Compensation

[HouseofPain]

Hey everyone. I would like any advice as my employment contract is being renegotiated. To give a little background I am employed by private anesthesia group which is contracted to provide pain services to a hospital through a PSA. I'll be working for the group for two years and have really built the practice from scratch. I will be up for partnership in two months. Currently I'm salaried at less than $400,000 with benefits. I do approximately 50-60 procedures a week and see close to 40 new patients/week with a few followups. I was given a NP which I didn't request and she sees ~75pts/wk. what has been offered by the group moving forward is an eat what you kill model basically total professional fees minus expenses from the group (np salary/benefits + 2/3rds of office staff for the group 4 people). The facility fees generated for the hospital aren't taken into account. I feel somewhat caught in the middle The hospital has done little to promote the clinic and really only provides me a space and a few nurses. The clinic is inefficient and the hospital/group have done little to improve it. The group has done little as far as marketing. The billing company has been terrible net collection rate <80% and AR through the roof. With all that being said they were still able to collect >1.5mil last year and the practice is profitable. Our current monthly growth rate is better than 30% year over year. My options at this point would be 1) equal compensation as a partner 2) base salary (significantly higher than current) + bonus 3) leave group and try to work out wRVU model with hospital 4) go out on my own 5) join another group. Any help or thoughts would be appreciated.

---

Members don't see this ad.

 

[willabeast]

You might factor in getting a partner if you think you will keep growing 30% a year. Are you on call 24/7?

 

[HouseofPain]

You might factor in getting a partner if you think you will keep growing 30% a year. Are you on call 24/7?

No call

 

[Ligament]

Hey everyone. I would like any advice as my employment contract is being renegotiated. To give a little background I am employed by private anesthesia group which is contracted to provide pain services to a hospital through a PSA. I'll be working for the group for two years and have really built the practice from scratch. I will be up for partnership in two months. Currently I'm salaried at less than $400,000 with benefits. I do approximately 50-60 procedures a week and see close to 40 new patients/week with a few followups. I was given a NP which I didn't request and she sees ~75pts/wk. what has been offered by the group moving forward is an eat what you kill model basically total professional fees minus expenses from the group (np salary/benefits + 2/3rds of office staff for the group 4 people). The facility fees generated for the hospital aren't taken into account. I feel somewhat caught in the middle The hospital has done little to promote the clinic and really only provides me a space and a few nurses. The clinic is inefficient and the hospital/group have done little to improve it. The group has done little as far as marketing. The billing company has been terrible net collection rate <80% and AR through the roof. With all that being said they were still able to collect >1.5mil last year and the practice is profitable. Our current monthly growth rate is better than 30% year over year. My options at this point would be 1) equal compensation as a partner 2) base salary (significantly higher than current) + bonus 3) leave group and try to work out wRVU model with hospital 4) go out on my own 5) join another group. Any help or thoughts would be appreciated.

With the volume you are doing, you should be making MUCH more than 400k. I have no idea how you could see 40 new patients per week. At minimum 30 minutes per new patient, thats 20 hours of new patients per week minimum.

 

[Ducttape]

that is off topic, but.... its the "a few follow up" part that you're forgetting/missing. ie new patient eval and injections, or 2 1/2 days of new patients, 2 1/2 days of procedures.
that sounds like the recipe for a pure interventional pain practice/block shop.




you probably have a prohibitive no-compete clause with that set up. what is the issue for you to get all the professional fees and the hospital to collect all the facility fees to pay for nursing etc.?

if you have an issue with the existence of facility fees, then by all means, go independent...

 

[jsaul]

that is off topic, but.... its the "a few follow up" part that you're forgetting/missing. ie new patient eval and injections, or 2 1/2 days of new patients, 2 1/2 days of procedures.
that sounds like the recipe for a pure interventional pain practice/block shop.




you probably have a prohibitive no-compete clause with that set up. what is the issue for you to get all the professional fees and the hospital to collect all the facility fees to pay for nursing etc.?

if you have an issue with the existence of facility fees, then by all means, go independent...

agree.... do you think you deserve part of these facility fee too??

I think you getting your professional fees- minus overhead is a great deal

 

[HouseofPain]

that is off topic, but.... its the "a few follow up" part that you're forgetting/missing. ie new patient eval and injections, or 2 1/2 days of new patients, 2 1/2 days of procedures.
that sounds like the recipe for a pure interventional pain practice/block shop.




you probably have a prohibitive no-compete clause with that set up. what is the issue for you to get all the professional fees and the hospital to collect all the facility fees to pay for nursing etc.?

if you have an issue with the existence of facility fees, then by all means, go independent...

I run a multidisciplinary comprehensive pain clinic but I don't give narcs to everyone who walks through the door. I tend to focus on interventional non narcotic meds as first line. The NP handles follow ups and med management for the most part. I don't see a lot of follow ups because of the new patient and procedure load. I do clinic 2 days a week and they are long days with no lunch/breaks spend on average around 30min a consult some a little less. I do procedures 3 days a week and average close to 20/day and I'm usually done by 1 or 2. For me this balances out the eval days. I don't think the professional fees-expenses is a bad deal if the collections were good (my collection rate is terrible and AR is through the roof). In my opinion the group/hospital have to take some responsibility for collections and improve them. I honestly feel until the collection issue is resolved I need some sort of guaranteed salary (I was thinking 550k?). I had the no-compete thrown out before I agreed to the position

 

[lobelsteve]

with your workload, anything less than 850k plus bennies is a non-starter.

 

[Dr. Ice]

“Blockjockinit”. If he works in the northeast or Cali he would be making at max 375-400/year with that schedule...although they are prolly killing it on facility fees off of his radiation exposure. The hospital will probably get his NP to eventually do the injections and pay said midlevel 1/3 his salary to do the job regardless of how “unideal” the fluoro pics are...

 

[Ducttape]

You don’t really run a multi disciplinary library clinic seeing new patients and then only seeing a prepped back.

Not prescribing narcotics(your term, not mine) is great but doesn’t define you as multidisciplinary.

 

[HouseofPain]

You don’t really run a multi disciplinary library clinic seeing new patients and then only seeing a prepped back.

Not prescribing narcotics(your term, not mine) is great but doesn’t define you as multidisciplinary.

Apparently you didn't read the post. I do narcotic med management as well as work with a pain psychologist and a group of surgeons (ortho and neuro) if surgical intervention is warranted. My patients routinely do PT/OT as well. Funny how I asked for advice about compensation and how should I approach and you want to question how I practice.

 

[lobelsteve]

Apparently you didn't read the post. I do narcotic med management as well as work with a pain psychologist and a group of surgeons (ortho and neuro) if surgical intervention is warranted. My patients routinely do PT/OT as well. Funny how I asked for advice about compensation and how should I approach and you want to question how I practice.

"The NP handles follow ups and med management for the most part."

Do you supervise the NP? So you are writing the narcs but not seeing the patient?

 

[Ducttape]

im calling a spade a spade. just come and say "Im run an IPM, and I want advice"

and the reason it is important is that will guide you to different directions based on salary. if you were running a primary multidisciplinary clinic (ie injections are not the majority of what you do), you could approach the hospital with what you can offer the system and the system's PCPs on pain management, and that you should consider joining the hospital in a wRVU model. talk up the PT/OT referrals, the opioid reduction practices in your clinic, ancillaries....

for an interventional pain management clinic, this is not a good option. if you become a physician of the hospital, and based in the hospital, you will probably be drawn in to seeing a much higher ratio of poor insurance and med management/non-IPM cases, harming your wRVUs.

you wont get facility fees. don't ask for them. I remember reading a post about it may run into Stark Laws?

If you join another group, you would lose all cache with the hospital. they are currently contractually tied to your group. and they want your facility fees.


what are your current professional fees? you should look closely at the books and you might find the "salary" offered by eat what you kill would be most satisfactory... (1.5 mil probably includes facility fees.)

 

[Ronin1]

Your percentage collected is only relevant to how realistic your charge structure is. For example charging high fees to Medicare and then writing down 90% off the charges.

But in any event if you are personally generating 1.5 in professional fees alone you need a better deal. Easy way is to eat what you kill in current situation. Should be at least 50%collections.

Best financial way. Open your own office