VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[WisNeuro]

Do you all think the outlook for positions will be better next year? I’m a first year neuro postdoc at a VA, and I was really hoping to stay in the VA system (and I’m geographically restricted to an area with doable commute to two separate VAs), and the VAs in this area actually have a higher starting salary (close to $30k difference based on recent job postings) than the AMCs and other community options.

From talks with my colleagues at the large VA here, there will be no neuro job openings for at least several years, unless there are several unexpected leavings of current providers. No planned retirements or planned moves, so they think it's actually likely that it will remain that way for the better part of a decade. That's just my area, though. Big contrast to the actual need. I have more work (clinical and forensic) than I can see, and a few of my colleagues are retiring in the next 3-5 years, in which the amount of work will increase exponentially. 4 of the 6 people who can do FAA evals in the state are retiring in less than 5 years. Currently debating planning to hire a few new people in that time span to capitalize on that.

tl;dr, look for non VA, non-AMC options as well.

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[summerbabe]

Do you all think the outlook for positions will be better next year? I’m a first year neuro postdoc at a VA, and I was really hoping to stay in the VA system (and I’m geographically restricted to an area with doable commute to two separate VAs), and the VAs in this area actually have a higher starting salary (close to $30k difference based on recent job postings) than the AMCs and other community options.

Always hard to predict since a lot seems to be in flux and we are also in an election year which can impact political priorities and subsequent budgets.

Wouldn't hurt to talk to your NP program manager and see if they have any insights (and make sure they know you would be interested if something were to be available).

Your best bet might be a facility that is currently sending a TON of NP consults into the community due to lack of staffing.

A big priority is reducing the community care budget and redirecting as much of those funds into facility staffing so a service/clinic demonstrating that it would save significant $$$ by hiring full-time staff versus relying on community care might have the best shot at getting positions approved in the near future.

But places with 'reasonable' wait times and lower community care spending might struggle with getting positions approved, even if a current provider leaves, since the effects of them no longer providing patient care won't show up until much further down the line.

If I had to make some loose predictions not based on any actual insider knowledge, given the current prioritization of access to care, specialty services like neuropsych will be lower on the list of mental health staffing priorities from an admin level (i.e., let's hire 2 LCSWs who can crank out 50+ encounters a week for the cost of a single neuropsych who does a couple of evals weekly).

 

[WisNeuro]

Always hard to predict since a lot seems to be in flux and we are also in an election year which can impact political priorities and subsequent budgets.

Wouldn't hurt to talk to your NP program manager and see if they have any insights (and make sure they know you would be interested if something were to be available).

Your best bet might be a facility that is currently sending a TON of NP consults into the community due to lack of staffing.

A big priority is reducing the community care budget and redirecting as much of those funds into facility staffing so a service/clinic demonstrating that it would save significant $$$ by hiring full-time staff versus relying on community care might have the best shot at getting positions approved in the near future.

But places with 'reasonable' wait times and lower community care spending might struggle with getting positions approved, even if a current provider leaves, since the effects of them no longer providing patient care won't show up until much further down the line.

If I had to make some loose predictions not based on any actual insider knowledge, given the current prioritization of access to care, specialty services like neuropsych will be lower on the list of mental health staffing priorities from an admin level (i.e., let's hire 2 LCSWs who can crank out 50+ encounters a week for the cost of a single neuropsych who does a couple of evals weekly).

Hey now, I did 4 evals a week in the VA! Well, probably averaged 3 with no-shows. And yes, still an embarrassingly low number compared to other real world settings.

 

[cara susanna]

We have a TON of neuropsych openings in our VISN (including my local facility, which I would beg anyone to please consider because WE DESPERATELY NEED A NEUROPSYCHOLOGIST and have been recruiting for years now), but not at geographically desirable sites.

 

[WisNeuro]

We have a TON of neuropsych openings in our VISN (including my local facility, which I would beg anyone to please consider because WE DESPERATELY NEED A NEUROPSYCHOLOGIST and have been recruiting for years now), but not at geographically desirable sites.

Is Zablocki still trying to hire? Did Kathy finally retire?

 

[WisNeuro]

We have a TON of neuropsych openings in our VISN (including my local facility, which I would beg anyone to please consider because WE DESPERATELY NEED A NEUROPSYCHOLOGIST and have been recruiting for years now), but not at geographically desirable sites.

I was curious how the job listing was worded and looked in USAjobs, I'm not seeing y'all come up in the list. I'm actually only pulling up 8 neuropsych openings nationwide at the moment.

 

[cara susanna]

I was curious how the job listing was worded and looked in USAjobs, I'm not seeing y'all come up in the list. I'm actually only pulling up 8 neuropsych openings nationwide at the moment.

Kathy retired but we were able to replace her easily. This opening is at a CBOC. I'm guessing it's not active on USAJobs because, due to the budget crunch and hiring freeze, we have to resubmit for approval.

 

[PsyDuck90]

Always hard to predict since a lot seems to be in flux and we are also in an election year which can impact political priorities and subsequent budgets.

Wouldn't hurt to talk to your NP program manager and see if they have any insights (and make sure they know you would be interested if something were to be available).

Your best bet might be a facility that is currently sending a TON of NP consults into the community due to lack of staffing.

A big priority is reducing the community care budget and redirecting as much of those funds into facility staffing so a service/clinic demonstrating that it would save significant $$$ by hiring full-time staff versus relying on community care might have the best shot at getting positions approved in the near future.

But places with 'reasonable' wait times and lower community care spending might struggle with getting positions approved, even if a current provider leaves, since the effects of them no longer providing patient care won't show up until much further down the line.

If I had to make some loose predictions not based on any actual insider knowledge, given the current prioritization of access to care, specialty services like neuropsych will be lower on the list of mental health staffing priorities from an admin level (i.e., let's hire 2 LCSWs who can crank out 50+ encounters a week for the cost of a single neuropsych who does a couple of evals weekly).

Yeah, I’ve had intermittent talks with my TD about being interested in staying on, but nothing very official since I have quite a bit of time left. And it’s still not super clear to me how the national budget cuts are affecting this VISN. Several of the general postdocs and current interns are being hired on as GS-11s and GS-12s for next year. I was just curious what some of the folks here who’ve been around for awhile and have seen similar hiring freezes/budget constraints in the past and how long they typically last for. I guess the main question is do these things typically blow over within a year or is there typically a prolonged glut in positions? You and Wis already kind of answered that, and it seems like my timing may not be the best in the grand scheme of things for VA neuro. Thank you!

 

[summerbabe]

Several of the general postdocs and current interns are being hired on as GS-11s and GS-12s for next year.

My understanding is that hiring freezes or pulled positions were reviewed on a facility by facility basis.

So if your facility has a major need for general MH services, those positions may have been identified as a facility-wide priority and thus spared while other positions may have been pulled.

Positions can still be submitted moving forward but I think there will be more and more scrutiny in terms of what gets approved.

 

[psycho1391]

Coming in here to say that I completely understand how EDRP is a strong retention incentive. Seeing my reimbursement in my account and subsequently my loan balance has incentivized me to get the rest of my EDRP money. Four more years!

 

[AcronymAllergy]

Coming in here to say that I completely understand how EDRP is a strong retention incentive. Seeing my reimbursement in my account and subsequently my loan balance has incentivized me to get the rest of my EDRP money. Four more years!

Yep, all things considered, EDRP is a pretty great deal for folks with loans. It's basically a straight addition to your take-home compensation.

The downside is that I'm sure folks without significant loans would like some sort of equivalent, but I don't think that's going to happen anytime soon (read: ever).

 

[JustNoticing]

Thank you very much to you VA folks willing to answer questions of curious but unfamiliar outsiders like myself.

1) What is the typical length of time from application to interview to hire? I imagine it varies quite a bit, but if anyone can give a couple of data point examples or a range that'd be helpful.

2) In perusing remote jobs on usajobs.gov I came across a listing for a fully remote emergency dept psychologist VA position. Anyone have any knowledge of the logistics of implementing a role like this remotely? Seems doable I suppose, but assessing/mitigating risk fully remotely sounds like it would probably need significant support from the staff that is on location. Any insider info or even speculation about considering a role like this?

Interview to hiring offer, can be quite quick (sometimes as soon as 24 hours after the last candidate is interviewed. Interview to start date is a different story, but I wouldn't expect anything under 3 months. This may be improving in some areas these days, but I don't have too much recent data on this in my VA.

2) That's very surprising. Do you have a link to the posting? quite possible that it is a position that they already have someone in mind for that they know needs to work remotely. Those are in person jobs at my local hospital for sure. You are correct, that would need an ED nursing staff member to be facilitating and sitting the patient throughout. Lots of risk assessment, safety planning and triaging for inpatient psych. So much of that type of work is consulting with the ED docs and the inpatient psych staff and being the go between that it seems like it would be much tougher remotely to build those relationships as the people in those roles I have seen are somewhat not full/regular members of either team. Feel free to DM if you have questions about that type of role.

 

[JustNoticing]

Always hard to predict since a lot seems to be in flux and we are also in an election year which can impact political priorities and subsequent budgets.

Wouldn't hurt to talk to your NP program manager and see if they have any insights (and make sure they know you would be interested if something were to be available).

Your best bet might be a facility that is currently sending a TON of NP consults into the community due to lack of staffing.

A big priority is reducing the community care budget and redirecting as much of those funds into facility staffing so a service/clinic demonstrating that it would save significant $$$ by hiring full-time staff versus relying on community care might have the best shot at getting positions approved in the near future.

But places with 'reasonable' wait times and lower community care spending might struggle with getting positions approved, even if a current provider leaves, since the effects of them no longer providing patient care won't show up until much further down the line.

If I had to make some loose predictions not based on any actual insider knowledge, given the current prioritization of access to care, specialty services like neuropsych will be lower on the list of mental health staffing priorities from an admin level (i.e., let's hire 2 LCSWs who can crank out 50+ encounters a week for the cost of a single neuropsych who does a couple of evals weekly).

Picture seems unlikely to change until 2025 at least. As others are noting, hiring is still happening. At my hospital, unfilled supervisory roles seem like they are slated to take the most hits, though not exclusively.

Oddly enough, they are making decisions here based on FTE rather than the amount of money a position costs (I think the goal is 10k positions nationally). That being said, 2 LCSWs can still do more encounters and reduce wait times for a service more than 1 neuropsychologist, so probably matters more how local leadership values those roles more than anything else.

 

[summerbabe]

Curious if anybody is aware of any potential consequences for being rated below fully satisfactory on a performance eval, including any impact on moving to other VA positions in the future.

In particular, this would be specifically related to hitting/not hitting RVU targets. Thanks!

 

[AcronymAllergy]

Curious if anybody is aware of any potential consequences for being rated below fully satisfactory on a performance eval, including any impact on moving to other VA positions in the future.

In particular, this would be specifically related to hitting/not hitting RVU targets. Thanks!

Entirely anecdotal: the folks who had the most inappropriate/problematic behaviors or personalities were usually promoted most often. Not sure if they actually had accompanying performance ratings, though.

I think if it entails being put on a performance plan, you might have to disclose it or might be asked about it when applying for a new position? If it's related solely to RVU targets, that seems easily defensible, especially if it's largely due to things like no-shows.

 

[cara susanna]

Curious if anybody is aware of any potential consequences for being rated below fully satisfactory on a performance eval, including any impact on moving to other VA positions in the future.

In particular, this would be specifically related to hitting/not hitting RVU targets. Thanks!

I've been below RVU targets a few times and never got rated unsatisfactory, for what it's worth. I would argue that, if you aren't generating enough RVUs, it's not really on you since your clinic probably handles scheduling.

 

[Sanman]

Curious if anybody is aware of any potential consequences for being rated below fully satisfactory on a performance eval, including any impact on moving to other VA positions in the future.

In particular, this would be specifically related to hitting/not hitting RVU targets. Thanks!

So, the biggest piece is that I believe the year in which you are not fully successful will not count towards your step bonus, you would lose EDRP eligibility, and there are a few other things. I think it might also affect if you can apply for a promotion/higher level GS position. Bottom line, you really do not want that.

 

[cara susanna]

Have you guys seen that OIG report on ADHD diagnostic practices in the VA?

Deficiencies in Attention Deficit Hyperactivity Disorder Diagnostic Assessment, Evaluation of Stimulant Medication Risks, and Policy Guidance | Department of Veterans Affairs OIG (vaoig.gov)

A lot of us are worried that this is gonna make psychiatry push them out onto psychologists again (we FINALLY got them to stop doing that)

 

[WisNeuro]

Entirely anecdotal: the folks who had the most inappropriate/problematic behaviors or personalities were usually promoted most often. Not sure if they actually had accompanying performance ratings, though.

I think if it entails being put on a performance plan, you might have to disclose it or might be asked about it when applying for a new position? If it's related solely to RVU targets, that seems easily defensible, especially if it's largely due to things like no-shows.

In places I was a staff member in the VA, also my experience.

 

[Sanman]

Have you guys seen that OIG report on ADHD diagnostic practices in the VA?

Deficiencies in Attention Deficit Hyperactivity Disorder Diagnostic Assessment, Evaluation of Stimulant Medication Risks, and Policy Guidance | Department of Veterans Affairs OIG (vaoig.gov)

A lot of us are worried that this is gonna make psychiatry push them out onto psychologists again (we FINALLY got them to stop doing that)

The report does not require it and more reason to have psychology around would not be a bad thing, imo. The issue is that they are not hiring staff to deal with it (or anything else currently).

 

[Harry3990]

Interview to hiring offer, can be quite quick (sometimes as soon as 24 hours after the last candidate is interviewed. Interview to start date is a different story, but I wouldn't expect anything under 3 months. This may be improving in some areas these days, but I don't have too much recent data on this in my VA.

2) That's very surprising. Do you have a link to the posting? quite possible that it is a position that they already have someone in mind for that they know needs to work remotely. Those are in person jobs at my local hospital for sure. You are correct, that would need an ED nursing staff member to be facilitating and sitting the patient throughout. Lots of risk assessment, safety planning and triaging for inpatient psych. So much of that type of work is consulting with the ED docs and the inpatient psych staff and being the go between that it seems like it would be much tougher remotely to build those relationships as the people in those roles I have seen are somewhat not full/regular members of either team. Feel free to DM if you have questions about that type of role.

I was mistaken about it being a VA posting. It is for the Indian Health Service in South Dakota, but here is the link in case you still wanted to see:

Clinical Psychologist

This position serves as a Clinical Psychologist in the Emergency Department at the Pine Ridge Service Unit in Pine Ridge, SD. The incumbent provides comprehensive mental health services via telehealth to pediatric, adolescent, adult and elderly patients. The position reports to the Emergency...

www.usajobs.gov

 

[cara susanna]

We're moving to OneDrive and I hate it! Let me keep my precious U: drive. I'm currently migrating stuff over and it's saying it'll take 5 hours...

 

[Harry3990]

I was considering trying to get contracted with the VA to do C&P evals - would this be worth it? I have no desire to go through those 3rd party agencies that contract you to do them. I've declined several offers to do those with those companies.

Came across a 3rd party company that seems to be offering a halfway decent rate for these. I’m curious what people would consider a decent rate though for doing these efficiently? I know this has been discussed a lot before, but $270-300 sounds a lot better than the rates I’ve seen offered in the past. Seems like keeping the eval to 2-2.5 hours including interview and report would be possible with some practice. The flexibility seems appealing.

Am I way off base here? I know people have cautioned against these 3rd party contractor jobs historically.

 

[WisNeuro]

Came across a 3rd party company that seems to be offering a halfway decent rate for these. I’m curious what people would consider a decent rate though for doing these efficiently? I know this has been discussed a lot before, but $270-300 sounds a lot better than the rates I’ve seen offered in the past. Seems like keeping the eval to 2-2.5 hours including interview and report would be possible with some practice. The flexibility seems appealing.

Am I way off base here? I know people have cautioned against these 3rd party contractor jobs historically.

I would accept nothing less than 300/hour, and it would have to include everything that I thought I would need to assess to adequately answer the question at hand. I am doubtful that one would be able to do a record review, background interview, CAPS, some SVTs, and write the report in anything under 5 hours, and even that is stretching things pretty thin. The only way to do these evals in under 3 hours is by cutting a lot of corners/doing a ****ty job.

 

[texanpsychdoc]

I would accept nothing less than 300/hour, and it would have to include everything that I thought I would need to assess to adequately answer the question at hand. I am doubtful that one would be able to do a record review, background interview, CAPS, some SVTs, and write the report in anything under 5 hours, and even that is stretching things pretty thin. The only way to do these evals in under 3 hours is by cutting a lot of corners/doing a ****ty job.

Indeed - I do diagnostic clarification cases in my practice and charge a flat rate of $2,500 which is good since these cases don't really take up a whole lot of time and effort compared to neuro testing I used to do.

I wouldn't take anything on less than $250 an hour since I tend to make $180 an hour for therapy through my various insurance panels I am on collectively. It's super easy work, no fuss, no lengthy paperwork, so considering when I see my patient for therapy and close out the video session, that's it. Their note is already submitted and I go chill out.

 

[AcronymAllergy]

Came across a 3rd party company that seems to be offering a halfway decent rate for these. I’m curious what people would consider a decent rate though for doing these efficiently? I know this has been discussed a lot before, but $270-300 sounds a lot better than the rates I’ve seen offered in the past. Seems like keeping the eval to 2-2.5 hours including interview and report would be possible with some practice. The flexibility seems appealing.

Am I way off base here? I know people have cautioned against these 3rd party contractor jobs historically.

Is that $270-300/hour or total? I'm guessing the latter, but wanted to check.

You can see the posts below RE: how long the evals could potentially take; with VA and military records, eating up a few hours with just records review would be pretty easy.

Even if you're able to churn through an eval in 2.5 hours, if it's $270-300 total, that's still only $120/hour for forensic work, which is on par with what you could be reimbursed by insurance for clinical work. And potentially much less per hour for longer evals. I don't know if there's much/any risk of deposition or trial for these evals, but I still wouldn't want to be setting my forensic bar that low. It's better than the $150/eval I've seen offered in the past, but it's still not very good.

 

[texanpsychdoc]

Is that $270-300/hour or total? I'm guessing the latter, but wanted to check.

You can see the posts below RE: how long the evals could potentially take; with VA and military records, eating up a few hours with just records review would be pretty easy.

Even if you're able to churn through an eval in 2.5 hours, if it's $270-300 total, that's still only $120/hour for forensic work, which is on par with what you could be reimbursed by insurance for clinical work. And potentially much less per hour for longer evals. I don't know if there's much/any risk of deposition or trial for these evals, but I still wouldn't want to be setting my forensic bar that low. It's better than the $150/eval I've seen offered in the past, but it's still not very good.

I am INN with BCBS, United, Aetna, and Sana Benefits. My average reimbursement is $147 - $180 an hour. I would be losing out on money if I accommodated a testing request at a $120 per hour. It's not worth it IMO, especially with having to write up a report and spend time doing records review. I wouldn't get out of bed for less than $250 an hour for assessments.

 

[Sanman]

I am INN with BCBS, United, Aetna, and Sana Benefits. My average reimbursement is $147 - $180 an hour. I would be losing out on money if I accommodated a testing request at a $120 per hour. It's not worth it IMO, especially with having to write up a report and spend time doing records review. I wouldn't get out of bed for less than $250 an hour for assessments.

Is that insurance rate for 90834 or 90837? Just curious what the hourly break down is?

 

[texanpsychdoc]

Is that insurance rate for 90834 or 90837? Just curious what the hourly break down is?

$180 is for 90791, and then for 90837 I average $147.07 to $152.01. I tend to have 1-3 new intakes a week, so I am using 90791 regularly. It's been consistent like this for 6 months. I see 27-30 people a week. I don't bill 90834 or 90832 since I always keep my sessions at 53 minutes so I am appropriately billing.

 

[Sanman]

$180 is for 90791, and then for 90837 I average $147.07 to $152.01. I tend to have 1-3 new intakes a week, so I am using 90791 regularly. It's been consistent like this for 6 months. I see 27-30 people a week. I don't bill 90834 or 90832 since I always keep my sessions at 53 minutes so I am appropriately billing.

Got it, thanks for the transparency. Hopefully those 90837s withstand utilization review. Back in the day, they led to endless audits from Optum and a few others.

 

[WisNeuro]

Got it, thanks for the transparency. Hopefully those 90837s withstand utilization review. Back in the day, they led to endless audits from Optum and a few others.

Regional, and cyclical, but still happens often.

 

[texanpsychdoc]

Got it, thanks for the transparency. Hopefully those 90837s withstand utilization review. Back in the day, they led to endless audits from Optum and a few others.

Haven't had any issues yet. Not worried. I've been billing for over a year now with insurances and have not been requested an audit, and I bill the same two codes across all my insurances.

 

[Sanman]

Haven't had any issues yet. Not worried. I've been billing for over a year now with insurances and have not been requested an audit, and I bill the same two codes across all my insurances.

No complaints from me if it does not. More money in our collective pockets. I am curious though as it was a factor in my original move to the VA. Though my previous practice was also much larger than yours and may have been a target for the insurance companies.

 

[AbnormalPsych]

What happens if they audit it? They just ask you to justify it?

 

[texanpsychdoc]

No complaints from me if it does not. More money in our collective pockets. I am curious though as it was a factor in my original move to the VA. Though my previous practice was also much larger than yours and may have been a target for the insurance companies.

Pehaps. I have hired 2 other psychologists who I've added to my panels, so I delegate and take 30% from their earnings, so I average weekly passive earnings of $1,132 per each contractor, which is $2,265 per week in added income. So, combined with my earnings, that's about $5700 a week. I like that. I've heard from others who have been audited and as long as you have the paperwork to back it up, you should be fine. I do. One thing I took away from my time at the VA was my proclivity to be meticulous in documentation. With my expertise in testing, that is something I inject in my therapeutic evaluations/intakes and therapy notes. I find a lot of people are fearful of insurance companies. You shouldn't let that deter you from accepting insurance.

 

[Sanman]

What happens if they audit it? They just ask you to justify it?

They ask you to justify your billing practices. Sometimes, one call and sometimes multiple. I used to spend 45 min to 2 hours on the phone per audited patient for certain insurances. If your justification does not meet their medical necessity and treatment guidelines, you are at risk for non-payment or clawbacks. So, for example, if you completed a 90837×10 sessions and they determine it should have been a 90834 after the fact, they will claw back the "overpayment". Multiply that by 10-20 patients and it was a giant timesuck. My practice was different from @texanpsychdoc (nursing homes). So, when certain insurances signed up the majority of patients, it became unavoidable.

 

[Sanman]

Pehaps. I have hired 2 other psychologists who I've added to my panels, so I delegate and take 30% from their earnings, so I average weekly passive earnings of $1,132 per each contractor, which is $2,265 per week in added income. So, combined with my earnings, that's about $5700 a week. I like that. I've heard from others who have been audited and as long as you have the paperwork to back it up, you should be fine. I do. One thing I took away from my time at the VA was my proclivity to be meticulous in documentation. With my expertise in testing, that is something I inject in my therapeutic evaluations/intakes and therapy notes. I find a lot of people are fearful of insurance companies. You shouldn't let that deter you from accepting insurance.

It is not about deterring me from taking insurance overall, but which ones I would choose. If one heavily audits and encourages 90834 and another allows 90837 more readily, that factors into which insurance to accept and overall reimbursement.

 

[texanpsychdoc]

It is not about deterring me from taking insurance overall, but which ones I would choose. If one heavily audits and encourages 90834 and another allows 90837 more readily, that factors into which insurance to accept and overall reimbursement.

At least here in Texas, I have not had any issues and I am INN with all but one of the major players. What I typically hear of are insurances auditing practices who primarily focus on psychological/neuro testing. There is one practice in North Houston who is pretty large and their bread and butter is testing. Unfortunately, they were audited and BCBS is clawing back a bunch of money from them. It's crippling. So, for me, I don't have that problem since I don't bill insurances for testing. All my testing cases are cash pay. Alternatively, therapy is my practice's bread and butter. I make very good income, and I will continue to bill those 2 codes. It's not worth it for me to bill for anything less.

 

[cara susanna]

Sounds like the budget deficit is even worse than we had already been led to believe.

 

[Sanman]

Sounds like the budget deficit is even worse than we had already been led to believe.

It is a big hole and it will continue to get bigger. They let veterans do whatever they want and with the graying of the veteran population the budget will continue to grow because most of what veterans can get in the VA is not provided in the private sector and what is provided for in the private sector they will continue to try and get there for more money.

 

[Sanman]

At least here in Texas, I have not had any issues and I am INN with all but one of the major players. What I typically hear of are insurances auditing practices who primarily focus on psychological/neuro testing. There is one practice in North Houston who is pretty large and their bread and butter is testing. Unfortunately, they were audited and BCBS is clawing back a bunch of money from them. It's crippling. So, for me, I don't have that problem since I don't bill insurances for testing. All my testing cases are cash pay. Alternatively, therapy is my practice's bread and butter. I make very good income, and I will continue to bill those 2 codes. It's not worth it for me to bill for anything less.

Testing may be the focus at the moment, but it is cyclical for them. Someone will come in with a plan to increase the insurance company revenues and increase cost savings so that they can get a bonus and the quarterly profits look better. That's their game.

 

[texanpsychdoc]

Testing may be the focus at the moment, but it is cyclical for them. Someone will come in with a plan to increase the insurance company revenues and increase cost savings so that they can get a bonus and the quarterly profits look better. That's their game.

Maybe. Maybe not. I can deal with the facts in front of me, not on possible futures. If that happens, I will deal with that when that comes, but I have a good quality of life and excellent earnings.

 

[Grenth]

My VA had "therapy dogs to decrease burnout" available yesterday for the psychologists for psychologist appreciation week.

Please note I like dogs. And I really don't care about psychologist appreciation week but the irony. I would rather have had free pizza to decrease hunger.

I'm guessing next year we'll all get five free minutes of brainspotting or EMDR for psychology appreciation week.

 

[Shiori]

We haven't received anything other than some of our star psychologists (I mean that genuinely. They highlighted some amazing folks) being recognized in one of the administrative emails no one reads. Fortunately, we got a big pay boost and that matters more to me than anything else the VA could do.

 

[WisNeuro]

Is burnout a thing in other VA's/non-neuro areas? I remember being bored to tears and hitting my productivity goals working what would be considered a .6 FTE in any other system.

 

[AcronymAllergy]

Is burnout a thing in other VA's/non-neuro areas? I remember being bored to tears and hitting my productivity goals working what would be considered a .6 FTE in any other system.

Pretty much anyone providing therapy at my VA was always bordering on burnt out. Not so much from the overt workload requirements, but from the requests/mandates to schedule above and beyond those. For me (and I imagine many of those psychologists), there was also the mental strain of being booked out for months and months, and feeling an obligation to try to do what I could to reduce the wait time by seeing more people, up to a point. I think most psychologists eventually learn that's impossible and to just work within the constraints they're under, but for me anyway, it was still stressful. And then just the frustration of the VA system as a whole. I perpetually had to push back against overbooks and meddling with my schedule/grid, and I was relatively well-protected by my direct supervisor and the fact most people in upper leadership didn't really understand what I did. I also get the feeling they thought I would've been more difficult to replace. The psychologists in general mental health had it much worse.

I usually saw that most folks at VA fell into one of two camps--the over-workers, who were often the newer employees and tried, valiantly but unsuccessfully, to stem the never-ending patient and administrative flow; and the under-workers, who did not just the bare minimum, but often complained about even that and tried to do less. And then there was a small middle class of folks who figured out the balance between towing the VA line and staying sane.

 

[Sanman]

Pretty much anyone providing therapy at my VA was always bordering on burnt out. Not so much from the overt workload requirements, but from the requests/mandates to schedule above and beyond those. For me (and I imagine many of those psychologists), there was also the mental strain of being booked out for months and months, and feeling an obligation to try to do what I could to reduce the wait time by seeing more people, up to a point. I think most psychologists eventually learn that's impossible and to just work within the constraints they're under, but for me anyway, it was still stressful. And then just the frustration of the VA system as a whole. I perpetually had to push back against overbooks and meddling with my schedule/grid, and I was relatively well-protected by my direct supervisor and the fact most people in upper leadership didn't really understand what I did. I also get the feeling they thought I would've been more difficult to replace. The psychologists in general mental health had it much worse.

I usually saw that most folks at VA fell into one of two camps--the over-workers, who were often the newer employees and tried, valiantly but unsuccessfully, to stem the never-ending patient and administrative flow; and the under-workers, who did not just the bare minimum, but often complained about even that and tried to do less. And then there was a small middle class of folks who figured out the balance between towing the VA line and staying sane.

I certainly agree with this. I will add that it also depends on local leadership and what services they agree to provide veterans. Is your service offering ADHD testing or refusing to see folks for it. I know services where that is 90% of their caseload and others where they refuse to see it. How about providing ESA letters, etc.? How are you managing suicide prevention mandates/CSREs? Are non-MH folks completing them or shoving them all onto MH? IMO, it starts with bad local management and ends in the death spiral of being short staffed until something happens to change the system.

 

[Sanman]

Is burnout a thing in other VA's/non-neuro areas? I remember being bored to tears and hitting my productivity goals working what would be considered a .6 FTE in any other system.

Bored to tears is the best option in the VA system.

 

[WisNeuro]

Bored to tears is the best option in the VA system.

Mayhaps, it just sucked when you had a 30-40% no show rate that the VA won't do anything meaningful about, have no work on Friday, and can't leave because if your "tour of duty." I much prefer the new system of if an IME no shows, I still get paid for the day, and then I work on other stuff, essentially earning double time for the same work.

 

[PsyDr]

What happens if they audit it? They just ask you to justify it?

I’ve been audited. It’s really not a big deal.

The insurance company asks for a random sample of your patient files. In this case, they asked for 5 specific patient files. We sent them off. They looked at the files, and said “looks right”, and that was the end of it. Took less than a month.

I did have a dementia patient complain to Medicare that I had never seen them. They asked that I send the file over to them. I included a note that dementia patients seem to forget things. They said everything was fine, and resumed payments.