Weekend IRF coverage

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JFS

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Currently looking into rounding on the weekends at a local acute rehab as a 1099 and trying to figure out what would be fair rate. Other threads on this topic don't quite fit the need.

Say average census of 25 with 4 admissions on the weekend, not on call during the week. Good support as-needed from IM and some specialties. 1-2 hours away from major city in western region. What daily rate do you all think would be fair for this kind of gig? Any resources you'd recommend for helping figure out the right number?

Edit: initial offer 1500 per day
 
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Following, curious. Also side note, you'll be doing this on the side, correct? What do you do full-time during the week?
 
Are you just doing admits on Saturday and leaving? Are you covering the entire service for issues or leaving it to IM on call? Are you rounding on follow ups on the weekend? Are you collecting on your patients or the hospital does and pays you a stipend? Are you coming in on Sunday as well?
 
DMBandFan86 said:
Are you just doing admits on Saturday and leaving? Are you covering the entire service for issues or leaving it to IM on call? Are you rounding on follow ups on the weekend? Are you collecting on your patients or the hospital does and pays you a stipend? Are you coming in on Sunday as well?
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Rounding on follow ups during Saturday and Sunday, admit Saturday and Sunday. Can leave when work is done but take calls until 5. Overnight handled by IM. Stipend only - no collections
 
JFS said:
Rounding on follow ups during Saturday and Sunday, admit Saturday and Sunday. Can leave when work is done but take calls until 5. Overnight handled by IM. Stipend only - no collections
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Whats the daily rate you were offerred?
 
Also depends on how desperate they are for coverage and how many other docs are interested. If you’re the only one they can find then you can call the shots. If they have others already on the weekend staff then they have a good idea what they will pay you and will probably offer that.

That’s really busy for the weekend. I imagine they would offer you something like 1000-1500 per day. But with the amount of work you are doing, I’d want 1500 or even more. If you just count Medicare collections for 20 follow ups and 2 admits per day at level 2 you are around 1600-1700 in collecting for the day. If you are signing pre admission screens then I would want more. If you are 1099 for weekend call the hospital shouldn’t really care about making profit on your billing as they are getting paid for the rehab.

That’s my opinion. But I also wouldn’t want to see that many people on the weekend. You also should be careful to not oversee people who are stable and potentially were already seen 5 days during the week. Unless the hospital has a policy that everyone has to be seen daily.
 
JFS said:
Initial offer 1500 per day
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Ok your answer posted as I was writing the above. 1500 is fair, but arguably a little low. Just depends how much you value your time. 22-25 patients could take some people 10-14 hours per day. Especially when you don’t know anyone.
 
Also your pay should increase over time. So even if you start at 1500 then next year you can ask for more.
 
DMBandFan86 said:
Also depends on how desperate they are for coverage and how many other docs are interested. If you’re the only one they can find then you can call the shots. If they have others already on the weekend staff then they have a good idea what they will pay you and will probably offer that.

That’s really busy for the weekend. I imagine they would offer you something like 1000-1500 per day. But with the amount of work you are doing, I’d want 1500 or even more. If you just count Medicare collections for 20 follow ups and 2 admits per day at level 2 you are around 1600-1700 in collecting for the day. If you are signing pre admission screens then I would want more. If you are 1099 for weekend call the hospital shouldn’t really care about making profit on your billing as they are getting paid for the rehab.

That’s my opinion. But I also wouldn’t want to see that many people on the weekend. You also should be careful to not oversee people who are stable and potentially were already seen 5 days during the week. Unless the hospital has a policy that everyone has to be seen daily.
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That was one of the problems with my former job - the Medicine team would see everyone everyday despite patients being stable, and even wrote notes on discharge day to bill and essentially say "patient discharging home" despite me doing all the dc stuff. Completely agree with your thoughts regarding not over billing and being cautious about over seeing patients that don't need to.
 
JFS said:
Currently looking into rounding on the weekends at a local acute rehab as a 1099 and trying to figure out what would be fair rate. Other threads on this topic don't quite fit the need.

Say average census of 25 with 4 admissions on the weekend, not on call during the week. Good support as-needed from IM and some specialties. 1-2 hours away from major city in western region. What daily rate do you all think would be fair for this kind of gig? Any resources you'd recommend for helping figure out the right number?
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1. That's a lot of people - particularly for the weekend, and particularly if you are seeing them for the first time and so they are not familiar to you - beware that that can be time consuming and complicated, and you might get stuck dealing with problems from the week which always seem to happen on weekends
2. Depends where you are, how desperate they are, how sick people are, and how much support/IM help you have. I know in the past comphealth was offering 2k/day. I would say no less than $1500, but probably closer to $2k. In the past, I was helping cover a former group where I typically saw 10-13 or so patients, so mostly half days, and was getting paid $2500 for the weekend. I'd ask for at least $3k-3500 for the weekend.

Out of curiosity why aren't the PM&R docs in the hospital helping to cover?
 
I agree--seeing that many patients you've never met is rough. I wouldn’t do that weekend coverage for $1500

As far as justifying seeing the patient, if PM&R is attending I think it’s easy to justify seeing the patient, even if it’s a low level charge. If PM&R is consulting it’s a different story though—especially if there’s no weekend therapy.
 
@RangerBob @Iamnew2 @DMBandFan86
Super helpful responses thank you so much! It was hard to get straight answers from my attendings about these kinds of topics so this has already been seriously helpful. For background, I'm fresh out of training where we'd round on weekends on at least 20 medically complex patients and be in-and-out in about 3-4 hours. Easy patients often got shunted elsewhere. About half of the time the patients were not known to us. Would focus on significant medical issues/changes so didn't spend much time in the room unless really needed. Not infrequently day would blow up from medical issues or would need to return to address something. Arguably patient care would have been much better if IM was involved in all our patients but they were spread thin across the hospitals and they didn't have much financial incentive to see more patients. No admissions on the weekends thankfully.

This particular IPR by comparison houses patients that are wayyyy less medically complex, but still IPR appropriate. IM and some other consultants seem easy to involve but not rounding on most patients. Looks like they get solid summaries from the screening crew on patients being admitted (I'm not used to this from residency) + they are in-house transfers anyways. The doc I spoke to is usually in-and-out in about 4-5 hours on weekends, rarely needs to come back.

There are a lot of rehab units in my metro area that are hiring full-time docs, so units like this farther away seem to struggle retaining docs. That means the docs that are there are often working more weekends than they'd like to. I've seen some similar units add an APP to offload, but this one hasn't tried that for whatever reason. Trying to figure out then how much I can push without them just immediately looking to find someone cheaper.

For those that do similar 1099 work, is there anything else besides these rates that you try to negotiate?
As an aside - anyone have perspective on the difficulty/ROI of this kind of work compared to IMEs?
 
paper_plates said:
Just out of curiosity…anyone have experience as a resident moonlighting in this kind of gig (weekend coverage)?
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far less lucrative - I think typically they give residents some bucks to round with attending and writing notes but not sure it's worth the trouble
 
DMBandFan86 said:
That’s my opinion. But I also wouldn’t want to see that many people on the weekend. You also should be careful to not oversee people who are stable and potentially were already seen 5 days during the week. Unless the hospital has a policy that everyone has to be seen daily.
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As a resident with no understanding of billing, why do you have to be careful not to oversee? What’s from stopping an ambitious newly grad from grinding and working 7 days a week always seeing people from a hypothetical standpoint.
 
You can work 365 days of the year if you want seeing and billing patients. My comment was a caution about overseeing a stable patient that doesn’t need a Saturday/Sunday follow up and had already been seen by primary 5 days that week. Especially with IM on board.

You should still have a reason to go see and bill a patient. If you’re as efficient and quick as you said, did you really have to go in and charge the patient to get the job done? Could you have just discussed with nursing? I’ve made it by with mostly doing only admissions on call weekends + seeing a d/c or sick patient for follow up as needed. Otherwise they are mostly fine. Doesn’t mean you can’t do it, but was just my opinion.

I think a main reason I said that in your case was that you are being paid a flat rate. So why not just see the admissions and triage any follow ups? You have no financial incentive to see everyone from what you said. So why work harder for the same money?

Theoretically you can get in trouble or denied for over billing. For instance, If your PCP told you to come in every week or even every month for no reason, your insurance would get upset and so would you for all the charges. Once IRF patients are stable then the concept is similar. Patients don’t like getting a charge for some random Doc they never saw before stick their head in the door for a few minutes. Insurance companies also may not pay for it unless you had a good justification to see them. As a covering doc, you are probably not going to get in any trouble if you round Sat/Sun. You will probably never even know about any insurance denials since you aren’t collecting. On another standpoint, you may also be setting up your partner to not see anyone not necessary on Monday since they were billed all weekend. That could hurt your partners WRVUs.

If you work somewhere that has a policy that every patient needs to be seen 7 days a week then ignore the above. The hospital takes any liability.
 
DMBandFan86 said:
You can work 365 days of the year if you want seeing and billing patients. My comment was a caution about overseeing a stable patient that doesn’t need a Saturday/Sunday follow up and had already been seen by primary 5 days that week. Especially with IM on board.

You should still have a reason to go see and bill a patient. If you’re as efficient and quick as you said, did you really have to go in and charge the patient to get the job done? Could you have just discussed with nursing? I’ve made it by with mostly doing only admissions on call weekends + seeing a d/c or sick patient for follow up as needed. Otherwise they are mostly fine. Doesn’t mean you can’t do it, but was just my opinion.

I think a main reason I said that in your case was that you are being paid a flat rate. So why not just see the admissions and triage any follow ups? You have no financial incentive to see everyone from what you said. So why work harder for the same money?

Theoretically you can get in trouble or denied for over billing. For instance, If your PCP told you to come in every week or even every month for no reason, your insurance would get upset and so would you for all the charges. Once IRF patients are stable then the concept is similar. Patients don’t like getting a charge for some random Doc they never saw before stick their head in the door for a few minutes. Insurance companies also may not pay for it unless you had a good justification to see them. As a covering doc, you are probably not going to get in any trouble if you round Sat/Sun. You will probably never even know about any insurance denials since you aren’t collecting. On another standpoint, you may also be setting up your partner to not see anyone not necessary on Monday since they were billed all weekend. That could hurt your partners WRVUs.

If you work somewhere that has a policy that every patient needs to be seen 7 days a week then ignore the above. The hospital takes any liability.
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I think the same goes for IM. IM should not be seeing patients daily that are stable.
 
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DMBandFan86 said:
You can work 365 days of the year if you want seeing and billing patients. My comment was a caution about overseeing a stable patient that doesn’t need a Saturday/Sunday follow up and had already been seen by primary 5 days that week. Especially with IM on board.

You should still have a reason to go see and bill a patient. If you’re as efficient and quick as you said, did you really have to go in and charge the patient to get the job done? Could you have just discussed with nursing? I’ve made it by with mostly doing only admissions on call weekends + seeing a d/c or sick patient for follow up as needed. Otherwise they are mostly fine. Doesn’t mean you can’t do it, but was just my opinion.

I think a main reason I said that in your case was that you are being paid a flat rate. So why not just see the admissions and triage any follow ups? You have no financial incentive to see everyone from what you said. So why work harder for the same money?

Theoretically you can get in trouble or denied for over billing. For instance, If your PCP told you to come in every week or even every month for no reason, your insurance would get upset and so would you for all the charges. Once IRF patients are stable then the concept is similar. Patients don’t like getting a charge for some random Doc they never saw before stick their head in the door for a few minutes. Insurance companies also may not pay for it unless you had a good justification to see them. As a covering doc, you are probably not going to get in any trouble if you round Sat/Sun. You will probably never even know about any insurance denials since you aren’t collecting. On another standpoint, you may also be setting up your partner to not see anyone not necessary on Monday since they were billed all weekend. That could hurt your partners WRVUs.

If you work somewhere that has a policy that every patient needs to be seen 7 days a week then ignore the above. The hospital takes any liability.
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I think you may have been directing your answer towards me although it was a different poster asking why not grind it out. Just for the resident’s learning I agree with everything @DMBandFan86 says here. The gig will pay me a flat rate and require me to see patients every day, even though it isn’t 100% necessary. If the requirement of seeing patients every day wasn’t there then I’d do exactly what DMB said.
 
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