occasional weekends that seem to offer more, but I haven't heard if there is a standard rate for overnight home call and for weekend coverage with these positions. Is there a typical rate or does it vary widely by region and specific position?

I don't know the strict answer to the way you phrased your question, but I would start with a reframing: what are night/home/weekend calls worth to you?

 

[SteinUmStein]

I think that's a good way to look at it. Just trying to compare as a lot of the averages and "expected" compensation numbers include positions with weekend and/or home call, and I'm looking to avoid that. Thus, it gets tricky as average salaries for outpatient psychiatry in some areas might be running in the mid-200s or higher, which includes positions with no call and positions with regular call. Basically, how much less should we expect to make with no call versus taking regular call (q4-6 weekends, occasional weeknights, or similar).

 

[Information Underload]

Anyone have guidance on how to compare outpatient positions with and without call? I've seen positions with some home call and occasional weekends that seem to offer more, but I haven't heard if there is a standard rate for overnight home call and for weekend coverage with these positions. Is there a typical rate or does it vary widely by region and specific position?

This is really just an economics question combined with a need question. They need you to cover call, and thus you are going to command more than you might during the week in a standard position. For instance, I cover a 27-bed unit on the weekends Q6-weeks. Roughly 20-follow-ups x 2 days per weekend (my state pays $75 for a level 2 inpatient follow-up) and 4-5 new admits ($215 per level 3) leaves you with between $3,800 and $4,000 in revenue generated. Multiply that by the number of call shifts, and that tells you about what you should expect to make in a weekend. Maybe subtract some so they keep some. Other variables include percent of private insurance v. self-pay patients (read: no pay patients). Phone call at night generates no revenue, so I wouldn't expect to be paid much for that and just look at it as a necessary duty associated with the hospital. In a larger system, you might expect more income, especially if not everyone is covering. I saw $600 a night listed above as one example. How busy a phone call is comes into play here, as well. For me? 3-4 calls per night.

About 33% of my take-home comes from bonus, so I look at call weekends as a balance between my lifestyle and my income along with simply being part of the team and doing my part. I also work in a smaller practice, so that team role definitely comes into the equation and is not something that I see as negotiable in my current role.

Looking at several of your questions, it's not a bad idea to understand how RVUs work and how much Medicaid/Medicare pay for services rendered when you look at a contract. I could tell pretty easily with some simple math that the contract that I signed was quite generous and that bonus was going to make up a substantial portion of my take-home. It made choosing my current position with a lower base pay a pretty easy one.

 

[JustAGuy]

I've heard that some seasoned VA doctors have been getting annoyed that new hires are coming on making more than they are. Can anyone talk about raises at the VA? Sounds like there isn't an automatic annual raise.

 

[scootad.]

Is anyone concerned about Trump and Paul Ryan's plan to privatize the VA?

Would that affect physicians in terms of further erosion of salaries and/or job stability?

 

[keifernny2]

I've heard that some seasoned VA doctors have been getting annoyed that new hires are coming on making more than they are. Can anyone talk about raises at the VA? Sounds like there isn't an automatic annual raise.

People hired before 2013 only have to pay 0.8% of salary (after tax) to retirement. People after 2014 have to pay 4.4%. On a 200k salary the difference is $7200 of after tax income, or basically a $10k salary difference. So, that explains 10k of difference right there. The rest may be individual.



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[JustAGuy]

People hired before 2013 only have to pay 0.8% of salary (after tax) to retirement. People after 2014 have to pay 4.4%. On a 200k salary the difference is $7200 of after tax income, or basically a $10k salary difference. So, that explains 10k of difference right there. The rest may be individual.



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How do they do pay raises in the VA?

 

[michaelrack]

This is really just an economics question combined with a need question. They need you to cover call, and thus you are going to command more than you might during the week in a standard position. For instance, I cover a 27-bed unit on the weekends Q6-weeks. Roughly 20-follow-ups x 2 days per weekend (my state pays $75 for a level 2 inpatient follow-up) and 4-5 new admits ($215 per level 3) leaves you with between $3,800 and $4,000 in revenue generated. Multiply that by the number of call shifts, and that tells you about what you should expect to make in a weekend. Maybe subtract some so they keep some. e.

Don't subtract anything, add some. You deserve extra for being on call. They can take the $ from the facility fee

 

[Blitz2006]

And if your lawyer was good enough, arrange for conjugal visits


It's not that great considering the cost of living. Take a lesser number by 20% in the midwest, and you end up with more still - purely from a numbers game.

Agreed

Im just comparing it with what I see here on East Coast, Boston to NYC to DC. You don't get 300k starting on this coast...(in the big cities)

 

[Shikima]

why especially? California pays more than anywhere else

No it doesn't.

 

[Blitz2006]

why especially? California pays more than anywhere else

Perhaps for jails.

Not otherwise or am I mistaken?

 

[Shikima]

all i can tell you is that none of the sh**y emails i get from recruiters with jobs in the middle of nowhere pay more than (and usually substantially less) than what is floated about in california. and i know that people are flying from other states to moonlight in california. jail psychiatry doesnt usually pay well btw. and prisons and state hospitals pay less than some other states (like in the moutain west or north dakota for example where the state hospitals pay more).

This speaks towards your bias for the coasts. Understandable. I once was the same way for the left coast. There are much better economic opportunities if geography isn't your limiting feature.

 

[masterofmonkeys]

Don't subtract anything, add some. You deserve extra for being on call. They can take the $ from the facility fee

This. Remember to shove the facility fee in their face. Especially useful for hospital affiliated outpaitent depts that get an extra facility fee.

 

[indiana27]

Have an intriguing job offer. Would appreciate any input.

Outpatient private practice in the South. Suburb outside of large Metro. Base salary is 250K with productivity bonus and option of having a Saturday clinic where I would be paid hourly rate of $125. No call. Would see only adolescents and adults in a general practice. Practice takes some insurance (BCBS, Aetna, UBH) and cash. Practice is med management only; 20 min f/u and 1 hr intakes generally. Average from 15-17 pts a day. Therapist in-house available for referral. May need to oversee a NP, though s/he would report to medical director first. It is fairly close to friends/family. Claims-based malpractice provided but I would need to provide tail coverage. Relocation reimbursed up to 5K; all licensure/certification fees reimbursed.

 

[dl2dp2]

Have an intriguing job offer. Would appreciate any input.

Outpatient private practice in the South. Suburb outside of large Metro. Base salary is 250K with productivity bonus and option of having a Saturday clinic where I would be paid hourly rate of $125. No call. Would see only adolescents and adults in a general practice. Practice takes some insurance (BCBS, Aetna, UBH) and cash. Practice is med management only; 20 min f/u and 1 hr intakes generally. Average from 15-17 pts a day. Therapist in-house available for referral. May need to oversee a NP, though s/he would report to medical director first. It is fairly close to friends/family. Claims-based malpractice provided but I would need to provide tail coverage. Relocation reimbursed up to 5K; all licensure/certification fees reimbursed.

Is this partnership track? If not the numbers aren't great. This kind of schedule generates possibly >500k revenue on their end: 15*100*48*5=360k, and these days 99213 alone can reimburse $100. 99213+90833 is usually in the $150+ range. The practice is charging above average overhead.

I would either ask for RVU based or partnership track with a reasonable buy-in schedule.

$125 per hour on Sat is pretty bad, esp. for C&A.

 

[indiana27]

Is this partnership track? If not the numbers aren't great. This kind of schedule generates possibly >500k revenue on their end: 15*100*48*5=360k, and these days 99213 alone can reimburse $100. 99213+90833 is usually in the $150+ range. The practice is charging above average overhead.

I would either ask for RVU based or partnership track with a reasonable buy-in schedule.

$125 per hour on Sat is pretty bad.

Thanks so much for the feedback. This was very helpful. And yes, this position would be considered for partnership track (not sure how much stock I can put into that statement). I agree that the hourly rate is quite poor - I'll certainly have my work cut out for negotiations!

 

[F0nzie]

Is this partnership track? If not the numbers aren't great. This kind of schedule generates possibly >500k revenue on their end: 15*100*48*5=360k, and these days 99213 alone can reimburse $100. 99213+90833 is usually in the $150+ range. The practice is charging above average overhead.

I would either ask for RVU based or partnership track with a reasonable buy-in schedule.

$125 per hour on Sat is pretty bad, esp. for C&A.

How would a partnership track work with an established psych practice? Divide all net profits down the middle? I wouldn't offer a partnership track in my business unless the individual had an existing business or proven track record. Risk would be way too high.


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[Shikima]

Don't subtract anything, add some. You deserve extra for being on call. They can take the $ from the facility fee

Ok, I'll be one of the first, what's a facility fee?

 

[dl2dp2]

How would a partnership track work with an established psych practice? Divide all net profits down the middle? I wouldn't offer a partnership track in my business unless the individual had an existing business or proven track record. Risk would be way too high.


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Fonz--I'm not in a partnership so don't know too much about this, but I have friends who are in anesthesia and ophtho and the way this works is you are on the track for a couple of years with a reduced salary (or no salary, where you get a "loan", which is "forgiven" upon making partner, with certain tax advantages that are opaque to me), with the stipulation that if you do well at the practice the reduction would be part of the "buy-in" whereby when you become a partner you would get a portion of the equity. With the portion of the equity you then get profit sharing (kind of like stock owners get dividends) in addition to your salary. The more equity you own the more profit shows up on your "schedule K".

As you can see, all kinds of things could go wrong there, where the managing partner/partners would make decisions about how much of the profit gets reinvested into the practice vs distributed to all equity partners. Usually your profit share also is coupled to your production, but this is all negotiated ahead of the time. But thankfully since people have done this for hundreds of years lawyers have standard formulations, and as long as you lawyer up yourself in theory nobody gets screwed. In practice obviously people get screwed all the time just like in any other kind of business venture.

Nevertheless I think the upside is that if you are partner you do end up getting a cut in all the profit the employed therapists generate, so on average a partnership track job end up being much more lucrative than a solo practice. In my area very few psychiatrists take insurance, so group practices are uncommon except as part of large managed care organizations (physician group), as cash practice doesn't have as much overhead and the advantage of economy of scale isn't as apparent. Permenente group, for example, is actually a physician partnership. So when you "work for Kaiser" what this means is you work on the partner track at the permenente group. They have to do this because of stark law. MDS can't be technically employees of the hospital they refer to. However, when you ar working for a very very large partnership, what ends up happening is that there is a standard formula that determines your profit share, not unlike when you work for Google and they give you stock options. It's essentially the same as cash and very easy to valuate. Whereas, if you work for a small suburban practice, and all of a sudden you hired 30 more therapists in the next year, your value of the equity in the partnership would explode.

A lot of this is pretty confusing to me also, and I'm not that interested in starting a partnership myself, but this is the extent of my understanding.

 

[Psychotic]

Ok, I'll be one of the first, what's a facility fee?

I went to see a doc whose office is in the main hospital building. When I looked at the explanation of benefits from the insurance company, I saw where there was a fee paid for the physician, and a separate "facility fee." I had never heard of this, and I actually submitted a dispute to my insurer, thinking I had been unfairly charged. Nothing ever came of it, so one day I asked around and found out about this pricing gouge on patients and insurers. It didn't cost me anything - our insurance is pretty good, no co-pay, no deductibles - but it pissed me off.

 

[st2205]

Ok, I'll be one of the first, what's a facility fee?

Whenever you submit billing for a patient (inpatient or outpatient) your facility is also submitting a bill for utilizing their facility for services, which is how the facilities are making money. There's been this erroneous idea spread around that you're only worth as much as your CPT codes. If you're only collecting your equivalent of CPT codes in your salary but then you're taking non-billable call, you're doing that for free as a service to the facility. We're the rate-limiting step to this whole thing rolling -- if there aren't psychiatrists, there's no revenue. You shouldn't be settling for doing free work. If someone suggests or believes you can't ask for more than your CPT codes to do work that's outside that, then you've already lost your leverage.

 

[PistolPete]

Whenever you submit billing for a patient (inpatient or outpatient) your facility is also submitting a bill for utilizing their facility for services, which is how the facilities are making money. There's been this erroneous idea spread around that you're only worth as much as your CPT codes. If you're only collecting your equivalent of CPT codes in your salary but then you're taking non-billable call, you're doing that for free as a service to the facility. We're the rate-limiting step to this whole thing rolling -- if there aren't psychiatrists, there's no revenue. You shouldn't be settling for doing free work. If someone suggests or believes you can't ask for more than your CPT codes to do work that's outside that, then you've already lost your leverage.

Amen.

 

[F0nzie]

If you have a high deductible those facility fees will take you to the cleaners.


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[FlowRate]

Ok, I'll be one of the first, what's a facility fee?

Just to complete the other answers, this fee can only be charged by hospitals. I lack knowledge of whether hospitals charge non-medicare insurers a facility fee (I believe they do), but it originated back when Medicare started the RVU system, as one of the components of the RVU charge for a visit. Facility fees vary based on location. They can also be exorbitant. My hospital charges ~$500 facility fee on top of the physician charge for an outpatient visit.

This is why hospitals are able to out-compete outpatient private practices so easily, they have a huge additional charge they're allowed to bill. In fact, hospitals have been charging their facility fee even for outpatient visits at satellite locations (quite controversially.)

 

[F0nzie]

The system is ripe for back and forth exploitation between hospitals and insurance companies until the consumer is completely crushed. Machiavelli would throw a party here.


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[Shikima]

How does one find out about facility fees for hospitals and hospital owned clinics?

 

[digitlnoize]

Anyone know what defines a "facility"? How does a practice/system get to be defined as a "facility"? If I owned an inpatient hospital that also had its own outpatient clinics, is that a facility? If this is the case, why do so many inpatient units have trouble making money? So many questions! To google I go...

 

[Shikima]

Anyone know what defines a "facility"? How does a practice/system get to be defined as a "facility"? If I owned an inpatient hospital that also had its own outpatient clinics, is that a facility? If this is the case, why do so many inpatient units have trouble making money? So many questions! To google I go...

lmgtfy.com