Productivity pay question

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Employer came up with a raw figure of $16/patient payment. It is supposed to 'encourage' me improve my numbers. States it's from the 'medicare pay per productivity formula'.....Average daily patient load is 25...there are many days with 30-35patients! (average of 10. 99214, 5 99215 & the rest are 99213 with maybe 2/3 new patients).The only other compensation is CEU 'up to 2k'. I am made to understand that I'm earning a lot......I believe the benefit is more for the employer while the employee works too hard to meet up with the desired pay (Family practice in south FL.)Anyone knows if this is a fair deal? Too much hard work I think! Anyone knows what's the best way out?

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Specializes in Adult Internal Medicine.

Have you been in this position for awhile or is it a new job? Are you an experienced NP or new to practice? Managing your own panel or assisting with another providers?

If more than half of your daily patients are 99214s the employer is going to be making out pretty well. But you may do ok as well. Figure an average 99214 is a 20-25 minute visit or more you are looking at 2-3 PTs an hour max. If you have a lot of 99213s that's 4-6 or more an hour.

I am surprised that 5 visits a day are 99215. There aren't many NPs in family practice that will get paid for billing a 99215, at least around here.

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Been at the job for about 2yrs. Offered this pay because I'm considered fast & efficient...Co-see patients with the doc...in essence, patients can be seen by either myself or Doc. Facility bills 'incident-to'...so 100%. The Doc sees less patients than I do. By 99215...I'm mostly referring to annual physicals.

My question for this forum is: is it really worth continuing on this path or opting for base salary +productivity bonus?..I find myself working REALLY/ TOO hard to make an annual salary of maybe 95k (no 401k, no health insurance, no extra bonus) ...whereas, I could choose a path of 20patients/less with base salary+productivity.....anything more than 20patients to be an additional compensation. Yes the pay is somewhat attractive...but quality of life?....appreciation bonus? :yes: (If there's anything like that)

...and yes! My 99214s are almost half of daily patient load....scheduling is crazy at this practice...double, tripple booking just to meet up the numbers...so I may see 2 99214s and 3 99213s within an hour! Some days, I have 39 patients scheduled upfront and as they cancel, urgent visits/ follow ups are added.....

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Specializes in Adult Internal Medicine.

It's the right time of your career to start considering productivity pay, it sounds like it would be good for you, though I think that $16/pt is low. You should be rewarded based on the E&M or RVU rather than a flat fee, at least in my opinion.

Also, think about it before you decide: will being paid for productivity change your practice? For some it won't. For some it will. Will you still be delivering quality care or will you being trying to squeeze another patient in every hour?

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Thanks BostonFNP.....truly...I consider the $16 low.....how does the RVU system work?Ive seen some posts on it but I don't understand it. Does it mean you have a base salary and still get set $$$ for RVU per pay period/month?

If if things don't change for me at this practice, at least I have idea of what to put across the table for the next practice....I know I won't agree to see 30patients on a Fixed salary

Anyone with brief explanation on productivity pay and RVU should PLS enlighten me. I feel I'm making too much money for this practice without being adequately compensated...

PS: I have some other skills:minor suturing, joint/trigger injection, cryotherapy, foreign object removal from nose, ears....and so on.....

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If I understand you correctly, the $16/patient is all you will earn on each patient; there is no base + productivity payment, correct? If so, that $16 seems low to me. And as an aside, I think they are running you ragged! 30-35 patients? :wideyed:

Just curious why you would bill annual physical as 99215, instead of 99396, G0439, etc.? 99215 visits require comprehensive physical and history, but also medical decision-making of high complexity. Most of the annual physicals that I do don't meet the criteria for medical decision-making of high complexity. Of course, there was the recent 54 y.o. patient who came in for a physical and during the ROS, stated she had stopped driving because she been having double vision and dizziness. And oh, a couple of falls in the last few months!

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Specializes in Adult Internal Medicine.

Yeah there is some billing stuff going on there that likely isn't the best practice but that likely isn't your problem.

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Yea...$16/patient....there is a very low base salary $2850 biweekly....if total number of patient for 2weeks falls below $2850, I will be paid $2850. If it's higher, I earn the higher pay...hence, I need to work my butts off to make above $2850/2 weeks!!!

yes PE are billed as you said....I hardly do PE without attending to other chronic/acute problems!!..just the way the practice is.

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At my practice, it is my problem. I am expected to code and document in such a way that the documentation supports the coding in the event of an audit. If I bill a 99215, I have to have the documentation (ROS, PE, data points, medical complexity, etc.) that will support that CPT code. Just the way my practice is. We have a biller, but she isn't expected to police our documentation and coding unless she sees a major problem. I also think it's good for NPs to really understand coding; it makes us that much more valuable to the practice. ;)

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Do a google search for RVUs. I found a couple of sites that explain how much the practice is paid per CPT code and how much each is per RVU. For example: I do nursing homes and rehabs. A 99307 is .7 RVU. That would be the patient is see and order a UA C&S. No real thought. However, most I am managing diabetes, HTN, etc. so those are 99308. That is like a 1.3. I am expected to have 20 RVUs a day. I can't bill for admissions as a NP. So those are my two most used codes. I was told that at that productivity level I am making my practice about 250K a year in billing. If you know that, you are in a much better negotiating position. I also just started as new grad so I didn't have the negotiating power you do. One of the NPs I work with gets paid half of her billings. Just saying...I am also in craptacular Florida.

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Thanks all for your input....I am actually moving on from this practice. The pay structure became less attractive to me by the day. Really love all the employees & my boss but ......got to go!Leaving on very good terms....new job with very strong base salary+productivity bonus and many lovely benefits!....

Lesson for anyone who comes across this topic here: dont agree to being paid per patient.....it sucks life out of you. while you continue to 'chase numbers' to make decent salary, your employer is relaxing with tripple revenue flowing in.

God bless!

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