Anybody know of any practice consultants?

[stickyshift]

At wit's end trying to find ways to make our practice more profitable. Anyone know of any consultants that might be of use (aside from the billings experts, who we've already tried).

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[coroner]

My former advisor from med school does this, on top of running his current practice. Not sure if he still does consulting. pm me if interested and I can get in touch with him.

 

[LADoc00]

They are useless. Trust me. Your practice is likely not profitable due to:
1.) volume problems either low volume or "bad" volume
2.) garbage payor mix with tons of Medi-Medi
3.) not enough ancillary services to recapture $, FISH, 88360-landia etc
4.) weak med directorship contracts
5.) overpaying TC staff or overspending in general
6.) prior partners sucking $ out like aged white haired skeletal vampires
7.) you read other SDN posts and somehow believed client billing arrangements taking only 25% of the global was worth it...

One of those my friend, one of those. Just white board it and zero in on which one.

 

[stickyshift]

Nice summary of potential problem spots. The ones that might pertain to my practice are 1, 2, and 4.
So,
1. What should be a decent volume/pathologist for a practice comprised of 70% shareholders? If the target is $400K/shareholder, would it be 4000 surgicals? 5000?
2. What is tons of Medi-Medi? About half of our volume is Medicare. Maybe a third is private . . .
4. We get about $50K/FTE for medical directorship. Is this about right?

 

[LADoc00]

Nice summary of potential problem spots. The ones that might pertain to my practice are 1, 2, and 4.
So,
1. What should be a decent volume/pathologist for a practice comprised of 70% shareholders? If the target is $400K/shareholder, would it be 4000 surgicals? 5000?
2. What is tons of Medi-Medi? About half of our volume is Medicare. Maybe a third is private . . .
4. We get about $50K/FTE for medical directorship. Is this about right?

hmm where to begin...

Volume is a very complex equation as all specimens are not equal. I could do 2500 cases/year and make 200% more $$ than someone doing 5000 a year even with the SAME payor mix. Its a CPT code density issue.
So I cant really tell you what volume you should be at, thats part of being a good businessman and analyzing the code changes each year when HHS releases them.

50% Medicare is very high if you consider you are also tugging Medicaid along with that.

$50K for a medical directorship is absurdly low unless it is a small 20 bed hospital or something. Imagine if a large hospital had to fully employee a medical director. They would have to base him/her at 200-250 per year, benefits another 75 a year AND cover vacation/illness and some call with other providers for another say around 100 minimum.
So a MINIMUM if you were have to pay market for that service is like 425+K per year for an average say 200 bed hospital with a L2+ trauma center.

So why are YOU only getting 50? Are they paying you also under the table in girls and drugs?? Are you feeling really generous you want to give them a massive discount?? Or is the leadership of your group so insecure, so passive that when CEOs of hospital hand you crumbs, you nod in appreciation and go back to life on your knees???

Why you are unprofitable is 100% clear to me, but make it clear to yourself and take the red pill.

 

[stickyshift]

Thanks for responding so quickly!
I have never heard of $400K+ for medical directorship. The most I've heard around here is $200K for a hospital requiring two FTEs. I seem to remember that there was some assumption that a pathologist's income was around $140k, and medical directorship duties took up about a third or so of his time. That's how we got our $50K.
I don't know if this has anything to do with anything, but we're contracted with a Catholic hospital chain. I've heard from others that they tend to be stingy about things like this.

 

[LADoc00]

Thanks for responding so quickly!
I have never heard of $400K+ for medical directorship. The most I've heard around here is $200K for a hospital requiring two FTEs. I seem to remember that there was some assumption that a pathologist's income was around $140k, and medical directorship duties took up about a third or so of his time. That's how we got our $50K.
I don't know if this has anything to do with anything, but we're contracted with a Catholic hospital chain. I've heard from others that they tend to be stingy about things like this.

Your assumptions are flat out wrong.

Pathologists do not make an average of 140 in any survey I have seen MGMA or otherwise. Median salary is sitting over 260 and MEAN salary is closer to 300+.
Now take that data set and eliminate: all the pathologists who do research, all the trainee pathologists and all the underemployed pathologists.
Now add in benefits, employer side payroll taxes, and on call reimbursements.

And then go and read the newest requirements for pathologists of high complexity labs serving as medical directors from Joint Commission. They are incredibly detailed.

I have worked for a Catholic hospital chain before and made multiples of that $$ number so it is a not a Catholic hospital chain thing. Dont give yourself excuses for a lack of revenue success, create a plan, read over the Joint Comission requirements for support and in your next negotiation raise that 50K to 200.

 

[AZpath]

50k per pathologist is about average from my limited data set .
I was in one group that got about 100K per FTE.
The lab was started by pathologists with the hospital as partner. They were very involved with clinical path.

Many hospitals pay zero for part A. All hospitals will fight giving you a raise unless you can shows some additional value.
Did they add some new outpatient facilities that you now direct? Do you help them save money on transfusion utilization?

Btw, who is billing? This is a big part of success. 50% or more billers suck.
Experts can help in billing area but the biller is the key.

 

[LADoc00]

"50k per pathologist" literally doesnt even make sense to me. Its a task requiring coverage 24-7 with onsite response time usually in the 30 min range. If one person did it or 8 people split the days how would change the value of the service? Why would I even let some a*shat try to price me on per pathologist basis to begin with??

And at 50K why am I even there? Why am I not at home, bring the f'ing slides to me and I will read them in my bathrobe while sipping Manhattans and smoking grade A Indica. Seriously, if they want to pay janitor rates just tell them to contract CP Med Directorship separately. 50K per year is a total insult. I just did READING for a medico-legal case sitting in my PJs last month for a long weekend and charged 15. Harvey Weinstein wouldnt even insult women he has molested with hush money payments that low.

If service X has a market rate of 200-300K per year how the would fact that you have 1 or 8 dedicated to the task change how $ you receive?

Folks we have a seriously fundamental disconnect. Paying zero is a not an option. Why would you even do that? Secondly that isnt even legal as it would be considered an inducement for other $ contracts and would violate Stark laws.

So we have a 2 tiered problem of 1.) not understanding how to get paid for tasks that do have a clear market value 2.) what the very laws that dictate the U.S. practice of medicine even are...

 

[LADoc00]

Does 50K a year go some epic long way in some super rural steel mill town I have never been to or something? Im just sitting here thinking I have random rental properties that bring in TWICE that amount and am blown away.

Are we actually talking 50,000 US dollars PER YEAR or am Im misreading all this and you mean per month?

If you are getting 50K per year just threaten to leave, if some degenerate pathologist group is willing to take what is less $ than a 19 year old stripper makes in 3 months where I am, then let them have it. Wow. But definitely tell the medical staff the admin of the hospital is paying you in like 1948 wage levels.

PS- Okay before I posted more I needed to actually check with my accountant. So yah, 50K per year is INSANELY LOW. In 2016, ON AVERAGE I cash flowed 58,235 per month in passive directorship income across all my labs. That is before I got any money for fee for service work. That is not an exaggeration, that is literally on the P&L for my business.

 

[icpshootyz]

In 2016, ON AVERAGE I cash flowed 58,235 per month in passive directorship income across all my labs.

But that number doesn't tell us anything unless you provide the number of labs, what type of labs (hospital, private, etc), who's paying, etc. I'm fairly certain our Part A/directorship is also around $50K/pathologist per year, with us getting all the PC at our hospitals. The large system we work under also recently hired consultants that showed we were on the high end of Part A payments to path groups in the entire region (Northeast). Maybe California is different, but no one is getting the money you're stating in this area.

 

[AZpath]

200K per pathologist?
Don't tell us which hospital. A bunch of us might show up and offer 125K per FTE.

All it will take is a hospital lab consultant to recommend a 75% cut. Then you are done.

I have Vachette's survey. Their data base is pretty accurate it is based on PP only. You would be in the top 1%. I can't remember the exact figures but the median it was closer to 5oK that 100K. ( Maybe I can find the survey )
I am not sure how they handled no pay part A hospitals like CHS, HCA and few other dead beats.

 

[AZpath]

"50k per pathologist" literally doesnt even make sense to me. Its a task requiring coverage 24-7 with onsite response time usually in the 30 min range.

Folks we have a seriously fundamental disconnect. Paying zero is a not an option. Why would you even do that? Secondly that isnt even legal as it would be considered an inducement for other $ contracts and would violate Stark laws.

So we have a 2 tiered problem of 1.) not understanding how to get paid for tasks that do have a clear market value 2.) what the very laws that dictate the U.S. practice of medicine even are...

Many hospital system are not afraid of Stark with pathology part A non payment. OIG put out a statement on this saying it is wrong not to pay years ago.

However, show me one hospital that got hit with a fine.?
To my knowledge no one has reported zero part A hospitals to the OIG.

Also, if you run an outpatient lab for someone they don't have pay squat.
How many path's help run an outpatient histolab or a clinical lab for doc's for only AP work?

I have friends at Zero pay part A hospitals. Most hospital CEO know they can quickly get another group. They fear they would be replaced if they pushed for payment.

That's the problem the market value for pathologist is low. It is harder to find a histotech than good pathologist in most areas.

 

[pongo]

We do what others have described - do time studies to make our case for how many "FTEs" are needed to cover part A duties. The number of FTEs is multiplied by a number slightly higher than MGMA. Each added facility is assessed for the number of FTEs, and our Part A goes up accordingly. So our ultimate part A/pathologist is significantly above those numbers described above (except LaDoc's). It is a sad state that people have devalued their other professional services so much over the years to keep AP business. A group up the road in a desirable college town long ago gave away their part A payment, and we are always worried that the empty suits will bring that up with us. With recent AP cuts, the group up the road is now willing to drive all over the state and enrich dermatologists and gastroenterologists in order to get a few extra crumbs in their pockets.

 

[stickyshift]

50k per pathologist is about average from my limited data set .
I was in one group that got about 100K per FTE.
The lab was started by pathologists with the hospital as partner. They were very involved with clinical path.

Many hospitals pay zero for part A. All hospitals will fight giving you a raise unless you can shows some additional value.
Did they add some new outpatient facilities that you now direct? Do you help them save money on transfusion utilization?

Btw, who is billing? This is a big part of success. 50% or more billers suck.
Experts can help in billing area but the biller is the key.

Our billing company is McKesson. We have had issues with them.

 

[stickyshift]

Many hospital system are not afraid of Stark with pathology part A non payment. OIG put out a statement on this saying it is wrong not to pay years ago.

However, show me one hospital that got hit with a fine.?
To my knowledge no one has reported zero part A hospitals to the OIG.

Also, if you run an outpatient lab for someone they don't have pay squat.
How many path's help run an outpatient histolab or a clinical lab for doc's for only AP work?

I have friends at Zero pay part A hospitals. Most hospital CEO know they can quickly get another group. They fear they would be replaced if they pushed for payment.

That's the problem the market value for pathologist is low. It is harder to find a histotech than good pathologist in most areas.

Ha! I beg my good histotechs not to leave because I don't know where to find another one. Another pathologist? They come around begging for jobs!

 

[AZpath]

Our billing company is McKesson. We have had issues with them.

You better talk with me offline. I have a lot to tell you.

 

[AZpath]

I started a new thread on part A.

Here is some current real data from vary good source .

Medical Director/Part A
Compensation Per Pathologist:
Sample 40+ different pathology practices with over 100 hospitals in a variety of locations nationwide
Average group= $80,000 per pathologist.

 

[jupiterianvibe]

50k per pathologist is about average from my limited data set .
I was in one group that got about 100K per FTE.
The lab was started by pathologists with the hospital as partner. They were very involved with clinical path.

Many hospitals pay zero for part A. All hospitals will fight giving you a raise unless you can shows some additional value.
Did they add some new outpatient facilities that you now direct? Do you help them save money on transfusion utilization?

Btw, who is billing? This is a big part of success. 50% or more billers suck.
Experts can help in billing area but the biller is the key.

100K per FTE in the group, or 100K per FTE determined by some metric to estimate clinical lab time? If the latter, what metric was used?

 

[LADoc00]

200K per pathologist?
Don't tell us which hospital. A bunch of us might show up and offer 125K per FTE.

All it will take is a hospital lab consultant to recommend a 75% cut. Then you are done.

I have Vachette's survey. Their data base is pretty accurate it is based on PP only. You would be in the top 1%. I can't remember the exact figures but the median it was closer to 5oK that 100K. ( Maybe I can find the survey )
I am not sure how they handled no pay part A hospitals like CHS, HCA and few other dead beats.

The problem with that thinking (and trust me when I was young I thought the same way) is that actually booting physicians is the LAST thing most hospitals want. If you are a good, admin knows what to expect. But with a new group, they have clue.

Even when things go HORRIBLY wrong for a pathologist oh like being arrested by the sheriff during a frozen section, hospital admin still do not cut them free in my experience.

The one case I do know of where one of the members of a group went behind everyone's back and got the contract for medical directorship with a hospital in Northern California (Alta Bates), the hospital had to pay out a massive judgement to the excluded pathologists like on the order of 10m.

"Hospital lab consultants" are also dying off as the bigger hospital chains I have interacted with have failed to see any of the positive cash flow from their boiler plate recommendations ever materialize. It was a joke to begin with.

At the end of the day if the hospital admin hates you, you are doomed. If they love you, you have room to wiggle. But honestly if you are so locked into a place you cant look a COO or CEO in the eye and tell them "I can and will walk, make more $ elsewhere and your bridge with me will be burnt until the board replaces you" then you are doing it wrong.

 

[coroner]

Paying zero is a not an option. Why would you even do that?

To keep your job. And not have to uproot your whole family and sell your house, send your kids to a new school, cause your spouse to look for a new job, etc.

Secondly that isnt even legal as it would be considered an inducement for other $ contracts and would violate Stark laws.

It's perfectly legal. If it wasn't, CEO's, major health care networks, and their team of attorneys would put a screeching halt to this. Per Medicare policy (and on CAP website):
Part A Compensation
Because reimbursement under Part A is made directly to the hospital, the pathologist or pathology group responsible for the management and supervision of the laboratory must seek payment from the hospital.

Does 50K a year go some epic long way in some super rural steel mill town I have never been to or something?

Very typical rates in the Rust Belt area which I'm familiar with (think b/w Chicago to Buffalo) even in bigger cities within this region.

I have friends at Zero pay part A hospitals. Most hospital CEO know they can quickly get another group. They fear they would be replaced if they pushed for payment.

This is true. I've interviewed at and know of hospitals with private pathology groups that get zero Part A.

But honestly if you are so locked into a place you cant look a COO or CEO in the eye and tell them "I can and will walk, make more $ elsewhere and your bridge with me will be burnt until the board replaces you" then you are doing it wrong.

Admin types know these are empty threats given the current oversupply of our field...

 

[Dave CX]

I would suggest that you calculate all your groups time on Part A activities. It requires a time study which is arduous, but very useful when negotiating a contract. Then apply the following formula ; Part A fte x medicare fraction x 400K. The key to doing a time study is knowing what constitutes part A. For instance, most pathologists don't know this, but half of your CME hours can be itemized as part A. Similarly every medical related phone call that doesnt reference a specific AP case is also part A. Tumor boards/inspections/lab meetings/administration meetings/ including all prep time counts. Inspections that you perform also. Autopsies 10 hrs each. Even the time you spend documenting part A hrs counts. This stuff adds up and demonstrates your value.

 

[stickyshift]

I would suggest that you calculate all your groups time on Part A activities. It requires a time study which is arduous, but very useful when negotiating a contract. Then apply the following formula ; Part A fte x medicare fraction x 400K. The key to doing a time study is knowing what constitutes part A. For instance, most pathologists don't know this, but half of your CME hours can be itemized as part A. Similarly every medical related phone call that doesnt reference a specific AP case is also part A. Tumor boards/inspections/lab meetings/administration meetings/ including all prep time counts. Inspections that you perform also. Autopsies 10 hrs each. Even the time you spend documenting part A hrs counts. This stuff adds up and demonstrates your value.

So, I spend about 40 hours/month doing Part A stuff, all nicely documented on my time sheets. That's pretty much a 0.25 FTE.
We are about 50% Medicare, I believe.

0.25 x 0.5 x 400,000 = $50,000 (which is what I'm getting)

 

[LADoc00]

HUgt

So, I spend about 40 hours/month doing Part A stuff, all nicely documented on my time sheets. That's pretty much a 0.25 FTE.
We are about 50% Medicare, I believe.

0.25 x 0.5 x 400,000 = $50,000 (which is what I'm getting)

Huh you had me until the 0.5 factor went into the equation, WTF is that for?!

 

[stickyshift]

HUgt


Huh you had me until the 0.5 factor went into the equation, WTF is that for?!

0.5 is for the 50% of my patient population that's Medicare. The formula takes into account the fraction of your patients that are covered by Medicare.

 

[LADoc00]

0.5 is for the 50% of my patient population that's Medicare. The formula takes into account the fraction of your patients that are covered by Medicare.

Huh, lol so they full expect you to get the remainder of your fees from billing CP Pro fees? What about the fact that a huge number of other payors dont pay it??

That is hilarious. What a con job!

Approaching this from a different angle, tell them every night you are on call you want $400, every night, EVERY GODDAMN NIGHT. 400x365=$146,000 pluses you up nicely.

If they dont pay you then you wont take call and every night you will immediately burn an 1/8th, drink 2 bourbon sidecars and pop a xanax and F_ OFF right at 5pm. Your phone will just replay Yoshi City over and over again if the hospital calls you.

 

[Dave CX]

So, I spend about 40 hours/month doing Part A stuff, all nicely documented on my time sheets. That's pretty much a 0.25 FTE.
We are about 50% Medicare, I believe.

0.25 x 0.5 x 400,000 = $50,000 (which is what I'm getting)

I'm guessing that you are probably short changing yourself on the hours a bit.

 

[Pathbusiness]

When the hospital administration knows that the pathology group is a "captive corporation" you don't have much leverage to negotiate fat Part A. Its a service you provide in exchange for surgicals.

 

[pathstudent]

Huh, lol so they full expect you to get the remainder of your fees from billing CP Pro fees? What about the fact that a huge number of other payors dont pay it??

That is hilarious. What a con job!

Approaching this from a different angle, tell them every night you are on call you want $400, every night, EVERY GODDAMN NIGHT. 400x365=$146,000 pluses you up nicely.

If they dont pay you then you wont take call and every night you will immediately burn an 1/8th, drink 2 bourbon sidecars and pop a xanax and F_ OFF right at 5pm. Your phone will just replay Yoshi City over and over again if the hospital calls you.

No doubt about the call. My brother does ortho trauma for a level 1 trauma center and he gets paid 3000 per night from the hospital to take call even if there are no calls. If there are calls he gets to bill for that. He takes call two nights a week and so makes almost 300k a year just from call. The hospital pays all the subspecialty surgeons like that.

 

[LADoc00]

No doubt about the call. My brother does ortho trauma for a level 1 trauma center and he gets paid 3000 per night from the hospital to take call even if there are no calls. If there are calls he gets to bill for that. He takes call two nights a week and so makes almost 300k a year just from call. The hospital pays all the subspecialty surgeons like that.

That makes a valuable point. Since so many pathologists often have like zero RL friends and definitely not friends who are surgical subspecs, they dont even realize being on call and putting your social life on hold has a dollar amount attached to it. Too often, pathologists have no life and thus put no value whatsoever on putting their non existent social life on hold for call purposes.