Contract changes

[thesauce]

The center that my friend is working for is trying to make some changes in the physician contracts. He is employed by the institution (W2 employee). The contract used to be a pretty standard base plus production incentive, but they brought forward the following proposed changes:

1. All docs in the group must meet median wRVUs based on MGMA or 20% of the production wRVUs for the entire group is forfeit.

2. Docs must meet certain unspecified "quality metrics" each year. If they do not, all wRVU production bonus is forfeit along with 33% of the base salary.

3. There is a "hard cap" on total compensation which is some percent of the MGMA.

Has anyone heard of this kind of thing happening? Would you guys sign this?

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[medgator]

Would you guys sign this?

How desirable is the location? If rural/away from coasts, not on your life

 

[BobbyHeenan]

Looks awful.

This is nothing more than the hospital trying to reduce their salaries, and they will often do this to make it more complicated but also will introduce hand waiving about their new found concerns that they're paying over market value for your services. They will define market value by whatever metric they want.

I would ask that that formula be applied to the prior three years data and see what kind of income numbers they spit out to at least get an assessment as to what kind of hit you'd be taking.

Generally speaking, there is usually not BOTH a downside benefit AND upside benefit for one party - ie the hospital. In this contract it looks like if volume suffers, the hospital may not have to pay much to make up for volume loss...but if volume is super high, payment is capped...so it's a win win for the hospital.

 

[BobbyHeenan]

In the end this may come down to a take-it-or-leave-it type of situation. To start, I'd want to know:

- What is the impetus for changing our contract? Are you unhappy with our group? If so, how can we do better?
- If we must put quality metrics in here, can we not have a say as to what they are?
- Overall RVU is not simply a function of physician referral pattern (due to the rad oncs). If the hospital loses insurance contracts, there are med onc or surg onc shake ups, or any number of items outside of the control of the rad onc that may drop volume/RVU's, then why is our group held responsible for a basement RVU median? If we meet our "quality metrics" but volume goes down, can we not say that we are providing good care but something else is dropping volumes?

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My internet message board view says there are one or two things (or some combo going on)...

1. THey don't like the group/care being given there
2. They may like the group/care, but they want to pay you less.

 

[thesauce]

How desirable is the location? If rural/away from coasts, not on your life

It is kinda middle of the road. It is not easy to recruit physicians there.

 

[medgator]

It is kinda middle of the road. It is not easy to recruit physicians there.

If the group is pretty tight and united, I'd fight it and line up some locums work if the hospital decides to play hardball. It's hard enough to recruit one RO to some of these areas, let alone a group

 

[nkmiami]

In the present job market, how hard it is to recruit.

In the end this may come down to a take-it-or-leave-it type of situation. To start, I'd want to know:

- What is the impetus for changing our contract? Are you unhappy with our group? If so, how can we do better?
- If we must put quality metrics in here, can we not have a say as to what they are?
- Overall RVU is not simply a function of physician referral pattern (due to the rad oncs). If the hospital loses insurance contracts, there are med onc or surg onc shake ups, or any number of items outside of the control of the rad onc that may drop volume/RVU's, then why is our group held responsible for a basement RVU median? If we meet our "quality metrics" but volume goes down, can we not say that we are providing good care but something else is dropping volumes?

====

My internet message board view says there are one or two things (or some combo going on)...

1. THey don't like the group/care being given there
2. They may like the group/care, but they want to pay you less.

Couldnt the impetus just be an oversupply of radoncs? I am sure there are plenty of new fellowship trained radoncs out there looking. As has been said before, this kind of thing should become more common.

 

[medgator]

In the present job market, how hard it is to recruit.

Couldnt the impetus just be an oversupply of radoncs? I am sure there are plenty of new fellowship trained radoncs out there looking. As has been said before, this kind of thing should become more common.

The idea of using residency expansion to solve the maldistribution problem in RO is fraught with problems.

Many of those folks will likely readily sign up for exploitative private or academic positions on the coasts (case in point, the recent Stanford junior thoracic faculty "mentorship" position), driving those salaries even further down. Location trumps salary for many, esp when it comes to having to live in rural/underserved areas

 

[nkmiami]

The idea of using residency expansion to solve the maldistribution problem in RO is fraught with problems.

Many of those folks will likely readily sign up for exploitative private or academic positions on the coasts (case in point, the recent Stanford junior thoracic faculty "mentorship" position), driving those salaries even further down. Location trumps salary for many, esp when it comes to having to live in rural/underserved areas

That is true for some people, but many -certainly if I was a new grad- would much prefer this hospital/contract than the Maryland fellowship that was just posted today -and Maryland is throwing in the title of "instructor."

 

[Fpg1245]

The center that my friend is working for is trying to make some changes in the physician contracts. He is employed by the institution (W2 employee). The contract used to be a pretty standard base plus production incentive, but they brought forward the following proposed changes:

1. All docs in the group must meet median wRVUs based on MGMA or 20% of the production wRVUs for the entire group is forfeit.

2. Docs must meet certain unspecified "quality metrics" each year. If they do not, all wRVU production bonus is forfeit along with 33% of the base salary.

3. There is a "hard cap" on total compensation which is some percent of the MGMA.

Has anyone heard of this kind of thing happening? Would you guys sign this?

It’s unique but not unexpected. Seems like the hospital is looking to cut costs ahead of CMS new proposals which are unfortunately putting those employed physicians in the hospital in hot water. Or at least that’s what it looks like.

 

[medgator]

That is true for some people, but many -certainly if I was a new grad- would much prefer this hospital/contract than the Maryland fellowship that was just posted today -and Maryland is throwing in the title of "instructor."

Not if the location was in nowhereville USA and the existing group had just bailed. Word gets out fast. I suspect it would be even harder to replace the dept with 2-3 new grads at the same time.

I think the situation in the OP requires those physicians to grow a pair and see how far the hospital is willing to take it if fair negotiations don't go anywhere

 

[BobbyHeenan]

In the present job market, how hard it is to recruit.

Couldnt the impetus just be an oversupply of radoncs? I am sure there are plenty of new fellowship trained radoncs out there looking. As has been said before, this kind of thing should become more common.

Make no mistake, these kinds of things are going to become more frequent with the over supply issue.

However, much of this remains local market driven as well - is there another linac option in town for the group to cover? is this an area that is easy to recruit to? does the hospital have a built-in referral base (ie they run all the surgery/med onc groups in town), etc so they just perceive the rad onc dept to need to be staffed by a warm body? So it's really hard to say how much over supply drives these things without knowing all the details.

If it really is a hospital big enough to have multiple docs there (ie "group") then blowing up the whole contract and hoping for new grads to come in and run the place is not a great idea. However, if a competing group in town is looking to expand and offer a more competitive offer back to the hospital, that could be something they're looking at as well.

In my experience one other main player here is whether the hospital has hired a new administrator. Damn near every time some new compliance or newly hired/admin comes in they seem to come in guns blazing needing to justify their position by finding all the reasons they need to pay the doctors less - either newfound "compliance" issues or just new budget concerns, etc.

 

[scarbrtj]

One wishes "hospital employed physician" wasn't even a thing. I once read a story about a guy who owned a private jet, and he said something like "You know, you can't really talk about your private jet with someone else who doesn't have a private jet without it sounding like you're arrogant." In healthcare, the doctor is sort of cursed. He or she can't really talk about money or physician autonomy, etc., with non-doctors without it always seeming like a certain arrogance to others in healthcare. How many times has a physician administrator told a physician, "You have to realize: you're paid really well." The doctor is such an integral piece of the healthcare machine--perhaps the most integral. Yet, in our choosing to become "W2 employees" it's created a commoditization of the physician role; certainly it has not furthered heightened respect of the physician or maintained a "primacy" (if there ever really was that) of the physician role. The vast gulf between penury and the 50% MGMA salary represents an unrealized profit margin to those in healthcare who aren't constrained by MGMA silly salary metrics.

But... the genie can't be put back in the bottle. You've got what you got, kids.

 

[Gfunk6]

The vast gulf between penury and the 50% MGMA salary represents an unrealized profit margin to those in healthcare who aren't constrained by MGMA silly salary metrics.

YES, agree 100%. Well put.

 

[RickyScott]

One wishes "hospital employed physician" wasn't even a thing. I once read a story about a guy who owned a private jet, and he said something like "You know, you can't really talk about your private jet with someone else who doesn't have a private jet without it sounding like you're arrogant." In healthcare, the doctor is sort of cursed. He or she can't really talk about money or physician autonomy, etc., with non-doctors without it always seeming like a certain arrogance to others in healthcare. How many times has a physician administrator told a physician, "You have to realize: you're paid really well." The doctor is such an integral piece of the healthcare machine--perhaps the most integral. Yet, in our choosing to become "W2 employees" it's created a commoditization of the physician role; certainly it has not furthered heightened respect of the physician or maintained a "primacy" (if there ever really was that) of the physician role. The vast gulf between penury and the 50% MGMA salary represents an unrealized profit margin to those in healthcare who aren't constrained by MGMA silly salary metrics.

But... the genie can't be put back in the bottle. You've got what you got, kids.

Well, if they can pay less, why wouldnt they? Supply and demand is like gravity...
Radoncs coming out today are highly competent, and in a town where the hospital employs or is closely aligned with the referral sources, you just need an affable/competent doc (90% of us), not a go-getter/schmoozer.

 

[VulgarDisplayOfPower]

I would not join any organization that puts a cap on your total compensation. Overtime by its nature is supposed to be paid at a higher rate, certainly not less than the nominal rate, and definitely not ZERO. Wtf?

 

[Mandelin Rain]

If you hit the "hard cap" in October, do you just get the rest of the year off, or are you expected to donate months worth of indentured servitude to your administrative overlords?

 

[OTN]

This seems like a truckload of crap.

 

[Pointless]

If you hit the "hard cap" in October, do you just get the rest of the year off, or are you expected to donate months worth of indentured servitude to your administrative overlords?

I would imagine that they just get the rest of the year off, right? I mean, it wouldn't make sense to just make someone work for free.... who would do that? Right? RIGHT???!

/sarcasm