Skilled Nursing Facility Medical Directorship Pay

[MrsIMDoc]

I am wondering if anyone in the WCI world is currently a medical director for a SNF and if so how are you paid? Currently I work for a large group and I am seeing all their patients in the various community SNFs and I am paid salary for this work.  However two of the SNFs have told me they are quite happy with my work and are requesting that I also become their medical director.

For the current medical directors of SNFs, do they "buy your time" from your medical group or do they pay you separately? Do you agree to a certain amount of time spent doing the required SNF medical director administrative work per month?   I am looking into the options but it is not clear how most medical directorships for SNFs are being paid. While I have great mentors medically, I am not sure they are the best financial mentors.

Feel free to private message me as well if you would prefer. Thanks!

[Megalops]

I am paid directly a monthly fee for being director. This is 1099 income. My charges for seeing patients go to the practice (employed physician) and I get the wrvu counting towards my production (100% production based).

[FutureDoc]

As a resident who doesn't know much about these sorts of positions, what all does a SNF medical director position entail?

[MrsIMDoc]

Every SNF is required to have a medical director.  Unfortunately the role is widely varied depending on the facility.  SNFs used to be places doctors would go to work when they "got in trouble" with their license, meaning many had low quality.  SNFs however are trying to improve in quality and some places are going towards a "SNFist" model where you have a physician that only does nursing home work or a significant portion of their practice is SNF work.  SNFist work is great for having children because it is flexible if there are emergencies with your kids.  There are no set "appointments".  As long as the required work for the week is done, then you are fine.  If you have a large amount of post-acute/sub-acute rehab patients then the medicine is still complex and therefore interesting.  If you like palliative care as well then you can incorporate that into your work.

The situation I am in is that the current SNFs basically pay someone to be their "medical director" but this physician does not do much for them.  Some SNF medical directors literally just sign paperwork and they do not even see patients at the SNF.  So for me, I want to be sure there are clear expectations, that I am part of their quality improvement process, and that I am paid fairly. Unfortunately, I have been having a hard time getting information on what that payment would look like.

[alakey]

Megalops:

Just to clarify, you receive a 1099 for your monthly fee for being director and then a W-2 for your time seeing patients, is that correct?  I have a client who historically only employed W-2 physicians, however, their medical director would like to receive a 1099 in addition to his W-2 physician wages.  I wanted to make sure the issuance of both a 1099 and W-2 is reasonable.  Thank you!