New work pay formats

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My place of employment is going to be rolling out new pay schedules and is already trying some with a few providers. They are essentially going with a bonus structure RVU model with three different tiers. I would like some insight into what some of you would choose and why. Right now my average patient load is about 12 patients a day and that is 8 months in as a new NP. This is partially due to mixes of high no-show rates and still developing a solid patient panel.

Tier 1: Meeting overhead

-Essentially your overhead calculated with your annual salary, leave, office expenses (MA/Supplies/leave/cme/etc) are factored in, divided per quarter, then 30% of what you make past those numbers are what your bonus looks like.

Tier 2: Eat what you kill

-A number (based roughly on 30% of reimbursement) is assigned to each code we charge for. So a 212-5 each has a monetary value assigned to them. You are paid based on these direct charges and don't get PTO/CME/etc. Benefit is you can chose your work schedule more flexibly.

Tier 3: Simply meeting encounters based on number of visits

-This one is similar to Tier 1, but rather than meeting financial totals, they estimate a patient total based on expenses and add bonuses per quarter for meeting these goals. This can be any number of varied visit types and regardless of what you see or revenue is generated, the money is paid out.

I have ethical concerns on tier two. The way the numbers break out, there is incentive given to every-day office visits that are short and fast and you lose money on physicals that are more time-consuming. We have providers who are longer-term who are trying tier 2 because many of their patients are quick turn over patients. These patients are Typically in for refills and many are in for monthly opiates. These providers are seeing patients every 10 minutes in some cases.

As most of you have seen here, I am not opiate man. And I am a bigger fan of providing quality care of providing quality care over quantity. Just wondering your thoughts on these models, what you would personally choose, and why.

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Specializes in Family Nurse Practitioner.

For me although I am efficient I have no interest to do 10 minute appointments on an OP basis. My focus has always been the bottom line so I would need to know the actual numbers for #1 and #2 to estimate my possible income. Is health insurance factored into either of those options also? Everything has a dollar sign you can assign to it so that is what I would do and then look at the likely gross.

I'm attracted to #2 as much for the name as anything and also because I work well with an incentive. I work this type scenario inpatient which I like because there are follow-ups and uncomplicated consults I can blow through quickly and the times I get slowed down by a particularly complicated case or getting collateral doesn't throw off my overall numbers.

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For me although I am efficient I have no interest to do 10 minute appointments on an OP basis. My focus has always been the bottom line so I would need to know the actual numbers for #1 and #2 to estimate my possible income. Is health insurance factored into either of those options also? Everything has a dollar sign you can assign to it so that is what I would do and then look at the likely gross.

I'm attracted to #2 as much for the name as anything and also because I work well with an incentive. I work this type scenario inpatient which I like because there are follow-ups and uncomplicated consults I can blow through quickly and the times I get slowed down by a particularly complicated case or getting collateral doesn't throw off my overall numbers.

If memory serves, the rough numbers were overhead of $240,000 was for option 1. 4800 patients a year on option 3, though those numbers change as they factor in their cost estimates on your salary/leave/ etc.

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Here are the per visit pay outs if you did tier 2:

99212: $23.00

99213: $25.00

99214: $27.00

99215: $30.00

99391-99393: $19.75

99203: $32.00

G0439, 99394-99396: $32.00

Hospital Follow Up/TOC: $32.00

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The company I work for pays based on RVUs and of course productivity. The folks seeing 20 patients a day make a lot more than those seeing 12.

As a new NP, I think you are on target with your numbers, still building a caseload and gaining experience.

Last January, our company supposedly revamped the pay structure, which has always been quite convoluted from my perspective. All year, some people have been up in arms complaining they are making less than last year, but I didn't notice much, if any, difference.

I don't think there is any way to know what works best for you without crunching numbers.

It is hard to get away from the fact that the quick and dirty visits are the bread and butter.

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Specializes in Family Nurse Practitioner.
Here are the per visit pay outs if you did tier 2:

99212: $23.00

99213: $25.00

99214: $27.00

99215: $30.00

99391-99393: $19.75

99203: $32.00

G0439, 99394-99396: $32.00

Hospital Follow Up/TOC: $32.00

These aren't great, imo, unless you are doing a very high volume. My RVU pay is in the $29 and change. It averages out to a minimum of $90 an hour but my volume is heavy.

Like OMH said you will have to crunch the actual numbers and see what will be the best for your style and financial goals.

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It will take quite a bit of time to figure this all out.

Now I can more easily accept the flow of the very simple visits and the problem cases. Knowing at the end of the day, it works out OK. In my favor.

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