Practice setup: A single room vs multiple patient rooms?

[Gavanshir]

As far as I know the majority of outpatient psychiatrists set up their practice in a single room, usually behind a desk and with a chair for the patient. And there is a receptionist out front. Has anyone set up their practice similar to medicine outpatient practices ie. A nurse tech bringing patients into 3-4 patient rooms and taking their vitals while they wait in the room for the provider. the psychiatrist would then go room to room to see the patients.

I am wondering if productivity would be higher with the latter model and if it can prevent lost time with unnecessarily long-winded patients. I also like to be on my feet more than I like to sit behind a desk from 9-5pm. I thought it may also be preferable for patients that may need an involuntary admission for the psychiatrist not to be stuck behind his desk.

Any downsides to this other than possibly increased overhead?

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[Shikima]

As far as I know the majority of outpatient psychiatrists set up their practice in a single room, usually behind a desk and with a chair for the patient. And there is a receptionist out front. Has anyone set up their practice similar to medicine outpatient practices ie. A nurse tech bringing patients into 3-4 patient rooms and taking their vitals while they wait in the room for the provider. the psychiatrist would then go room to room to see the patients.

I am wondering if productivity would be higher with the latter model and if it can prevent lost time with unnecessarily long-winded patients. I also like to be on my feet more than I like to sit behind a desk from 9-5pm. I thought it may also be preferable for patients that may need an involuntary admission for the psychiatrist not to be stuck behind his desk.

Any downsides to this other than possibly increased overhead?

For med management only. They would know that you are there to talk about medications and side effects.

 

[Armadillos]

I can't see this being cost effective, in medical settings seems the main purpose of having many rooms is to allow people time to get a gown on and allow the doc to bounce between patients while waiting on a point of care lab result or materials for a minor procedure,etc.

 

[Stagg737]

As far as I know the majority of outpatient psychiatrists set up their practice in a single room, usually behind a desk and with a chair for the patient. And there is a receptionist out front. Has anyone set up their practice similar to medicine outpatient practices ie. A nurse tech bringing patients into 3-4 patient rooms and taking their vitals while they wait in the room for the provider. the psychiatrist would then go room to room to see the patients.

I am wondering if productivity would be higher with the latter model and if it can prevent lost time with unnecessarily long-winded patients. I also like to be on my feet more than I like to sit behind a desk from 9-5pm. I thought it may also be preferable for patients that may need an involuntary admission for the psychiatrist not to be stuck behind his desk.

Any downsides to this other than possibly increased overhead?

One of my attendings operated like this. I'd say about 90%+ of his outpatients were stable and were there for a refill or minor med adjustment, so most of those patients were 10 minute encounters or less if the patient just wanted to get a refill on their SSRI or mood stabilizer and get out. For the few patients that were more complex, things would get slowed up a bit but we'd still see a lot of patients in a day. He also doesn't do any therapy and is generally very straightforward with his patients in terms of compliance and keeping appointments.

I've got much less experience than the psychiatrists here, but him and his partners definitely made it work and are both personally successful and well-known as one of the better psychiatric groups in their city. I'll also add that I think this model is heavily dependent on your patient population. If you've got more complicated patients or a good number of patients with compliance issues then Idk if you could really make it work. If you've got a large number of stable, compliant patients it seems like a very feasible model.

 

[wolfvgang22]

Some folks may not like this, but in my opinion if you aren't interested in taking time working with your patients and doing at least some supportive therapy, you aren't really interested in doing Psychiatry.

Therapeutic rapport is hugely important, and while spending 10 minutes in multiple rooms is probably financially profitable for the clinic, it's hard to get much by rapport by herding large volumes through the clinic like this. I hate being reduced to a prescription machine.

I am considering getting a standing desk so I am not sitting so much when I'm documenting, but not when I'm with the patient.

 

[st2205]

Some folks may not like this, but in my opinion if you aren't interested in taking time working with your patients and doing at least some supportive therapy, you aren't really interested in doing Psychiatry.

Therapeutic rapport is hugely important, and while spending 10 minutes in multiple rooms is probably financially profitable for the clinic, it's hard to get much by rapport by herding large volumes through the clinic like this. I hate being reduced to a prescription machine.

I am considering getting a standing desk so I am not sitting so much when I'm documenting, but not when I'm with the patient.

If you're seeing 6 people per hour, the odds that you could really bill above a 99213 are slim for the vast majority of cases. I mean, you could, but if more than 20% of encounters are 214s then the extra time would eat into the productivity of the set up. What I'm getting at is you can see 6 patient an hour under this model or see two patients per hour and generate the same amount of RVUs.

 

[wolfvgang22]

This is true.
I bill a lot of 99213 with the brief therapy add on 90832. Add in a couple of 90792 for new patients each day and the odd Interactive Complexity code 90785, some 99214s here and there, and I am billing way more than my employer actually pays me including my benefits and I'm pretty sure enough to pay the receptionist, nurse, and keep the lights on. I see 9 to 12 patients a day on average. This doesn't count consultations and the occasional call to the ER to evaluate someone. I kind of like doing consults some because I get to walk around the hospital and get away from the desk.

I never upcode and try to document everything I do. Sometimes I forget to document some things I do in the clinic when I have a complex patient who has no payer, so I can't bill for those things, but I promise I'm working on that.

 

[MedMan80]

Is billing at the VA same for outside of the federal system?

 

[wolfvgang22]

Is billing at the VA same for outside of the federal system?

Short answer: Yes. The VA bills insurance or patients just like any other hospital or clinic and uses the same CPT codes .

Elaboration:
The VA tracks our RVUs the same as any other hospital or clinic along with other metrics, increasingly more the last few years due to pressure from certain political elements.

Veterans can have varying levels of service connection benefits with the VA that can pay part or all of their bill. Veterans can have no service connected illness (ie; PTSD from childhood trauma prior to military service) all the way to 100% (ie; PTSD that occurred because of or aggravated by military service). The VA does bill insurance and Medicare/Medicaid if service connection doesn't cover care, and their are also other benefits a veteran may qualify for.

It is a complicated system with many different benefits for veterans, but overall care at the VA is less expensive than outside the VA for almost all veterans and is fairly comprehensive.
Most of the problems the VA has are due to shortage of physicians and overly complicated administration of the benefits.
In my opinion it would probably be more cost effective to eliminate the bureaucracy and just provide actual universal coverage within the VA and eliminate the service connection system. That would however eliminate the jobs of many veterans who in fact staff the regional benefits offices, so you can see that would be unpopular with those veterans.