Trainee Reimbursement Legislation

[WisNeuro]

Fopr all of you who want interns/postdocs to get paid more, you better be contacting your Senators/Reps about this.

Multipronged advocacy effort leads to introduction of legislation to support Medicare reimbursement for interns and postdoctoral residents

APA applauds Senators Barrasso (R-Wyoming) and Bennet (D-Colorado) for their introduction of the Accelerating the Development of Advanced Psychology Trainees (ADAPT) Act.

www.apaservices.org

---

Members don't see this ad.

 

[PsyDr]

if it’s work: you should get paid.

 

[WisNeuro]

if it’s work: you should get paid.

Now if we could only get legislation to also reimburse supervisors for their time. Unfortunately, it doesn't seem this gets at prac student stuff, so still a lot of private practice places that won't take on students depending on their payor sources.

 

[PsyDr]

Now if we could only get legislation to also reimburse supervisors for their time. Unfortunately, it doesn't seem this gets at prac student stuff, so still a lot of private practice places that won't take on students depending on their payor sources.

US law says that the use of unpaid interns, who works in positions that are habitually paid, is evidence that the position does not follow the Fair Labor Standards Test. If a practica fails this standard, the student is due compensation. How many places are using students as psychometricians? It is only a matter of time before some pissed off student tests this out.

There are some pretty big problems with practica ahead.

 

[LM02]

Now if we could only get legislation to also reimburse supervisors for their time. Unfortunately, it doesn't seem this gets at prac student stuff, so still a lot of private practice places that won't take on students depending on their payor sources.

Wanted to add that a lot of people do not realize that faculty supervisors in medical centers typically do not have any compensation for their time providing supervision built into their salary structure. It's not just a private practice issue. And the benefits of getting a faculty appointment in exchange for free labor may not be enough to overcome the tight squeeze everyone is feeling on the ground these days.

 

[WisNeuro]

Wanted to add that a lot of people do not realize that faculty supervisors in medical centers typically do not have any compensation for their time providing supervision built into their salary structure. It's not just a private practice issue. And the benefits of getting a faculty appointment in exchange for free labor may not be enough to overcome the tight squeeze everyone is feeling on the ground these days.

We got time offsets in the VA for supervision, but teh VA doesn't really care about reimbursement. In my non-VA position per-PP, supervision was just on top of your regular schedule. Only the TD got a time offset. There's no way in hell I'd take on a prac student or intern in my PP, it'd just be a humongous time and money suck.

 

[Shiori]

I'm passing this along to folks. Thanks for the information!

 

[LM02]

We got time offsets in the VA for supervision, but teh VA doesn't really care about reimbursement. In my non-VA position per-PP, supervision was just on top of your regular schedule. Only the TD got a time offset. There's no way in hell I'd take on a prac student or intern in my PP, it'd just be a humongous time and money suck.

This makes sense. I'm thinking largely of faculty who are operating under heavy RVU expectations in civilian healthcare settings. This is true not only for psychology faculty supervisors but pretty much any medical specialist providing supervision to medical residents, too. The faculty appointment is losing its appeal relative to the loss of revenue they experience by taking time to provide supervision (vs. seeing another patient). It's a total house of cards.

 

[WisNeuro]

This makes sense. I'm thinking largely of faculty who are operating under heavy RVU expectations in civilian healthcare settings. This is true not only for psychology faculty supervisors but pretty much any medical specialist providing supervision to medical residents, too. The faculty appointment is losing its appeal relative to the loss of revenue they experience by taking time to provide supervision (vs. seeing another patient). It's a total house of cards.

LOT of federal funds (15+billion) for medical residencies. Not so much for clicnial psych.

 

[Sanman]

This makes sense. I'm thinking largely of faculty who are operating under heavy RVU expectations in civilian healthcare settings. This is true not only for psychology faculty supervisors but pretty much any medical specialist providing supervision to medical residents, too. The faculty appointment is losing its appeal relative to the loss of revenue they experience by taking time to provide supervision (vs. seeing another patient). It's a total house of cards.

It's happening everywhere. While the VA is more generous with time offsets it is still difficult to find supervisors. Those offsets only cover the official supervisor . If you happen to be teaching didactics or sharing duties because a supervisor is out or an intern needs an extra assessment case, you get nothing. As systems become less forgiving about RVUs, clinicians are less generous with their time.

I said this in another thread, but telehealth is changing the landscape. It is getting harder to convince experienced folks to give extra time and energy when remote telehealth positions exist.

 

[Freud’sMommy]

Somewhat related to this issue are the CMS rules barring grad trainees from seeing Medicare pts and effectively zero reimbursement for psychometry support. I’ve personally missed out on a couple hundred direct hours because of being placed on practicums that were hit hard

 

[WisNeuro]

Somewhat related to this issue are the CMS rules barring grad trainees from seeing Medicare pts and effectively zero reimbursement for psychometry support. I’ve personally missed out on a couple hundred direct hours because of being placed on practicums that were hit hard

I don't believe that they bar grad trainees from Medicare work, we just can't bill for it. As for psychometry support, they essentially pay the same rates for a psychometrist as when the neuropsychologist does the testing themselves as of the last big coding update. If you do a high volume of patient care, you essentially need a psychometrist at this point.

 

[Spydra]

Hmmm can someone explain, like I'm 5, how this is going to lead to interns and postdocs being paid more? Because my internship was in a state that allows Medicaid billing for interns and we saw how much the agency was getting for our work. We also knew our supervisors weren't being compensated for supervision nor did they have protected time for all the work they put into training us. So we interns asked why 1) we weren't being paid more and 2) our supervisors weren't being compensated.....you know what we were told? That tired bull**** about "this is the way it's always been." Yet when we asked where the extra money was going it turned out no one actually knew. So pardon me if I'm not seeing how this is actually going to lead to more money for hard working trainees let alone supervisors. I'm not seeing anywhere in the article where it's stating how much interns or postdocs should be paid based on adding Medicare to the billing pool or how sites will be required to pay more.

 

[AcronymAllergy]

Hmmm can someone explain, like I'm 5, how this is going to lead to interns and postdocs being paid more? Because my internship was in a state that allows Medicaid billing for interns and we saw how much the agency was getting for our work. We also knew our supervisors weren't being compensated for supervision nor did they have protected time for all the work they put into training us. So we interns asked why 1) we weren't being paid more and 2) our supervisors weren't being compensated.....you know what we were told? That tired bull**** about "this is the way it's always been." Yet when we asked where the extra money was going it turned out no one actually knew. So pardon me if I'm not seeing how this is actually going to lead to more money for hard working trainees let alone supervisors. I'm not seeing anywhere in the article where it's stating how much interns or postdocs should be paid based on adding Medicare to the billing pool or how sites will be required to pay more.

I'm not sure how things were setup, or how they were billing, at your internship. But the more funding sources there are available to pay interns for their services, the more money those services will generate (e.g., if you're able to bill for 100% of an intern's provided services vs., say, only the 30% that is Medicaid or an insurance willing to reimburse). It also allows for opening more training sites, as many/most sites end up losing money on interns. VA is an exception, of course.

As it stands, if only a few sites are actually making money off of interns, they really have no need to try to increase intern pay when every other site that's losing money is struggling to pay $30k/year.

Although we could probably look at medical residents to see how this might play out as well, since I'm pretty sure they generate more than what they're paid.

 

[WisNeuro]

I'm not sure how things were setup, or how they were billing, at your internship. But the more funding sources there are available to pay interns for their services, the more money those services will generate (e.g., if you're able to bill for 100% of an intern's provided services vs., say, only the 30% that is Medicaid or an insurance willing to reimburse). It also allows for opening more training sites, as many/most sites end up losing money on interns. VA is an exception, of course.

As it stands, if only a few sites are actually making money off of interns, they really have no need to try to increase intern pay when every other site that's losing money is struggling to pay $30k/year.

Although we could probably look at medical residents to see how this might play out as well, since I'm pretty sure they generate more than what they're paid.

Remember that medical residencies get a huge amount of federal funding.

 

[AcronymAllergy]

Remember that medical residencies get a huge amount of federal funding.

Also true, yep.