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Discussion

Offer: any advice?

Hello everyone.

I am currently working as a hospitalist in eastern KY. I am in the midst of contract renegotiation, but have had an offer from a local nephrologist. He has asked me to join his practice. He wants to open an office in a small town for 4-5 days per week and have me see his patients, but also let me establish a primary care practice within the same clinic. I currently make 100k+ and receive free health insurance and retirement match. This position would offer a lower base salary and I would have additional commitments at multiple community hospitals including dialysis centers. The questions that I have are:

1. What are the legal implications of seeing nephrology patients in the outpatient setting and seeing primary care patients (adults) in the same setting? The nephrologist is also an internist, so would this be ok? I would be taking collections eventually from the patients that I established for primary care concerns.

2. Would it be worth it for me to venture out into this type of practice setting with my current situation? I have a great salary and benefits, my schedule is 7-3 daily so I have no call once I leave. The other practice has insurance for individuals, and I am currently unsure of the retirement, but I would be mostly independent.

3. If at some point, this nephrologist retired, would it be difficult to find a collaborating physician to continue my practice. From my understanding, a nurse practitioner can own a private practice in Kentucky, but still has to have a collaborating physician to continue practicing.

4. Could I still use my established medicare and medicaid billing numbers, or would I have to establish new billing numbers for this practice?

I guess it boils down to what I believe my potential may be as a primary care provider. I understand that I have a great situation where I currently am, but as I establish a rapport with patients in the community and establish my practice, I feel that the growth potential is unlimited. At the same time, I feel like that I would be taking a big risk and would risk losing some of benefits when moving to a different role. Does anyone have any thoughts on this matter?

Thanks

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    • Experts

    Sounds lucrative. I work in a large (17MD, 5 mid-level)nephrology practice. We have our own surgical side too and surgicenter where we do access surgery.

    A couple of questions:

    1. How many dialysis pts would you be responsible?

    2. How many dialysis units would be visiting?

    3. How far away are these units?

    Dialysis pts are chronically ill and hospitalized frequently. In order to get the max reimbursement from medicare, you need to see these pts 4 times/month (1 MD visit and 3 APN visits).

    For many dialysis pts, nephrology are the primary care providers - lol. (This is not the way ALL nephrologists want it though).

    I see 210 dialysis patients every week in a 45 mile area. Twice a month, I go another 50 miles to see pts at a really rural area. This takes approx 45-55 hours/week. (45 hours/week in months where I take NO PTO, 55 hours/week if I take a week off during the month).

    I have a very generous salary, free health insurance for myself, a fully funded employer paid retirement (403b) plus CME money, etc. (the usual perks).

    As to the other, I just don't know much about that.

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    • Author

    Hello again. I am really unsure of the exact number of patients (Ive requested some numbers from this guy). I would be within about a 60 mile diameter from a central location visiting 4-5 centers. Also, I am still unsure of how much I would be responsible for. Feel like giving me some hard numbers to work on from your prospective?

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    • Experts

    much depends on exact numbers of pts at centers. how many shifts per day. I have pts that start as early as 0530 and get off at 0830. then others that start as late as 1800. all I do is round. I have seen some office pts and hospital pts too but the money that's out there isin rounding on dialysis pts. I also had a learning curve come from er to nephrology. I got approx 5 months orientation.

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