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PA position in Skilled Nursing Facility


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I recently had a telephone interview for a position for a SNF. They had two NPs covering and one left so they opened it up to PA/NP. The HR represented emphasized repeatedly that the position is compensated based upon performance using rvu's as their metric. However, the position advertises that the purpose of the position is to expand care coordination. After the HR telephone call, I had a call with the physician at the group. I ended the interview with some uneasiness about the position. This could be due to my lack of experience in SNFs. My concern relates to compensation. If compensation is based on rvu's , then it depends on census. In my experience in acute care hospital settings, census can fluctuate widely. I wouldn't want my income compromised because the practice didn't have enough patients for me to manage. The other concern relates to "care coordination." My understanding is that Medicare only pays $40 per patient per month for care coordination. If I can't bill rvu's for care coordination and the position has no support staff, it would seem to impact my income. 

 

Does anyone have experience with this kind of compensation in this type of setting? I know this is a little vague on actual location and firm but if you can give a reasoned opinion based on the above facts, I would appreciate the input. 

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Not so fast

 

The local SNF pay based on RVU's through a company

 

Can actually be very lucrative and a great deal. They want to have you seeing patients, not taking days off and still getting paid

 

Care coordination statement seems to be a statement which someone with out the full knowledge of billing and receipts made. Yes you can make $$ from care coordination - but I "think' this can not be done in the SNDF/LTC facility - so what they might be talking about is make in sure all the "services" are being utilized....

 

So you need to go back to them with some specific questions

1) do you see for routine/regulatory visits - doc must to do admission, and typcially every other visit - but you can do every other, and she prior to the admission to stabilize them. As well you can see all acute visits. There is plenty of E/M visits to do in a LTC

As well you can bill for Advnaced CAre Planing (MOLST or DNR discussions)

2) How does Doc plan on supporting this?

3) who is doing billing? It MUST be a company different then the nursing home - if you are a direct employee of the NH you can not bill for services... Therefore you should be an employee of the physician practice

4) with this arrangement - they should be offering you all the typical employee benefits, and you will likely have to take some call

5) you will need to be credentialed with Medicare and your big payers - it is fraud to bill under a doc - when the PA did the whole visit

6) as always you MUST have FULL access to all billing info - this is a deal breaker as they will "edit and alter" the reports to thier benefit (likely) if not

7) how is the environment in the LTC facility - if it is toxic and crappy care - just say no thank you

8) as Hospitals are D/C sooner and sooner, if you have a sub acute rehab be prepared for some "hospital" medicine, not just long term care.... I think this is good - keeps you sharp

9) hours are a strange beast in a NH - you should have specific days that you work and will be there and not get roped into the "you always have to cover" mentality. You are not on call 24x7, you need time off..... Sure you will want to do a great job initially, but that does not mean working for free (and the nursing staff will come to rely on you) so make sure you have defined times to be there, and when you are not supposed to be there - leave

10) time management is key - it is very easy to talk and socialize in the LTC setting and be really unproductive. Pay attention that you need to see at least 12-15 patients in a full time day (8 hours) or you will not support your salary - hence why they are likely looking to pay based on RVU

11) as there is little to no overhead to support you - you should be getting >50% of collections -

 

I would highly recommend a base salary - say 80k/ year. Then some type of RVU pay over this - that gets figured out MONTHLY based on collections (not billed). This limits the risk to the employer and you get paid for being and employee, and does not penalize you to bad for vacation. Also, I have seen some companies group PA/NP together in a POD type setting where EVERY employee has to meet productivity thresholds in order for any employe to get RVU bonus - this is pure crap and should never be done. In this setting a PA unexpectedly lost a son, and was out for 2 months, and 5 PA/NP's had their RVU portion of pay withheld (costing each one 4-10k) solely based on this one PA being out. Company mane an extra 20-50k off the employees for that!!!!

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