collaborating fees

lucianne · Jun 22, 2009

That's ridiculous. How much collaboration does the MD actually do? In my state it's pretty much a formality but in other states the MD actually is required to provide more involved supervision. Even if this is the case in your state, I think that 50/50 is absurd. I knew my first collaborating physician as a friend as well as colleague and she did not charge anything. My current collaborating MD is my supervisor where I work, so the collaboration is part of my employment. I know of the NPs who have supervision with their MDs periodically and pay the regular hourly rate if they are not co-workers. I say look for someone else to collaborate with. I know it can be hard to find someone if you aren't well-connected and are trying to practice independently. Good luck.

Whispera, MSN, RN · Jun 22, 2009

Do you work for a hospital or a doctor's office or do you work on your own? If you work for someone else, you collaboration fees should be covered by the employer. If you work on your own, I'd say an hourly fee would be appropriate. One hour per week is pretty normal. Also, if more than one person needs collaboration, can you combine the time of the meeting as a group meeting? Then the doctor can talk to each of you during that time. A friend of mine has her collaboration that way...each CNS or NP discusses a problem, and the doc signs the required paperwork, and then everyone's on their way--it takes an hour a week. 50/50 is inappropriate. Whose 50 pays for someone to do billing, filing, etc.?

deanaha · Jun 22, 2009

Thanks for the advice. He also works with another CNS who does not have prescriptive authority. I call him for advice on meds to prescribe, etc, but he does not see the pts. So far my arraignment is for part time (I also teach at the University). He pays for the billing and secretarial support.

lucianne · Jun 22, 2009

So are you working for him? If this is the case and he is covering overhead (billing, rent, secretarial support, supplies, etc.), that is a different matter. In that case, I think a 60/40 split would be more appropriate but 50/50 is not unheard of.

deanaha · Jun 22, 2009

I am working for him seeing pts in Nursing Homes, when a psy consult is requested. I do the initial assessment and all follow ups. The paperwork is done electronically- I email my reports to his office and they distribute to the Nursing Home. We talk on the phone for consulting or by email. I am not in the office. I write the orders, he does the billing. if it were 60/40 who is the 40%?

Whispera, MSN, RN · Jun 22, 2009

I'm torn on this.

If you get the proceeds of billing rather than an hourly wage (or a salary rate) for your work, it is logical that it would be 60/40, to cover overhead costs (billing [dealing with insurance companies is very time-consuming], filing, other secretarial work, appointment setting) as well as his time collaborating with you. Do you pay for your supplies (Rx pads, patient education things, etc.)? I'm wondering how much the office gets for patient contact....how much of this are you getting, and are you making a reasonable hourly rate if you boil it down to that? Would 40-60 percent of this be a reasonable rate? Different insurance companies pay different rates...isurance companies pay CNSs a percentage of what they pay a doctor for the same contact. For instance, when I was working for a psychiatrists' office, one insurance company would pay the psychiatrist about 100 dollars for a certain type of visit. I would "pull in" $85 to the office for the same visit, and I got paid $30 an hour. Do you know what the office "pulls in" for each patient contact you complete? I think all of this can make a difference, and is something you should be able to know.

If you are able to get the insurance company to pay you rather than the office, maybe the split is reasonable, and maybe even 60/40, with you being the 40 is reasonable.

If you're hourly or on salary, I'd say you should not have to contribute to him, since he gets the insurance payments and pays you out of them.

I think you need to get the actual numbers so you can be more logical about it when you talk to him.

deanaha · Jun 22, 2009

Thanks, I have been going over this for awhile. I was thinking of retiring from education and working with a Dr in pvt practice when this opened up. So far I am seeing pts in the Nursing home, as I said, and that reimbursement for me is around $35. The billing is now under my name but his office handles the paperwork. I pay for my malpractice, which will take a while to recoup- especially doing this part time.

I appreciate the validation of my questioning if this is worth it.

Whispera, MSN, RN · Jun 22, 2009

Malpractice is many hundreds of dollars (or was when I had it). 35 per visit? With the 50/50 split? Ask around to see what other CNSs in your area are earning (hourly) and see how your rate fits. You also have to pay for your DEA and other prescriptive license I would assume. It's not fair for the doctor to make all the profit for your work, and it's not fair for him to not recoup his expenses either.

Anyway, that's my opinion....