Contract Renegotiation

[UMD0480]

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I am currently finishing up my first year out of fellowship and I am starting the process of contract negotiations for my second year. Based on the contracts of former fellows at my training program I feel there is a chance I am being underpaid. I wanted to gather a larger pool of data before I started talks with my practice.

Currently the contract I have is a base salary with no collections the first year. Next year is going to be a percentage of collections and the base salary goes away. At this point I am estimating that by the end of the first year I will have done around 1 million of collections. Collections are just the professional fees for procedures and New Patient visits (no facility fees from ASC).

I am trying to see what this type of production would net me in other practices.

 

[Agast]

For gross estimates:
A level 4 new patient visit will get you about $160.
A level 3 return patient visit will get you about $90.
If you're doing all your procedures at an ASC and only get your professional fee, you will collect anything from $100 (for sacroiliac joints) to $300 (for bilateral lumbar facet joints) and around $500 for the spinal cord stimulators and single level kypho.

If you're doing your procedures in office, that's like an extra $50-100 per injection.

These are really rough numbers, but you can estimate how many new and return patients you anticipate seeing in a day and how many procedures you think you will do in a week. Multiply your expected weekly collections by how many weeks you plan to work in a year. That will give you a rough estimate of how much you would expect to make by practice the medicine portion. Then consider what your monthly expenses will be. What is the overhead? If you want to increase your collections by seeing more patients you have to hire more staff or an NP/PA or you will be really behind in clinic. I highly doubt a single physician can bring in a million in collections without a midlevel provider. When I signed my contract and wanted to negotiate on vacation time, the group say "Look - you can take as much vacation time as you want. But any time you spend not working, is money you're not going to earn." That's the blessing and curse of private practice. Your in's and out's are directly correlated to how much elbow grease you're willing to put into it.

What I would want to know is if this group can guarantee you referrals. Presumably if they're still hiring there's a need that you can fill, but you will have to put in some leg work to make sure your clinic is filled with the kind of patients you want to see.

I saw a lot of starting contracts with baseline salary $250,000 per year + bonus after a percentage of collections. I suspect it's because the group wants to make sure they don't /lose/ any money on you if you're unable to fill your clinic and procedure roster and less because of nefarious purposes. However, they would still be making bank off of your contributions to their ancillaries.

 

[UMD0480]

thanks for the response.

1) I am currently doing 12 procedure days per month with one of those days being at an ASC (just collecting professional fees) and the other 11 in office.
2) I am seeing around 50 NP per week. On NP days I am seeing them with 2 PA's. PA's see the followups (no collection on followups)
3) I have no overhead expenses as I am an employee of the practice
4) In the 7 months that I have been at the practice referrals have never been a problem. Two full time marketers that keep them coming in from different practices around town.

I really am just trying to figure out the percentage of collections and what is a fair number to ask for.

 

[Yo GabbaPentin]

thanks for the response.

1) I am currently doing 12 procedure days per month with one of those days being at an ASC (just collecting professional fees) and the other 11 in office.
2) I am seeing around 50 NP per week. On NP days I am seeing them with 2 PA's. PA's see the followups (no collection on followups)
3) I have no overhead expenses as I am an employee of the practice
4) In the 7 months that I have been at the practice referrals have never been a problem. Two full time marketers that keep them coming in from different practices around town.

I really am just trying to figure out the percentage of collections and what is a fair number to ask for.

Ask to buy in to be partner.

 

[painfree23]

thanks for the response.

1) I am currently doing 12 procedure days per month with one of those days being at an ASC (just collecting professional fees) and the other 11 in office.
2) I am seeing around 50 NP per week. On NP days I am seeing them with 2 PA's. PA's see the followups (no collection on followups)
3) I have no overhead expenses as I am an employee of the practice
4) In the 7 months that I have been at the practice referrals have never been a problem. Two full time marketers that keep them coming in from different practices around town.

I really am just trying to figure out the percentage of collections and what is a fair number to ask for.

How many procedures on ur procedure days? Are the PAs coming out of ur salary and why are you not collecting on the followups?

 

[UMD0480]

25-30 on procedure days
PA's are not coming out of my salary or collections next year
honestly never thought about the followups. I guess since I was not seeing them and the practice is paying the PA's salary I never questioned it

 

[Ducttape]

you can get collections if you have the time to talk to PA, see patient, and write abbreviated note....

 

[painfree23]

25-30 on procedure days
PA's are not coming out of my salary or collections next year
honestly never thought about the followups. I guess since I was not seeing them and the practice is paying the PA's salary I never questioned it

25 to 30 procedures in a day, that's pretty good. Just in the mo

25-30 on procedure days
PA's are not coming out of my salary or collections next year
honestly never thought about the followups. I guess since I was not seeing them and the practice is paying the PA's salary I never questioned it

lot of bread and butter stuff? U should get something for doing so many procedures in a day. Also u get 30 procedures in ur clinic day? What's ur set up (ie staff etc), that's pretty good.

 

[UMD0480]

25 to 30 procedures in a day, that's pretty good. Just in the mo

lot of bread and butter stuff? U should get something for doing so many procedures in a day. Also u get 30 procedures in ur clinic day? What's ur set up (ie staff etc), that's pretty good.

All bread and butter stuff.

Set up: 1 procedure room, 4 bed "pacu", 1 consent room
Staff: 1 CRNA, Medical Assistant running fluoro, MA editing notes, 2 MA in pre-op/post-op: walking patients in/out, filling out consents.

 

[BobBarker]

Yea your boss is getting rich off of you. Billing for crna MAC for si joint injections is deplorable also. Probably the crna is out of network.

 

[UMD0480]

Thanks for your wisdom and insight Mr Barker.


Sent from my iPhone using SDN mobile

 

[BobBarker]

Let me put it this way...
if you were on RVU at $60 or so per unit, you would make well over $1,000,000 per year. It appears you have over twice as many procedures a month as I do...

 

[Agast]

Call me cynical, but it sounds like you signed up to join a block shop. You only see new patients, you do 30 procedures a day for 3 days a week? And you never follow up on how the patients improved after you did the injection? Do some of them need repeat or different procedures and is the PA the one who decides that? Who is prescribing the pain meds? There's a reason why they hired a new fellow and there isn't a seasoned pain guy doing this.


I mean, the only other place I've heard of that ran pain management similar to this got shut down by the DEA. The main guy would hire new grads and pay them $$$ until they started to feel a bit uncomfortable with what was going on. They did all the injections and he was writing for massive amounts of narcotics and collecting all the ancillaries in house. Now fortunately since he didn't want to share the big bucks, when he was put on trial they didn't name the other guys who worked for him...so those guys still have a career.

I don't mean to alarm you but I would sniff around to see what's happening on the PA side and what the other doctor is actually doing with his patients.

 

[clubdeac]

Yeah I think it would be hard to know if you were actually giving the patient the best and most appropriate injection if you were getting fed that many procedures from PAs. Not saying it's not doable. I just know if I were in that situation, I probably wouldn't have a clue on what the next step or plan was on half my patients. Just point and shoot... next patient

 

[UMD0480]

Our day is kind of stretched out as we are starting at 5:30am with the last procedure starting at 4pm. I was not a huge fan of starting that early but those are some of the first time slots to fill up

 

[UMD0480]

I do appreciate all the responses it has definitely given me lot to think about


Sent from my iPhone using SDN mobile

 

[gdub25]

I am also a first year guy who joined a private group and my production has been about what UMD0480 has described. Our setup is different though because we have no midlevels and I see all my own patients. It's a mature practice that had a reputation set years ago that it was mostly interventional and didn't write meds so we rarely get those types of patients showing up. Most of what we see is spine stuff and there are a lot of people who have acute herniations that we start on gabapentin, send to PT, give ESI, and send to surgeon if needed. Also get a lot of stuff sent by large surgeon group in town for diagnostic injections. Most procedures are done in the office without sedation. In my opinion it is a very ethical practice where we have the luxury of of only seeing the types of patients we want to see and do a lot of procedures because it's what I like to do and it makes more money. We aren't doing unnessessary procedures, we aren't prescribing many pills, and if there's a patient who needs help with a more comprehensive approach we send them to friends in town who do that because we recognize that we aren't that. For the original question, I get 33% of my collections for now and the rest is for overhead/sweat equity. After a year I get the option to buy in and at that point I get to keep whatever is left over after I pay my share of the overhead. We have no ancillaries. I might make them a little money this first year but in the long run it's a good investment in my opinion to be in the practice.

 

[painfree23]

I am also a first year guy who joined a private group and my production has been about what UMD0480 has described. Our setup is different though because we have no midlevels and I see all my own patients. It's a mature practice that had a reputation set years ago that it was mostly interventional and didn't write meds so we rarely get those types of patients showing up. Most of what we see is spine stuff and there are a lot of people who have acute herniations that we start on gabapentin, send to PT, give ESI, and send to surgeon if needed. Also get a lot of stuff sent by large surgeon group in town for diagnostic injections. Most procedures are done in the office without sedation. In my opinion it is a very ethical practice where we have the luxury of of only seeing the types of patients we want to see and do a lot of procedures because it's what I like to do and it makes more money. We aren't doing unnessessary procedures, we aren't prescribing many pills, and if there's a patient who needs help with a more comprehensive approach we send them to friends in town who do that because we recognize that we aren't that. For the original question, I get 33% of my collections for now and the rest is for overhead/sweat equity. After a year I get the option to buy in and at that point I get to keep whatever is left over after I pay my share of the overhead. We have no ancillaries. I might make them a little money this first year but in the long run it's a good investment in my opinion to be in the practice.

So in ur first year did how much incentive pay did u make?

 

[BobBarker]

Gdub you are doing over 360 procedures a month? That is what OP said he was doing.

 

[painfree23]

Gdub you are doing over 360 procedures a month? That is what OP said he was doing.

U should be clearing at least 500k doing this
360 procedures x 100 (minimum avg professional fee) x 12 -- 432k. Thats JUST PROCEDURES. With ur clinic and new pts u should easily be making 500k, but likely more. Hope ur not getting ripped off by the supervising physician