Productivity Bonus

[new_horizons555]

Are there any particular questions to ask a prospective employer regarding productivity bonus? I'm excited that this is even a possibility as this is the first time it has ever been discussed! Bonus would be offered annually after I can "break even."

I know every NP will vary on this, but realistically, for an NP with fairly limited clinician experience (under a year), when should I expect to bring in revenue that would allow for a bonus? After working a full year?

I saw from other threads to ask how bonus is calculated.

Also, if I see a good deal of acute visits would the productivity bonus still be as high? Have NP's found that traveling to different locations to perform primary care services impacted productivity than from those remaining in one location?

Thanks everyone!

[BostonFNP, APRN]

Ideally you will be profitable in your first year, but don't count in that as money in the bank, it may take two or three years, and honestly, in your first year you should be focused more on the patients you are seeing vs how many you could see.

You want to have the exact specifics of how your productivity is calculated. There are many many different ways this can be done and you want to be very sure you know the formula and have full access to all the numbers.

Any time you travel you lose productivity.

[BlueDevil, DNP]

What do you mean by profitable? As in having earned enough to cover your draw, pay for your benefits and costs of recruitment, training, etc? That could take a while because you probably aren't starting out with a zero balance, you may start about about 75K in the red.

I got small bonuses quarterly in the first year, but nothing to write home about. It went up gradually in increments between 6 and 36 months. It took me 3 full years to earn the max available bonus, but it is significant, amounting to an additional 50% of my salary. HCC bonuses offer an outstanding opportunity if you have capitated patients, so I'd ask about those as well.

[new_horizons555]

Thanks BostonFNP and BlueDevil. That's a good point about capitated patients and I will make sure to ask. I recognize that it takes quite some time to be profitable (i.e., pull in greater revenue for the practice than at the starting point where there is a debt due to overhead, training, learning curve, etc). Yet even possibly earning even a small bonus quarterly is exciting at this stage in my life..lol I agree Boston that I should not be focused on the "numbers" in the beginning. It is more of an incentive though than working the same job without this financial structure in place. Thanks!

[BlueDevil, DNP]

Capitated patients can be a windfall, but they are often complex and take more time. The goal is to limit their office visits (through provision of comprehensive care), but to code those visits to the highest possible payment. My HCC bonus for the 3rd quarter of 2013 was $7,500. I haven't seen data from the 1st quarter of 2014 yet, but I expect it will be roughly the same. Learning the tricks to HCC coding is very advantageous and although most of that comes from procedures, anyone can get good at HCC coding and profit from doing it accurately. Just be sure that the bonus funds come to you the provider, and are not just absorbed by the employer.

There isn't a huge difference between documentation necessary to code a 99214 (or 04) vs a 213 (or 03). Knowing how to get to a 14, or 15 when applicable, is going to make a huge difference. Sometimes it is as easy as adding a little family history or new allergy! Everyone of my pts gets an assessment of constitutional symptoms, cardiac, pulmonary, neuro and psych, and every pt gets counseled on something, regardless of presenting c/o.

I don't care if they came in for a splinter or an ear lavage, I assess a minimum of 5 or 6 systems on every pt, every time. 5 systems (both ROS and exam) plus documentation of family history and updating allergies and counseling, without even addressing the cc will get you to a 14, unless the medical decision making is too straightforward. In that case, I bill for time. Now if, for instance, the pt is nauseated, well that is the 6th system (abdominal) and you as the provider may order an antiemetic, which makes it moderately complex decision making (because you wrote a script) but even if you don't you are going to at least provide education, and then you're golden. When all else fails, tell them to lose weight or stop smoking and you are in 14 territory. We use Novartis, which awards extra points for new (to you) diagnoses. Unfortunately, this can make the problem list a mess, since no one wants to use the same diagnosis more than once due to payment. So last week's "URI" is going to be coded today as "viral infection." If they come back next week, it is going to be "cough." Anything to get a new ICD code, lol.

I never code less than a 14 anymore, and I do a lot of 15s. Be very friendly to the coders, they can help you tremendously!

[Dixiecup]

I worked family practice for about three years. I got five dollars extra for every pt I saw over 12 per day. It was paid annually.