response #2: staff practitioner compensation structure
David Fenton
Description
Collection
Title:
response #2: staff practitioner compensation structure
Creator:
David Fenton
Date:
7/7/2014
Text:
Original Question:
Greeting List,
Question for owners of small O & P facility: In these challenging and
unjust financial times, what creative structures are being used to
compensate staff practitioners? In light of situations where the revenue
generated and recorded for a particular month can be quite different after
a Medicare takeback occurs months later or payment is delayed for a year or
two.
Thanks
Response 4
As a young practitioner currently studying for exams at this very moment I
find this email disheartening. It is one of the main reasons why I have
been considering not practicing clinically and using my engineering
background to get into design and manufacturing or R and D aspects.
Several others that graduated with me are considering leaving the field
all together. We spent so much money on school and graduate and small
companies are always trying to compensate us so poorly or fire us if (is as
my boss says) we can’t “PULL IN” more money. I ask how I do that, amputate
legs myself? become a marketing master? suggest wildly inappropriate
billing codes? make new braces when new ones really aren’t needed?
Something needs to change or practitioners will continue to walk away from
the field. I mean who get a masters degree and wants to be paid 40-50
grand? No one. It’s forcing us out.
It may not be what you asked, but I wanted to share as I feel it is a
growing problem and source of frustration.
Response 5
Response number three is why Certified practitioners should unionize
Response 6
We own a 3 office, multi state facility and have an incentive that includes
total cost of sales for practitioners as well as overall profit for the
business as part of the calculations. I do not feel that any recoupment of
funds is the fault of the practitioner. I am a very proactive person, so I
have my admin assure that we have appropriate MD notes for all things
relevant (this relevancy is ever changing, but currently encompasses just
about everything we provide). We get notes FIRST and then we proceed with
the order. If there's any question or doubt, the notes flow through me for
a final decision. I feel that if we do not pass an audit and have
recoupment, it is MY fault and not the fault of my practitioners, so I
would not hold them accountable nor would I deduct funds from their
incentives. If I've trained my staff correctly, we should have what we
need. I've probably faced well over 200 audits in the last few years and
have failed only 2. One was for diabetic shoes. The patient got
hospitalized and kept rescheduling and we ended up missing the 6 month
deadline. This wasn't the practitioner's fault. I should have had some
sort of safeguard in place to prevent this, so this loss was my fault. I
now flag each file with a must deliver by date. The other was a
bilateral K2 who completely destroyed his K2 feet within 6 months. He was
BCBS at the time he got his original prosthesis so we reimbursed BCBS for
those feet not because we had to, but because it was the ethical thing to
do. We rebilled for K3 feet to Medicare as this was primary now. Our
notes were for K2, but he's bilateral and the policy clearly states that
bilaterals will be judged differently and cannot be strictly bound by the
K-levels. Plus, I had documented proof that he destroyed K2 feet
instantly. I argued that line of policy & described the stresses of
bilateral amputees on feet as the epitome of why that line was in the
policy. It went clear to the ADL level and I felt very positive about the
case, but ultimately lost. Was this the practitioner's fault? Was it his
fault that we didn't get paid for those feet? No. He did everything
right. I even supported his decision to reimburse BCBS for the entire
amount of the Lcode! Medicare was WRONG in that decision, claiming he was
only K2 and therefore the K3 feet were not medically necessary. Some
things are just the cost of doing business. I would find it ethically
appalling to hold my practitioners accountable for business practices that
are ultimately my domain, my policies and my decisions.
response 7
Just be honest. Base incentives on cash received , not on uncollected
receivables .
If they read this list serve they know what is happening
Greeting List,
Question for owners of small O & P facility: In these challenging and
unjust financial times, what creative structures are being used to
compensate staff practitioners? In light of situations where the revenue
generated and recorded for a particular month can be quite different after
a Medicare takeback occurs months later or payment is delayed for a year or
two.
Thanks
Response 4
As a young practitioner currently studying for exams at this very moment I
find this email disheartening. It is one of the main reasons why I have
been considering not practicing clinically and using my engineering
background to get into design and manufacturing or R and D aspects.
Several others that graduated with me are considering leaving the field
all together. We spent so much money on school and graduate and small
companies are always trying to compensate us so poorly or fire us if (is as
my boss says) we can’t “PULL IN” more money. I ask how I do that, amputate
legs myself? become a marketing master? suggest wildly inappropriate
billing codes? make new braces when new ones really aren’t needed?
Something needs to change or practitioners will continue to walk away from
the field. I mean who get a masters degree and wants to be paid 40-50
grand? No one. It’s forcing us out.
It may not be what you asked, but I wanted to share as I feel it is a
growing problem and source of frustration.
Response 5
Response number three is why Certified practitioners should unionize
Response 6
We own a 3 office, multi state facility and have an incentive that includes
total cost of sales for practitioners as well as overall profit for the
business as part of the calculations. I do not feel that any recoupment of
funds is the fault of the practitioner. I am a very proactive person, so I
have my admin assure that we have appropriate MD notes for all things
relevant (this relevancy is ever changing, but currently encompasses just
about everything we provide). We get notes FIRST and then we proceed with
the order. If there's any question or doubt, the notes flow through me for
a final decision. I feel that if we do not pass an audit and have
recoupment, it is MY fault and not the fault of my practitioners, so I
would not hold them accountable nor would I deduct funds from their
incentives. If I've trained my staff correctly, we should have what we
need. I've probably faced well over 200 audits in the last few years and
have failed only 2. One was for diabetic shoes. The patient got
hospitalized and kept rescheduling and we ended up missing the 6 month
deadline. This wasn't the practitioner's fault. I should have had some
sort of safeguard in place to prevent this, so this loss was my fault. I
now flag each file with a must deliver by date. The other was a
bilateral K2 who completely destroyed his K2 feet within 6 months. He was
BCBS at the time he got his original prosthesis so we reimbursed BCBS for
those feet not because we had to, but because it was the ethical thing to
do. We rebilled for K3 feet to Medicare as this was primary now. Our
notes were for K2, but he's bilateral and the policy clearly states that
bilaterals will be judged differently and cannot be strictly bound by the
K-levels. Plus, I had documented proof that he destroyed K2 feet
instantly. I argued that line of policy & described the stresses of
bilateral amputees on feet as the epitome of why that line was in the
policy. It went clear to the ADL level and I felt very positive about the
case, but ultimately lost. Was this the practitioner's fault? Was it his
fault that we didn't get paid for those feet? No. He did everything
right. I even supported his decision to reimburse BCBS for the entire
amount of the Lcode! Medicare was WRONG in that decision, claiming he was
only K2 and therefore the K3 feet were not medically necessary. Some
things are just the cost of doing business. I would find it ethically
appalling to hold my practitioners accountable for business practices that
are ultimately my domain, my policies and my decisions.
response 7
Just be honest. Base incentives on cash received , not on uncollected
receivables .
If they read this list serve they know what is happening
Citation
David Fenton, “response #2: staff practitioner compensation structure,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/236572.
