Hospital Based Reimbursement

[mehul_25]

Hypothetical...

If one was to be employed by a hospital and they were responsible for overhead, nursing, OR time/staff what would be the % of ideal collections of professional fees that should go to the physician?

---

Members don't see this ad.

 

[Aether2000]

One would potentially be skating on thin ice when it comes to talking about taking a percentage of fees with a hospital. Stark regulations or worse may be invoked that prohibit physician "kickbacks". Most people who are employed by a company are not offered percentages of the profits...that arrangement is called ownership. Instead, a salary plus bonus that does not involve percentage kickbacks but rather productivity in numeric patients is a wiser arrangement.

 

[drusso]

One would potentially be skating on thin ice when it comes to talking about taking a percentage of fees with a hospital. Stark regulations or worse may be invoked that prohibit physician "kickbacks". Most people who are employed by a company are not offered percentages of the profits...that arrangement is called ownership. Instead, a salary plus bonus that does not involve percentage kickbacks but rather productivity in numeric patients is a wiser arrangement.

Wise Algos,

Please elaborate! Does this mean RVU's? How should salary + bonus arrangements be optimally negotiated in these arrangements. Also, what do you think is a "reasonable" estimation of facility/group overhead costs for bringing on a young'in pain physician??

 

[Aether2000]

I speak more from the experience of antiquity than from wisdom, but we recently brought on a physician that was not credentialed in the majority of insurances....
The cost to the practice of a new physician is dependent on the vestment conditions of profit sharing/401K/company match, health care benefits, salary, any bonuses promised, vacation time, etc. If the physician is not credentialed in many insurance plans, add an extra 25-40% since you will be carrying that physician for a quarter or half a year on your own profit, and they may be working far less than you anticipated.
RVUs or blocks + new patients seen + a percent of followups at a given dollar value for each over an arbitrary baseline value is seemingly acceptable since is does not involve a "percentage" of the profits.

 

[Mister Mxyzptlk]

Algos is this something you actually know or are you speculating? Is it compensation in exchange for referrals if the doctor is an employee? A percentage of collections would simply be how the employee is paid. Lots of employees work on commission without it being considered a kickback, and it's certainly not "ownership".

As for the % number sought in the root post, people love "50-50" deals. They think it's "fair". I would start with 60% and see if they will counter-offer 50%. In exchange for them doing everything and paying for everything 40-45% wouldn't be all that bad. Make sure it's gross and not net.

You will need to spell out a lot of terms and conditions because you are forfeiting control over a lot of things that you control absolutely when self-employed. Suppose you feel you need a piece of equipment or you want nicer furniture. Who decides whether or not you get it, and what are the rules?

Who pays for malpractice, meetings, books, computers, and so on? Will they pay for your car? How about gas, parking, etc? If you're self-employed those are potential business expenses. Buying with pre-tax dollars through your business is a powerful thing.

Who has the final say on hiring and firing of staff? Suppose you hate the nurse but they won't replace her?

If you're truly an employee you are eligible for any health insurance, 401(k), etc, they offer. What are those like, especially the 401(k) - how many years to vesting? Matching contributions? What kind of investments? Some employers screw the employees by getting a plan with low management fees in exchange for only offering investment vehicles that provide front-end commissions to the plan manager.

Finally, consider that you will probably hate working for the hospital unless you enjoy being treated like chattel. I can't imagine having a hospital administrator sign my paychecks. As I mentioned in another post, it's probably the way medicine is headed for a lot of doctors in the future, but I would have to be dragged kicking and screaming.

Would they consider a first year income guarantee, reduced rent on one of their offices for one year, and you set up your own practice? It's legal and that's how I'd do it. You could walk away from it a year later, set up an office down the street, take all your cases to the competition, and there's not a damn thing they could do about it - because they can't offer compensation and demand referrals in exchange.

 

[Aether2000]

I was told this by a contract lawyer, but if you ask 3 lawyers, you may get 5 opinions. The issue is largely semantics since any type of bonus based on productivity formulae will have the same effect, but the issue apparently becomes thorny when hospitals are splitting their income based on a percentage. This may be changing given the increased flexibility in physician ownership of hospitals that was largely forbidden in the past.
Definitely absolutely get an attorney involved, one that has experience in exactly the type of physician-hospital contract you are contemplating. Remember hospitals derive significant amounts of income from physicians doing procedures there. The average medicare patient pays at least 56% more to have the same procedure done in a hospital than in an office.

 

[Doctodd]

Also use as your negotiating tool the rapid turnover you have compared to an ortho or NS. You can do 4 procedures in the same time it takes an ortho to turn over one procedure in the same room.....plus the cost for a typical ortho kit is alot more than an epidural tray.

Another way to do it is to be a medical director and receive a stipend for the actual responsibilities of such. There has been a "crackdown" on medical directorships.....you just have to prove you put in the hours doing it and fulfilled certain responsibilities. I would rather be a medical director at a hospital than at your local MRI center or for a local DME company.

T

 

[deleted472101]

error