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Possible billing loophole in PEI - delegated services


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After going through each province’s respective fee schedule, I have found that PEI is the only province that explicitly permits physicians to bill for visits that they delegate to a member of their staff.

The most attractive service that is eligible for this seems to be PEI’s counselling (akin to GP psychotherapy) code, which currently pays 182$ per hour, rising to about 200$ per hour in 2023. (code 2501 for those interested)

If delegated, the physician may bill 75% of the original amount, so currently 137$ per hour rising to nearly 150$ per hour.
 

Seeing as one could hire a psychologist at around 60$ per hour or a clinical therapist at 40-50$ per hour, couldn’t this be a great way for a family physician to increase their income?

I’m not sure that the province would look favourably at an incoming family physician storming Brackley Beach on an LCVP filled with 10 psychotherapists, ready to bill 1500$ an hour, but could hiring a single one be a good way to make some extra income?

 

 

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2 hours ago, -JAG- said:

The most attractive service that is eligible for this seems to be PEI’s counselling (akin to GP psychotherapy) code, which currently pays 182$ per hour, rising to about 200$ per hour in 2023. (code 2501 for those interested)

If delegated, the physician may bill 75% of the original amount, so currently 137$ per hour rising to nearly 150$ per hour.
 

Seeing as one could hire a psychologist at around 60$ per hour or a clinical therapist at 40-50$ per hour, couldn’t this be a great way for a family physician to increase their income?

You won't be able to find a psychologist who would work 60$/hr, maybe a clinical therapist/counsellor at 50$/hr if you can gaurantee them steady back to back bookings...but even then thats hard.  Most of these people can already bill 100-200$/hr+ with insurance. Why would they work 8 hours for 400$ if they could work 2-4hrs for the same? 

Only part is maybe newer grads or immigrants who might not have their licenses ported over yet, as a way to work? Hard to say.

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1 hour ago, ellorie said:

I'd be hard pressed to find a clinical psychologist who would work for 60 dollars an hour, given that they bill anywhere from 200-250 when they work in private practice.

I think that that’s a tad misleading.

I’m not an expert on how much clinical psychologists make, but it was always my understanding that they have high overhead and don’t bill anything close to 40/hrs per week. The average clinical psychologist makes around 100k according to most job sites, which comes out to 50$/hr. The government’s trend analysis of psychologists’ wages seems to corroborate this. (https://www.jobbank.gc.ca/wagereport/occupation/2223)

If private practice psychs could really bill 250 an hour, work 40 hours a week and keep overhead at 25%, they would make close to 400k/yr for a job with few emergencies, no call and much less schooling than physicians. No one would want to go to med school if psychologists pulled in that kind of money. If they actually do, I think many here would reconsider their career paths. 

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59 minutes ago, JohnGrisham said:

You won't be able to find a psychologist who would work 60$/hr, maybe a clinical therapist/counsellor at 50$/hr if you can gaurantee them steady back to back bookings...but even then thats hard.  Most of these people can already bill 100-200$/hr+ with insurance. Why would they work 8 hours for 400$ if they could work 2-4hrs for the same? 

Only part is maybe newer grads or immigrants who might not have their licenses ported over yet, as a way to work? Hard to say.

My reply to ellorie touched on this, but I maintain that the amount that psychologists and social workers bill is in no way representative of their true income.

50$/hr is about 100k/yr. That’s about what most psychologists make (https://www.jobbank.gc.ca/wagereport/occupation/2223) and more than what most social workers make.

If they could really bill 200/hr and keep overhead reasonable (say 25%, as is possible for a physician), they would make more than some doctors with significantly less schooling and a much less stressful job, which I doubt is true. If it were, we would see a lot more competition to become a psychologist or social worker.

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200/hr sounds about right. Thing is most psychologists aren't doing 40hr/wk billable i.e. face to face time, so you can't just extrapolate 200/hr to 400k a year. Cancellations, unexpected downtime, holidays, and practice management all consume time and drag down the average hourly rate.

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11 hours ago, -JAG- said:

50$/hr is about 100k/yr. That’s about what most psychologists make (https://www.jobbank.gc.ca/wagereport/occupation/2223) and more than what most social workers make.

You're not factoring in hours worked. The few counsellors I know only see max 4-5 patients a day at 130$/hr+   It would be too exhausting for them to do 8hrs a day, though many younger ones do if they can fill up their slates. Most counsellors/psychologists aren't working 40hrs a week. Not to mention all the downtime for charting, and no shows/not filling up your schedules. It is unlike medicine where you would have a full-slate without fail in many specialties due to backlogs and govt payer model.

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11 hours ago, -JAG- said:

If they could really bill 200/hr and keep overhead reasonable (say 25%, as is possible for a physician), they would make more than some doctors with significantly less schooling and a much less stressful job, which I doubt is true. If it were, we would see a lot more competition to become a psychologist or social worker.

The ones I know, in a big city, as master-level counsellors, bill 130$/hr+  and make just below 100k due to the hours they work. They pay 25-30% overhead from their billings. One of them(without administrative assistants and such) just rents a room in a medical complex on a monthly basis, so their "overhead" is actually 15%. But they dont have a admin assistant to do bookings etc, and do it themself all online, and referral basis. 

So tldr: billing per hour is high, but alot would not want to work 40hrs/ week consistently due to the drain effect, and some even if they did, may find it difficult to get to 8+ patients a day for booking purposes and supply/demand of counsellors avail.

 

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Ontario: most psychologists are billing $150-200 per hour. I do not know the rules in PEI for delegating psychotherapy to others. I do know that if you are in Ontario you can get a license for PEI to possibly providing virtual care to those in PEI. Psychotherapy could be a very good thing for PEI residents given the high demand for child and adolescent and adult psychiatry with ++ wait lists.  If you have an interest in GP psychotherapy there may be a role for this. Anything can be modified by a government so I don't know what is doable now is sustainable in the future regarding virtual care from another province or the delegations of tasks such as psychotherapy.  

 

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On 6/26/2020 at 11:46 AM, JohnGrisham said:

You're not factoring in hours worked. The few counsellors I know only see max 4-5 patients a day at 130$/hr+   It would be too exhausting for them to do 8hrs a day, though many younger ones do if they can fill up their slates. Most counsellors/psychologists aren't working 40hrs a week. Not to mention all the downtime for charting, and no shows/not filling up your schedules. It is unlike medicine where you would have a full-slate without fail in many specialties due to backlogs and govt payer model.

My earlier comment was unclear. I (mistakingly) referred to a yearly income using a full time hourly wage.

This may paint a clearer (or at least more representative) picture:

We assume that the standard model of 50 minutes of face-to-face interaction followed by 10 minutes of note taking holds true.

Our social worker sees 5 patients a day for a total weekly workload of 25 hours. For this delegated service, you would bill 150$/hour and the patient would bare no expense, which limits no-shows and increases the “supply” of new patients. Yearly billings come out to around 170k.

The social worker makes 100k per year, which comes out to a full time hourly wage equivalent of around 50$/hour.

Since overhead increases would be negligible if done in an existing family medicine practice, the physician could theoretically pocket 70k per year.

Not a princely sum, but enough to work on student debt repayment, retirement or any other financial goal a little bit faster.

 

 

 

 

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2 hours ago, -JAG- said:

My earlier comment was unclear. I (mistakingly) referred to a yearly income using a full time hourly wage.

This may paint a clearer (or at least more representative) picture:

We assume that the standard model of 50 minutes of face-to-face interaction followed by 10 minutes of note taking holds true.

Our social worker sees 5 patients a day for a total weekly workload of 25 hours. For this delegated service, you would bill 150$/hour and the patient would bare no expense, which limits no-shows and increases the “supply” of new patients. Yearly billings come out to around 170k.

The social worker makes 100k per year, which comes out to a full time hourly wage equivalent of around 50$/hour.

Since overhead increases would be negligible if done in an existing family medicine practice, the physician could theoretically pocket 70k per year.

Not a princely sum, but enough to work on student debt repayment, retirement or any other financial goal a little bit faster.

 

 

 

 

I definitely can appreciate the viewpoint! I certainly think there is a potential use-case, but i wonder how likely it is for those in PEI to want to do so for the 50$/hr?

My only experience is my colleagues, in a big centre, and as I said, they are making 130-200$/hr seeing 4-5 patients a day, and fully-booked 2 months into the future..so certainly they aren't struggling to agree to half to one third their rate after overhead. 

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  • 2 weeks later...
On 6/27/2020 at 9:27 PM, -JAG- said:

My earlier comment was unclear. I (mistakingly) referred to a yearly income using a full time hourly wage.

This may paint a clearer (or at least more representative) picture:

We assume that the standard model of 50 minutes of face-to-face interaction followed by 10 minutes of note taking holds true.

Our social worker sees 5 patients a day for a total weekly workload of 25 hours. For this delegated service, you would bill 150$/hour and the patient would bare no expense, which limits no-shows and increases the “supply” of new patients. Yearly billings come out to around 170k.

The social worker makes 100k per year, which comes out to a full time hourly wage equivalent of around 50$/hour.

Since overhead increases would be negligible if done in an existing family medicine practice, the physician could theoretically pocket 70k per year.

Not a princely sum, but enough to work on student debt repayment, retirement or any other financial goal a little bit faster.

FYI in Ontario the psych association recommends its own members charge $225/hr for their own private practice (https://www.psych.on.ca/OPA/media/Public/OPA Guidelines and Reviews/GUIDELINES-FOR-FEES-AND-BILLING-PRACTICES-FINAL.pdf?ext=.pdf). Most psychologists do bill a bit less than that amount ($150-200/hr as mentioned above).

Of course PEI might be a completely different beast when it comes to psychologist earnings... but if it's anything similar to Ontario this wouldn't be an attractive option.

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