Note: I'm open to being corrected on any of this, and perhaps should be moved to private forum, but I don't want new grads seeing only disinformation.
The ROCR Pro Fees payment table is up on their
website. It's roughly based on average CMS collections for services by disease sites across America
right now, today. [actually: "
Those rates were based on radiation oncology payment data under the Hospital Outpatient Prospective Payment System (HOPPS) between 2017-2019 and trended forward to 2024"]. Some sites are less than 3k, some are more than 3k. Prostate is more than 4k. Let's assume about 3k per patient right now to keep the numbers easy. That's Medicare. Let's say your private payor contracts are about 100-150% Medicare. This is
definitely not true in all markets, but they are nice round and reasonable numbers to start with between straight Medicare and what the hospitals get. To again keep it easy, let's assume that only 50% of your patients have private insurance and the rest on straight Medicare or state.
Let's say you have 24 patients (busy-ish, but easily doable practice) on treatment consistently and your average treatment course is about 4 weeks. That's 6 new patients per week or about 300 new starts per year. Half public, half private payor.
3k for public x 150 = 450k
4.5k (3k x 150%) for good contracts private x 150 = 670k
3k (3k x 100%) for not so good contract private x 150 = 450k
Total Range: 900k - 1.12mil
To my knowledge, this does not include E/M charges like consults or follow ups [edit:
"All evaluation and management (E/M) codes associated with the initial consult would continue to be paid FFS."] or med director stipends or whatever else outside of the bundled treatment specific pro fees. So you'd likely get a bit more (about 10% for E/M per my experience).
Obviously,
a ton of assumptions and rounding being made here. Does not apply to everyone, etc.... And you certainly don't get to keep all those collections. You have to pay billers, and other administrative overhead, and med mal, and your own health/disability insurance, and your own retirement funding. However, I don't think it's a wholly unreasonable model either. and even if it's 2x more generous that it should be, and you cut that total collection in half.... you still arrive at about.... MGMA median salary.
Saying that
"You can’t run a practice and even get paid anywhere near MGMA with pro fees only." just feels erroneous prima facie. You need a reasonable volume and a decent mix of cases/payors. But that's true anywhere. Ain't no hospitals paying you 800k to treat 4 patients in the middle of nowhere anymore.
EDIT: I'd place unity for an average employed vs average PSA salary at somewhere between 15-20 patients on beam in an average clinical scenario/geography. Less than that and you almost assuredly would be better off employed. More than that, and you almost assuredly would do better on a PSA. Because most clinics operate at about those volumes, the pay between private PSA groups and employed docs have become fairly similar which is why I full heartedly agreed with this statement, "
The real delta now is in the level of control over the practice more then anything else." I think that's right and important.
