Inpatient Coverage Reimbursement

[OutofNetwork]

Looking forward to any advice this forum can provide.

I just joined a hospital based outpatient ortho clinic with inpatient privileges. The hospital has a small inpatient rehab service (16 beds, no TBI/SCI) and the primary physiatrist (solo) reached out to me to provide coverage for her vacation (2-3 weeks a year) and 1 weekend a month. Since she's solo and never gets time off, I'm glad to do this but the question I have is - what can I ask for as far as reimbursement goes? And who do I ask?

TIA!

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[DMBandFan86]

It depends. Are you billing and collecting or doing a fixed contract?

 

[OutofNetwork]

It depends. Are you billing and collecting or doing a fixed contract?

I'm wRVU with hospital group. She told me I can bill for the patients I see, so essentially collect more wRVUs.

 

[cowboydoc]

I'm wRVU with hospital group. She told me I can bill for the patients I see, so essentially collect more wRVUs.

No, no and ____ no.

The hospital would have to pay a locums to fill in while she is out. That’s a good starting point in negotiating. IIRC, that may be about $2000-2500/day.

You would be inconvenienced by shuttering you’re clinic for that time and earn less in your primary area of practice. Add to the argument that you are vested in the system and will provide continuity and superior care to that of a locums. How about they pay you the SAME as a locums for a higher level of care and call it a day.

You are being a “team player” and a helpful partner, orrrr they can just let a locums deal with it and you do your thing. You have almost nothing to lose here.

 

[Iamnew2]

No, no and ____ no.

The hospital would have to pay a locums to fill in while she is out. That’s a good starting point in negotiating. IIRC, that may be about $2000-2500/day.

You would be inconvenienced by shuttering you’re clinic for that time and earn less in your primary area of practice. Add to the argument that you are vested in the system and will provide continuity and superior care to that of a locums. How about they pay you the SAME as a locums for a higher level of care and call it a day.

You are being a “team player” and a helpful partner, orrrr they can just let a locums deal with it and you do your thing. You have almost nothing to lose here.

I don't think it's realistic for inpatient rehab to get $2000-$2500. I have never seen that rate in any inpatient setting. I remember when I tried to get a raise to $1200-1500 per day when I was covering for my former private practice, they stopped asking me to cover, lol. But doubtful anyone would pay that kind of rate for PM&R inpatient locums. I do agree though that just billing and collecting does make sense in this case. Pay upfront is appropriate as opposed to collecting though.

 

[lejeunesage]

There is a huge gap between what hospitals pay locum agencies and what they are willing to pay physicians.
Often, they'll pay the locum company $2,400/day, but the physician will get only about half of that.
You might think they'd be willing to cut out the middle man and land somewhere around $1,600-1,800, but they rarely budge on that.

Realistically, the hospital will only want to pay you $1200-1400 + perhaps $100-250 if there is night call.

Depending on how many patients they expect you to see, this might be a great deal or a rip-off.

It's a superb rate if you have to round on about 10 patients, a fair rate if you have to round on about 15-18, and a crappy deal if you have to round on more than 20.

For a 16-bed unit, I would start by asking for $1600 a day. Personally, I wouldn't accept anything below $1400.

My 2 cent.

 

[Iamnew2]

There is a huge gap between what hospitals pay locum agencies and what they are willing to pay physicians.
Often, they'll pay the locum company $2,400/day, but the physician will get only about half of that.
You might think they'd be willing to cut out the middle man and land somewhere around $1,600-1,800, but they rarely budge on that.

Realistically, the hospital will only want to pay you $1200-1400 + perhaps $100-250 if there is night call.

Depending on how many patients they expect you to see, this might be a great deal or a rip-off.

It's a superb rate if you have to round on about 10 patients, a fair rate if you have to round on about 15-18, and a crappy deal if you have to round on more than 20.

For a 16-bed unit, I would start by asking for $1600 a day. Personally, I wouldn't accept anything below $1400.

My 2 cent.

I am going to piggy back on this thread and ask - do you all do PAPEs anymore? I was told by my hospital that the PAPE is no longer required? I have never heard of that. I have been doing them all along. i was told that CMS no longer requires it. Thoughts?

 

[lejeunesage]

I haven't done PAPEs for about a year now.
I just have a few lines at the end of my note that:

1. Mention the Impairment Group Code and Etiologic Diagnosis
2. Confirm that the patient has improvement potential and can participate in a schedule of 3 hours X 5 days (of 15 hours over 7 days)
3. Talk about how the co-morbidities in my assessment and plan will affect the rehab course.

This is all pre-templated and takes me less than a minute to complete.

 

[Iamnew2]

I haven't done PAPEs for about a year now.
I just have a few lines at the end of my note that:

1. Mention the Impairment Group Code and Etiologic Diagnosis
2. Confirm that the patient has improvement potential and can participate in a schedule of 3 hours X 5 days (of 15 hours over 7 days)
3. Talk about how the co-morbidities in my assessment and plan will affect the rehab course.

This is all pre-templated and takes me less than a minute to complete.

Wow! that's awsome. My PAPE is pretty long. Maybe I should adjust this so that it's not as painful. Yes my PAPE was templated also, and only had a few fill in categories. Good to know though thank you!

 

[RangerBob]

Yes, PAPE no longer required. Our was templated so it really didn't save us much time when it went away--mostly just saves some note bloat and a few fill-ins. So I have a few extra minutes in my day now.

Waiting for the IPOC to go away now...

 

[Iamnew2]

Yes, PAPE no longer required. Our was templated so it really didn't save us much time when it went away--mostly just saves some note bloat and a few fill-ins. So I have a few extra minutes in my day now.

Waiting for the IPOC to go away now...

I doubt the IPOC will go away any time soon.

I am hoping we can get rid of the oral boards. While I passed when I took them the first time around, that was the most pointless and probably irritating exam I have taken. Not to mention $$! $1900 down the drain. And I guess I was one of the blessed ones that was able to take it during the first virtual time they did it, which saved me who knows how much in transportation costs.

Why are we one of the few specialties with an oral boards still?

 

[RangerBob]

I doubt the IPOC will go away any time soon.

I am hoping we can get rid of the oral boards. While I passed when I took them the first time around, that was the most pointless and probably irritating exam I have taken. Not to mention $$! $1900 down the drain. And I guess I was one of the blessed ones that was able to take it during the first virtual time they did it, which saved me who knows how much in transportation costs.

Why are we one of the few specialties with an oral boards still?

I agree-it was a waste of time. CS, which I thought was useless, was still more valid than oral boards in my opinion, because at least you had to demonstrate the physical exam and communication with patients (never mind OSCEs test all that…).

I still don’t see why oral boards are in Rochester. Move them to Chicago. It’s like they want to make it as difficult and expensive on everyone as possible.

 

[Iamnew2]

I agree-it was a waste of time. CS, which I thought was useless, was still more valid than oral boards in my opinion, because at least you had to demonstrate the physical exam and communication with patients (never mind OSCEs test all that…).

I still don’t see why oral boards are in Rochester. Move them to Chicago. It’s like they want to make it as difficult and expensive on everyone as possible.

I agree. Rochester is in the middle of nowhere and I would imagine hard to get to (not that I have ever been). but at the very least they should have it in a main city - Chicago, NY, Orlando, etc etc - not the middle of nowhere. or at least do it in multiple places so that people can pick. But there is no reason that if they won't get rid of this useless exam at least they can't at least be considerate and keep it virtual.
Why can't we petition the removal of this ridiculous exam though?

 

[Iamnew2]

I agree. Rochester is in the middle of nowhere and I would imagine hard to get to (not that I have ever been). but at the very least they should have it in a main city - Chicago, NY, Orlando, etc etc - not the middle of nowhere. or at least do it in multiple places so that people can pick. But there is no reason that if they won't get rid of this useless exam at least they can't at least be considerate and keep it virtual.
Why can't we petition the removal of this ridiculous exam though?

Apparently they are keeping it virtual at least for the time being! That is at least partial success!