85% the reimbursement of Physicians

Dranger · Jan 2, 2016

Stemming the tide of new grads by raising admission standards and cutting down on the proliferation of poor quality schools. Lessen the supply to increase the demand. It's what med schools do.

Goldenfox · Jan 2, 2016

if we are reimbursed at 85% of Physicians, why aren't we making 85% of their salary.

Because the physicians are better at manipulating the political games that determine these things than nurses. The docs understand their playing field and they guard it jealously. Their boards of medicine protect them and look out for their interests. They have better and better funded lobbyists promoting their agenda in the state capitals and in Washington DC. They also have a tacit honor system whereby they will protect each other for the overall good of their profession. We in nursing have never had a good game when it comes to these things.

In comparison, our playing field is a joke. There are way too many NP schools (some of questionable reputation) and it's way too easy to get into them and to become an NP. State boards of nursing are more antagonistic than supportive towards nurses. Even among many NPs, there isn't a whole lot of appreciation for higher quality education and more challenging clinical training, its more about not wanting to do beside RN work anymore. And, we have no honor system. Some of us find greater pleasure in criticizing and putting others down than in elevating our profession and that is how many spend a lot of their time. If you take a closer look at what some NPs are doing in the state capitals to try to get laws changed and to improve the reimbursement issue, it is a LOT of work. But only relatively few of them are doing it. They repeatedly beg NPs for support but get relatively little---even for help with simple things like making phone calls or sending emails to the various House subcommittees that review the proposed amelioration bills. Many of these bills die in committee because too few NPs care enough to bother to call or email and harass the politicians who can bring about the type of changes that you are asking about.

For the docs, maintaining that distinction between themselves and "extenders", as they call us, is an important part of the whole thing. Although, to be fair, some of it can be rationalized. After all, it takes a lot more study and many more years of schooling and clinical training to become a physician than it does to become a nurse practitioner. It also works in their favor that medical schools are not easy to get into or to get through so there isn't an oversupply of physicians in most parts of the country; exactly the converse of this is true for nurse practitioners. The low pay that most NPs earn isn't really so much about reimbursement rates or what the docs can afford to pay, it's about what they know that they can get away with paying.

Its economics, whenever there is an oversupply of anything the price of it declines. They can offer to pay an NP $70k (and in some cases less) because they know that there are more NPs than available jobs. Dranger's post is correct.

Psychcns · Jan 2, 2016

Anyone have Tips to find out how much you are bringing in to a practice and how much of that should go to you..

I currently work inpatient locum tenens geriatric psychiatry. I submit my billing daily per patient. How do I find out how this translate to revenue for the physician group which hired me. I heard the group gets paid per admission. Length of stay 7-14 days and sometimes more.

PG2018 · Jan 2, 2016

Anyone have Tips to find out how much you are bringing in to a practice and how much of that should go to you..
I currently work inpatient locum tenens geriatric psychiatry. I submit my billing daily per patient. How do I find out how this translate to revenue for the physician group which hired me. I heard the group gets paid per admission. Length of stay 7-14 days and sometimes more.

You need to stay on top of the billing staff. You need to know what insurances you're credentialed with and if any others are being billed "incident to" under the physician. Second, you need to know what you typically bill for. I've got it easy since I only use 90792, 99213, 99214, and on the rare occasion 99212 which I will submit a bill for if I merely end up talking to a patient about a problem in the hallway, lobby, ect. Third, know as best you can the reimbursement rates for insurances you're credentialed with such as Medicare, Medicaid, Blue Cross Blue Shield, Ambetter, United Healthcare, et al. Keep tabs on what coding you're submitting, and billing should be able to run reports for you showing this.

Or you could scrap the whole thing and work in the ideal world of cash up front or no service. Man, I'd love that!

I actually keep a note page all month for my services, and I make three columns 99213, 99214, and Psych Eval with dates in the left margin. I place a hash mark under each when I see the patient. I tried to hire somebody off Craigslist to build me a nice spreadsheet on Excel, but no one responded so my low tech method works. Quite honestly, I don't tally up the numbers based on anything but Medicaid rates. Why? They're one of the highest reimbursing evals for me (docs and NPs are paid equally in evals) and the med check rates are among the lowest, lol. At the end of the week, I write out in the right margin how much I would've made based on those rates. It lets me keep track of where I'm at in paying my salary, and then bonus. Although Medicaid rates are low, the majority of my patients seem to have it, and I make up for the low rates by volume. I feel like the Walmart of psychiatry. It's usually fairly close in judging how much I'll get. I've only not made salary once, which because I'm salaried I still get salary regardless of revenue, however, that cut out my bonus for the month. Typically, I meet salary and then get another 2500-3200 net for bonus. The differences when actually broken down properly based on the reimbursement mechanism are never great - typically circa 700 bucks.

smd2521 · Jan 2, 2016

Very good post Goldenfox.

I agree NP mills are popping up. As far as easy admission programs, I'm hoping the tied is changing. I know the FNP program where I went wasn't easy at all to get into. There were around 460 applicants and they only took 27 and now the class has even become smaller due to insufficient faculty. Family Practice is flooded with applicants, my faculty said they flipped through the applicants looking for RNs with at least 10yrs experience. Not one classmate was a new RN. The director of the nursing school said at graduation, it was now harder to get into the FNP program than the undergrad RN program. The more and more RNs leaving for Advance practice, will force a bottle neck. They will need to filter applicants. Most of which is due to not having enough faculty. This is a problem in undergrad RN programs. I agree there should also be a entrance exam, GRE or maybe something unique. Physicians pride themselves on only excepting the brightest. Why shouldn't we want the brightest Nurses? I agree with you on the political side of things, and the support for "in the private club" mentality.

I wanted to start the conversation because many nurses just except what they are offered. They have never even considered negotiations. We must advocate for our own profession. We don't need to demand the world see us as Physicians, because we are not, and never will be unless we go through their rite of passage. But

We must pull up a chair to the table of personal choice, in regards to healthcare, and be compensated for such.

Psychcns · Jan 2, 2016

How do I find out what Medicaid and Medicare reimburse for a hospital admission?? I have heard it varies by state. I have heard it is hard to find out. Any thoughts??

Thanks psych guy for your info above. I agree we all need to know more about what we are bringing in to a practice.

jer_sd · Jan 7, 2016

Another issue is many NPs have a clock in clock out mentality. They do not understand billing, payments and cost of practice. As more NPs own their own practices this will change as they learn the business of medicine/nursing. Understanding how to generate revenue and the cost of a practice are two huge issues to capture equity in practice.

If a NP only sees post op patients in a global period they will generate zero dollars in reimbursement, however it will allow the physician to generate significant revenue by having more time to operate. This is indirect revenue.

What codes are billed, what is the payer mix. Are clinic visits billed incident to are hospital visits billed as shared visits are the billing rules being followed? Both incident to and shared visits do not give credit to the NP.

To get parity for work done it will require a more business related approach