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Anyone else round at nursing homes?


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I just left a primary care job for a nice 1099 job where I take home 60% of billing but all I do is round at nursing homes. Employer pays malpractice.

 

My previous job, I only went to the nursing home/ALF 1 day/week was salaried and was not exposed to the billing side of nursing home visits. I would probably say that 90% of my visits were quick pop ins and the patients were doing fine; hardest part was the charting (which wasnt hard and we would do it back at the office).. The actual time spent at the nursing home was 1.5 - 2 hrs, jot down some notes about patients that needed medicine/orders, and head back to the office.

 

I'm assuming my next job would be similar. Anyone else have a similar experience? Seems so much more relaxed than in the office with the time constraints and scheduled time slots. Any pitfalls I should be aware of? What's the catch? Why aren't more docs or practices only nursing home?

 

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I  did this for a few years but did it on a "per patient" flat rate. You might want to research fee splitting which is illegal. I'm not sure if this would or wouldn't qualify. I'm no expert.

On a per patient basis I was doing quite well for myself and I suspect with your 60% you will as well. Once you get to know you patients, which can take a little time, it is generally as you described. Fairly fast visits for lab orders, med changes etc. It s very relaxed because, as I often said, I can go anytime and the patients will be there. No hard time lines to keep.

A quick thought about 60% of the billing...who is doing the billing and counting the 60%? Everyone is always in love at the beginning of the process but you need to have a method decided ahead of time for accounting and what your redress is if you think the numbers are wrong. Can you have an independent audit done? Can you have your own billing expert or accountant see everything in and out? Something like that should be in your agreement.

The only downside I found was being on call for the nursing home. They function 24/7 and have to call for every simple silly thing you can imagine. There were days I'd get 30-40 calls from them in a 24 hour period.

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I agree with SAS. 

Downsides:

- call is absolutely the downside. They are generally staffed with LPNs and CNAs and depending on facility policy, may have to call for every fall  (whether injury or not), death (expected or not), "med clarification", after hours lab, etc. You can minimize that with good, clear policies, communication with nursing staff and good instructions.

- endless regulations from the federal government and the state. They require documentation of every psychotropic, prn psychotropics have to be discontinued if not used in 2 weeks and need to be carefully documented. Patients have the right to eat whatever they want, which means lots of calls about weight gain in CHFer or high blood sugar in diabetic. 

- resources are not what you have in hospital but are more then you have in clinic. I can get a stat xray or ultrasound within a business day. Stat labs can take several hours but can be done 24/7. Some facilities can do IV fluid, IV antibiotics, wound vac, etc and some can't. 

- make sure your visits are medically necessary, one national company is in trouble for doing visits that were not necessary or for upcoding

 

Upsides:

- schedule flexibility

- autonomy

- longitudinal care of ill patients. I prefer assisted living or SNF patients to clinic patients. I know what's going on and can get input from nursing staff. I know my long term patients very well

- staff can be great to work with and you really get to participate in team based care

 

Many of the new admissions to SNF/rehab are very complex and hospital discharge orders can take forever to figure out and transition safely. It's generally interesting, team based work. Chosen carefully, the environment can be a help or hinderance. 

 

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On 12/18/2017 at 9:00 AM, sas5814 said:

I  did this for a few years but did it on a "per patient" flat rate. You might want to research fee splitting which is illegal. I'm not sure if this would or wouldn't qualify. I'm no expert.

On a per patient basis I was doing quite well for myself and I suspect with your 60% you will as well. Once you get to know you patients, which can take a little time, it is generally as you described. Fairly fast visits for lab orders, med changes etc. It s very relaxed because, as I often said, I can go anytime and the patients will be there. No hard time lines to keep.

1. A quick thought about 60% of the billing...who is doing the billing and counting the 60%? Everyone is always in love at the beginning of the process but you need to have a method decided ahead of time for accounting and what your redress is if you think the numbers are wrong. Can you have an independent audit done? Can you have your own billing expert or accountant see everything in and out? Something like that should be in your agreement.

2. The only downside I found was being on call for the nursing home. They function 24/7 and have to call for every simple silly thing you can imagine. There were days I'd get 30-40 calls from them in a 24 hour period.

1. They have a hired billing department that does the books. This was a concern for me as well. Before I signed the contract, I asked and they stated I will have access to the books. I made sure they made this transparent and in my contract that I signed.

2. As for call, I was told the supervising physician would handle 100% of calls. Only exceptions would be if he were to go out of the country and not get phone service, which would not be that often they said. I am used to this set up because at my last practice that I worked at, it was similar call-- only if SP was not in the country.

 

I know I sound a little naive but it is just weird hearing about and signing a contract that doesn't seem to be screwing over the midlevel. My last job was very much a, "New grads welcome, will train!" type of position-- and one where it didn't take long for me and the new grad ARNP that they brought along to realize how much money we were generating and bringing to the practice.

Best part about my 1099 contract is that there are is not a non-compete, no time duration, and no financial penalty for ending contract early (because no time commitment). Also, it's only 30-day notice for termination of contract.

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