Psych CNS's and NP's, Fee for service pay ranges in the northeast

anyone have any info?
BUMP

look up reinbursement in your area baded upon most common cpt codes you will be using. Info is available on medicares website ire see if you can track down a private carrier, then you might want to turn a bit less to account for the administrative support.

I don't do psych but there are a number of issues that you need to think about here. One is that you mention that the job does not pay benefits. When you speak about insurance I am assuming you are talking about medical. What about malpractice insurance? This is going to be more expensive and you also need to be able to purchase the tail for most coverage. While administrative support is nice, you need to be able to cover your expenses.

As far as visits, there are a couple of issues. The people that I know in psych do initial visits and then follow up visits. Part of this depends on how much therapy that you are going to be doing. Many psych practices use the NPPs only for medication management (similar to what many psychiatrists are doing). In these cases you may see 8-10 patients per hour (worst case) and only look at how the meds are working. If you are doing therapy then the time is considerably more. From discussing this with people in the field, 1/2 hour visits and one hour initial appointments are common. Some psychiatrists and PAs who do therapy do one hour appointments across the board. It depends on your workload and reimbursement.

As far as setting reimbursement on what medicare pays, you should be aware that many providers set their rates with insurance plans at a percentage above medicare. It sounds like a county health plan where you would be working with an indigent/medicaid patient population. In that case there will be an upper limit that they will be willing to pay given that they will not be reimbursed for it.

The question of per person vs. hourly really depends on what you are doing. If you are just doing medication review then a per patient rate makes sense. This incentive's you to see more patients (although that may lead to less than optimal patient care). On the other hand an hourly rate with reasonable encounter times may be better (especially for newer grads) if you are doing therapy. The real answer may be something in between. For example per patient with an hourly guarantee.

David Carpenter, PA-C

I've never heard of or met a PA who does therapy. Are they really out there?

Sure. There are two PA post grad programs that teach therapy as well as psychopharmacology . The more common route is for someone with a PsyD to go to PA school. This allows them to not only prescribe but also do therapy. There are about 700-800 PAs working in psychiatry. Inpatient management is the most common, followed by hospital outpatient management, followed by community health center. Surprisingly few work for either solo or group specialty practice.

David Carpenter, PA-C

Interesting. I didn't know about the PsyD/PA trend.

The APPAP website lists the Cherokee Mental Health Institute postgraduate PA program in psych. Where is the second program?

I don't know if its a trend but the numbers seem to be consistent. We had one MSW and a PsyD in our class. The issue is that once you have your PA-C you can work in other fields, and a lot reimburse better than mental health.

I'm not sure where the second program went. It was there a few months ago. It was also in Iowa. It may have merged with the Cherokee program since there seems to be more slots now.

David Carpenter, PA-C