autonomous practice under another ortho practice?

Started by myrandom2003
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graph 1 - a legitimate graph showing discrepancy between administrators and physicians as a whole. a good grounds for discussion

graph 2 - an individual doctors $/wRVU which is not representative of a standard salary.

chart 3 - not related to salary at all. but a good grounds for discussion



you bring up legitimate points. however, your graphs are not concordant and you cannot draw any conclusions to the industry as a whole with the second graph.



and you added a completely separate issue with the last image.

please dont conflate the 2.
 
Hello, I am just shy of two years at my practice and would like to gain an understanding going into renegotiations. I would appreciate and welcome any input.

In my second year of practice at an ortho practice, I am projected to produce 1.2-1.3 million in professional fees with about 4 million in facility fees at the ASC. My projected wRVU is between 14k and 15k this year. At this production, the proposed package would be around 450-500k in take-home salary before income tax. I am the first of my specialty in my practice.

My practice is offering partial ancillary shares (including the ASC) but no partnership in the practice. There is no promise of it increasing to a full share which all surgeon partners get to. My overhead structure is such that at the collection production above, my effective overhead (after paying payroll taxes, malpractice, etc.) is around 70% of collections.

Based on the numbers above, what would a reasonable salary/compensation package be in your opinion? Happy to share more information if it would be helpful.
 
pmr10 said:
Hello, I am just shy of two years at my practice and would like to gain an understanding going into renegotiations. I would appreciate and welcome any input.

In my second year of practice at an ortho practice, I am projected to produce 1.2-1.3 million in professional fees with about 4 million in facility fees at the ASC. My projected wRVU is between 14k and 15k this year. At this production, the proposed package would be around 450-500k in take-home salary before income tax. I am the first of my specialty in my practice.

My practice is offering partial ancillary shares (including the ASC) but no partnership in the practice. There is no promise of it increasing to a full share which all surgeon partners get to. My overhead structure is such that at the collection production above, my effective overhead (after paying payroll taxes, malpractice, etc.) is around 70% of collections.

Based on the numbers above, what would a reasonable salary/compensation package be in your opinion? Happy to share more information if it would be helpful.
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There are a million ways to do this math, but if your total comp is 500k for 14-15k wRVU you are being royally screwed.
Simple calc is to take a reasonable dollar per wRVU and multiply it out I don't have recent MGMA data, but even if you low-ball yourself at 60/wRVU, that means you should be getting paid a bare minimum of 840k (14000 wRVU * 60). In reality, you should be making more than that if you're actually as productive as you claim, as this group is making a killing off of you.
 
Underpaid.

Pro fees seem low for how busy you are.

Buying ASC shares is like buying stock. You should buy if there's growth potential. Sounds like it's already humming.
 
Interesting topic, in my opinion pain management in orthopedics is not comparable to hopd practice, so much easier to get 10k plus wrvus, some physician in my area does 90 injections in the morning, he does not seem to be rushed, very standard to see 50 office patients, however this practice is not fair, you should have equal partnership as any other orthopedics guys. 1.2 m professional fee with 4 m facility fee tells us you are doing more higher asc rewarding procedures, it is the key to negotiate with asc shares. Good luck!
 
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RoloTomassi said:
No way, this sounds impossible
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I won’t believe until i saw, this is a very extreme example in ortho practice, only lumbar injections, no rfa, most of them one level injections, patients come in as a group of 6-8, everything is ready to start, quick in and out.
 
SC Tian said:
I won’t believe until i saw, this is a very extreme example in ortho practice, only lumbar injections, no rfa, most of them one level injections, patients come in as a group of 6-8, everything is ready to start, quick in and out.
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SC Tian said:
I won’t believe until i saw, this is a very extreme example in ortho practice, only lumbar injections, no rfa, most of them one level injections, patients come in as a group of 6-8, everything is ready to start, quick in and out.
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Fluoro pics saved look good? Patient always doing the correct side? Seems impossible to do this well and not make a mistake even if truly an assembly line.
 
MD87 said:
Fluoro pics saved look good? Patient always doing the correct side? Seems impossible to do this well and not make a mistake even if truly an assembly line.
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This is a very good question, Using the standard criteria in this forum they are not good, i was following up how he does for a while, i believe there are some mistakes, so he changed to interlaminar for most injections LOL
 
SC Tian said:
some physician in my area does 90 injections in the morning, he does not seem to be rushed
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90 injections in the AM? Assuming you start at 7a and go to noon, that's 90 injections in 5 hours. 18 injections an hour. That's one injection every 3.33 minutes, nonstop for 5 hours. At that rate, the amount of time it takes to walk from one procedure room to the next and to put on gloves actually becomes very relevant. Also, every single patient is as compliant as a cadaver? None of them vagal, squirm, complain, need to reposition, ask a question etc etc etc?There is also obviously no way to generate a chart contemporaneously in that timeframe.

I mean, this is theoretically possible, but this seems like malarkey.
 
BoardingDoc said:
90 injections in the AM? Assuming you start at 7a and go to noon, that's 90 injections in 5 hours. 18 injections an hour. That's one injection every 3.33 minutes, nonstop for 5 hours. At that rate, the amount of time it takes to walk from one procedure room to the next and to put on gloves actually becomes very relevant. Also, every single patient is as compliant as a cadaver? None of them vagal, squirm, complain, need to reposition, ask a question etc etc etc?There is also obviously no way to generate a chart contemporaneously in that timeframe.

I mean, this is theoretically possible, but this seems like malarkey.
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good point, the set-up is the key, he has three MAs, two RNs during the entire procedure session, starting 7 to 12:30, his injection normaly less than 1 min, definitely less than 2 min, the staff takes care the rest.
 
SC Tian said:
good point, the set-up is the key, he has three MAs, two RNs during the entire procedure session, starting 7 to 12:30, his injection normaly less than 1 min, definitely less than 2 min, the staff takes care the rest.
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lol. Being a bad doctor is key. Nothing else.
 
There is a doc that does 60 at the asc. But that's all day. I thought that was bad but apparently that's nothing
 
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Doing 90 in a day and thinking it’s legit is similar to thinking someone like lance Armstrong is legit. Some docs are slow, some are fast, but if you’re superhuman then there’s something else at play…
 
MD87 said:
Doing 90 in a day and thinking it’s legit is similar to thinking someone like lance Armstrong is legit. Some docs are slow, some are fast, but if you’re superhuman then there’s something else at play…
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I agree; even 90 in one day is more than I can handle in ASC. The group investigated him in some way two years ago, and surprisingly, most patients like him and his shots. How funny it is! However, we deviate too much from the topic. What I mean to say is productivity in ortho groups can be much higher than in HOPD settings. I was looking at my professional and facility revenue; it is about a 1:2 ratio. I think this is in the norm range.
 
Doctodd said:
this is a 2+ year old thread.......

OP how did it work out?
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Overall pretty good. Lots of challenges and pushback with growing the practice, but have just put my head down to grind it out. Just want to be fairly compensated. I'm told that monthly overhead in the practice is 100-125k per person, so seems quite high, but it is an expanding practice. I've gotten some of the things I've asked for, but not all. No mid-level still and spending more days in the ASC than in the office procedure suite. Hence I think the relatively low collections in comparison to wRVU.

On another note, our percentage collected from billed is around 30-40%. I am billing 250-350k per month, but collecting only around 100-110k on average per month. Not sure why it is so low... Any thoughts? Payor mix isn't terrible so I am confused.
 
The number you bill is a made-up number, you always grade your services at a higher price than your contract. You can set up monthly meetings with your billing department to see if your collections are half your billing due to write-offs vs denied payments.
 
Without pay structure changes, it is almost impossible to get fairly compensated. 4m facilty revenue probably is the top revenue by single physician in asc. It all depends on how much they value you, you can show them if you decide to do all procedures in office, how much revenue they will lose, there are many ways they can compensate your asc profits that is likely more than your salary if they are willing to.
 
SC Tian said:
Without pay structure changes, it is almost impossible to get fairly compensated. 4m facilty revenue probably is the top revenue by single physician in asc. It all depends on how much they value you, you can show them if you decide to do all procedures in office, how much revenue they will lose, there are many ways they can compensate your asc profits that is likely more than your salary if they are willing to.
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Thanks for your thoughts.

Is there a quick and easy way to see what I could bring in if I did all of my injections and scs trials in office instead for the past year? I do cervicals as well which I don't know if I'd bring them out to clinic.

Also they are structuring a method of percentage of pro fee collections plus a fraction of asc shares that may rise to a nearly a full share every few years. The partners have an increase in their fractional share every year until they are at a full share.

I almost think a wrvu structure makes more sense but am told that owning ancillaries is important, esp at a profitable asc. Is this true?
 
Agast said:
The number you bill is a made-up number, you always grade your services at a higher price than your contract. You can set up monthly meetings with your billing department to see if your collections are half your billing due to write-offs vs denied payments.
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Thank you. I think they are mostly for write offs. Does that just mean we are over billing?

Just doesn't seem consistent because the others in our practice collect nearly 50 percent of what they bill. I'm closer to mid 30's.
 
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.neuromodulation.abbott/content/dam/nm/neuromodulation/downloadables/her/021924/NationalChronicPainCodingGuide.pdf
some idea about scs, rfa, you should be able to get from your biller. Ancillaries are MRI, PT, xrays and DMEs, not too much compared to asc profits.
 
pmr10 said:
Thank you. I think they are mostly for write offs. Does that just mean we are over billing?

Just doesn't seem consistent because the others in our practice collect nearly 50 percent of what they bill. I'm closer to mid 30's.
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You're not over billing. Your number is arbitrarily higher than what your colleagues' numbers are relative to what insurance will pay. To reiterate, this percentage doesn't matter (barring you trying to balance bill patients which is an entirely different conversation and frequently irrelevant in a post NSA world).

What is helpful to know is what percent of your bills are being paid. This does not mean "if I bill $1000 dollars, how much do I collect." This means: "if I see 1000 patients and send them a bill, how many of those bills result in money coming into the practice? 1000? 900? 500?" The amount that comes in is generally unrelated to the amount that you bill as insurers will set their own reimbursement for each procedure. You just want to make sure that each bill you write is triggering that reimbursement amount and isn't getting denied.
 
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SC Tian said:
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.neuromodulation.abbott/content/dam/nm/neuromodulation/downloadables/her/021924/NationalChronicPainCodingGuide.pdf
some idea about scs, rfa, you should be able to get from your biller. Ancillaries are MRI, PT, xrays and DMEs, not too much compared to asc profits.
Click to expand...
Thank you! Looks like I have a lot of number crunching to do 😂
 
BoardingDoc said:
You're not over billing. Your number is arbitrarily higher than what your colleagues' numbers are relative to what insurance will pay. To reiterate, this percentage doesn't matter (barring you trying to balance bill patients which is an entirely different conversation and frequently irrelevant in a post NSA world).

What is helpful to know is what percent of your bills are being paid. This does not mean "if I bill $1000 dollars, how much do I collect." This means: "if I see 1000 patients and send them a bill, how many of those bills result in money coming into the practice? 1000? 900? 500?" The amount that comes in is generally unrelated to the amount that you bill as insurers will set their own reimbursement for each procedure. You just want to make sure that each bill you write is triggering that reimbursement amount and isn't getting denied.
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Is this something that would be easily attainable if I ask my billing department to look into how many injections and em visits I did and how many were reimbursed in the past month? Seems simple enough of an ask...
 
Hello I was wondering if I could get any insight. Appreciate your tips and thoughts on the renegotiation terms.

After negotiating, I was given 3 options, none of them with partnership:

1) Increased OH structure with 80% of ancillaries (full share is around 450-500k per year and in the MRI/ASC) -- rising to 80% shares within 3-4 years in a tiered, sweat equity structure
2) Slightly increased OH structure with a smaller percentage of ancillaries
3) Only collections based with a more favorable OH structure, but no ancillaries

My questions are:

1) As a non-partner, are ancillary shares paid out as K1? If so, are taxes on this considerably less? If so, how much usually, compared to W2 in a non-income taxed state?
2) Which of the three options is the best, assuming the dollar amount is the same at the end of the 3-4 years after the "buy-in" period is over?

Thank you in advance
 
pmr10 said:
Hello I was wondering if I could get any insight. Appreciate your tips and thoughts on the renegotiation terms.

After negotiating, I was given 3 options, none of them with partnership:

1) Increased OH structure with 80% of ancillaries (full share is around 450-500k per year and in the MRI/ASC) -- rising to 80% shares within 3-4 years in a tiered, sweat equity structure
2) Slightly increased OH structure with a smaller percentage of ancillaries
3) Only collections based with a more favorable OH structure, but no ancillaries

My questions are:

1) As a non-partner, are ancillary shares paid out as K1? If so, are taxes on this considerably less? If so, how much usually, compared to W2 in a non-income taxed state?
2) Which of the three options is the best, assuming the dollar amount is the same at the end of the 3-4 years after the "buy-in" period is over?

Thank you in advance
Click to expand...

You can't be paid based on ancillaries unless you are an owner.
 
That's what I thought but there have been several other pain docs getting shares in the asc without being a shareholder at other facilities near me. Not sure how that worked...

drusso said:
You can't be paid based on ancillaries unless you are an owner.
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What is a typical overhead for an interventional pain practice within a larger ortho group? If generating around 1.5 million in professional fees, would about 900k in overhead be reasonable?
 
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