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Salary for Geriatrics - skilled and LTC

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I am currently up for review after two years at current job and am attempting to get feedback on wage.

Currently making $42/hr in Colorado, 32 hrs a week. Started at $40.

I have 7 hears exp as a PA (5 in family med, 2 in geriatrics now.)

I work in a skilled nursing facility and Longterm care. At least half is skilled rehab pt's - ie, high acuity - and the other half is LTC. I work at 4 facilities. Majority is Medicare payment.

I see approx 12 people daily.

Though it is difficult to get specifics and I'm not in contact locally with other PA's w similar job, my hourly wage seems low so I am trying to get some information to negotiate with.

Regarding benefits - 2 weeks PTO, 1 week $2000/yr, health ins and 401k.


Thanks for your input!!

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wage is low, but the # of patients seen is also low.....


medicare pays a physician $49-135 for the codes - your reimbursement will be 85% of that  - if you are a good coder and they are good at billing/collecting you might be at $85/vist



60 visits per week


5 weeks off (10 holidays, 2 weeks PTO, 1 week cme) means you work 46 weeks


2760 visits in a year


$234,600 is likely your max revenue generated - more likely you are in the 180-200k mark (having spoken with many PA/NP in the past and time off and productivity numbers combined with the 20% copay of medicare and claims written off)



$87360 is you salary



common thought is that you have to cover your salary again for bennies (office based and not so much in LTC)


your cost as an employee is $174,720 and you might be only generating $180,000 so there really is not much hope for a raise***    

*** LTC if done right can run at much less overhead, but if you are part of a group that is outpatient based or a larger company you have to support their overhead.... and they want to make $$ off you




You should be able to see more then 12 patients a day!


Instead of a raise (no employer likes giving raises as they are for ever) request a producitivty bonus to be paid quarterly (I think either every other month of quarterlly is the best timing - monthly to frequent, anything longer then quarterly is too long)






same salary

one more week vacation 

Bonus structure - after collections hit 200% of your salary in that (month/quater) you get 50% of collections - ie if you earn 10k - when collections hit 20k you get $0.50 of every dollar collected beyond this.


Problem with this is that you have to have full access to your financials......  sometime tough to do





same salary

one more week vacation

every patient over 60/week you see you get $30/patient - this you can track yourself and they can not fudge the numbers..... but someone seeing all level 1 visit will work the system to their favor.....





let us know the outcome

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Thank you for that thorough reply.


Some more details -

- 6 holidays

- I don't always take my full CME time, in 2013 I took 1 day I think.

- I work closely with my SP so he actually eyeballs the majority of our skilled pt's and we get 100% reimbursement for 7 or 8 of the 12.

- Yes pt's seen per day is low (which is actually a nice perk, especially coming from FP), but, we are limited by how many pt's we have total. At times when our skilled census is low, it's not possible to see more pt's.


Anyway, review is tomorrow and Illl post the outcome.



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be VERY careful with the doc "eyeballing" the patient and billing at the higher rate......   CMS has come down pretty hard on this in the past.


Tricks to get more visits


every INR is a level 2 visit


Every time a nurse asks you to check out a patient - document that the nurse requested an eval for   X issue - this is in direct response to CMS also tracking high utilization providers in a facility due to the ability to "generate visits" and self refer 


Make sure you are getting your regulatory visits in in the last week before they are due - remember q 30 days for the first 90 days - then every 60 days thereafter and can do alternating visits


Reviewing labs - sit down and talk with the patient about the results - then call health care proxy if invoked - and document time


Document start and stop times for all visits in the notes - get familiar with time based billing and how to document so that you can capture the time - there is certain things you HAVE TO HAVE IN THE NOTE or you will get rejected on audits.....  figure these out first.....


reasonable to document expected follow up times for DM and CHF management especially after a hospitalization!  

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