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Telepsych contract

Yellow mellow

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I have a contract for telepsych (remote work) that is paying 150/hr. I’ve never done telepsych before. Don’t know if this is a a good number.
The contract says I’m responsible for EMR recurring charges, provisions of H323 compliant static IP camera, etc.. Does anyone know how much I’m looking at ?
Also, contracts also states that “when agreed upon by provider and company, with execution of a physician NP protocol agreement, provider will be paid $600/month stipend per NP overseen for up to 4 mid-level providers as allowed by state law.” I have no idea what this means. Is anyone here familiar with this or what this means ?
I’m looking for an attorney for contracts and future work but was hoping someone on forum may help me out.
 
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sluox

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I have a contract for telepsych (remote work) that is paying 150/hr. I’ve never done telepsych before. Don’t know if this is a a good number.
The contract says I’m responsible for EMR recurring charges, provisions of H323 compliant static IP camera, etc.. Does anyone know how much I’m looking at ?
Also, contracts also states that “when agreed upon by provider and company, with execution of a physician NP protocol agreement, provider will be paid $600/month stipend per NP overseen for up to 4 mid-level providers as allowed by state law.” I have no idea what this means. Is anyone here familiar with this or what this means ?
I’m looking for an attorney for contracts and future work but was hoping someone on forum may help me out.


You don't really need an attorney IMO. Just try it out and if you don't like it quit and find someone else. These companies are so plentiful these days you can find half a dozen by just scrolling down your Instagram, literally.

In terms of numbers: $160 is actually not bad--could be higher, but not the worst I've seen. I've thought a bit about how much I would demand for supervising an NP. It'd totally depend on the context, but the approximate math as someone who knows a bit about this kind of business: roughly NPs make 100k salary. They generate about 200-300k revenue, with a residual profit margin of somewhere between 50-100%. So, if you leave the owner another 50% of profit I think it'll be fair given you are the one taking the vast liability. So I think the bare minimum number would be $3000 per month per NP.
 
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liquidshadow22

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You don't really need an attorney IMO. Just try it out and if you don't like it quit and find someone else. These companies are so plentiful these days you can find half a dozen by just scrolling down your Instagram, literally.

In terms of numbers: $160 is actually not bad--could be higher, but not the worst I've seen. I've thought a bit about how much I would demand for supervising an NP. It'd totally depend on the context, but the approximate math as someone who knows a bit about this kind of business: roughly NPs make 100k salary. They generate about 200-300k revenue, with a residual profit margin of somewhere between 50-100%. So, if you leave the owner another 50% of profit I think it'll be fair given you are the one taking the vast liability. So I think the bare minimum number would be $3000 per month per NP.

If you did this in multiple states, let's say supervising 8 nps in 2 different states. You could theoretically earn over 300k per year without seeing a single patient in person haha

Is it common to see practices actually pay this much for supervision. Most I have seen is about 15k to 20k per NP.
 
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oldiebutgoodie1211

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I have a contract for telepsych (remote work) that is paying 150/hr. I’ve never done telepsych before. Don’t know if this is a a good number.
The contract says I’m responsible for EMR recurring charges, provisions of H323 compliant static IP camera, etc.. Does anyone know how much I’m looking at ?
Also, contracts also states that “when agreed upon by provider and company, with execution of a physician NP protocol agreement, provider will be paid $600/month stipend per NP overseen for up to 4 mid-level providers as allowed by state law.” I have no idea what this means. Is anyone here familiar with this or what this means ?
I’m looking for an attorney for contracts and future work but was hoping someone on forum may help me out.
If you did this in multiple states, let's say supervising 8 nps in 2 different states. You could theoretically earn over 300k per year without seeing a single patient in person haha

Is it common to see practices actually pay this much for supervision. Most I have seen is about 15k to 20k per NP.

supervising an NP for less than 5k per month is a horrible deal. I had a friend lose his license supervising an NP because he thought it would be a good money maker and the NP went overboard prescribing controlled substances and misdiagnosing patients..he recently got his license back after hard fought battles..I am never supervising an NP especially if it’s not in person. Also the person who said supervise 8 NPs good luck losing your license in 1 year..I’m sure that’s worth it..NPs barely have any training and don’t know what they don’t know..very risky you’re playing with fire unless it’s a close and trusted NP that you have educated along the way.
 
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sluox

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If you did this in multiple states, let's say supervising 8 nps in 2 different states. You could theoretically earn over 300k per year without seeing a single patient in person haha

Is it common to see practices actually pay this much for supervision. Most I have seen is about 15k to 20k per NP.

Supervising 8-10 NPs *SHOULD* be a full-time job at the medical director level TBH (so 300k is a low ball figure).
To do it correctly:
Think about it, you need to meet them at least once a week to go over med lists for most of their patients (and we are talking a minimum of 100-200 med mgmt patients), then there's half dozen new intakes and difficult follow-ups you might need to be in the room, then paperwork, dealing with billing issues, etc.

At full capacity 8-10NPs would gross 2M, and they would yield a net profit of 500k minimum for the owner. Why shouldn't get at least 300k of the 500k for taking on most of the liability?? What value does the practice owner really add?

Of course if you get to pick and choose the NP you work with, once they demonstrate a track record of reliability you can stay a bit more hands-off. But the whole problem of the NP pipeline is that the variance of quality is huge, and to a certain extent the higher profit margin is a hedge for taking on more risks. So being a medical director without ownership and hence the ability to fire/hire is the WORST arrangement IMO. I personally would never do that kind of job without a profit-sharing agreement, but it's understandable that some people might from a financial perspective if they prefer this over a patient mill grind..
 
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BiscoDisco

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Supervising 8-10 NPs *SHOULD* be a full-time job at the medical director level TBH (so 300k is a low ball figure).
To do it correctly:
Think about it, you need to meet them at least once a week to go over med lists for most of their patients (and we are talking a minimum of 100-200 med mgmt patients), then there's half dozen new intakes and difficult follow-ups you might need to be in the room, then paperwork, dealing with billing issues, etc.

At full capacity 8-10NPs would gross 2M, and they would yield a net profit of 500k minimum for the owner. Why shouldn't get at least 300k of the 500k for taking on most of the liability?? What value does the practice owner really add?

Of course if you get to pick and choose the NP you work with, once they demonstrate a track record of reliability you can stay a bit more hands-off. But the whole problem of the NP pipeline is that the variance of quality is huge, and to a certain extent the higher profit margin is a hedge for taking on more risks. So being a medical director without ownership and hence the ability to fire/hire is the WORST arrangement IMO. I personally would never do that kind of job without a profit-sharing agreement, but it's understandable that some people might from a financial perspective if they prefer this over a patient mill grind..

By your numbers, one should be able to generate ~50k profit per NP. If one were to open their own cash private practice, is it relatively easy to hire an NP who accepts insurance and add income that way? Or are there some steps that make this more difficult? I'm wondering why more docs don't add an NP or two to bump their yearly income another 1-200k.
 
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sluox

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By your numbers, one should be able to generate ~50k profit per NP. If one were to open their own cash private practice, is it relatively easy to hire an NP who accepts insurance and add income that way? Or are there some steps that make this more difficult? I'm wondering why more docs don't add an NP or two to bump their yearly income another 1-200k.

It's "easy" in the sense that legally and regulatorily anyone can do it. In practice it's not easy because it's annoying to have hybrid insurance/cash practice. Furthermore, because it's so easy, it's also easy for NPs to set up their own shops--and in fact they do, see: Instagram.

1. PP psychiatrists, especially good ones, can focus on their medical practice and be very successful anyway without NPs. On a per hour basis, you can bump your yearly income another 1-200k by just work a bit more clinically. You have only so many hours a day, you either do that by seeing patients or managing staff, and the latter isn't necessarily more efficient on a per hour basis. Sometimes it's better to be hyper-specialized and charge a higher fee than try to derive profit by building a larger organization. I hope this is clear because this also applies to many many other fields.

2. There are genuine logistic challenges, most notably the hiring/firing process which will be ongoing and tedious. I personally very much dislike the work of managing incompetent people and hence would never be a senior executive of a middling large system. For example, even if I were put in charge of doing this kind of work, I'd be much more focused on fundraising, marketing etc rather than operations. I'd try to outsource the operations work. Your mileage may vary, and in small practices, you have to do everything.
 
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splik

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It'd totally depend on the context, but the approximate math as someone who knows a bit about this kind of business: roughly NPs make 100k salary.
NPs don't get paid 100k these days. Round here they get paid about 200k. The lowest for new grads is about 160k here. As with psychiatrists, psych NP has gone up considerably...
 
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liquidshadow22

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supervising an NP for less than 5k per month is a horrible deal. I had a friend lose his license supervising an NP because he thought it would be a good money maker and the NP went overboard prescribing controlled substances and misdiagnosing patients..he recently got his license back after hard fought battles..I am never supervising an NP especially if it’s not in person. Also the person who said supervise 8 NPs good luck losing your license in 1 year..I’m sure that’s worth it..NPs barely have any training and don’t know what they don’t know..very risky you’re playing with fire unless it’s a close and trusted NP that you have educated along the way.
It's "easy" in the sense that legally and regulatorily anyone can do it. In practice it's not easy because it's annoying to have hybrid insurance/cash practice. Furthermore, because it's so easy, it's also easy for NPs to set up their own shops--and in fact they do, see: Instagram.

1. PP psychiatrists, especially good ones, can focus on their medical practice and be very successful anyway without NPs. On a per hour basis, you can bump your yearly income another 1-200k by just work a bit more clinically. You have only so many hours a day, you either do that by seeing patients or managing staff, and the latter isn't necessarily more efficient on a per hour basis. Sometimes it's better to be hyper-specialized and charge a higher fee than try to derive profit by building a larger organization. I hope this is clear because this also applies to many many other fields.

2. There are genuine logistic challenges, most notably the hiring/firing process which will be ongoing and tedious. I personally very much dislike the work of managing incompetent people and hence would never be a senior executive of a middling large system. For example, even if I were put in charge of doing this kind of work, I'd be much more focused on fundraising, marketing etc rather than operations. I'd try to outsource the operations work. Your mileage may vary, and in small practices, you have to do everything.


Can you explain why it's annoying to have a hybrid cash/insurance practice? In theory the psychiatrist doesnt participate and the NP is credentialed with the insurance. How does it become an issue? I could see it perhaps being an issue if you have TMS or Ketamine etc in your practice, but if it's just straight psychopharm and therapy, shouldnt be too big of an issue right?
 
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Yellow mellow

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You don't really need an attorney IMO. Just try it out and if you don't like it quit and find someone else. These companies are so plentiful these days you can find half a dozen by just scrolling down your Instagram, literally.

In terms of numbers: $160 is actually not bad--could be higher, but not the worst I've seen. I've thought a bit about how much I would demand for supervising an NP. It'd totally depend on the context, but the approximate math as someone who knows a bit about this kind of business: roughly NPs make 100k salary. They generate about 200-300k revenue, with a residual profit margin of somewhere between 50-100%. So, if you leave the owner another 50% of profit I think it'll be fair given you are the one taking the vast liability. So I think the bare minimum number would be $3000 per month per NP.

Actually it’s a two year contract. And it’s 150/hr. Paying my own malpractice insurance too.
 
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sluox

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NPs don't get paid 100k these days. Round here they get paid about 200k. The lowest for new grads is about 160k here. As with psychiatrists, psych NP has gone up considerably...

In general, facilities salary goes up as revenue goes up. If you are supervising someone who makes 200k, you better not get paid $600 a month doing it. I hope this much is clear to everyone involved...
 
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oldiebutgoodie1211

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I’m shocked by these jobs some people are entertaining..an NP is a very big liability you need to be paid for it at least a few thousand a month minimum..if they don’t want to pay just tell them you won’t supervise it’s that simple. Also 150/hr and you have to pay your own insurance!? Is this a joke?
 
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TexasPhysician

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The hours they ask for actually works best for me right now, 8 hrs/week. Do you have any suggestions in terms of negotiations?

Free equipment, no charges, $5k/month/NP or no midlevels at all. Midlevels require a lot of time and effort. You need to review all of the charts, provide education, be on-call for them 24/7/365, and coordinate care. That and it raises the odds of a lawsuit. You should have collaborative agreements with each one that details their limitations.
 
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Yellow mellow

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Free equipment, no charges, $5k/month/NP or no midlevels at all. Midlevels require a lot of time and effort. You need to review all of the charts, provide education, be on-call for them 24/7/365, and coordinate care. That and it raises the odds of a lawsuit. You should have collaborative agreements with each one that details their limitations.

Thanks for the input TexasPhysician. I think I’ll just decline their contract offer. I wasn’t sure about the contract initially but after reading all the posts here, it does seem like I was offered a raw deal.
 
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Yellow mellow

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I’m shocked by these jobs some people are entertaining..an NP is a very big liability you need to be paid for it at least a few thousand a month minimum..if they don’t want to pay just tell them you won’t supervise it’s that simple. Also 150/hr and you have to pay your own insurance!? Is this a joke?

Ugh, I feel like a fool for even entertaining the contract. I wasn’t thrilled with the pay but since I don’t have any telepsych experience and only wanted less than 10 hrs/week, I figured why not. But having to pay my own insurance and cover for NPs wasn’t appealing.
 
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calvnandhobbs68

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Average is $140-160. I do see $100-200 as the range.

Yea from what I see in the telepsych Facebook group that’s about what people are being offered. I think people were getting more up to 200 before COVID but now everyone and their NP sister is doing telepsych and realizing it’s not that hard. Also, with the relaxing of controlled substance regulations, every tech telemedicine company is trying to make hay while the sun shines and prescribe everyone they can Adderall and suboxone before they reimpose regulations on controlled subs for new patients.

OP I know you’re not taking the job but I would have at least made them pay for equipment if they want you to have some specific type of camera/setup, especially for a year+ long contract.
 
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