Originally Posted by MApsychCNS
Hello,
I live in Boston, MA. I am interviewing and have come across a "semi" fee for service position that I am considering. I say "semi" because I still get paid regardless of whether or not a patient shows, which is great because the show rate is at times not good in areas where people have socioeconomic difficulties and are very ill. Anyway I was asked what I would want per hour or per patient. I told her I would prefer to be paid per patient (if not what would be my incentive to fit in more appointments?). Since the job post did not mention it was fee for service, this question caught me off guard. I told her I would get back to her in a few days after I research what would be a fair amount. Keep in mind I am not offered insurance through this company. I am able to use the administrative staff to help organize my appointments and call patients or give me messages from patients. Which is a nice benefit. I will also have the use of my own office. It's important to note that they are overwhelmed with patients so there would be plenty of work. Also I am still a pretty new practitioner.
I want to request a fair amount, while also making a good paycheck to pay for all those loans I have! and health insurance!
Can anyone help, any information or insight would be helpful.
Does anyone do work per hour or is it usually per patient. Is it different for an intake vs a followup. If so what is the price range for these different types of appointments..
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
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Psych CNS's and NP's, Fee for service pay ranges in the northeast
