Sunday, October 02, 2011

Compensation for Sleep Physicians

An experienced sleep technician recently asked me about compensation for sleep physician services at a sleep disorders center (IDTF) he is starting. Below is what I told him (disclaimer: this is based on my experiences over the last several years talking to numerous sleep professionals, and not on my own salary/compensation) -

1. There are 2 basic options for compensating the sleep physician for interpreting sleep studies. One is for the physician to bill for the professional component (-26) of the study, and the IDTF for the technical component (-TC). The other option is for the IDTF to bill for the studies on a global basis and pay the physician a fee for each interpretation. This fee typically ranges from $75 to $175 ($100-125 is average).
Although I am unsure if you can legally take it into account, the physician is going to probably expect to receive somewhere in the higher range if he is generating many of the referrals to the sleep center or providing outpt follow up to the patients. In this case, I would recommend letting the physician just bill for the professional component.

2. Medical director fees: Although some sleep centers try to bundle this in with interpretations, it is best from a legal standpoint to pay a separate fee for medical director duties (such as supervision of technicians, developing policies and procedures, administration, etc). There are 2 basic options. First, the medical director can keep a log of his administrative hours and be compensated on an hourly basis (typically $100-$150 per hour). The other option is to pay the medical director a fixed monthly fee- this is usually based on number of beds. $500-1000 for a 4 bed lab and $750-$1500 for a 6 bed lab are typical salaries.

One of the reasons that I don't recommend bundling sleep study interpretation fees with medical director fees is that it makes things "messy" if a 2nd sleep physician (other than the medical director) starts interpreting studies.

There are a lot of legal pitfalls in setting physician compensation, and I recommend consulting with an experienced healthcare attorney familiar with both federal regulations and the laws of your state.

I welcome reader comments regarding this subject

11 comments:

Fred Maywood said...

Crazy expensive for either of those options.

kid1285 said...

I agree with you . Sleep has two 2 period.Thanks for post
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judilou47 said...

Back to your restless discussion some time back. What diagnosis have you used that medicare will approve for ordering ferritin and such - last time I had to do three different diagnoses to get ferritin, B12 and VitaminD

Charles Holland said...

Any word on Sleep reimbursements for 2012?

TheLankyLefty said...

Thank you for this blog on all things Sleep related. I appreciate your honesty. I try to accomplish this open and honest information to patients through my FreeCPAPAdvice.com website. There is a forum there as well where I can answer questions etc. I would love it if you would stop by since you have wonderful insight. I am about to attempt to open my own lab and some of this information is invaluable.

Question: Does the medical director of a sleep lab need to be boarded in sleep? Thank you!

Michael Rack, MD said...

LL:

To meet American Academy of Sleep Medicine accreditation (which is required by BCBS in many states) criteria, the medical director needs to be board certified or board eligible in sleep.

TheLankyLefty said...

Thanks Dr. Rack. Are you saying that to accept BCBS you have to already be accredited by the AASM?

Do you know if it is legal in California to run sleep studies under another labs license. I would have Lab A that runs independently from Lab B (which has a Medicare number and accepts most insurances). Lab A would get their own referrals, but Lab B would bill as if they ran the studies, basically outsourcing them to Lab A and taking a percentage of the reimbursement.

If not, would that be legal if the owner of Lab B had some ownership in Lab A?

Michael Rack, MD said...
This comment has been removed by the author.
Michael Rack, MD said...

LL: The sleep centers that I am associated with had their initial accreditation before AASM provisional accreditation was an option. Insurer policy varies state to state, and I encourage you to check with insureres in your state to see if they will accept PROVISIONAL accreditation.

What you are describing doesn't sound legal. However, some insurers may allow you to put all sleep labs (with the same ownership) in a given state under the same #/license, and that is an option you can look into.

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kaney said...

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