Highest paying procedures in Family Medicine

[HmTwoPA]

Just got offered an excellent opportunity in a private practice that I currently work UC in. I will be transferring to Family medicine and paid between 50-65% of collections on a tiered system that moves pretty quickly to the 65% reimbursement rate. A few of the PA's in the practice if hustling hard will make 300k+. In my previous primary care positions before UC I would do procedures such as Large joint injections, toenail removals, skin biopsy, benign lesion removals, trigger point injections, and lipoma removals. I am interested in doing IUD placement, but would retraining in it. 

My question is two fold- 

1) Is the reimbursement for these procedures worth doing vs just seeing another patient at a 99213/4 rate? 

2) Are there any high paying procedures that would be of value to my patients I should learn? 

 

Thank you in advance!

[rev ronin]

So, it's always going to depend on the insurer, but I'm not sure it would even be reasonably possible to assess this.  I currently just code on time due to the specific needs and limitations of my practice, but when I was doing family med, there were very, very few 99213s, and a 99214 could be a pretty quick visit.

I love POCUS as a worthwhile revenue generator: you do the scan, you get a clinical answer right away, and you get a separate billable line item. I think it's a great place to be.

For my situation, an u/s guided large joint injection is reimbursed between a 99213 and 99214, and takes a substantial amount of materials cost ($20+) that should be taken into account as well: not a huge finacial "wow" when 30 minutes of talk+charting add up to another 99214. Given the opportunities for things to go wrong and the time invested, I view these as essentially "break even" investments in making the patient's life better, which is OK as far as I'm concerned: I want to decide based on the patient's needs, not my paycheck.

[ohiovolffemtp]

The key issue is time vs. RVU.  I do EM, so the patients dictate what procedures are needed.  However, some procedures such as nerve blocks and trigger point injections are very quick and high RVU.  I&D's and lac repairs can be fairly time and labor intensive, especially repair of large lacs that actually don't provide a good RVU/hour ratio.  FB removals vary.  The very high RVU procedures such as joint/fracture reduction, intubations, and central lines also tend to take a long while, especially when you wait to muster all of the needed troops.

[EMEDPA]

I believe standard exercise stress tests pay fairly well. There may be a difference between inpt and outpt, but when I did them in an ED obs unit 10 years ago they billed out at around $500 and most folks only had to do 8-15 min to pass their study. Bruce protocol with 3 min accelerations and tilts is the standard way to do it, but the kaiser protocol of small increases every minute seems more humane.

[ventana]

65% of collections is unheard of. 
PA run about 38-41%
docs runnabout 48%

I have owned on practice and starting another.  Can’t see 65% of collections unless the books getting cooked 

 

 

 

[HmTwoPA]

On 11/21/2022 at 8:49 PM, ventana said:

65% of collections is unheard of. 
PA run about 38-41%
docs runnabout 48%

I have owned on practice and starting another.  Can’t see 65% of collections unless the books getting cooked 

 

 

 

I got all the official spreadsheets in regards to pay. You're right that its not as great as it once seemed, but still pretty good. The pay scale goes from 38% up to 350k and then it creeps up in percentage to 65% of collections over 750K a year. APP's then get a 30% decrease compared to the Physicians. There is also a bonus for Medicaid physical percentage, panel size, amount of medicaid and medicare patients over 550 on your panel and coding capture. 

A few of the PA's who have been here for a long time and hustle make 350-400 a year. It helps that the practice is owned by a large amount of physicians, PA's and NPs. The majority share owner and president is a PA. They offer you partnership into the company after you've been here for a while. I got offered partnership earlier this year. I feel very fortunate and lucky to have this rare opportunity offered to me. 

Talking to a couple of my close friends and colleagues that have been for a while they said average after a couple years of building your practice is around 250 a year. Thats not including dividends as an owner, which is not always given depending on how the company does that year. 

Edited December 1, 2022 by HmTwoPA