Rounding at Skilled Nursing Facility

[visoriano]

Hi! Hope everyone is well in their 2018. An offer came up to me and given my lack of experience I could only think of asking here after doing a search of possible previous posts covering the topic and coming empty handed.

An opening to round at a local SNF where I'm a Hospitalist came up; they are looking for a prn rounding physician, average once or twice per week in which I would need to have my own malpractice insurance and bill/collect myself. I have already figured the non-compete in my contract and it's OK from that aspect but I have no idea about billing or buying malpractice myself or even if this is a profitable venture. Would like to read your thoughts on this or if someone is/has been in that situation, read your experience.

Thanks

[childay]

What do you mean you're a hospitalist at a SNF?

[visoriano]

My current job is as a Hospitalist and there is a SNF in the same town my Hospital is at that is looking for a rounding physician.

[childay]

That makes more sense then!

It sounds like you are employed by the hospital?  You are sure your current malpractice won't cover?  I wonder if you could add coverage to that policy instead of getting a new one.   The questions about cost of billing and malpractice are good ones, someone hopefully will help there.

My experience rounding as a geropsychiatrist in nursing homes is that it really depends on how you set it up.  You need someone there who is invested in helping you round, who knows the patients, can ensure you aren't trying to hunt them down etc.  And don't interrupt BINGO whatever you do!

 

[MrsIMDoc]

Geriatrics here - You need more information. SNF pay and reimbursement is low if you do a good job (i.e. actually spend time with patients).  I do not cover my salary with my production but the idea from my healthcare group is that I prevent re-admissions.

Questions to ask - Who is the medical director of the SNF? How much sub-acute rehab vs LTC patients? Who covers call? Will there be a NP covering your patients, and if so are they competent?

I am essentially a SNFist (50% of my time doing SNF work) and it is a different beast then hospital or outpatient.

 

[visoriano]

Thank you both for your replies sharing your thoughts

childay wrote:

That makes more sense then!

It sounds like you are employed by the hospital?  You are sure your current malpractice won’t cover?  I wonder if you could add coverage to that policy instead of getting a new one.   The questions about cost of billing and malpractice are good ones, someone hopefully will help there.

My experience rounding as a geropsychiatrist in nursing homes is that it really depends on how you set it up.  You need someone there who is invested in helping you round, who knows the patients, can ensure you aren’t trying to hunt them down etc.  And don’t interrupt BINGO whatever you do!

 

Click to expand...

I'm part of a staffing company contracted by the Hospital to provide my services. I haven't explored if my current malpractice would cover but I'm assuming it wouldn't without my employer taking the reimbursement for my services for the company and just paying me a salary...

MrsIMDoc wrote:

Geriatrics here – You need more information. SNF pay and reimbursement is low if you do a good job (i.e. actually spend time with patients).  I do not cover my salary with my production but the idea from my healthcare group is that I prevent re-admissions.

Questions to ask – Who is the medical director of the SNF? How much sub-acute rehab vs LTC patients? Who covers call? Will there be a NP covering your patients, and if so are they competent?

I am essentially a SNFist (50% of my time doing SNF work) and it is a different beast then hospital or outpatient.

 

Click to expand...

Those are very good questions that I had not asked! I will... thanks a lot.

[MrsIMDoc]

I think billing for yourself as a PRN rounding at a SNF is going to lose money.  A few years ago our physician group of outpatient docs decided the burden to see their own patients in the SNFs was too high (similar to hospital rounding), so they created a position for a physician to see all of them (SNFist).  Unlike hospitalist it does not reimburse well.  There is a benefit of familiarity with the SNF and staff to streamline processes so it works for us.   My RVUs cover less than 50% of my salary.  So if you are billing yourself that is unlikely to be a money making opportunity.  It is challenging to find anyone to cover locums SNF work as a physician unless a hospital is paying the bill.  I heard of a group in Alaska where they pay the hospitalists a hospitalist salary to see SNF patients because they could not get anyone else to do it, but they were losing quite a bit of money on that.

Many SNFs rely on ARNPs heavily because they do not reimburse well.  However, Medicare requires every SAR patient to be seen every 30 days by a MD/DO and every LTC patient every 120 days.

[SValleyMD]

Snfs need you a lot more than u need them.

Imo- They pay for the “coverage” - not just give u an opportunity to bill a couple more encounters

I agree with others. Can’t see how that would be worth your time but I don’t have a lot of experience with it. Most seem to pay flat fees/stipend based on market rates (or the cheapest they can find someone to do it)

[childay]

How do the nursing home CPT code reimbursements compare to outpatient codes?

[White.Beard.Doc]

SNF reimbursement is low.  In our area, the majority of the SNF work is done by an NP.  For an NP salary and benefits, the patient billing can cover the expense, but there is not much profit in it.  The physician still has to see some of the patients periodically as required by regulations.

As a hospitalist, you would likely receive double the compensation by doing inpatient per diem shifts at another hospital.  Rounding as a per diem hospitalist is tough since you don't know the patients well, but doing admitting shifts on an intermittent basis tends to work out fine.