It depends on what exactly you're doing in these consults.
The easiest inpatient consults are where you go see the patients to determine whether they're a good candidate for IPR. It's basically what you would have done in residency if you had a consult service.
You're focused on:
1. Good fit for IPR vs SNF
2. Current barriers to admission.
Insofar as you make recommendations, it's to manage things that might be an impediment to participation in therapy. For instance, you might recommend changes in their analgesic regimen to improve their participation/performance in PT.
Super simple stuff. Insofar as you're adding value, you might be able to save an IPR unit from admitting an inappropriate patient (assuming they care) or you might help a patient slated for a SNF discharge where they'd get few therapy hours rerouted to an IPR admission.
It's possible to do this job without any connection to an IPR: get yourself credentialed at one or more hospitals as an independent contractor, working closely with case management teams to improve throughput, but it would be a precarious position:
- You'd be seen as replaceable by case managers and clinical liaisons.
- If you don't have access to an IPR or SNF where you or your group can admit these patients, your value is lessened. Hospitals only care if you can help them get these patients off the floor and out the door.
- If this is your only/main revenue stream, your life will be easy, all it would take is for a case manager, surgeon, or hospital administrator to decide to stop consulting you because they don't consider that you're adding any value and you'd be screwed.
Your best bet if you're going to do inpatient consults is to:
1. Be an admitting physician at an inpatient rehab unit. There's a big difference between saying "this patient would make an excellent candidate for IPR admission" and "I will admit this patient to my unit today/tomorrow."
2. Try to add value other than just "IPR vs SNF." You won't be able to do this in every case, but can you help with medication management for impulsivity, agitation or sleep-cycle optimization in brain injury patients? Can you make recommendations to surgeons who don't care to manage that stuff but haven't consulted IM regarding lab abnormalities/BP issues that are a barrier to IPR admission?
As for the pay, it's similar to inpatient billing. Your main codes will be 99223/99222 and 99232. Depending on the insurance mix where you consult, the results might or might not be impressive. If you work in a ritzy suburb where you primarily see rich people with commercial insurance, you'll do well. If you work in a place with a high Medicaid population, you won't make much. If memory serves, MediCal (Medicaid in CA) pays something like 40% the Medicare rate. You won't retire rich on that kind of income.
Assuming you only see Medicare patients, and you focus on only Medicare patients are you're able to see 5 new consults a day + 5 return visits, you'll bill about $1350.
The trick is being able to get those new consults. 5 new consults (that's where the money is) per day isn't that easy to get in most hospitals. If you're aiming for more, you might need to split your time between 2 or 3 hospitals.
If you're able to see something like 8 new consults a day a bill 99223, you're looking at about $1600 in billings per day, which is not bad at all. Still, if this is your only revenue stream, you're always going to have some anxiety about whether the consults will keep on coming.
If you do the combined IPR + consult route, once you get your efficiency up (it came after a few years for me) and hire a scribe, it's relatively easy if census allows to see 20 patients and have all the charting + conferences done in 5 hours. After that, assuming your rehab unit is attached to your acute care hospital, it's super easy to go to the neuro/ortho/surgical floor and do some consults. Even if you can add 2 new 99223 charges per work day (about $400 at the Medicare rate), you'll be very happy at the end of the month.