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Physiatry Jobs

PHYSIATRY JOBS

When it comes to negotiating a contract for a physiatry job, one typical clause is the non-compete clause.  It’s typically something that one would not think is negotiable but it’s worth trying.  Perhaps you can negotiate the distance, the time limit, or the fine.  Compromises are possible.  It may take some skillful negotiation.

Most physiatry jobs have a non-compete clause in the contract.  The monetary penalty associated with a non-compete usually ranges from $10,000 to $250,000. The geographic limitation may range from 5 miles to 100 miles of the practice/hospital.  The larger limit relates to large hospital systems with many satellite offices.  The length of the non-compete is from 1 – 3 years after leaving the entity.  Some options if you leave a practice and have to wait until the non-compete is over are locum tenens work although you may need to get another state license or telemedicine.

Non-compete agreements are frequently challenged in legal cases.  “Many states do not allow non-competes and some states have legislation in the works,” according to Jon Appino, Principal and Founder of Contract Diagnostics, a firm that helps physicians with contract reviews. Yet he still encourages doctors to check all local laws, explaining that even when a doctor hears that a non-compete is unenforceable, the contract may have predetermined damages that are tough to fight against.  https://www.medicaleconomics.com/view/non-compete-clauses-what-physicians-need-know

Physiatry jobs vary based on so many factors.  One of these factors is the compensation model.  If it is your first PM&R job out of residency you probably won’t be able to choose the compensation model nor do you want to unless you are the rare exception that has some prior practice experience.  It usually takes awhile for a new physical medicine and rehabilitation graduate to ramp up their productivity so a guaranteed salary if helpful.  As an experienced physiatrist, even given guarantees from the new practice/hospital, you usually don’t know all the in’s and out’s of the new practice dynamics to ensure your success so a model with some certainty of income is the best.  However, you might be able to negotiate the compensation model so it’s wise to select one that fits you, e.g., your productivity, your practice style, etc.

One form of compensation associated with a physiatry job is when the entity guarantees/loans a physiatrist “X” dollars a year and that these guarantees/loans are forgiven if, for example, you stay at the job for three years. What isn’t considered by some physiatrists is that there are income taxes due on these amounts.  You may not pay tax on those amounts as received, but you will need to report the income and pay taxes on those dollars as they are forgiven.

Imagine if the total of practice support, educational loan repayment, relocation dollars, and signing bonus adds up to $450,000 (plus interest). The loans are to be forgiven over a three-year period following the end of the support period. The physiatrist is making $200,000 at the time forgiveness commences. This means that each year, for three years, the physiatrist’s taxable income will be reported as approximately $350,000 (this is $200,000 salary plus one-third of the $450,000 loan plus interest) and not just $200,000.  https://www.physicianspractice.com/view/physician-recruitment-agreements-4-things-consider

On the flip side, practices should determine the buy-out arrangement as early as when they post a physiatry job and not wait until the associate leaves.  Almost all medical groups have readily demonstrable value. Practices often believe they should vary the payout formula according to whether they have a new physiatry job because a physician’s departure is due to death, retirement, or disability, or if a physician retires “too young.” It is only fair to reward fully a departing PM&R partner who has participated in the group’s growth long enough to deserve a full payout, regardless of the reasons for the departure; after all, the physiciatrist is leaving behind essentially the same tangible and intangible values. An ongoing physical medicine and rehabilitation practice will almost always have the same patient loyalty and forecast for success, regardless of whether the departing physician dies, relocates, or retires. Such variations usually intend to penalize “inappropriate” departures to discourage partners from withdrawing voluntarily. But a practice’s success, to include successfully filling a physiatry job need, is usually tied inherently to the collegial, if not synergistic, interdependence of its physician members. Someone who no longer wishes to be in the group but who stays because of economic coercion will provide a negative influence on the continuing group practice. https://www.seak.com/wp-content/uploads/2014/09/LegalMistakesFinal.pdf

Physiatry groups that obtain life and/or disability insurance for their new PM&R physician when filling a physiatry job in amounts sufficient to fund buyout proceeds usually waste their money. It may be comforting to know that departures may have little economic effect on the remaining physicians, but this emotional comfort is often expensive and misplaced. First, even when the insurance is funded collectively by the group, a departing member will wind up paying for an allocated portion of his or her own insurance, which then benefits the group. The accounts receivable generated by that physician remain with the group. Thus, the doctor subsidizes his or her own insurance and provides a gift back to the remaining colleagues of the receivables and other intangible values he or she generated. Second, the practice’s receipt of insurance proceeds may trigger the alternative minimum tax under federal tax law, making this arrangement far less attractive. If the physicians try to avoid the agreement with a “cross-purchase” arrangement (by which the shareholders individually purchase policies on each other), this is a complicated process at best, and unwieldy when the group has more than two or three physicians. Third, insurance funds a departure only under certain circumstances. A life insurance policy will not fund a payout due to disability, nor will a disability policy fund a death payout. Neither will fund a retirement. The group may have to fund a payout regardless of insurance, so why not just structure the payout to be affordable and eliminate the insurance? On the other hand, sometimes a medical group has a physician whose drawing power, reputation, or influence is so great compared with that of the other physicians that the group is unsure whether it can survive that physician’s death or disability. In that case, insurance may be justified, to provide cash flow that would not necessarily be sustainable otherwise. https://www.seak.com/wp-content/uploads/2014/09/LegalMistakesFinal.pdf

Please visit www.farrhealthcare.com for a list of physiatry jobs.

PHYSIATRY JOBS

There are many physiatry jobs to consider.  Covid dampened the number of PM&R practice opportunities but as the pandemic eases so too has the job market.  Inpatient physiatrists are in particular strong demand.  Farr Healthcare, Inc. tries to make your practice search has worry-free as possible.  We can help direct you to positions that are a good match and guide you through the process.  Farr Healthcare also serves as your cheerleader to employers!

The physiatrist position falls under the broad category of physicians and surgeons, positions with exceptional job prospects. According to the U.S. Bureau of Labor Statistics, the projected employment for doctors and surgeons is expected to grow much faster than average through the year 2024. Board-certified physiatrists, who have an even better job outlook, also command higher salaries. Reference: https://careersinpsychology.org/physiatry-careers/

The PM&R practice search process starts with identifying practice opportunities of interest to you, talking with these entities and to the ultimate end of securing a job.  You can count on it taking 6 months or more usually when one considers the time to meet the practice, get references, get a state license, get on the payor panels, etc.

With experience in physiatry recruitment for over 30 years, Farr Healthcare is able to help doctors to find practice opportunities and employers to find physiatrists.  Not only are we able to find practice opportunities and physiatrists, we make every effort to make connections that are best-suited to both parties.  We use our insight to ask hiring entities information to help discern what candidates are the best fit.  We listen to physiatrists looking for work and ask questions to help identify what practice opportunities are the best for each individual.  We aim to be customer-friendly!

We are always striving to be in front of as many physiatrists and rehab organizations as possible to ensure that each will respectively have enough practice opportunities and physiatrists when their time comes for a search.  For example, we keep in touch with residency and fellowship programs.

According to the Association of Academic Physiatrists, there are over 10,000 board-certified physiatrists in the U.S., yet there is a growing patient base and needs in a variety of environments:

  • Older adults are working longer: People are retiring later in life, and may incur on-the-job injuries that require PM&R treatment. By 2022, older males will compromise 27% and older females will make up 20% of the U.S. labor force.
  • A number of areas in the U.S. currently have a shortage of rehabilitation services and/or physiatrists. Like other medical specialties, there is a geographic maldistribution of physiatrists. In certain geographic areas, no physiatric services are available.
  • According to an article in McKnight’s, a medical industry publication, there is a growing need for physiatrists in sub-acute rehabilitation settings, such as skilled nursing facilities, due to shifts in payer level-of-care preferences. According to Dr. Gnatz: “Rehabilitation in the skilled nursing facility environment is rapidly emerging as the predominant level of inpatient rehabilitation care in the United States.”
  • Physiatry’s greatest unmet need is in the number of academic physiatrists. PM&R residency programs continue to experience a shortage of academic talent to fill the growing number of chairperson and faculty positions.

Part of the PM&R practice search process is reference checking.  Given the years of experience that Farr Healthcare has in physiatry recruitment, we have developed relationships with physiatrists that enable us to gain greater insights during our reference-checking process. With a reputation for honesty, we present to the employer thorough information about physiatry candidates.

Typically, an interview follows if the references are good.  Here are some possible questions for the interview process according to https://www.betterteam.com:

  1. What process do you follow to locate and diagnose a patient’s source of pain?

Demonstrates broad medical expertise and the ability to diagnose various medical conditions.

  1. Describe a time when you collaborated with other medical professionals, such as a physical therapist, to develop a treatment plan for a patient. Was it successful?

Shows the ability to work with others.

  1. Describe your most successful medical case to date. What factors contributed to your success?

Proves work experience.

  1. How do you stay up to date with new treatments and advancements in physical medicine and rehabilitation?

Shows continuous training and professional development.

  1. How do you motivate patients that are feeling despondent? How do you deal with patients who refuse to cooperate with you?

Tests interpersonal skills.

 

Congratulations!  You’ve been offered a physiatry job and received a contract.  Now what?  Most physiatrists pursue professional advice when a contract has been presented.  There’s a reason for that.  The contract is a vehicle to determine the terms of your PM&R work with a hospital or practice.  It also governs what happens when you leave it.

A few legal practices are listed on my website under the Resources tab that I have met while at various conferences.   I can not recommend any of these practices.  You may have local lawyers to assist you.  Of course, you want someone who has experience with physician contracts.

The physiatry contract you receive will no doubt have been crafted by the hiring entity’s attorney to protect their interests so it makes sense that you, too, should consult your attorney to safeguard your interests.  You should consult a lawyer to make sure that their contract is not overreaching in what it requires of you and, if so, you will want to negotiate those points.

One of the key features of the PM&R contract is the compensation section.  It spells out what you’ll receive, the terms of the finances, the calculation of the payment formula, etc.  Hence, it is important that it is as clear as possible and as complete as possible.  I might even suggest that an accountant review the financial part of your PM&R contract.

There are also practice management firms that will review doctor contracts.  Some of them are listed on my website, again under the Resources tab.  These practice management firms specialize in physiatry.  Again, I have never used any of them personally so I can’t recommend any one of them.

Don’t forget to look at the Openings page on my website, www.farrhealthcare.com

 

Potential COVID-19 Hardship Exception Extended to 2021 MIPS

CMS is offering the option of obtaining a COVID Exception from reporting for MIPS for 2021, according to the following stated criteria from CMS:
Can I Apply for an Extreme and Uncontrollable Circumstances Exception?
Yes. If you believe you have been affected by an extreme and uncontrollable circumstance (such as the public health emergency triggered by the COVID-19 pandemic), you can apply for this exception whether reporting traditional MIPS or the APM Performance Pathway (APP).
Extreme and uncontrollable circumstances are defined as rare events entirely outside of your control and the control of the facility in which you practice. These circumstances would:
 –  Cause you to be unable to collect information necessary to submit for a MIPS performance category;
  –  Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example. if you were unable to collect data for the quality performance category for 3 months), and/or,
  – Impact your normal processes, affecting your performance on cost measures and other administrative claims measures.
In order to apply for this Exception, go to:
  https://qpp.cms.gov/mips/exception-applications
–  Go to the Section “Extreme and Uncontrollable Circumstances Exception Application Window is Now Open” and hit Apply
– Select ALL 4 program categories (Quality, Promoting Interoperability, Improvement Activities and Cost).
If approved, you should receive an instantaneous email confirming Approval.

If you get approved, it’s one less headache for your practice in 2021!

This article was contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482, www.physiatrymedicalbilling.com
physiatrybillman@aol.com

6 out of 10 People Choose a Doctor Based on a Convenient Location

location buildingWhen a patient chooses a doctor or a hospital, the decision process is often driven, not by quality factors, but by simple geography. Check out these surprising and insightful numbers…

Three recent surveys seem to agree; “location” is a highly significant consideration. What’s more, according to Healthgrades data, “convenient location” is more than twice as important to consumers selecting a physician or a hospital than success rates or outcome data.

Here are some of data points that I recently shared in my marketing talk at the Cleveland Clinic Patient Experience Summit. Many hospital marketers, CEOs and healthcare/patient experience pros at the Summit were shocked that people choose hospitals based upon location and friendly staff vs. quality.

Choice of Physician: Consumers who have selected a physician in the past three years are more concerned about convenient location (62%); friendly office staff (56%); than success rates (22%).

Source: 2014 Healthgrades American Hospital Quality Report to the Nation

And, for the still-to-be-convinced crowd, the findings run parallel to a prior Healthgrades study about consumer choices:

Factors Most Often Considered When Selecting a Physician

  • Whether my physician is covered by my health insurance plan (72%)
  • The physician’s office location (69%)
  • Which hospital he/she is affiliated with (49%)
  • How long it takes to get an appointment with that physician (47%)
Source: Consumer Research: America’s Readiness to Choose a Doctor or Hospital; Healthgrades; Prepared by Harris Interactive; October, 2012

And a third survey—this one by the American Osteopathic Association (AOA)—similarly revealed “location” as one the five most important factors adults consider when choosing a physician for themselves or a loved one:

  • Acceptance of insurance plan (83.3%)
  • Bedside manner/empathy (60.5%)
  • Proximity of office to home, work or school (57.4%)
  • Convenient office hours (42.9%)
  • Medical specialty (37.5%)

And where do consumer/patients find information? The AOA survey reports that adults use the following top five resources when finding a physician:

  • Word of mouth, i.e. family, friends, coworkers (65.9%)
  • Insurance provider directory (51.9%)
  • Physician rating websites, i.e. Vitals, Healthgrades (22.8%)
  • Hospital website (10.8%)
  • Consumer review websites, i.e. Yelp (10.5%)

The selection of a physician or medical facility nearly always employs a combination of reasons. And an increasingly informed and engaged public means more people are shopping carefully…and often, close to home.

Taken from https://healthcaresuccess.com/blog/hospital-marketing/6-10-people-choose-doctor-based-convenient-location.html#

When you want to add a physiatrist or are looking for a PM&R position, please visit the Openings page on my website, https://farrhealthcare.com/openings/

Business Consultants/Guide to Starting Your Own Medical Practice

8 Myths About Being a Self-Employed Physiatrist

Do you dream of being a self-employed physiatrist but feel like you don’t have the money, knowledge, or skills to get a practice going? Your concerns might be unfounded and grounded in some of the common myths about self-employment. Imagine being able to increase your income and have a more flexible schedule. These benefits are a real possibility when you are your own boss. So, let’s start exposing the eight myths for what they really are.

1. Self-employed means working long hours. Many people who work for themselves do work long hours, but this is frequently a choice. They simply love what they do. Many people can start practices that generate income even while they aren’t working. If you choose a practice that includes passive recurring income, you won’t necessarily have to spend a lot of time working once you get going.

2. Being an employee is less risky. This is one of the biggest myths. Employees get laid off all the time. And what if you need to raise some extra cash quickly? That’s tough to do when you’re working for someone else, and your income is fixed. Being self-employed gives you more control over your income and the assets of the practice. Control helps reduce risk.

3. Self-employment means putting all your eggs in one basket. If you’re an employee, how many patients do you have to lose in the practice in order to lose your paycheck? This can be as little as one patient. But if you have a number of patients, they all have to fire you for you to lose all of your income.

4. Self-employment equals stress. When you work for yourself, you can create whatever work environment you choose. You can have greater stability over the long term, and you have more control over your hours. You can also choose a practice that isn’t inherently stressful. Generally, you can make it whatever you want it to be, which will make your stress level only as high as you find acceptable.

5. Being self-employed is lonely. Working for yourself can be a much more pleasant lifestyle if you choose. With more flexibility, you can often rearrange your schedule to suit your social life. When you work for someone else, your coworkers tend to be your social life. Over time, that can get old.

6. Self-employment means doing everything yourself. While you’re the one that has to ensure that everything gets done, that doesn’t mean you have to do everything yourself. Hire people to do the work for you. Your time should be spent growing and expanding the practice, not doing the grunt work.

7. Running your own practice is complicated. Yes, there is quite a bit to know, but none of it is difficult. There are books and experts available to help you along the way. Nothing is overly complex about insurance, payroll taxes, and bookkeeping. It’s just new to you. Plus, you only have to learn information once. Then you can start as many practices as you like.

8. You can’t start a practice without a lot of money. That largely depends on the practice. A website and accompanying social media platforms can cost less than $100 a year. Your home phone or cell phone is already paid for as part of your monthly expenses. A tank of gas isn’t that expensive, relatively speaking, nowadays, plus they have electric vehicles. And ads are inexpensive also. There are a lot of inexpensive ways to start and market a practice. You could market directly to other doctors and/or set up free educational webinars that describe your services.

Where there’s a will, there is a way. Don’t let a bunch of myths stop you from taking the plunge into self-employment. You can even start a practice on the side and continue working your regular job until your new practice brings in enough income to replace it. Now that we’ve separated myths from facts, what are you going to do? Put on your thinking cap and figure out a way to make your dream a reality. There’s no time like the present to take control of your life.

This article was contributed by Hassan Akinbiyi, M.D., https://drhassanrehab.com/about-dr-hassan/

ProMedica Partners has released a new step-by-step guide about starting your own medical practice.  They gathered the best quality resources, references, tools, & information you need to open your own practice, all in one place.  One of the items in this blog on their website provides information about the possible need to hire a practice startup consultant.   “Though consultants can be expensive, their fees can be well worth it, if you utilize their services effectively. Start with a professional association such as the NSCHBC, and also ask colleagues for reference, especially others in your specialty.”  To find out more of their comprehensive information on this subject, Check out part 2 of the new guide here

This information is courtesy of ProMedica Partners, https://promedicapartners.com/

Physiatry Practice Opportunities

The number of physiatry practice opportunities is less this year because of COVID.  There are sports medicine fellows who are open to general rehab positions and residents who want to do inpatient who are open to outpatient work.  This applies to the urban areas and less so for more suburban or rural areas.

There are more and more subacute and skilled nursing facility physiatry practice opportunities. Some of them are with private practices and some are with large national or regional companies.  These companies often have an income guarantee and then take approximately 30% of the billings.

Part-time physiatry practice opportunities are not unusual in large metropolitan areas like New York City.  Physiatrists there may not be able to find a full-time position.  Sometimes it’s wise to have two part-time physiatry practice opportunities so that if one physiatry practice opportunity folds then the physiatrist has the security of the other job.

Licensure is an aspect of the practice search that is often overlooked.  Most physiatrists prefer to hold off on licensure because of its cost.  However, licensure puts you at an advantage over a physiatrist who is not licensed in that state.  Therefore, it’s worthwhile to pursue a license particularly in states that are in high demand such as NY, FL, and CA.  It’s also important to pursue a license early on if you’re interested in a state which licensure process is lengthy such as TX, CA and NJ.  Sometimes, practices/hospitals will pay for a license if you take their practice opportunity.  Without a license, you put yourself in possible financial disadvantage because credentialling with insurers can’t be started until you have a license number.

When considering physiatry practice opportunities, be wary of practices/hospitals with a revolving door of doctors.  You may hear about this situation at a hospital/practice from doctors in the area or through research.  It happens more often in metropolitan locations where there is a high demand for physiatry practice opportunities.  In these locations, a hospital/practice can easily replace one doctor for another doctor.

When considering physiatry practice opportunities, you may want to consider the cost of living of various areas across the country.  For example, a practice in Las Vegas with a physiatry practice opportunity makes a point that for what you’re saving by not living in Los Angeles, CA, you could buy a new car very year!  If you make $212,000 in Los Angeles, it’s equivalent to making $300,000 in Las Vegas.

Another consideration when thinking about is state income tax.  I know one NYC physiatrist whose main consideration with physiatry practice opportunities was states with no state income tax.  States without a state income tax are AK, FL, NV, NH SD, TN, TX, WA and WY.  As one physiatrist in NV told me who is hiring a physiatrist, a doctor moving here from a state with income tax would be able to buy a new car each year.  For example, for every $100,000 you earn, you would save $10,000 by not having to pay state income tax.  Hence, the savings amounts to a new car each year!

Interviewing is a major component of the practice search process when considering physiatry practice opportunities.  Be prepared to answer the standard questions such as “What do you have to bring to the table?”  “What are your practice interests?” and “Tell me about yourself.”  You can find countless tips online describing how to respond to the typical interview questions and to show that you’re an excellent candidate for the job to include on our website.

Another type of interview question are personality/psychological questions.  Examples of these type of questions are “Describe your approach to patients.”  “Tell me about a patient who came to you unhappy with the care they received elsewhere, and how you handles it.” “What makes you uncomfortable?”  “When are you the happiest?”  Tell me about one of your professional relationships.” “Tell me about your best supervisor.”

These questions are to see how you work under pressure.  They want to know how you react to surprises, and if you can handle unusual situations quickly, creatively and effectively.  The interviewer will likely ask questions about you and your work style to determine how to handle stress and challenging situations.  There are no right or wrong answers to these questions, but you’ll still want to prepare as much as possible.  You’ll want to answer honestly while at the same time trying to match your replies to the practice’s needs.

You can still practice how to handle these questions.  First, you can practice answering strange questions with a friend or family member.  This will help you practice staying calm and confident, even when you feel stumped.  Show empathy and compassion in your responses.  Try to demonstrate your listening skills, interest in patient education and ability to engage patients in their healthcare.  If you are stumped by a question and need a little more time to respond, ask the employer to ask the question again and/or repeat the question that’s been asked.

Also, be prepared to ask questions during an interview. It shows that you have an interest in the physiatry practice opportunity.  Asking good questions won’t guarantee you the job but they will certainly help make a good impression.  Sample questions to ask include “How much time is allotted for appointments with new and follow-up patients?”, “How much time is allotted for appointments with new and follow-up patients?”, “How many patients a day will I be expected to see?”, “What constitutes a full-load in your practice?” and “Is this a new or replacement position?”

Having said all of these objective items to do during your physiatry practice search, it remains to be said that using your intuition/gut to decide if it’s a good physiatry practice opportunity is very worthwhile.  All the questions and answers during an interview still aren’t enough to decide on a physiatry practice opportunity.  Beyond what objective information you can secure, use subjective information to decide on a job.  Read between the lines of what was said and not said by the employer.

In regards to compensation, according to MedScape’s 2019 physiatry survey from data collected between October, 2018 and February, 2019, the average compensation for a physiatrist is $306,000.  This is up from $269,000 in 2018.

Compensation varies by area.  For example, Atlanta on average pays 29% more than the national average, Miami 5% more, Tampa 1% more, Cleveland 3% less, NYC 5% less, Chicago 8% less and Philadelphia 23% less.  This is information according to payscale.com.

Also, according to payscale.com, the average physiatrist salary is $208,543 with an average bonus of $72,000, and an average profit-sharing percentage of 10%.  The low compensation for a physiatrist is $147,000, $290,000 as a median and $286,000 as the 90th percentile.

When considering physiatry practice opportunities, there are 3 basic compensation models:  straight salary with incentive, equal shares and production-based.  A straight salary is most often seen in HMO’s  and academic settings.  Obviously, a straight salary is the easiest to determine its value.  They are guaranteed regardless of your productivity.  On the other hand, if you are a hard worker and productive, then a straight salary is not your best friend.  They also don’t offer an ownership track.

Regarding an incentive, you need to find out how it is derived and if it’s achievable.  According to a physiatrist, it’s much more important to know an incentive’s derivation than simply that one exists.  She was offered an incentive to earn an additional $50,000 a year provided her billings exceeded a certain amount.    The problem was that the higher earnings were unrealistic.  Looking back, she realized that she should have asked for the performance financials for other physiatrists in the practice, the payor mix, the productivity of the other physiatrists, etc.  Find out how the incentive works in practice, not just in theory.

The incentive may be modest the first and second years of practice as it takes that long for the practice to break even with a new doctor.  If you’re in a private practice, the incentive formula will probably start at 25% the first year, 35% the second year and 50% the third year.  It’s usually by the third year that you become a partner.

Even though you probably won’t be able to negotiate the compensation model, it’s important to understand it to realize what annual income you might anticipate.  Determine how the compensation model works initially and at different points in time.  For example, if the first one or two yea’s salaries are fixed and then compensation then moves to a productivity basis, ask for details on how the transition is handled and how other physicians have fared in year two and three.  As Merritt Hawkins Executive Vice President Mark Smith says, “if physician can’t determine how much they will earn while brushing their teeth, the plan is too complex.”

One type of incentive formula is based on getting a percentage after x times the salary or receipts.  For example, you might get 20% of collections after three times your salary.  For example, a salary of $180,000 with collections of $600,000 would result ($180,000 x 3 =$540,000, $600,000 – $540,000 x 20%) in a $12,000 incentive bonus.    This is an example of what I spoke to earlier that you should make sure the collection incentive is attainable.  Also, I was just talking with a physiatrist yesterday who told me there were different collection thresholds with different associated percentages.  The percentages should be the same.

Another type of incentive formula is a percentage of the difference between the net income and expenses.  For example, if your gross collections for a quarter are $150,000 and there are $60,000 in overhead expenses and $60,000 in physician expenses like malpractice, benefits, etc., the net is $30,000 and at a bonus of 20% you would receive $6,000 for the quarter.  Years ago, a physiatrist I recruited warned me of the physiatry owner who had a very large rental expense which a portion was to him and greatly reduced his income.  You may also receive a share of the ancillaries like PT and lab.

A third compensation formula is purely production-based.  There are a myriad of variations with these formulas just as is the case with the incentive formulas.  You might be paid a percentage of billings OR collections OR RVS units of service.  One physiatrist told me how his compensation formula was different than his older associates.  The overhead should be shared unless perhaps in situations of multispecialty groups.  The positive of a production-based compensation formula is that you are rewarded for the work you do.  A negative is that it might cause friction among the physicians as some physiatrists will be paid more than other physiatrists.

Other compensation considerations are to find out the percent of billings that the physician group/hospital typically collects and how quickly it collects it.  The time value of money comes into play.  It’s far better to step away from a practice opportunity before digging yourself in a hole.

Find out the patient mix.  Private pay pays the best but you have to be in a demographic that will support it.  The order of payment thereafter is commercial insurance, Medicare and Medicaid.  Personal injury payments usually are much longer to receive.  Also find out if you’ll be seeing the same share of these patients as the other doctors.

Don’t count on the incentive even if it looks likely.  This past year was a perfect example with the impact of Covid.  I talked with a doctor who told me she hasn’t earned the incentive in the 30 years with the hospital!

Partnership terms usually aren’t discussed upfront.  Until the doctor group works for you and feels comfortable with you, partnership won’t be discussed.  However, you could probably find out what the terms are for the existing physicians.  A five-year partnership track may be far less appealing than a two-year track and the longer route to partnership may mean less long-term earning potential.

Finally, the last aspect of considering a physiatry practice opportunity is the contract.  Large corporations and health systems have boilerplate contracts and won’t negotiate them so a legal review is not as valuable as it might be.  However, I recently had a group which told me to tell the physician to whom they offered a contract that it is a boilerplate that he couldn’t negotiate.  However, he did ask for a sign-on bonus and received a sizeable figure.

If you decide to work as an independent contractor and are responsible for your own billings, you might want to refer to my website to the Resources tab which includes for one, Physiatry Billing Specialists.  Other resources are included on this tab to include lawyers, billings, and practice management.

So here’s best wishes to you in your consideration of physiatry practice opportunities!

 

MIPS Reporting

FREE MEDICARE HELP WITH MIPS
 
CMS has launched a Small, Underserved, and Rural Support
initiative to provide free, customized Technical Assistance to
clinicians in small practices.
 

Technical assistance includes:
– Understanding general requirements of the MIPS program
– Advice on choosing measures
– Help in submitting data
 
Based on my experience, these companies are excellent!
 
Each state has a different company providing this technical assistance.
 

You can find who to contact by clicking on this link and entering
your state, or by calling the CMS MIPS Help Desk 1-866-288-8292
 
 https://qpp.cms.gov/resources/small-underserved-rural-practices

This article was contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
physiatrybillman@aol.com

AUTOMATIC MIPS Exception for Performance Year 2020

CMS issued a new directive on 2-25-21 – CMS will apply an AUTOMATIC extreme and uncontrollable circumstances exception (EUC) to the following clinicians for the MIPS 2020 performance year:

  1. Individual clinicians that haven’t submitted data. If you haven’t submitted data for 2020, then you don’t need to, if you want to avoid a penalty in 2022.
  2. Individual MIPS eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period).

If you meet either of the above criteria, you will be automatically identified and will receive a neutral payment adjustment(i.e. – no penalty) for the 2022 MIPS payment year. You don’t need to take any additional action!

The automatic exception is welcome news for individual clinicians who are having trouble  meeting the requirements of the 2020 MIPS program.

Additional details may be found at https://qpp.cms.gov/resources/covid19 or by calling the QPP Help Desk at 866-288-8292.

This article was contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
physiatrybillman@aol.com

7 Types of Insurance to Protect Your Medical Practice

7 Types of Insurance to Protect Your Medical Practice

If you’re a family physician who manages your own private practice, then you are well aware of the challenges that come with being a business owner. You’re the judge, jury and executioner when it comes to laying the ground rules for how you want your practice to operate. But if you’ve recently acquired your own independent practice, there are a few things you need know – namely how you can protect your practice from various risks.

From day one of opening your practice, you expose yourself to certain liabilities, which is why it’s important to have the right types of insurance in place. One lawsuit or catastrophic event could be enough to wipe out a small business before it even has a chance to get off the ground. In this post, we’re reviewing the types of protection an independent family physician practice needs in order to protect everything you and your staff have worked so hard to achieve.

  1. Professional Liability Insurance

Professional liability insurance, or malpractice insurance, protects your practice in the unfortunate event that you are sued by a patient who claims negligence or that you failed to perform your job properly, resulting in harm.

While there is no one-size-fits-all policy, professional liability coverage helps cover the costs of legal defense and settlements, which can run into the hundreds of thousands of dollars. Since many small physician practices won’t have the resources to cover expensive claims, malpractice insurance is a must.

  1. Property Insurance

When you first opened your practice, you probably invested a lot of time and money in getting the right equipment, medical supplies, furniture and other necessary fixtures to make your business inviting to patients. However, if there was a natural disaster, how would you replace these items?

That’s where property insurance comes in. It protects the property you use in case it becomes lost or damaged due to common issues such as fire or theft. Property insurance covers both the physical building of your practice and personal property that is vital to the operation of your business (office furnishings, inventory, computers, etc.). Whether you own or lease your space, property insurance should not be neglected.

  1. Business Auto Insurance

Some physicians who are on their own have the flexibility to make house calls. This is especially common for concierge doctors who often drive to a patient’s home. If you use your own car for business purposes, you may want to consider business or commercial vehicle insurance. Most personal auto insurance policies won’t cover damages to cars involved in an accident used mainly for business purposes. A business auto policy covers cars owned by a business.

This insurance pays any costs resulting from bodily injury or property damage for which your business is legally liable. Depending on your coverage, your policy may pay for repairs or replace your vehicle due to damage from accidents, theft, and/or other events.

  1. Workers Compensation Insurance

As a business owner, you probably hired a few hard-working, dedicated employees. If any one of them were to become seriously injured, how would you be able to run your practice? In all states (with the exception of Texas) an employer must have workers compensation insurance, depending on the number of hired employees.

This insurance pays for medical care and replaces a portion of lost wages for an employee who is injured during the course of employment, regardless of who was at fault. Even if your employees perform low-risk or low-impact work, slip-and-falls or other medical conditions such as carpal tunnel syndrome could result in expensive claims.

If a worker dies as a result of their injuries, the insurance then compensates the employee’s family. This is definitely a type of insurance you don’t want to overlook, especially for the livelihood of your staff members.

  1. Business Interruption Insurance

Depending on where you practice, your business may be more prone to natural disasters such as earthquakes, hurricanes or tornadoes. If a disaster or catastrophic event occurs, it is likely that your business’s operations will be interrupted. To help your practice get back up and running, consider a business interruption insurance policy.

This coverage is different from property insurance in that it covers incomes lost due to a disaster-related closing of a business or due to the need for structural rebuilding of the practice. However, BII can also be combined with a property insurance policy – this package is known as a Business Owner’s Policy.

  1. Life Insurance

While it may not seem directly related to your practice, life insurance is another form of financial protection that is often left on the backburner. If you were to pass away, who would provide for your loved ones’ future? Who would treat your patients?

Life insurance offers a death benefit to your appointed beneficiaries in the event that you can no longer financially provide for them. This type of insurance is very important because it allows peace of mind for you, your family, and your business partners. Life insurance is a great way to unburden your loved ones due to the loss of your income. If you need assistance protecting your family’s financial future, the AAFP Insurance Program is here to help.

  1. Practice Overhead Insurance

If you were unable to practice medicine due to an injury or illness, you’d probably consider Individual Disability Insurance. While this is a form of protection you should certainly have in your back pocket, think about your practice. If you’re out of the office, who will see your patients?

Practice overhead insurance steps in if you are temporarily out of the office due to a disability. It helps cover certain expenses such as utility bills, rent, salaries, taxes and other office costs. Don’t risk losing your income or control of your practice due to an injury.

 

By having the right types of insurance in place, your medical practice can avoid a major financial loss due to lawsuits or catastrophic events.

Taken from the AAFP, 2015, https://www.aafpins.com/2015/12/7-types-of-insurance-to-protect-your-medical-practice/

PHYSIATRY JOBS

PHYSIATRY JOBS

There are many physiatry jobs available in many different physical medicine and rehabilitation subspecialties.  The demand for physical medicine and rehabilitation is greater than the supply.  Although Farr Healthcare only recruits for physiatry, my understanding is that it is a specialty that is more in demand than many other specialties and has exceptional job prospects.  Please visit www.farrhealthcare.com for a list of physical medicine and rehabilitation practice opportunities.

There is a need for inpatient, general outpatient and interventional physiatrists.  The need is greatest for inpatient physiatrists, followed by general outpatient physiatrists and then interventional physiatrists.  The need is greatest for inpatient rehab because many middle age and younger physiatrists have chosen to pursue outpatient work.

Farr Healthcare doesn’t usually have many general outpatient physical medicine practice opportunities.  This may be due to there being less a demand for them and that there is a fairly large pool of outpatient physiatrists available.  It is usually in more rural locations that Farr Healthcare is asked to recruit general outpatient physiatrists.

The general outpatient sector can be broken down from the standpoint that some physiatry practices treat mostly acute cases while other physiatry practices treat mostly chronic cases.  The latter physical medicine and rehabilitation practices have experienced censure from the federal government for the use of opiates and some physical medicine specialists have even lost their licenses as a result.  As a result, many physiatrists shy away from treating chronic pain patients.

Outpatient physiatry work can also involve to a greater or lesser extent the care of personal injury and worker’s compensation cases.  As in all of the various areas of care physical medicine and rehabilitation doctors can pursue, the choice of this type of work is one of personal preference with some attention to economics.

Interventional physiatry practice opportunities are greater from the standpoint that there are so many different specialties seeking out their services, e.g., physiatrists, neurosurgeons, orthopods, anesthesiologists.  The compensation and partnership opportunities can vary significantly among these specialties.  One shouldn’t presume that because it is a physical medicine group that the compensation and partnership opportunities are greater.  They are different and unique on a case-by-case basis, and not necessarily particular to the specialty.

A guesstimate is that two-thirds of graduating physiatry residents however go onto spine fellowships thereby reducing the number of physiatrists available for general work.  Some employers require an ACGME-accredited fellowship.

It may be advisable to pursue a spine fellowship to increase your skill set but it may box you in later when you want to pursue other physiatry work such as inpatient.  Inpatient employers want physical medicine and rehabilitation doctors who have done inpatient work within at least the past year.  This interest in due to the many and changing Medicare regulations that inpatient rehab physicians must know.

Another field is regenerative medicine which has a much smaller supply of physiatrists due to its relatively new beginnings and the small number of physical medicine doctors qualified to provide these services.  The opportunities to learn these services are fairly small.  The reimbursement for services by insurance providers may not be recognized and private pay patients may be less able to partake of these services in difficult economic times.

Some physiatrists go into traumatic brain injury, spinal cord injury and pediatric fellowships.  The number of physical medicine and rehabilitation residents going into these specialties seems to be rising in the last 5+ years but not to the extent that it was 20 years ago.  There is a huge demand for these subspecialties.  Starting compensation for these subspecialties is usually higher although not relatively significant.

Other subspecialties are rising such as neuromuscular, palliative, research, etc. but the number of physiatrists in these remain few in number.  It is probable that these fellowships will grow in the number and in the number of graduates.   Again, as in the case of these and other subspecialties, one of many determining factors will be the ability and level for reimbursement of these subspecialties.

Service settings which have grown in the number of physiatrists in the last 15 or so years and continue to grow are subacute, long term acute care and skilled nursing facilities.  There are many large national and regional companies that own these facilities.   There are also many national and regional companies that contract with the facilities and then in turn contract with physical medicine and rehabilitation doctors to provide these services.  Some companies compensate based on a set salary while others are on a pure production basis.

As a result of the demand for physiatry, the compensation is often open to much negotiation.  Most hiring entities set a salary base with an incentive component.  Negotiation would usually focus on the base salary.

The other day a physiatrist commented to us about the future of inpatient rehab.  In his area, he was one of the few doctors of physical medicine and rehabilitation doing inpatient work.  He felt that inpatient rehab jobs in general were diminishing.

The reality is that there are many inpatient physiatry practice opportunities and that companies continue to grow and build more inpatient programs and facilities.  The supply of inpatient rehab doctors is much less than the demand as many physical medicine and rehabilitation residents go onto interventional fellowships.

Occasionally, we’ll hear from an interventional physical medicine doctor who wants to return to an inpatient job which has less overhead, less competition and less decreased reimbursements.

Some physiatry residencies have affiliations with for-profit hospitals, subacute facilities, etc.  This is a great opportunity for the physical medicine and rehabilitation residents to experience life as it will be once they graduate and help direct them in their career choice.  Physiatry residents graduating from such programs are also more desirable to these settings as they have the experience working in such settings and therefore are more inclined to have a longer retention in their positions.

Future prospects for physiatry practice opportunities should continue due to the aging population, the ability of physical medicine and rehabilitation doctors to treat pain and the complications resulting from Covid. According to the 2020 Association of American Medical Colleges Physician Shortage Report “population growth and aging — continue to be the primary driver of increasing demand from 2018 to 2033. During this period, the U.S. population is projected to grow by 10.4% from about 327 million to 361 million. The U.S. population under age 18 is projected to grow by 3.9%, while the population aged 65 and over is projected to grow by 45.1% by 2033. Therefore, demand for physician specialties that predominantly care for older Americans will continue to increase.”

Addressing the demand in physiatry services is the increase in graduating residents.  There has been a twofold increase in physiatry resident graduates in the last ten years.  Although this might seem to address the demand, it seems physiatry continues to be one of the few specialties seeing a shortage of physicians.  According to an article titled Physiatry rising: on engaging the next generation of physiatrists by Charles Odonkor, MD in 2016 “For every 5 people in the US, 1 has a disability and in order to be able to serve and meet this population’s medical needs, more physiatrists are needed. With aging of the population, the rise in chronic disease, chronic pain, neuromuscular and musculoskeletal conditions, post-war traumatic and dysvascular populations, demand for physiatry will continue to increase. ” 

 

 

PHYSIATRY RECRUITMENT QUIZ

How much do you know about the various aspects of physiatry recruitment to include compensation, contracts, practice management?

Take this quiz and find out!

QUESTIONS

Question #1.   Should you hire someone with a personality like yours?

Question #2.   What are the two major reasons doctors leave their employer?

Question #3.   How long does the average practice search take?

Question #4.   Can a restrictive covenant apply to part-time work?

Question #5.   What was the average physiatry compensation in 2019?

Question #6.   When you leave a practice what items might you have to repay?

Question#7.   What are the 3 main factors in determining the value of the practice in a buy-in agreement?

Question #8.  What should you do to resolve insurance denials?

ANSWERS

Answer #1.  No.  Although it would seem that you should because you think you would get along better, studies show that this is not always the case.  And, hiring someone with a personality unlike your personality is good in that they will have a different perspective which will broaden your practice’s abilities.

Answer #2.  Contract loopholes and low compensation are the two major reasons doctors leave their employer.

Answer #3.  The average practice search takes 6 months.  This considers the time to find the physiatrist, interviewing, negotiation, licensing, etc.

Answer #4.  Yes.  Part-time jobs can also be considered for restrictive covenant clauses.

Answer #5.  The average physiatry compensation in 2019 was $306,000.

Answer #6.  Sign-on bonus, recruitment stipends, relocation, student assistance clauses often include requirements that you must repay them if you leave before a certain amount of time.

Answer #7.  The 3 main factors in determining the value of the practice in a buy-in agreement are tangible assets, accounts receivable and good will.

Answer #8.  Phone calling is often necessary to resolve insurance denials.  It can be stressful and time consuming but it often resolves insurance denials.

Promoting Interoperability Hardship Exception Deadline 12-31-2020

As part of MIPS reporting for Performance Year, Eligible Providers are required to report under the “Promoting Interoperability” category (formerly known as Advancing Care which was formerly known as EHR(Electronic Health Records). For most hospital-based rehab providers, whose practice is in a free-standing rehab facility (such as Encompass Health), there is probably no capability of using an EHR system which satisfies CMS’ physician requirements – Encompass Health’s system does not meet physician reporting requirements.

In order to avoid losing 25% of points in the MIPS Scoring system, these providers can submit  a very simple Hardship Exception indicating:

-“Lack of Control over the availability of CEHRT,” or

– “Eligible Clinician in a Small Practice”(under 15 clinicians).

If approved, the application will move the 25% scoring from “Promoting Interoperability” to “Quality,” thus avoiding a loss of 25% scoring in the MIPS program.

Additional information regarding this exception can be found at:

https://qpp.cms.gov/mips/exception-applications#promotingInteroperabilityHardshipException-2020

This article was contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
physiatrybillman@aol.com