Employeed Pathologist?

[musom]

I'm currently an employed fella, by choice. I'm talking to the admin team soon to work on my first contract renewal. Without disclosing too much financial information, my current compensation is strictly a base salary. Admin is considering a more incentive (productivity) based compensation plan. In it's most basic design, my current base will not decrease and after my base is covered I basically will retain most of the net of the overage, quarterly. Admin is very unfamiliar with compensation models on Pathologists, as I'm the first and only employed Pathologist. I'm trying to educate/protect myself.

My questions to the audience:

Does anyone have experience with RVU/CPT driven compensation models? Anything I should look out for?

Admin has said an "average Pathologist will obtain about 4500 RVU's/yr" Anyone familiar with this number? How can I standardize an RVU/CPT goal to me/my institution? (ie....I do X frozen sections/yr, X in-house IHC, and see X accessions/yr).

Any idea how an RVU is calculated based on a CPT? (ie....88305 = X RVU?)

Lastly, what about incentive bonuses? Can any employed groups out there comment on potential bonuses? Things I've heard of before:

1. >90% of frozen sections under 20 minutes
2. >90% agreement on external QA review (I'm a solo pathologist)

Thanks for your help.

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[Autopsy101]

There may be a list or an easier way to see it, but this data can be found on CMS website if you search for all the individual CPT that you bill.
https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

I just did the search for 88305 and included it below.

 

[Thrombus]

Tell them to kiss your arse. This is America -- You should be entitled to bill for what you do. You are the doctor and will ask them when you need their input. Admin is to be seen more and heard from less.

 

[bosco77]

In my limited experience, RVU/year seems to be closer to 20,000 than 5000

 

[musom]

20,000 RVU's/yr? When an 88305 = .75 RVU? That seems excessive.

I spent time today, added up all CPT codes for Jan 2016, and punched them into a "work rvu calculator" which gave me 517 RVU's; annualized at about 6200. That number represents around 4400 accessions/yr with average IHC interpretation. I would venture a guess of about 1.8 specimens/accession.

I'd find it difficult to manage much more than that as a solo practitioner, and would be surprised if a non-derm, non-GI pathologist could reach that 20,000 RVU mark. Just my .02

 

[bosco77]

http://apsmedbill.com/sites/default/files/whitepaper/2015_cms_projected_ap_fee_schedule.pdf
maybe this is helpful

 

[musom]

Very interesting. There is a marked discrepancy between:

http://apsmedbill.com/sites/default/files/whitepaper/2015_cms_projected_ap_fee_schedule.pdf

https://www.aapc.com/practice-manag...05,88342,,,,,,,,,&u=4500,500,0,0,0,0,0,0,0,0,

It looks to be the difference between a wRVU and a standard RVU. A large discrepancy though......

 

[AZpath]

20,000 RVU's/yr? When an 88305 = .75 RVU? That seems excessive.

I spent time today, added up all CPT codes for Jan 2016, and punched them into a "work rvu calculator" which gave me 517 RVU's; annualized at about 6200. That number represents around 4400 accessions/yr with average IHC interpretation. I would venture a guess of about 1.8 specimens/accession.

I'd find it difficult to manage much more than that as a solo practitioner, and would be surprised if a non-derm, non-GI pathologist could reach that 20,000 RVU mark. Just my .02

Your productivity is good for a hospital practice. I had similar solo position a long time ago.

Make sure you capture all your CPT codes and they are down not coding 88307 and 88309 to 88305.
If you were in private practice you would be at 425K -475K.

May sure you include a Part A calculation for the time you spend in the clinical lab.
We spend 25% of our time with the lab and hospital committees.

Asking 400-425 K if you are solo is not unreasonable especially if you are rural based.

 

[musom]

Thanks AZ. I am indeed (very) rural based. My assumption with the PartA is that my "cut" will come in my medical directorship fee, which I believe to be fair, I think? I can confidently predict a 20% bump in volume in the next month, as I have acquired a new contract from an outside facility. That should take me to around 6,000 accessions/yr at that same 1.8 specimens/accession ratio.

I'd be more than satisfied at 400k, but I predict I will, after negotiation, land in the 320-340 range, excluding medical directorship. They'll throw me some incentive stuff, which will most likely be too difficult to attain...

I review all CPT codes before I sign out each individual case, as I have a vested interest in making sure nothing is left on the table. That being said, I have zero say so in what is billed versus is what is collected. Many of the payers in this area are Medicaid and many "private payers" end up as "never payers".

 

[AZpath]

Thanks AZ. I am indeed (very) rural based. My assumption with the PartA is that my "cut" will come in my medical directorship fee, which I believe to be fair, I think? I can confidently predict a 20% bump in volume in the next month, as I have acquired a new contract from an outside facility. That should take me to around 6,000 accessions/yr at that same 1.8 specimens/accession ratio.

I'd be more than satisfied at 400k, but I predict I will, after negotiation, land in the 320-340 range, excluding medical directorship. They'll throw me some incentive stuff, which will most likely be too difficult to attain...

I review all CPT codes before I sign out each individual case, as I have a vested interest in making sure nothing is left on the table. That being said, I have zero say so in what is billed versus is what is collected. Many of the payers in this area are Medicaid and many "private payers" end up as "never payers".

600oK you should be making at least 550K. That's high numbers for a solo guy. You should be fully incentivized.

Collections are their problem not yours. They should be doing a better job.
A hospital should have contracts with Medicaid and typically private pays for a hospital employee are in network.
If they are saying "you eat what you kill "then tell em you killed by they still have to collect it.
I would examine going to a private practice model if what you say is true about their ability to collect.

 

[stickyshift]

If the billing service owes you a couple thousand dollars, they have a problem.
If they owe you a couple hundred thousand dollars, you have a problem.

 

[Zarniwoop]

My experience is that hospitals are happy to pay surgeons based on their RVUs. However, when they see a pathologist should make
bank based on RVU calculations, they go back to the straight salary model. It is somehow acceptable for a hospital to pay a surgeon, cardio, etc a huge chunk of their professional component based on RVUs, but pay pathologists pennies on the dollar for the same revenue and RVU levels.

 

[musom]

My experience is that hospitals are happy to pay surgeons based on their RVUs. However, when they see a pathologist should make
bank based on RVU calculations, they go back to the straight salary model. It is somehow acceptable for a hospital to pay a surgeon, cardio, etc a huge chunk of their professional component based on RVUs, but pay pathologists pennies on the dollar for the same revenue and RVU levels.

What the admin team would ideally do with my position is to give a conservative base and incentivize productivity. My best case scenario would be to give a stronger base and still the same incentive for anything above and beyond that base. The only issue is, is I have no clue how everything is calculated. If my base is per say 300k and total compensation package is like 360k (with 401k matching and other benefits) then once I meet that 360k, how much of the overage do I get? 75%? 90%? Is that 360k in charges or collections? Is it better to base the compensation model on total influx of physical dollars or on this esoteric RVU stuff?

It's hard enough running a solo practice in a rural area, let alone trying to protect myself financially when, truth be told, I'm quite ignorant to this horse stuff, but hey....I can spot a tubular adenoma from 100 yards.

 

[LADoc00]

20000 RVU/year/FTE?! WTH. No...google a bit on the web. At most 500 RVUs/month or 6000/yr/FTE Pathologist.

For that I would ask $350,000 base with a fully funded 401K (=18,000 in your own deferred comp from payroll + 35000 from corporate), 4 weeks of vacation/sick/CME, full medical and dental and eye care, relocation, all professional memberships paid for and CME costs covered.

And most importantly NO in person call after 4pm or on weekends.

And the location would have to low cost of living: Midwest, Deep South etc. No California/New England for that price.

Median home price for that needs to be at the most $240,000.