Estimating my revenue generated

[Greenbayslacker]

I have a list of every case I have done for my employer, I am just curious if there is any way I can ballpark how much anesthesia billing revenue was generated for a case. I feel this would be a useful tool when it comes time to negotiate my contract. For example, GA for a simple emergency lap chole would bill for how much?

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[GassYous]

It depends on how long you were in there and what you did. It also depends on the payor mix. It's really not that simple. Each case has a startup unit value. Did you block? Did you follow up? ASA class?

 

[deleted162650]

It’s easy to figure out how many units each case generates. Get yourself a copy of the ASA book which lists start-up units for each case. It’s then a unit for every 15mins plus any modifiers which will also be in the book.

They trickier part is figuring out what a unit is worth at your shop. If you are employed, that is information your employer won’t want to divulge.

It varies based on the insurer. Medi-Care is in the low 20$ range, and Medi-Caid varies by state, but is often worse than Medi-Care. Private insurance rates vary widely by region and contract. Anything from 40-120$.

 

[pjl]

It’s easy to figure out how many units each case generates. Get yourself a copy of the ASA book which lists start-up units for each case. It’s then a unit for every 15mins plus any modifiers which will also be in the book.

They trickier part is figuring out what a unit is worth at your shop. If you are employed, that is information your employer won’t want to divulge.

It varies based on the insurer. Medi-Care is in the low 20$ range, and Medi-Caid varies by state, but is often worse than Medi-Care. Private insurance rates vary widely by region and contract. Anything from 40-120$.

Easy version:
Step 1: make friends with the person who does your billing
Step 2: ask them.

Moderate difficulty
Step 1: calculate units
Step 2: find/guess blended unit rate
Step 3: multiply

Hardest:
Step 1: Calculate units
Step 2: Find insurance carrier for each case, and $/unit with each individual insurance, along with all modifiers (which will vary by insurance)
Step 3: Add each case

Don’t forget that the billing department, HR, manager, other employees, office space, etc. all should be attributed to a small degree to you, and not all collections should pass through directly.

If you find your total units, and commercial insurance: other patient ratio, as well as rough location, someone nearby can probably give you a guess within 50k.

 

[dabears505]

Like others have said, the key is how much each unit is worth.

 

[deleted126335]

Even if you appear to be paid more than you generate, there is very likely to be a subsidy from the hospital to anesthesia company. How that is to be accounted for is open to interpretation.

 

[IMGASMD]

10-12000 units.
40-60 blended
That’s the numbers that’s thrown around.

I like to know how will you use that information?

 

[nimbus]

Your employer knows to the penny how much you generate and it’s on a spreadsheet somewhere. Make friends with the billing office.

 

[turnupthegas]

Where are people getting $120/unit? BAAALLLLLIN

 

[deleted162650]

Where are people getting $120/unit? BAAALLLLLIN

AMC’s in the South according to Blade.

 

[nimbus]

AMC’s in the South according to Blade.

In this survey, the highest reported unit value was $256 in the South. The national median commercial rate was $72/unit. The mean commercial rates in IL, NY, and NJ were over $100/unit. AL, CA, MI, KY, PA, WA, and OK were all near the bottom with unit values in the $60s. LA was the worst with a unit value of $52.

ASA Monitor

pubs.asahq.org

 

[deleted126335]

10-12000 units.
40-60 blended
That’s the numbers that’s thrown around.

I like to know how will you use that information?

All information is potentially useful at some point.

 

[dhb]

In this survey, the highest reported unit value was $256 in the South. The national median commercial rate was $72/unit. The mean commercial rates in IL, NY, and NJ were over $100/unit. AL, CA, MI, KY, PA, WA, and OK were all near the bottom with unit values in the $60s. LA was the worst with a unit value of $52.

View attachment 320775

View attachment 320778

ASA Monitor

pubs.asahq.org

The differences are huge!
Might be the reason for the disparity of numbers thrown around this board.

 

[IMGASMD]

All information is potentially useful at some point.

I am also interested in how managing partners would handle this?

How transparent can you really be?

 

[GassYous]

I am also interested in how managing partners would handle this?

How transparent can you really be?

I know the unit value, how many startup units for each case and block, how many time units I generate and how much is taken out for billing/office costs/taxes/benefits.

 

[nimbus]

The differences are huge!
Might be the reason for the disparity of numbers thrown around this board.

The interesting thing is that the jobs listed on gaswork for Louisiana offer very good pay. There’s one that offers 360k for 17 weeks of heart call in a low-moderate volume place. Supply/demand I guess.

 

[IMGASMD]

I know the unit value, how many startup units for each case and block, how many time units I generate and how much is taken out for billing/office costs/taxes/benefits.

Then you realized that you really need hospital subsides to survive. Your group is actually not profitable, then what?
Now you’re in the know.

 

[pjl]

As a managing partner, if an employee physician asked me this, I would say that they could see the books, but it won’t change anything for them until they become partner next year.
Which is the expectation of all our employee physicians.

I normally tell them a much more meaningful number is my personal take home pay, then show them my paystub if they want.

If they still want to see the books, I make them do some early leadership stuff to grow those skills, since almost nobody actually cares about it beyond seeing how much they take home.

 

[pjl]

I should add that if someone were not on a partnership track, I would give them no info, and neither would our billing department.

 

[nimbus]

Updated data.

https://pubs.asahq.org/DocumentLibrary/ASMOnlineFirst/2021/OCT%20Payment%20Prac%20Mgmt_ONLINE%20FIRST.pdf

 

[Mman]

Updated data.

https://pubs.asahq.org/DocumentLibrary/ASMOnlineFirst/2021/OCT%20Payment%20Prac%20Mgmt_ONLINE%20FIRST.pdf

we need to up our rates. Used to be 90th percentile or so geographically but looking more like 60th-70th percentile.

Healthcare inflation is real.

 

[Aheadbyacentury]

I make them do some early leadership

Oh brother.. I wonder what that could mean.... If anyone said this to me I would give you my resignation

 

[narcotics999]

In this survey, the highest reported unit value was $256 in the South. The national median commercial rate was $72/unit. The mean commercial rates in IL, NY, and NJ were over $100/unit. AL, CA, MI, KY, PA, WA, and OK were all near the bottom with unit values in the $60s. LA was the worst with a unit value of $52.

View attachment 320775

View attachment 320778

ASA Monitor

pubs.asahq.org

NJ/NY/IL anesthesiologists do not make much more $ than CA ones. I guess AMC and hospitals are collecting the extras.

 

[pjl]

Oh brother.. I wonder what that could mean.... If anyone said this to me I would give you my resignation

If it helps, I don’t know what I was thinking about when I said that either.

I assume I was thinking it is a pain in the ass to have the accountant come over and explain everything.

For all but 1 of the 10 MDs we have added, they care about nothing more than seeing the level of detail that shows total in to group, total expenses, and how it is divided by partners.

The actual “books” show all the Billings/collections on a case by case basis, insurance rates, indiexpenses etc. They just are not enjoyable to look at, take a long time to explain, and in the end don’t matter unless you can modify something.

Generally for us “early leadership” stuff is any non clinical work. Everyone has skills and in a small group we try to match the required tasks with skills, and grow people to match our holes. Some end up doing a lot, some a little, but everyone does something.

Honestly, if someone wasn’t willing to do ANY non clinical work, they probably aren’t partner material. I would be sorta happy to know that upfront.

 

[GassYous]

If it helps, I don’t know what I was thinking about when I said that either.

I assume I was thinking it is a pain in the ass to have the accountant come over and explain everything.

For all but 1 of the 10 MDs we have added, they care about nothing more than seeing the level of detail that shows total in to group, total expenses, and how it is divided by partners.

The actual “books” show all the Billings/collections on a case by case basis, insurance rates, indiexpenses etc. They just are not enjoyable to look at, take a long time to explain, and in the end don’t matter unless you can modify something.

Generally for us “early leadership” stuff is any non clinical work. Everyone has skills and in a small group we try to match the required tasks with skills, and grow people to match our holes. Some end up doing a lot, some a little, but everyone does something.

Honestly, if someone wasn’t willing to do ANY non clinical work, they probably aren’t partner material. I would be sorta happy to know that upfront.

?? I went to medical school not accounting school

 

[aafisahar]

this is the wrong way to think about it. No anesthesia = no surgery. That's the starting point.

That's what our cardiology group says. Don't look at the per cardiologist production. No cardiology = no CV surgery.

 

[pjl]

?? I went to medical school not accounting school

Which is the response of virtually everyone, and why seeing the “full books” makes no sense for 99% of anesthesiologists.

If you are talking about the expectation of work beyond clinical, it is being a go to for the group to specific surgeon groups for practice wide changes, modifying ordersets, dealing with complaints, running M+M, or any of the 1000 other details of being a group.

 

[IMGASMD]

how it is divided by partners.

That’s the key….

 

[gasdoc77]

SDN- it's blockchain, it's peer to peer secure transactions, buy low sell high, there's limited supply, it's the future.

Also SDN: I didn't go to school for accounting

Lesson(s): learn to read balance sheets and understand valuations, including your own value. Anyone who took organic chemistry can do this in their sleep.