Got 2013 MGMA Compensation Survey Data?

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lwestfall

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Anyone have the 2013 versions of the following median numbers that I have from the 2012 MGMA compensation survey?
Code: 
Specialty    $/wRVU    RVUs    $ Comp
FM           42.73     4,815   200,114
FM w/OB      43.63     4,714   204,411
OB/Gyn       46.31     6,714   295,144
GI           56.44     8,492   481,347
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Comment: I am a Family Practice physician. My corporation recently forced on us the new payment system. I used to be paid based on RVUs and did very well. I used to do a lot of dermatology procedures and injections, and every other procedure possible.
Now we get paid based on performance determined on statistics, if I convince enough patients to have colonoscopy etc. My yearly income dropped from above 200K to 150K.
In our corporation the RVU for family physician has been reduced about 3 years ago to $39 per RVU.
Now I am referring patients to dermatologists and orthopedics so they get the satisfaction of practicing the procedures and I am concentration of making sure that gastroenterologists get all the referrals for colonoscopies and I get paid for "coordination of care".
Also please note that for exactly the same procedure, the specialist gets more pay because 1 RVU for primary care is much less than 1 RVU for specialty.
 
realism said:
Comment: I am a Family Practice physician. My corporation recently forced on us the new payment system. I used to be paid based on RVUs and did very well. I used to do a lot of dermatology procedures and injections, and every other procedure possible.
Now we get paid based on performance determined on statistics, if I convince enough patients to have colonoscopy etc. My yearly income dropped from above 200K to 150K.
In our corporation the RVU for family physician has been reduced about 3 years ago to $39 per RVU.
Now I am referring patients to dermatologists and orthopedics so they get the satisfaction of practicing the procedures and I am concentration of making sure that gastroenterologists get all the referrals for colonoscopies and I get paid for "coordination of care".
Also please note that for exactly the same procedure, the specialist gets more pay because 1 RVU for primary care is much less than 1 RVU for specialty.
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This reply makes me so super sad. Just one more reason I don't have a permanent job.
 
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I would never allow myself to be paid based on RVUs. You always get screwed.
 
Blue Dog said:
I would never allow myself to be paid based on RVUs. You always get screwed.
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I would be interested if you could elaborate. I found myself in a situation (for many factors), that I felt I would need to have some guarantee of compensation, so I have a guarantee for the first 3 years of contract. After three years I go to production based on wRVU. In year 2, if my productivity exceeds my base, i get paid the difference based on a conversion factor and wRVU's.

Ideally, I would have gone into a private practice and had a great payor mix, but that just doesn't seem to be reality, and my base is SIGNIFICANTLY higher than I've been seeing offered by private practices (and other).

My ultimate goal if this whole employed thing doesn't work out (ideally, negotiate up my CF if doing well for the hospital system), I'd like to go to Concierge or possibly private practice.

Anyway, I'd be interested in your comments on this subject. I'm facing having to support a family and start paying back around 300K in loans, so I felt that employment was best option for me (my financial situation seems to be very similar to what Cabin was facing). I'll be 38 when I finish residency next summer.
 
Blue Dog said:
I would never allow myself to be paid based on RVUs. You always get screwed.
Click to expand...
I am then curious what you would suggest for us employed physicians? I think we all agree that straight salary, without any kind of production bonus, is not ideal. What then should we shoot for, if employed by a hospital system?
 
Like I've said previously, show me the money. RVUs make it too easy for your employer to screw you by hiding the money behind an inscrutable formula. With revenue, it's simple: revenue - overhead/expenses = paycheck. Of course, if your overhead and expenses are hidden, then you're probably already being screwed. RVUs just make it worse.
 
Blue Dog said:
Like I've said previously, show me the money. RVUs make it too easy for your employer to screw you by hiding the money behind an inscrutable formula. With revenue, it's simple: revenue - overhead/expenses = paycheck. Of course, if your overhead and expenses are hidden, then you're probably already being screwed. RVUs just make it worse.
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That only works well if you have a good payer mix, which most employed practices don't. Even the good practices still take some amount of Medicaid which screws up the whole "revenue - expenses = paycheck" deal you've got going. Plus, your model does kinda suck for new doctors coming in who're trying to build up their numbers.
 
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VA Hopeful Dr said:
That only works well if you have a good payer mix, which most employed practices don't. Even the good practices still take some amount of Medicaid which screws up the whole "revenue - expenses = paycheck" deal you've got going. Plus, your model does kinda suck for new doctors coming in who're trying to build up their numbers.
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VA,
What's a realistic take-home for an FM doc living in a place that normal people actually want to live?
 
Silent Cool said:
VA,
What's a realistic take-home for an FM doc living in a place that normal people actually want to live?
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Depends. OB or no OB, inpatient/outpatient or just outpatient, hospital employed or private group, what do you mean by place people want to live?
 
VA Hopeful Dr said:
Depends. OB or no OB, inpatient/outpatient or just outpatient, hospital employed or private group, what do you mean by place people want to live?
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Like, a decent city, such as the places that Cabin mentioned.
 
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VA Hopeful Dr said:
Those places are going to pay much less, starting around 130-150k from what I've seen.
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Damn. That's ridiculous. No wonder Cabin does locums ;)
How the hell can someone reasonably pay back 400K in loans with that income?
 
VA Hopeful Dr said:
That only works well if you have a good payer mix, which most employed practices don't. Even the good practices still take some amount of Medicaid which screws up the whole "revenue - expenses = paycheck" deal you've got going.
Click to expand...

A poor payer mix wouldn't change the validity of the comp plan, just the amount of the compensation itself. You can increase volume, or just make less money, which is typically what happens when you're employed in a practice with a crappy payer mix regardless of how the comp plan works (salary, RVUs, whatever). Your income will never be greater than your revenue after expenses, unless you're being subsidized.

Plus, your model does kinda suck for new doctors coming in who're trying to build up their numbers.
Click to expand...

Not at all. They're on a salary guarantee for up to three years.
 
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VA Hopeful Dr said:
Those places are going to pay much less, starting around 130-150k from what I've seen.
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Yep, because they are saturated markets. Employees don't have to pay more than that since there is a surplus of providers in cities. Gotta choose what's important to you. Paying your debt down and maybe working in a rural area or living in a city making nothing and struggling?
 
cabinbuilder said:
Yep, because they are saturated markets. Employees don't have to pay more than that since there is a surplus of providers in cities. Gotta choose what's important to you. Paying your debt down and maybe working in a rural area or living in a city making nothing and struggling?
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From everything I've seen, and granted I'm looking at somewhat smaller markets that Chicago/SF/NYC, starting salary is usually kinda poor but after 1-2 years when production kicks in, those salaries tend to just up to normal levels.
 
Just finished interviewing at a rural program in western NC. Loved it. Felt like "home".
PGY3s here told me they're getting offers around $130-150k.
Giant gulp. No way can I afford that. I made around $100k as a PA and now have $160ish more educational debt.
Can anyone talk me down from the ledge here? :)
 
primadonna22274 said:
Just finished interviewing at a rural program in western NC. Loved it. Felt like "home".
PGY3s here told me they're getting offers around $130-150k.
Giant gulp. No way can I afford that. I made around $100k as a PA and now have $160ish more educational debt.
Can anyone talk me down from the ledge here? :)
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Just remember that all numbers are negotiable. Use your PA past to your advantage. They will put out the lower number they think they can get away with. So come back with 160K and have them throw in loan repayment, etc. You are the hot commodity in FM. You are the one in control - use that. Get a contract lawyer to negotiate for you.
 
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primadonna22274 said:
Just finished interviewing at a rural program in western NC. Loved it. Felt like "home".
PGY3s here told me they're getting offers around $130-150k.
Giant gulp. No way can I afford that. I made around $100k as a PA and now have $160ish more educational debt.
Can anyone talk me down from the ledge here? :)
Click to expand...
Those folks are doing something wrong. In my class of 10, only 2 of us started at less than 160k. One of those was Northern VA (right outside DC). Everyone else was around 170-180k.
 
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primadonna22274 said:
Just finished interviewing at a rural program in western NC. Loved it. Felt like "home".
PGY3s here told me they're getting offers around $130-150k.
Giant gulp. No way can I afford that. I made around $100k as a PA and now have $160ish more educational debt.
Can anyone talk me down from the ledge here? :)
Click to expand...

MAHEC? If so what did u think of the program? It's on my radar but I'm still a couple years out. And those numbers do not get me excited. I'm sorry, but doctors are worth more than that.
 
Smokemont said:
MAHEC? If so what did u think of the program? It's on my radar but I'm still a couple years out. And those numbers do not get me excited. I'm sorry, but doctors are worth more than that.
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Yes, MAHEC Hendersonville, NC. Outstanding small program. Not quite the right fit for me, but if you're the kind of person who wants to learn and do EVERYTHING, great training. (I myself am not a fan of longitudinal OB e.g. When you're on call, you're on for the entire hospital--medicine, peds, OB--regardless of whether you're PGY-2 or PGY-3 and no matter which month it is. I prefer to suffer through any OB I have to do--as little as possible--and be done with it and leave it behind!)
I suspect a lot of the depressed salaries are because many of these folks choose to stay in the area which is an outdoor lover's paradise--climbing, rafting, hiking, skiing, you name it--and has a vibrant cultural/arts scene as well. Really gorgeous place but highly desirable living areas, even when rural, tend to drive salaries way down.
 
primadonna22274 said:
Yes, MAHEC Hendersonville, NC. Outstanding small program. Not quite the right fit for me, but if you're the kind of person who wants to learn and do EVERYTHING, great training. (I myself am not a fan of longitudinal OB e.g. When you're on call, you're on for the entire hospital--medicine, peds, OB--regardless of whether you're PGY-2 or PGY-3 and no matter which month it is. I prefer to suffer through any OB I have to do--as little as possible--and be done with it and leave it behind!)
I suspect a lot of the depressed salaries are because many of these folks choose to stay in the area which is an outdoor lover's paradise--climbing, rafting, hiking, skiing, you name it--and has a vibrant cultural/arts scene as well. Really gorgeous place but highly desirable living areas, even when rural, tend to drive salaries way down.
Click to expand...

Thanks for the reply. I love the area so I will apply just hoping to be able to visit for an interview :)
 
Smokemont said:
Thanks for the reply. I love the area so I will apply just hoping to be able to visit for an interview :)
Click to expand...
They put you up in a lovely B&B and residents host dinner in their homes the night before. It's actually a very nice, cozy change from restaurants where you can't hear anyone.
 
Not so sure wRVU system is that bad, certainly depends on payor mix as the wRVU system removes incentive to go with certain commercial payors. My $185k base and $40 (not THAT great I know) per wRVU above the median feels like its working ok, especially considering I'll be billing ~7,000 wRVUs/year, you do the math...
 
thethom said:
Not so sure wRVU system is that bad, certainly depends on payor mix as the wRVU system removes incentive to go with certain commercial payors. My $185k base and $40 (not THAT great I know) per wRVU above the median feels like its working ok, especially considering I'll be billing ~7,000 wRVUs/year, you do the math...
Click to expand...

We can't do the math unless we know the median.
 
VA Hopeful Dr said:
The median last year for office-based FP with no OB was right at $40 per wRVU. If the above poster is getting $40 ABOVE the median... well that's impressive.
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I think what he actually meant was that he gets a base salary plus an additional $40 per wRVU for every wRVU above the median. He expects to bill 7,000 wRVUs per year. So, to calculate how much he'll earn above his base salary, we would need to know the median number of wRVUs billed (in his group, I imagine). If the median is 8,000, for example, he won't get squat. If the median is 6,000, he'll get an additional $40,000.
 
Blue Dog said:
I think what he actually meant was that he gets a base salary plus an additional $40 per wRVU for every wRVU above the median. He expects to bill 7,000 wRVUs per year. So, to calculate how much he'll earn above his base salary, we would need to know the median number of wRVUs billed (in his group, I imagine). If the median is 8,000, for example, he won't get squat. If the median is 6,000, he'll get an additional $40,000.
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That makes more sense.

For what its worth, the median nationwide last year as, per Merritt Hawkins, was about 188k. So if they're using national data, that's not a bad deal. It is kinda surprising though, most places I've seen that do salary plus RVU have the extra RVU income kick in once you're "earned" your salary in RVUs.
 
kinda depressing read this…
 
Blue Dog said:
We can't do the math unless we know the median.
Click to expand...

Yes, good point Blue. Its set at 75% FM and 25% SM of whatever the MGMA median yearly wRVU is, somewhere between 4800 and 5000 but it changes a little up or down yearly of course. It is not based on my partners' (All FM trained) productivity. Base salary plus $40 for EACH wRVU past the MGMA median.
 
VA Hopeful Dr said:
That makes more sense.

For what its worth, the median nationwide last year as, per Merritt Hawkins, was about 188k. So if they're using national data, that's not a bad deal. It is kinda surprising though, most places I've seen that do salary plus RVU have the extra RVU income kick in once you're "earned" your salary in RVUs.
Click to expand...

That makes sense, if the national median is around $40 per wRVU then it would take ~4700 wRVU/year to get to that $188k. Its only a little different for a family medicine/sports medicine hybrid as discussed above.

Of course now that we have gotten good at the fee for service model, there no telling what will happen in our hospital group next with ICD10 and our "ACO" moving more towards the "pay per complexity" type model.
 
thethom said:
That makes sense, if the national median is around $40 per wRVU then it would take ~4700 wRVU/year to get to that $188k. Its only a little different for a family medicine/sports medicine hybrid as discussed above.

Of course now that we have gotten good at the fee for service model, there no telling what will happen in our hospital group next with ICD10 and our "ACO" moving more towards the "pay per complexity" type model.
Click to expand...
If we had decent complexity metrics that could work -- but how does patient compliance and cognitive capacity fit into that formula? For there exists a real difference in trying to explain things (and expect that explanation to take root and hold) between populations. Case in point -- I have a particular (largely geographically constrained) population that it takes three rounds and 15 minutes of explaining on what it means to remove a bandage at 48hr...
 
I've never heard the term "pay per complexity," although that's pretty much what today's CPT system is based on, in theory anyway.

The ACO model typically involves a care management fee (per-member-per-month, or PMPM) in addition to fee-for-service, as well as a shared-savings bonus if you're successful at controlling costs (typically targeted at certain high-cost areas, such as ER over-utilization and hospital re-admissions, as well as management of high-cost chronic diseases such as diabetes, CHF, COPD, etc.) The PMPM is intended to be used to improve care delivery along the lines of the Patient Centered Medical Home (PCMH).

As far as patient compliance goes, none of the metrics require 100% attainment. Low-literacy patients and the vulnerable elderly benefit greatly from care coordination, which is an integral component of the PCMH.
 
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RVUs make it too easy for your employer to screw you by hiding the money behind an inscrutable formula.
Click to expand...

Actually it's quite easy. Each E/M code and procedural CPT's give a RVU with a work unit. Your contract will give you a base RVU you must hit. As long as the billing people are doing their job this formulation stays simple.

Talk about hiding behind number, unless you are owner/part owner, a practice than pays you based on a productivity of income minus expense has plenty of places to hide money. I know this first hand.
 
Newdoc2002 said:
Talk about hiding behind number, unless you are owner/part owner, a practice than pays you based on a productivity of income minus expense has plenty of places to hide money.
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Yes, I'm a "part owner." Nothing's hidden.
 
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