Compensation questions

[DopaDO]

Hi everyone. Had a question about comp.

At the moment- I'm a pretty high volume cataract, glaucoma, refractive. I do about 200 cataract surgeries a month and a fair amount of migs/lasik. I'm currently paid on an EWYK model. I have an investment in an ASC that is not owned by my group. I also have ownership coming through a nontraditional route that should not have anything to do with my compensation for the purposes of this question.

My first question is production based. My EWYK percentage changes depending upon how much I collect- this number typically falls around 38-44%.

My concern comes from talking to some of my colleagues. Especially those who are RVU based - they seem to be taking a much higher piece of their pie than I am. Maybe they are just lucky?

For example - medicare pays 540 for 66984 provided I do post op (which I usually do not). If we assume I do, 40% of that is 216 - if I don't do post ops which is more typical - then it's 172. That feels so low - compared to my friends who are rvu based who are making 280 and even in the 300s per case.

What gives? I was under the impression that my percent collections was pretty reasonable or even pretty good...

What does sdn say?

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[EyesOnThePryze]

Based on my weighted wRVU average, I am getting about $330 for 66984 including post ops, $264 with co-management. But for me, that is the same for all payers and doesn't change with private insurance. What would be your net pay be with all payers considered?

Edit: wrong math, now corrected.

 

[mjohnsonets]

I would say you seem to be doing fairly well if you're collecting up to 44% (average of your range 41%) of collections as a high volume anterior segment doc. You may make less per case based on medicare payments but what % of your cases are upgraded and have a fee for service component?

I'll preface by saying it may not be with all cases of RVU based comp but in my experience, most of your colleagues on an RVU model are in hospitals or academics and don't tend to have as high a conversion rate for premiums as PP docs and aren't necessarily compensated extremely well for them. In one case I've had a doc tell me they weren't compensated for multi-focals.

Overall, co-management does eat up a lot of the medicare reimbursement but it drives up the surgical volume and typically income as well. I guess you would need to sit down and see what the balance is between how much work you're doing now vs what you could be doing if you didn't co-manage and see if you like the difference in pay for the difference in work.

 

[Rhexis]

Hi everyone. Had a question about comp.

At the moment- I'm a pretty high volume cataract, glaucoma, refractive. I do about 200 cataract surgeries a month and a fair amount of migs/lasik. I'm currently paid on an EWYK model. I have an investment in an ASC that is not owned by my group. I also have ownership coming through a nontraditional route that should not have anything to do with my compensation for the purposes of this question.

My first question is production based. My EWYK percentage changes depending upon how much I collect- this number typically falls around 38-44%.

My concern comes from talking to some of my colleagues. Especially those who are RVU based - they seem to be taking a much higher piece of their pie than I am. Maybe they are just lucky?

For example - medicare pays 540 for 66984 provided I do post op (which I usually do not). If we assume I do, 40% of that is 216 - if I don't do post ops which is more typical - then it's 172. That feels so low - compared to my friends who are rvu based who are making 280 and even in the 300s per case.

What gives? I was under the impression that my percent collections was pretty reasonable or even pretty good...

What does sdn say?

Currently 66984 generates 7.35 wRVU. Work RVU Calculator - AAPC

I think the national average for Ophthalmology compensation/RVU is around $45-47 per RVU. That number varies per region, but the overall national average last year was around that. So, if we use $46, the average cataract would reimburse $338 to the employed doc in that system.

In terms of premium IOLs, that is an area where hopefully you have some negotiating power if the department is new. If you're joining a big group or system they probably have a policy in place already for the rest of the ophthalmologists, though, and you'll be stuck with that. The best contracts I've seen are where you get paid a percentage of your premium IOL charges, say 60% of your charge for the premium IOL (after the cost of the lens taken out). So, if somebody does a premium IOL and charges $1000 for surgeon fee for premium IOL, the surgeon in this system would get 60% of that, or $600.

You are very, very high volume. You do about 50 cases per week, which is probably in the top 1% in surgical volume in the country. The majority of surgeons I know do 35-75 cases per month.

In my system you'd make over $800,000 on cataract surgery alone given your numbers. This isn't even counting premium IOL income, which if you had even a decent conversion rate would increase your income by a lot. And that isn't even including income from clinic!

 

[DopaDO]

Based on my weighted wRVU average, I am getting about $264 for 66984 including post ops, $211 with co-management. But for me, that is the same for all payers and doesn't change with private insurance. What would be your net pay be with all payers considered?

Good point - I've been trying to get data on my Payer mix from management - we got a few other things going on so response of been slow - it's true that my reimbursement is better than I stated bc of my Payer mix. I just don't have the numbers yet.

 

[DopaDO]

I would say you seem to be doing fairly well if you're collecting up to 44% (average of your range 41%) of collections as a high volume anterior segment doc. You may make less per case based on medicare payments but what % of your cases are upgraded and have a fee for service component?

I'll preface by saying it may not be with all cases of RVU based comp but in my experience, most of your colleagues on an RVU model are in hospitals or academics and don't tend to have as high a conversion rate for premiums as PP docs and aren't necessarily compensated extremely well for them. In one case I've had a doc tell me they weren't compensated for multi-focals.

Overall, co-management does eat up a lot of the medicare reimbursement but it drives up the surgical volume and typically income as well. I guess you would need to sit down and see what the balance is between how much work you're doing now vs what you could be doing if you didn't co-manage and see if you like the difference in pay for the difference in work.

I have about a 30% conversion rate which is OK I think - and like I mentioned, I get at 40ish percent of the profit (after lens cost is subtracted). Most people I know who are on RVU system get a similar amount as I do for premium IOLS.

 

[DopaDO]

Currently 66984 generates 7.35 wRVU. Work RVU Calculator - AAPC

I think the national average for Ophthalmology compensation/RVU is around $45-47 per RVU. That number varies per region, but the overall national average last year was around that. So, if we use $46, the average cataract would reimburse $338 to the employed doc in that system.

In terms of premium IOLs, that is an area where hopefully you have some negotiating power if the department is new. If you're joining a big group or system they probably have a policy in place already for the rest of the ophthalmologists, though, and you'll be stuck with that. The best contracts I've seen are where you get paid a percentage of your premium IOL charges, say 60% of your charge for the premium IOL (after the cost of the lens taken out). So, if somebody does a premium IOL and charges $1000 for surgeon fee for premium IOL, the surgeon in this system would get 60% of that, or $600.

You are very, very high volume. You do about 50 cases per week, which is probably in the top 1% in surgical volume in the country. The majority of surgeons I know do 35-75 cases per month.

In my system you'd make over $800,000 on cataract surgery alone given your numbers. This isn't even counting premium IOL income, which if you had even a decent conversion rate would increase your income by a lot. And that isn't even including income from clinic!

This right here is the crux of my issue.

336 is insanely better than what I'm currently getting. Again, in speaking to others - it feels like my percentages are pretty good - I really need to do a deeper dive into my payer mix as a previous poster stated but I can't imagine I'm even close to this number even considering my Payer mix.

I don't think I can negotiate better percentages and I doubt my practice would switch to an RVU compensation so I may just be stuck...

 

[EyesOnThePryze]

This right here is the crux of my issue.

336 is insanely better than what I'm currently getting. Again, in speaking to others - it feels like my percentages are pretty good - I really need to do a deeper dive into my payer mix as a previous poster stated but I can't imagine I'm even close to this number even considering my Payer mix.

I don't think I can negotiate better percentages and I doubt my practice would switch to an RVU compensation so I may just be stuck...

Sorry, it may have been too early in the morning but my math was screwed up in my previous post. My weighted wRVU average is right around $45 so my number is $333 for 66884.

The slower colleagues in my group are closer to $30-$35 per wRVU.

One other thing that stands out to me is your 40% of collections, which implies 60% overhead. In talking with my PP friends, that seems on the high side. If you can lean practice your way to 50%, that should make a huge difference (for you and all your partners).

I would guess that with a decent rate of private insurance and lower overhead, you should be doing favorably when comparing to employed models.

 

[DopaDO]

Sorry, it may have been too early in the morning but my math was screwed up in my previous post. My weighted wRVU average is right around $45 so my number is $333 for 66884.

The slower colleagues in my group are closer to $30-$35 per wRVU.

One other thing that stands out to me is your 40% of collections, which implies 60% overhead. In talking with my PP friends, that seems on the high side. If you can lean practice your way to 50%, that should make a huge difference (for you and all your partners).

I would guess that with a decent rate of private insurance and lower overhead, you should be doing favorably when comparing to employed models.

So before I negotiated my compensation rates, I talked to a few friends in private practice - they all had around 35% rate - so I thought getting 40% or more was really good. I also looked at several articles online from reputable sources- these articles indicated that typical ophthalmology practice overhead was around 55-60% - again in line with what others from multiple groups have told me both in my area and in other parts of the country. Retina has lower overhead - are the folks you are talking to retina based? I'm definitely going to need to talk to my group about this.

Maybe others can weigh in about overhead?

 

[dantt]

I have about a 30% conversion rate which is OK I think - and like I mentioned, I get at 40ish percent of the profit (after lens cost is subtracted). Most people I know who are on RVU system get a similar amount as I do for premium IOLS.

Sounds like you clear 7 figures easily. I would fly under the radar and milk it for as long as possible. It's unusual to get that high of a percentage percentage an employed doc but if you are more power to you.

 

[Openglobetrotters]

my compensation rate is 35%. 200 cataracts a month is awesome!