Moonlighting rates

[Docbeans]

Hi all, not sure if this is an appropriate question for this forum, but will ask nonetheless....I am  looking into options for part-time work and thinking of moonlighting for practices in town in my specialty-nephrologist here-at least to begin with. Wondering if anyone can give me an idea of moonlighting rates per patient, not per unit time. Since reimbursements for in-hospital consults/follow-ups are the same in all medical specialties, is there a "going rate" for this? I know 1 IM doc who does this and charges 75% of CMS rates for every pt, regardless of insurance (it evens out over the long term) and the practices bill for her. No benefits, and she pays for her own malpractice. My online search on this topic revealed only per diem rates- which are obviously widely different in different specialties- though I coudn't find that information specifically for nephrology- only for IM (other subspecialties- cardiology/GI/EM, etc had far more info on them). I found absolutely nothing on per pt rates. Does it sound reasonable?

Thanks in advance!

[The White Coat Investor]

Never heard of per patient rates. In emergency medicine, almost all moonlighting/locums type gigs are on an hourly basis and rates range from $75 to $600 an hour, depending on how desperate a place is. Imagine Podunk USA, a new contract with a corporate EM group, on the overnight shift for Christmas Eve. That's where the $600 rate comes in. More typical rates are $150-300/hour.

In your case, you can charge whatever the market will bear. I like the idea of charging the group you're moonlighting for so you don't have to bill yourself. But obviously you want that rate to be as high as possible. Why not start at CMS rates + 25%-50% and see if they bite. If they negotiate you down to 75% of CMS rates, well, you're no worse off than the other guy.

[PhysicianOnFIRE]

I have not heard of a per patient rate, either.  Locums rates for anesthesiologists have been in the $150 to $200 an hour range and steady for the last 10 years.  I have not seen more than $250 / hour for overtime.

[Docbeans]

Thank you very much for responding WCI and PoF! It seems that per patient rates are not common at all. However, I am not sure I understand WCI’s suggestion to negotiate for >100% of CMS rates. Here’s my thinking: Say their hospital census on any given day is 50. They are able to see the sickest 35 and only check labs, etc for 15- which they are not able to bill for. If I come in and help them out, all 50 are seen and billed for. But this only makes sense for them if they pay me <100% of the money they were leaving on the table, i.e., 15 x avg reimbursement/pt (we are assuming CMS is avg). What am I missing?

[BCBiker]

He is saying that you should start negotiating with a high initial offer. Never start a negotiation from where you think is fair. Ask for more and let them bring you down to a fair rate.  If they really need you, they will be willing to take a likely loss because presumably you are covering hours that they do not want to cover themselves.

Negotiation is a topic never mentioned in medical school and I am surprised at how the basic concepts don't seem to penetrate, much to the great pleasure (with likely some back room jokes) of hospital administrators.

[Zaphod]

Docbeans wrote:

Thank you very much for responding WCI and PoF! It seems that per patient rates are not common at all. However, I am not sure I understand WCI’s suggestion to negotiate for >100% of CMS rates. Here’s my thinking: Say their hospital census on any given day is 50. They are able to see the sickest 35 and only check labs, etc for 15- which they are not able to bill for. If I come in and help them out, all 50 are seen and billed for. But this only makes sense for them if they pay me <100% of the money they were leaving on the table, i.e., 15 x avg reimbursement/pt (we are assuming CMS is avg). What am I missing?

Click to expand...

You are probably only thinking about your portion of fees which often times can be a very small part of it. Of course systems do not want to tell you what they are actually getting for a facility fee, etc...on top of your cut as well. There is usually room. Dont negotiate for their behalf to your detriment, thats their job. They will not give you the same courtesy, and it has zero to do with patients, care, fairness, etc....if you offer to pay them for the privilege they would take it.

Most employed physicians have no idea how much money they are making hospitals (and sometimes an accurate number can be very hard to pin down), but its certainly more than your wRVU or other productivity numbers suggest. Why do you think they buy up private practices and even if everything stays the same can afford to possibly pay you more than you were making on your own? Facility fees are being gamed big time. This will eventually get whacked as every time something is gamed cms eventually gives them a haircut.

[Docbeans]

Thank for the clarification, BCbiker- yes, I agree- I need to start high to get to where want (hopefully).

Zaphod, agree with your point of view totally- however, these are small independent groups I am talking about- so they will not make anything more out of me than H&P/follow up reimbursements. In the outpatient setting, it may be slightly different since the technical components come into play- I haven't thought about that part yet.

[FirstFruits]

I am a fellow in urology and cover weekend call in a small town in TN.  For covering Friday at 5pm to Monday at 5am, I get a rate of about $5900, plus or minus.  Usually amounts to about 15 hours of work for the whole weekend.

[Docbeans]

Wow, that's really good... works out to $400/hr- sounds like you are fulfilling a great need for them- good for both parties!

[FirstFruits]

yea, but I have to be "available" the other 45 hours I am not "working".  So I think of it more as $100/hr.  But sometimes that is just sitting at home watching TV or sleeping, but always chance of septic stone at 2am...