Collections in first several years

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usmleq

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Does anyone have any data or anecdotal numbers for what a fresh dermatology graduate can expect in collections if they join a mid sized dermatology group or multi-specialty group practicing general dermatology (in the southeast). The groups I am considering are all fairly busy and I would expect to have a full schedule within a few months of starting.

I'm trying to compare several offers, they all have varying levels of base pay and varying levels of bonuses, the bonuses are all based on collections so I need to have an estimate of what I might collect to compare the contracts.

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Does anyone have any data or anecdotal numbers for what a fresh dermatology graduate can expect in collections if they join a mid sized dermatology group or multi-specialty group practicing general dermatology (in the southeast). The groups I am considering are all fairly busy and I would expect to have a full schedule within a few months of starting.

I'm trying to compare several offers, they all have varying levels of base pay and varying levels of bonuses, the bonuses are all based on collections so I need to have an estimate of what I might collect to compare the contracts.

You can look up MGMA #s, you can ask the groups to provide collections numbers of their own staff with blacked out names, you can ask your colleagues for their numbers. I find there are too many variables to get a really good grasp.

Are you taking over for a departing or retiring physician? You may be busier earlier this way.
Do they have someone who will assist you in getting your schedule busy? I've seen a lot of graduates burned because they assume they will have full schedules within a few months of starting. To use myself as an example, I was promised absurd collections and yet, wasn't truly busy even 1 year into practice. Heck, I wasn't even credentialed on some insurance plans until 6 months into the job.
What is the payer mix like?
What are the contracted rates?
How is your schedule structured? Do you have time slots that will be more valuable? (e.g. surgery time, cosmetics, etc)

Maybe it's because I got burned (although that seems to be the rule amongst my peers rather than the exception) but my advice to a new graduate is to negotiate for a higher base and perhaps multiple tiers to the bonus (so even at lower collection levels, you'll still get something). Trying to compare offers with varying bonus levels that depend on collections just introduces too many variables. You would be better off picking the group where you can best see yourself long term (subjective) or simply the highest base pay (objective and guaranteed, unlike those promised bonuses)
 
I agree it really depends on the situation you are in. it is typically fair game to ask for general collection numbers of the other dermatologists in the practice. It is difficult to have very high collection numbers in the first year, partially because your schedule is not full or you are not seeing as many patients per hour as you are orienting, and partially because there is a lag time of typically 2-6 weeks for collections to come in. my first month I billed for 60k and my collections were 7k, and it is difficult to recover from that for your first year incentive bonus.
Based on my experience, full time general derms might bring in collections of 600k to 1.3 mil, but more like 400-750k for the first year. as stated above, consider asking the individual practice for rough collection numbers because it varies widely. hope that helps a little.
 
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I agree it really depends on the situation you are in. it is typically fair game to ask for general collection numbers of the other dermatologists in the practice. It is difficult to have very high collection numbers in the first year, partially because your schedule is not full or you are not seeing as many patients per hour as you are orienting, and partially because there is a lag time of typically 2-6 weeks for collections to come in. my first month I billed for 60k and my collections were 7k, and it is difficult to recover from that for your first year incentive bonus.
Based on my experience, full time general derms might bring in collections of 600k to 1.3 mil, but more like 400-750k for the first year. as stated above, consider asking the individual practice for rough collection numbers because it varies widely. hope that helps a little.
What percentage of your billing do you actually collect? And do insurance companies give you guys a hard time about it?
 
What percentage of your billing do you actually collect? And do insurance companies give you guys a hard time about it?
the office collects the vast majority of collectable billings. i don't know exactly the percentage of billing collected, but it's not a terribly relevant number anyway... we could "charge" $500 for a skin check, but it doesn't change the fact that medicare pays $85 for it, and that insurance Y pays 104% of medicare rates, insurance Z pays 106%, etc. it's not easy to negotiate with a lot of leverage as a private practice (hospital systems do a bit better); with the relative scarcity of derm in many areas, there's always the option of dropping private insurances with unacceptable rates or policies, and still maintaining more than enough patients to see.
 
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the office collects the vast majority of collectable billings. i don't know exactly the percentage of billing collected, but it's not a terribly relevant number anyway... we could "charge" $500 for a skin check, but it doesn't change the fact that medicare pays $85 for it, and that insurance Y pays 104% of medicare rates, insurance Z pays 106%, etc. it's not easy to negotiate with a lot of leverage as a private practice (hospital systems do a bit better); with the relative scarcity of derm in many areas, there's always the option of dropping private insurances with unacceptable rates or policies, and still maintaining more than enough patients to see.

Is 104-106% over medicare average for private insureers?
 
Collections will vary by the practice and institution, as well as location, patient mix, payer mix. For large institutions derm is usually low on the totem pole for collections - high volume but relatively low billing per visit, vs huge reimbursements for surgeries. worthwhile to find out how aggressive they are will collections and average collection rate. it is not uncommon to hear 50% as good.

Alternatively you can negotiate reimbursement based on billing not on reimbursement, and avoid the whole mess.
 
I strongly agree with asmallchild's advice of negotiating a good base salary for first year starting out. So many (often not transparent) variables with payor mix, credentialing, volume etc that it's important to have a decent base as a new graduate to sustain you while you get a better feel for the practice and ramp up. I'd avoid contracts mainly based on %collections alone starting out unless you have another source of income (wealthy spouse, significant savings etc) and are willing to take a risk.
 
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