ASC profit margins

[itzamemario]

Is there a place where I can find how much procedures should make in profit at an ASC after paying for the implants on average?
I'm looking mostly for SCS, pump, SIJ fusions, Minuteman, kyphoplasty, PNS, intracept.

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[BobBarker]

It all varies on your purchasing power and negotiation abilities. Many managed surgery centers may be in a GPO which has ok at best costs but then they get a fat rebate at the end of the year. Abbott is by far the most expensive that I use for SCS. Over $4000 higher for Eterna than MDT Intellis.


Si fusion- there are two many companies selling screws so should be able to drive this way down.

Intracept is around $7500 and not any negotiation.

 

[bedrock]

It all varies on your purchasing power and negotiation abilities. Many managed surgery centers may be in a GPO which has ok at best costs but then they get a fat rebate at the end of the year. Abbott is by far the most expensive that I use for SCS. Over $4000 higher for Eterna than MDT Intellis.


Si fusion- there are two many companies selling screws so should be able to drive this way down.

Intracept is around $7500 and not any negotiation.

I think our ASC pays $6150 for intracept, and there was no negotiation.

 

[BobBarker]

Probably $7500 is the hospital rate

 

[pmrmd]

We are 6841.80 for Intracept.
6900 for Inspan and Sacrix

 

[thecentral09]

Following. Looking to start a single specialty surgical center

 

[Status Sciaticus]

I think our ASC pays $6150 for intracept, and there was no negotiation.

We are 6841.80 for Intracept.
6900 for Inspan and Sacrix

what's yalls reimbursement rate?

 

[itzamemario]

Following. Looking to start a single specialty surgical center

Same. I'm looking at the ASIPP reimbursement, but not sure if that is gross or net, as in after I pay for the device from whatever company, what the ASC would get to keep.

 

[PMROralBoards]

It all varies on your purchasing power and negotiation abilities. Many managed surgery centers may be in a GPO which has ok at best costs but then they get a fat rebate at the end of the year. Abbott is by far the most expensive that I use for SCS. Over $4000 higher for Eterna than MDT Intellis.


Si fusion- there are two many companies selling screws so should be able to drive this way down.

Intracept is around $7500 and not any negotiation.

I naively didn’t realize that the different IPGs would be priced differently for the same company. Do you know the rough cost for the proclaim vs eterna? I’ve been generally recommending eterna over the proclaim for less pocket site pain if they are open to recharging. It wouldn’t impact how I counsel patients but would be good to know.

 

[BobBarker]

Proclaim costs around $1000 less than Eterna.

 

[BobBarker]

Vanta actually costs more than Intellis.

 

[Status Sciaticus]

what about intellis vs inceptiv?

 

[BobBarker]

Inceptive is about $6000 higher currently but told that will be fixed soon.

 

[Status Sciaticus]

Inceptive is about $6000 higher currently but told that will be fixed soon.

any improvement in reimbursement?

 

[BobBarker]

Reimbursement is the same no matter what system you use unless there is a new technology add on payment. Nevro had one many years ago.

 

[Orin]

Does anyone have a list of the average contribution margins for pain cases in ASCs vs HOPDs?

 

[gdub25]

I may do a call over this, have discussed in another thread and there was interest. I think there are far too ma y people wanting to open up an ASC than should. They are extremely expensive.

 

[gazzer]

I may do a call over this, have discussed in another thread and there was interest. I think there are far too ma y people wanting to open up an ASC than should. They are extremely expensive.

A deep dive would be great. Looking forward to it.

 

[PMROralBoards]

Opposite question- The ASC I’m associated with is not interested in giving me privileges for PNS, SIJ fusion, or MILD. I’ve expressed interest in becoming a shareholder in the future but haven’t gotten that information yet. I’m hospital employed but take my RFAs, most epidurals, scs trials, and of course implants to the ASC. I realize SIJ fusions are controversial, however the patient population I would generally offer this to are elderly patients with obvious sij pain who don’t get relief for longer than one month. Many already have lumbar fusions and hip replacements.

If I can’t get this resolved with the ASC, is there any world where I could negotiate increased compensation through some kind of medical directorship with the hospital to only do these procedures in the clinic and bring incisional cases to the OR?

 

[SpineandWine]

Opposite question- The ASC I’m associated with is not interested in giving me privileges for PNS, SIJ fusion, or MILD. I’ve expressed interest in becoming a shareholder in the future but haven’t gotten that information yet. I’m hospital employed but take my RFAs, most epidurals, scs trials, and of course implants to the ASC. I realize SIJ fusions are controversial, however the patient population I would generally offer this to are elderly patients with obvious sij pain who don’t get relief for longer than one month. Many already have lumbar fusions and hip replacements.

If I can’t get this resolved with the ASC, is there any world where I could negotiate increased compensation through some kind of medical directorship with the hospital to only do these procedures in the clinic and bring incisional cases to the OR?

Do office

 

[RoloTomassi]

Can't do PNS or mild in office. Can only do posterior allograft type SI fusion in office.

 

[SpineandWine]

Nalu in office trials
Do posterior SI fusion in office
Need ASC or HOPD for mild

 

[BoardingDoc]

Opposite question- The ASC I’m associated with is not interested in giving me privileges for PNS, SIJ fusion, or MILD. I’ve expressed interest in becoming a shareholder in the future but haven’t gotten that information yet. I’m hospital employed but take my RFAs, most epidurals, scs trials, and of course implants to the ASC. I realize SIJ fusions are controversial, however the patient population I would generally offer this to are elderly patients with obvious sij pain who don’t get relief for longer than one month. Many already have lumbar fusions and hip replacements.

If I can’t get this resolved with the ASC, is there any world where I could negotiate increased compensation through some kind of medical directorship with the hospital to only do these procedures in the clinic and bring incisional cases to the OR?

Why are you doing RFA in the ASC? Obviously, your compensation model may be unique in a way that favors this for you, but if you're purely collections based, you're getting paid less than half of what you would in office.

Edit: Nevermind. Saw that you're hospital employed, and thus almost certainly wRVU based. Makes sense.

 

[PMROralBoards]

Can't do PNS or mild in office. Can only do posterior allograft type SI fusion in office.

I would try to get set up with block time in the hospital OR. Wouldn’t be too difficult. Main reason I’m not doing that already is the potential partnership with the ASC and quicker turnover.

Nalu in office trials
Do posterior SI fusion in office
Need ASC or HOPD for mild

Only doing sprint for now, considering nalu.

Why are you doing RFA in the ASC? Obviously, your compensation model may be unique in a way that favors this for you, but if you're purely collections based, you're getting paid less than half of what you would in office.

Edit: Nevermind. Saw that you're hospital employed, and thus almost certainly wRVU based. Makes sense.

Wrvu based

 

[SpineandWine]

I would try to get set up with block time in the hospital OR. Wouldn’t be too difficult. Main reason I’m not doing that already is the potential partnership with the ASC and quicker turnover.

Only doing sprint for now, considering nalu.

Wrvu based

If you want more money, negotiate higher wRVU rate then. If you can get to 70$/wRVU, easy to get close to 1M

 

[PMROralBoards]

If you want more money, negotiate higher wRVU rate then. If you can get to 70$/wRVU, easy to get close to 1M

I get $66/wrvu currently. The clinic is set up to see up to 15 patients a day and only open four days a week. I can try to optimize this going into the future. What do you think would be fair to ask for an increase to? Generally do around 30 wrvu daily for clinic and 40-80 for procedures depending on if there are advanced ones or just bread and butter.

 

[SpineandWine]

I get $66/wrvu currently. The clinic is set up to see up to 15 patients a day and only open four days a week. I can try to optimize this going into the future. What do you think would be fair to ask for an increase to? Generally do around 30 wrvu daily for clinic and 40-80 for procedures depending on if there are advanced ones or just bread and butter.

I had similar at 66$/wRVU, was able to do 30 patients (NP and/or procedures) at my last job in North Carolina, hitting 700k or so

I think your issue is volume of patients/unit time if you want to increase revenue.

I’d do 66$/wRVU flat for office visits and procedures…Depending on your location, you may be able to increase wRVU to 70-75$/wRVU. However, at 66/wRVU for office visits and procedures, you can hit much higher number if you double your volume

 

[BoardingDoc]

I get $66/wrvu currently. The clinic is set up to see up to 15 patients a day and only open four days a week. I can try to optimize this going into the future. What do you think would be fair to ask for an increase to? Generally do around 30 wrvu daily for clinic and 40-80 for procedures depending on if there are advanced ones or just bread and butter.

You're better off increasing volume. 15 patients per day is quite slow.

 

[PMROralBoards]

I had similar at 66$/wRVU, was able to do 30 patients (NP and/or procedures) at my last job in North Carolina, hitting 700k or so

I think your issue is volume of patients/unit time if you want to increase revenue.

I’d do 66$/wRVU flat for office visits and procedures…Depending on your location, you may be able to increase wRVU to 70-75$/wRVU. However, at 66/wRVU for office visits and procedures, you can hit much higher number if you double your volume

I guess what I was asking is if I bring all of my procedural volume back to the hospital rather than the 75% that is currently at the ASC not owned by the hospital, is there any point in asking for supplemented income from it due to their significant increase in facility fees from my productivity.

You're better off increasing volume. 15 patients per day is quite slow.

In my last job I was seeing 30 patients a day but most were med refills. Very easy and quick appointments while still being able to eval for msk pathology.

At this point most of my visits are new patients to clinic or new patients to me with imaging to review, years of procedures to review that of course aren’t working anymore, full physical exams most of the time, etc and documenting enough to warrant 992x4s despite no med management. Also constant redirection of patients given their ages and clinical staff that I’m trying to replace because they complain any time I ask to add patients on.

I think if/when I get to the point that most patients are follow ups I can get back to 15 minute appointments but at this point I’m still building and getting to know my panel.

 

[BoardingDoc]

I guess what I was asking is if I bring all of my procedural volume back to the hospital rather than the 75% that is currently at the ASC not owned by the hospital, is there any point in asking for supplemented income from it due to their significant increase in facility fees from my productivity.

In my last job I was seeing 30 patients a day but most were med refills. Very easy and quick appointments while still being able to eval for msk pathology.

At this point most of my visits are new patients to clinic or new patients to me with imaging to review, years of procedures to review that of course aren’t working anymore, full physical exams most of the time, etc and documenting enough to warrant 992x4s despite no med management. Also constant redirection of patients given their ages and clinical staff that I’m trying to replace because they complain any time I ask to add patients on.

I think if/when I get to the point that most patients are follow ups I can get back to 15 minute appointments but at this point I’m still building and getting to know my panel.

Agree that getting everyone to the follow-up phase of things will make things much smoother. Some thoughts in the interim:

1: Getting a 992x4 should be easy in virtually all of these cases. Ostensibly, the patient has at least 1 chronic condition (their pain generator) with acute exacerbation or else they wouldn't be seeing you. You then are either A: writing an Rx, or B: booking them for a procedure. Both will get you a lvl 4 in the risk column. If you're doing neither, but reviewing imaging as you mentioned, just document your independent interpretation of the scan/Xrays. That's a lvl 4 in data. Any documentation beyond that for the purpose of billing is extraneous.

2: Get your scheduler to start using 20 min booking slots instead of 30. Or 15 instead of 20. You don't need to fill all of them, but staff will see that this is the expected number of patients and it should help better align their expectations with reality. Barring that, you already said you were working on replacing your lackadaisical staff which is clearly the right idea.

3: Full physical exams? I'm assuming you mean a thorough focused exam, and you're not burning time using a stethoscope or pressing on people's bellies.

4: There is certainly an art to telling patients to shut up and get back on track. I don't have any specific tips for this except to 1: commiserate and 2: say that you can get very facile with this over time which will greatly speed up your encounters.