Corporate says we are losing money every month. Are my calculations way off?

[actoutfit]

I work in a small community ED where we see approx 100 patients a shift.

We are staffed with 24 hours of doc coverage and 36 hours of midlevel coverage and a physician scribe for 24 hours.

If docs make approx 250/hr thats 6k/day

If midlevels make approx 70/hr thats 2.5k/day

We have a scribe that costs 20/hr thats $500/day

So staffing costs are 9k/day

If the company is collecting $150/patient that means they are collecting $15k/day.

How are we possibly losing money with this staffing model? Am I missing something? Or like usual - are the corporate overlords just full of it.

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[allantois]

They are I’m sure loosing money on useless admin

 

[alpinism]

You forgot the payments to private equity.

 

[Boatswain2PA]

Employee expenses are far beyond just hourly pay. Benefits, taxes, insurance, and reasonable overhead can easily cost 50% of the what employees are paid.

And then Corporate has to pay the $400K salary for the new Vice President of DEI. That's gotta come from somewhere.

 

[Vandalia]

I work in a small community ED where we see approx 100 patients a shift.

We are staffed with 24 hours of doc coverage and 36 hours of midlevel coverage and a physician scribe for 24 hours.

If docs make approx 250/hr thats 6k/day

If midlevels make approx 70/hr thats 2.5k/day

We have a scribe that costs 20/hr thats $500/day

So staffing costs are 9k/day

If the company is collecting $150/patient that means they are collecting $15k/day.

How are we possibly losing money with this staffing model? Am I missing something? Or like usual - are the corporate overlords just full of it.

If it is a “small community ED” there is no way they are collecting $150/patient. A lot of no-pays, Medicaid, etc. Billing and collections are very different. Unless it is a wealthy suburb

Also a lot of overhead: liability insurance, billing, etc.

That is assuming just the professional practice. If it is the ED itself you need to add in nursing, pharmaceuticals, equipment and all that.

 

[allantois]

If it is a “small community ED” there is no way they are collecting $150/patient. A lot of no-pays, Medicaid, etc. Billing and collections are very different. Unless it is a wealthy suburb

Also a lot of overhead: liability insurance, billing, etc.

That is assuming just the professional practice. If it is the ED itself you need to add in nursing, pharmaceuticals, equipment and all that.

I’m not in ED but I was under the impression that an average ED visit generates something like $10k with labs, imagining, etc

 

[Janders]

Assume of all the money coming in that 15% needs to go to coding. Billing, HR fees, banking, licensing, scheduling and actual required local admin duties. This could approach 20%.

The rest of the Money is available for employee cost but as mention that includes salary tax malpractice retirement health dental retirement etc. So maybe 75% to salary and 25% to other costs (highly variable depends on package).

Anyway we see about 100 a day, have about 34hr MD coverage and 20hr Pa coverage, and are not losing money. But we have completely open books so I know where every penny goes and 10% ain’t going to private equity…

 

[Janders]

I’m not in ED but I was under the impression that an average ED visit generates something like $10k with labs, imagining, etc

We are speaking professional fee only. $150 is a reasonable ballpark not knowing location or population or insurance status.

 

[allantois]

We are speaking professional fee only. $150 is a reasonable ballpark not knowing location or population or insurance status.

Yes but then you say factor in HR, nursing, etc so you should factor in all revenue

 

[Janders]

Yes but then you say factor in HR, nursing, etc so you should factor in all revenue

I said nothing about nursing.

I meant the HR to run a physician group. At least to meet the minimal corporate standards etc.

 

[emergentmd]

If your volume is 100/dy, have essentially 3 MD on daily pay (3 midlevel equivalent to a doc pay), and losing money on professional charges then you guys need a stipend. Some crappy insured/medicaid areas pay terribly but then they require a stipend. These hospitals to be functional must get gov assistance given the poor payer mix.

It is not your job to make corporate revenue positive. It is there job to find revenue somewhere.

100ppd with single coverage and 36 APP hours deserves a min of 300/hr.

When we were a SDG in an avg/alittle above avg payer mix. We were 100/dy with about 45hr MD coverage making 250-300/hr. you guys are essentially 36 hrs coverage for the same volume. No way should they decrease your pay which is what they are laying the seed for.

 

[WorkNoteEmergency]

That’s what they told us before they cut our pay and just a couple months before they hired a “Chief Value Officer”

 

[wholeheartedly]

Budgetary gerrymandering is an interesting idea I came across.

Even in the lab at big fancy hospital, I was managing a project that was going to save major dollars annually across the system, but cost us in our lab another $10k just once on an extension of an analyzer service plan (tiny portion of our budget) and the fricking bean counters were losing their minds. This was a big tertiary care system. They absolutely had the resources and expertise to calculate system savings but nope, each departments financial performance was assessed in isolation and managers raked over the coals for not reducing costs enough. No credit for reducing costs or increasing revenue somewhere else in the system outside our lab. jerks. And that toxic **** was why I left the awesome job that I loved. 😡

 

[thegenius]

Yes but then you say factor in HR, nursing, etc so you should factor in all revenue

Usually ER's charge patients twice - one is the doctor fee (ER doc, maybe Rads, too. Any doctor helping you out). Then pt gets a facility use fee, which is checking in, nursing, meds, lab draws, etc. Doctors collect on the first fee. The second fee is what keeps the ER open.

Good groups the doc gets about ~85% of the collections brought in. The 15% does go towards malpractice, scheduling, biling/coding are the biggies. Bad setups are where docs get < 70%. When we were with TeamHealth (e.g. TeamSuckySuck) they were taking like 33-35% of collections and we were oblivious to it for over a decade.

 

[JacobMcCandles]

I’m not in ED but I was under the impression that an average ED visit generates something like $10k with labs, imagining, etc

What is billed and what is collected are two very different things in the ED.

 

[JacobMcCandles]

How are we possibly losing money with this staffing model? Am I missing something? Or like usual - are the corporate overlords just full of it.

Who is corporate for you?

 

[Kryptocoin]

Someone is gaslighting you. Facility fee is where the money's at. How did you think some Urgent Cares stay profitable even when they're seeing only 7pts/day?

 

[NYEMMED]

Work harder, work faster. Some guy like Dom Bagnols need his fifth yacht

 

[EctopicFetus]

Work harder, work faster. Some guy like Dom Bagnols need his fifth yacht

He needs another tower at the Ohio State football stadium.

 

[GatorCHOMPions]

Someone is gaslighting you. Facility fee is where the money's at. How did you think some Urgent Cares stay profitable even when they're seeing only 7pts/day?

How come we don’t often hear about urgent care ownership as a viable path to financial success for EP’s? Does it tend to be difficult to sustain profits?

 

[Birdstrike]

There’s no way to know whether they’re truly losing money, without auditing their books. Even then, without having significant business or accounting knowledge, it would be hard to understand what you’re looking at.

Gross incompetence and mismanagement can lead to loses even when there shouldn’t be.

They could also be wordsmithing in regards to a certain department or segment of the company that is showing loses, while the whole is profitable, so you won’t be mad about some cuts, lack of services or other changes they’re making.

Or they could be outright lying.

Ultimately, if you’re an employee and not owner/part-owner, you’re playing a guessing game on what to believe.

 

[Dr Mantis Toboggan]

How come we don’t often hear about urgent care ownership as a viable path to financial success for EP’s? Does it tend to be difficult to sustain profits?

You have to put up a significant investment up front: lease or buy space, build it out, get equipment, staff etc. Then you either work it yourself for little or no money as a startup or pay people to do it for you, which delays profitability. Banks want their money guaranteed, and it’s tough to do all that for less than hundreds of thousands, if not a million depending on where you are. It can also be hard to get in network with insurance, yes you can try to go cash only but that’s the minority of your population that is willing to do that and not use insurance.

It can be done of course but working shifts is a much safer play.

 

[NYEMMED]

You have to put up a significant investment up front: lease or buy space, build it out, get equipment, staff etc. Then you either work it yourself for little or no money as a startup or pay people to do it for you, which delays profitability. Banks want their money guaranteed, and it’s tough to do all that for less than hundreds of thousands, if not a million depending on where you are. It can also be hard to get in network with insurance, yes you can try to go cash only but that’s the minority of your population that is willing to do that and not use insurance.

It can be done of course but working shifts is a much safer play.

What he/she said….

Plus Location, Location, Location

It needs to be in a well insured-affluent area to make money, but that’s where everyone wants their urgent care.

 

[Kryptocoin]

How come we don’t often hear about urgent care ownership as a viable path to financial success for EP’s? Does it tend to be difficult to sustain profits?

It used to be a profitable "out" for burnt-out ER docs. Then the market got flooded. Like most things, greed and mismanagement took hold. Some docs were opening over 10+ UCs/FSEs in a single state. The market crashed. Private equity swamped in and picked off most of the surviving ones.

The funny is, the core business model hasn't changed, though. You don't need to see a ton of pts to run a profitable UC or free-standing ER.

 

[EctopicFetus]

It used to be a profitable "out" for burnt-out ER docs. Then the market got flooded. Like most things, greed and mismanagement took hold. Some docs were opening over 10+ UCs/FSEs in a single state. The market crashed. Private equity swamped in and picked off most of the surviving ones.

The funny is, the core business model hasn't changed, though. You don't need to see a ton of pts to run a profitable UC or free-standing ER.

Fsed break even has been reported at 8-11 patients a day. For uc 25.

 

[Kryptocoin]

Fsed break even has been reported at 8-11 patients a day. For uc 25.

Yes, I guessed I used FSED/UC interchangeably. FSED is the one with low break-even numbers.

 

[emergentmd]

Bre

Fsed break even has been reported at 8-11 patients a day. For uc 25.

Break even numbers is 3 yrs old pre covid. Insurance pressures puts FSER break even around 12-17 depending on debt load. UC appears higher than 25ppd too but not by as much percentage wise.

FSERs are feeling the same pressures as CMGs/hospitals. FSERs at its birth used to open/print money and now transformed to having good operators.

 

[GassYous]

Sounds like you need to cut some useless admin

 

[EctopicFetus]

Bre

Break even numbers is 3 yrs old pre covid. Insurance pressures puts FSER break even around 12-17 depending on debt load. UC appears higher than 25ppd too but not by as much percentage wise.

FSERs are feeling the same pressures as CMGs/hospitals. FSERs at its birth used to open/print money and now transformed to having good operators.

Debt isn’t taken into account into break even numbers. That’s a huge variable.

 

[emergentmd]

Debt isn’t taken into account into break even numbers. That’s a huge variable.

Even without any debt, I would say break even is min 12ppd which includes the doc salary. If the docs do not take on a salary, then 8ppd would do it. The barrier is cost of opening one up which typically requires debt.

 

[emergentmd]

Sounds like you need to cut some useless admin

I wish this was the case, our doc owned group is quite lean. The cost of staffing, supplies, rent, equipment are all going up and reimbursement down. Good money still to be had but in now way will there be another First Choice b/c they are too bloated and VC have already caught the falling knife.

 

[EctopicFetus]

Even without any debt, I would say break even is min 12ppd which includes the doc salary. If the docs do not take on a salary, then 8ppd would do it. The barrier is cost of opening one up which typically requires debt.

Agreed. I know it’s reality to take on debt. Still 0.5 pph to break even is impressive. Meanwhile hospitals cry poor and won’t fund Ed’s seeing way more.

 

[TooMuchResearch]

I’m not in ED but I was under the impression that an average ED visit generates something like $10k with labs, imagining, etc

"gif of someone doing a spit take"

No, it's definitely not like that.

 

[thegenius]

"gif of someone doing a spit take"

No, it's definitely not like that.