IAmTheOne1

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Would appreciate any advice on this situation:

Recently joined private practice in which I was signed as a 1099 independent contractor seeing patients in clinic and also doing procedures in an ASC (Clinic side and ASC are independent corporations - both owned by a senior member). On the clinic side, I collect professional fees for seeing patients minus a fixed percentage for overhead. On the ASC side, I perform procedures on my patients who I’ve seen in consultation/follow-up in the clinic and also collect the professional fee minus a fixed percentage for overhead. The owner would like to structure a way for me to make some money off the facility fees from my procedures in the ASC but doesn’t want to offer shares for ownership in the ASC. When asked why, a previous physician was given shares in the ASC and very soon after stopped performing procedures while continuing to collect a share of facility fees and it became a problem. The owner has asked me to come up with a solution(s) where I can make money off facility fees while not violating Anti-Kickback Law. Any thoughts or solutions would be greatly appreciated.
 

bedrock

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Would appreciate any advice on this situation:

Recently joined private practice in which I was signed as a 1099 independent contractor seeing patients in clinic and also doing procedures in an ASC (Clinic side and ASC are independent corporations - both owned by a senior member). On the clinic side, I collect professional fees for seeing patients minus a fixed percentage for overhead. On the ASC side, I perform procedures on my patients who I’ve seen in consultation/follow-up in the clinic and also collect the professional fee minus a fixed percentage for overhead. The owner would like to structure a way for me to make some money off the facility fees from my procedures in the ASC but doesn’t want to offer shares for ownership in the ASC. When asked why, a previous physician was given shares in the ASC and very soon after stopped performing procedures while continuing to collect a share of facility fees and it became a problem. The owner has asked me to come up with a solution(s) where I can make money off facility fees while not violating Anti-Kickback Law. Any thoughts or solutions would be greatly appreciated.

Simple.
1-You need to get 100% of your professional fees on procedures.
2- they need to rethink your overhead percentage for clinic patients
 

SSdoc33

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Simple.
1-You need to get 100% of your professional fees on procedures.
2- they need to rethink your overhead percentage for clinic patients

#1 i actually a good idea.

the money is in the facility fees, so it'd be nice for you to see actual piece of that pie. the standard way is way ASC shares

you really need to flush out the legality of all of this, though.
 
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BobBarker

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You can sign a PSA with the surgery center and then get paid on RVU’s.
 

IAmTheOne1

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You can sign a PSA with the surgery center and then get paid on RVU’s.

would working for RVUs be any different than just collecting the professional fee? Looking for a way to collect the professional fee but ALSO share in some percentage of the facility fee. Not sure how RVU model would facilitate that. Would appreciate any further explanation or ideas. Thanks!
 

BobBarker

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How does someone get paid in RVUs? Is it like a Bitcoin and you can spend it directly or convert it at an exchange? Or is each unit converted at a specific rate to US dollars that varies from individual to individual, situation to situation?
 

lobelsteve

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How does someone get paid in RVUs? Is it like a Bitcoin and you can spend it directly or convert it at an exchange? Or is each unit converted at a specific rate to US dollars that varies from individual to individual, situation to situation?



Rvu is like 80s Wheel of Fortune shopping spree after winning a puzzle. 15 rvu is a porcelain Dalmatian.
 
Nov 21, 1998
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Would appreciate any advice on this situation:

Recently joined private practice in which I was signed as a 1099 independent contractor seeing patients in clinic and also doing procedures in an ASC (Clinic side and ASC are independent corporations - both owned by a senior member). On the clinic side, I collect professional fees for seeing patients minus a fixed percentage for overhead. On the ASC side, I perform procedures on my patients who I’ve seen in consultation/follow-up in the clinic and also collect the professional fee minus a fixed percentage for overhead. The owner would like to structure a way for me to make some money off the facility fees from my procedures in the ASC but doesn’t want to offer shares for ownership in the ASC. When asked why, a previous physician was given shares in the ASC and very soon after stopped performing procedures while continuing to collect a share of facility fees and it became a problem. The owner has asked me to come up with a solution(s) where I can make money off facility fees while not violating Anti-Kickback Law. Any thoughts or solutions would be greatly appreciated.

Just do what the hospitals do: YOU become his W-2 employee on the clinic. He collects *ALL* your pro fees and facility fees in both the clinic and the ASC. Then, he takes some money from that pot and pays you. It's no different than how he would pay the janitor or receptionist. Why make it complicated?
 
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IAmTheOne1

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Just do what the hospitals do: YOU become his W-2 employee on the clinic. He collects *ALL* your pro fees and facility fees in both the clinic and the ASC. Then, he takes some money from that pot and pays you. It's no different than how he would pay the janitor or receptionist. Why make it complicated?

with W2, can you be paid on a variable rate each month? The issue is that my earnings need to be directly tied to my production. A janitor’s work doesn’t fluctuate and isn’t tied to anything he or she does. With my situation, I can work really hard or not so hard and the compensation should reflect that. If I do 10 stims a week vs 5 interlaminar epidurals a week, that’s a big difference. If I’m paid a flat rate W2 then that could potentially be unfair to both sides depending on my productivity. If he’s allowed to pay me a variable rate W2 based on my productivity isn’t that violating the spirit of the Anti kickback law? I guess that law is just very nebulous and that’s at the heart of the issue...
 
Nov 21, 1998
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with W2, can you be paid on a variable rate each month? The issue is that my earnings need to be directly tied to my production. A janitor’s work doesn’t fluctuate and isn’t tied to anything he or she does. With my situation, I can work really hard or not so hard and the compensation should reflect that. If I do 10 stims a week vs 5 interlaminar epidurals a week, that’s a big difference. If I’m paid a flat rate W2 then that could potentially be unfair to both sides depending on my productivity. If he’s allowed to pay me a variable rate W2 based on my productivity isn’t that violating the spirit of the Anti kickback law? I guess that law is just very nebulous and that’s at the heart of the issue...

Yes, it can fluctuate every month but can't be tied to your production volume. It can't be based on volume or metrics that derive from volume to be Stark compliant (assuming you take federal payers). Also, your compensation needs to meet a minimum IRS standard for physicians (it's a pretty low bar). We give the janitor a perk and bonus for timeliness of cleaning the toilets, no customer complaints about the bathrooms, and no unexpected outages of toilet paper (it's a never event). As long as she hits those metrics she gets her bonus. You can set up the same scheme.
 
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TikiTorches

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It seems that the juice on the site of service (SOS) differential vig is going to get squeezed out...it all depends how well MD's advocate

Mds should not advocate for facility fees. They drive up the price of healthcare
 

gdub25

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You can sign a PSA with the surgery center and then get paid on RVU’s.

Bob had suggested the best option in my opinion. Signing a PSA and him paying you based on RVU will let you get a piece of the facility fee in that it will be disguised in the RVU payment. Your pro fee on an ESI is around $100. RVU for an ESI is 1.5. Negotiate an RVU payment of $100/RVU if you’re attorneys say it will be ok from legal standpoint (that amount is about 90th percentile of MGMA I believe). Then, instead of getting $100 for every ESI you will instead get $150.

On a side note, no way should the dude be currently getting all the facility fee AND a portion of the pro fee for “overhead”. The overhead portion of the ASC costs should be taken care of with the facility portion of the payment.

Drusso has another idea of just packaging everything together and letting them keep it and making you an employee but in my opinion, from a legal standpoint, you’d really just have to pick a salary everyone agrees is fair and go with it. Could maybe throw some bonuses in there but it would b had to figure something out to pay you for the amount of work you do without it clearly being based on volume without making it an RVU deal.
 
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