Fair critical care salary

[lunaire]

I have found myself in a rather interesting career position. Hoping for some advice from the more experienced intensivist here.

Long story short: I am resigning from a full time position in a growing open heart surgery intensivist position. Job is actually pretty easy - about 6-12 critical care census with a handful of easy periop medical management consults on floor. Problem is, we have a lack of night-time and weekend ICU coverage. The lack of coverage is causing some preventable morbidity and mortality, and is the primary reason for me resigning. As I am the one and only intensivist of the group, the administration is basically telling me I can ask for whatever I want if I stay. What I want is full 24/7 ICU coverage.

Now for the question: what would you think is a fair compensation for an intensivist position working 7 days on/off, with 12 hours in house shift and night-time at home call? Location is terrible, extreme flyover state with nothing going on; patient load is relatively light, as mentioned above. Plan is to negotiate for myself, as well as for recruiting a second intensivist position.

I am not trying to screw the group over, so please do not throw out an unrealistically high number; but it should be a number that would allow us to really attract a good candidate to an undesirable location, with the rather unusual working condition I listed above.

Any other ideas or personal experience in this kind of situation would be welcome too.

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[Merely]

Why are you not trying to screw the group over? Ask for 800k

 

[jdh71]

Why are you not trying to screw the group over? Ask for 800k

That's not market value anywhere and illegal lol

 

[Merely]

That's not market value anywhere and illegal lol

Illegal!??? Wtf???

 

[lunaire]

Why are you not trying to screw the group over? Ask for 800k

I actually like the group. Aside from the coverage issue, it's actually a decent gig.

 

[jdh71]

I have found myself in a rather interesting career position. Hoping for some advice from the more experienced intensivist here.

Long story short: I am resigning from a full time position in a growing open heart surgery intensivist position. Job is actually pretty easy - about 6-12 critical care census with a handful of easy periop medical management consults on floor. Problem is, we have a lack of night-time and weekend ICU coverage. The lack of coverage is causing some preventable morbidity and mortality, and is the primary reason for me resigning. As I am the one and only intensivist of the group, the administration is basically telling me I can ask for whatever I want if I stay. What I want is full 24/7 ICU coverage.

Now for the question: what would you think is a fair compensation for an intensivist position working 7 days on/off, with 12 hours in house shift and night-time at home call? Location is terrible, extreme flyover state with nothing going on; patient load is relatively light, as mentioned above. Plan is to negotiate for myself, as well as for recruiting a second intensivist position.

I am not trying to screw the group over, so please do not throw out an unrealistically high number; but it should be a number that would allow us to really attract a good candidate to an undesirable location, with the rather unusual working condition I listed above.

Any other ideas or personal experience in this kind of situation would be welcome too.

Tell them to purchase the MGMA data FOR YOU. Ask for the 75%ile of pay going to critical care for the midwest *salary* plus benefits above with generous 401k/403b match (ask for 1 to 1 match, why not?). $500 to respond to overnight calls by coming in and $250 per hour, rounded to the nearest hour for your time in house responding.

Edit: you need some vacation too. 7on/7off will smolder - sounds pretty good at first blush - but I'd ask for two weeks of vacation, which would give you 6 weeks off in two three week blocks

 

[jdh71]

Illegal!??? Wtf???

Until further adjudicated differently paying that much over market is considered an inducement and a violation of the Stark Law. It's a bit silly because where else are you going to "refer" these critically ill patients, especially since they are already in the hospital, but there isn't a hospital legal counsel anywhere that will let you get away with asking 2x market for an employed job in medicine.

 

[bigdan]

Are you doing “home call” with an expectation that you go back in? I know a group that did that.

They got a flat rate: worked out great if sleeping all night, not so good if back in the hospital 48h straight.

I second the idea of getting a pager rate + call in bonus.

Regarding very high pay (and admitting I know nothing about the law), I think you could angle your request to a very respectable number by saying you 1. Provide a critical service, 2. You are working for the money (and be aware: 180 nights of home call is work), 3. You’re a bit of a unicorn - you sorta define the market in your area for a physician that is critical care boarded, taking home call with possible call back for HALF THE YEAR, in a hard to recruit area. I don’t understand how any number you ask for would be out of the “usual” pay for your position, because no one else has your position.

I know you are well worth at least $600,000 for that service, and folks with that home call arrangement are getting that much in larger cities than you described.

 

[Merely]

Until further adjudicated differently paying that much over market is considered an inducement and a violation of the Stark Law. It's a bit silly because where else are you going to "refer" these critically ill patients, especially since they are already in the hospital, but there isn't a hospital legal counsel anywhere that will let you get away with asking 2x market for an employed job in medicine.

That’s why you have to craft a deal that works, whether that’s 1099 or whatever it is, if they need you enough they will pony up..this FMV garbage is just another way to deny patients care and decrease doctor income

 

[jdh71]

That’s why you have to craft a deal that works, whether that’s 1099 or whatever it is, if they need you enough they will pony up..this FMV garbage is just another way to deny patients care and decrease doctor income

You let me know how all of that works out for you.

 

[GonnaBeADoc2222]

Rake them over the coals. Know thy value.

 

[Hamhock]

7on-7off is hard-core, IMO...especially with night coverage (could easily turn into 36h straight in the hospital).

I would think about this more from a recruiting perspective. What do you think it will take to recruit someone to be your partner for 7on-7off (including night call with the potential to be in-house).

And coverage for vacations is a must and a significant complicating factor in your plan.

TBH, I would not take that for 600k.

I honestly hope that perspective helps.

HH

 

[lunaire]

Thank you all for the input.

I figure it would be a high number. Not sure if admin is willing to invest that much...

Guess I'll probably be moving on.

 

[jdh71]

Thank you all for the input.

I figure it would be a high number. Not sure if admin is willing to invest that much...

Guess I'll probably be moving on.

Asking 600k will be a nonstarter.

75%ile of MGMA is something admin can wrap their minds around. Tell them to pull the data. Make them spend the money. Request pay to answer inpatient needs at night. Crunch the numbers. Then make an unfit bed deciding.

 

[Merely]

Asking 600k will be a nonstarter.

75%ile of MGMA is something admin can wrap their minds around. Tell them to pull the data. Make them spend the money. Request pay to answer inpatient needs at night. Crunch the numbers. Then make an unfit bed deciding.

You’re not getting that this job is not worth it for less than 600k and in many opinions even more than, why would he ask for less than that?

 

[VA Hopeful Dr]

You’re not getting that this job is not worth it for less than 600k and in many opinions even more than, why would he ask for less than that?

And you're not getting that if the government finds out the hospital is paying way outside FMV they will sue the hospital for tens if not hundreds of millions of dollars.

 

[CCM-MD]

Ask for 90%ile of MGMA. Which is 549k on the 2018 data.

 

[jdh71]

You’re not getting that this job is not worth it for less than 600k and in many opinions even more than, why would he ask for less than that?

I don’t know if this job is only “worth” 600k.

6-12 post op CV patients at a time? I would argue isn’t “worth” 600k. As an Intensivist I might know.

I’ve also been through one or two contract negotiations. I understand the federal law here. And you can’t simply ask for any wild ass number. The other consideration is taking advantage of a situation in a fairly extreme way that can come back to bite you in the ass later.

What I have proposed is not only aggressive but actually *reasonable* and *legal* what are *you* not getting about that?

 

[jdh71]

Ask for 90%ile of MGMA. Which is 549k on the 2018 data.

You can’t ask for a 90%ile baseline. You can ask I guess. It’s too much to be considered legal.

 

[NicMouse64]

You can’t ask for a 90%ile baseline. You can ask I guess. It’s too much to be considered legal.

how do people get paid 90% then if it's illegal to ask for it?

 

[jdh71]

how do people get paid 90% then if it's illegal to ask for it?

You MAKE it.

If you are employed you have a base and you then have production also applied to every RVU made above once you’ve made your salary.

If you are a privateer you are eating what you kill until you get there.

Bottom line: you are working, a lot.

 

[CCM-MD]

Depends if you have a production based set up or if you are getting paid per shift or hour.

A hospital paying an intensivist 400k base with 300k in production or 700k total, not tied to production, will ring the same FMV bells. This is the same reason some ICC/HCA intensivist contracts specifically put an upper limit cap on the number of shifts one can work in a year.

 

[Merely]

And you're not getting that if the government finds out the hospital is paying way outside FMV they will sue the hospital for tens if not hundreds of millions of dollars.

Oh I didn’t realize the hospital might put itself at risk, why didn’t you tell me that before!? That’s terrifying! Anything to protect the hospital!

 

[jdh71]

Oh I didn’t realize the hospital might put itself at risk, why didn’t you tell me that before!? That’s terrifying! Anything to protect the hospital!

Doctors have actually gone to jail too.

Play with fire at your own risk.

 

[Merely]

Doctors have actually gone to jail too.

Play with fire at your own risk.

We’re going to jail for accepting a high income? Bro loosen up a lil

 

[VA Hopeful Dr]

We’re going to jail for accepting a high income? Bro loosen up a lil

15 things to know about Stark Law

Enacted more than two decades ago with the simple purpose of curbing physician self-referral, Stark Law has evolved into a complex set of regulations, which some argue impede efforts to transition away from a fee-for-service system.

www.beckershospitalreview.com

 

[Merely]

15 things to know about Stark Law

Enacted more than two decades ago with the simple purpose of curbing physician self-referral, Stark Law has evolved into a complex set of regulations, which some argue impede efforts to transition away from a fee-for-service system.

www.beckershospitalreview.com

Is he being paid so he can then order extra tests and make the hospital money? Or is he being paid because no one wants to work there and that’s the only way they can recruit someone?

 

[VA Hopeful Dr]

Is he being paid so he can then order extra tests and make the hospital money? Or is he being paid because no one wants to work there and that’s the only way they can recruit someone?

You can do that but you have to be able to prove that's the fair market value which is hard.

 

[jdh71]

We’re going to jail for accepting a high income? Bro loosen up a lil

Try that response to the US attorney asking you why you are getting paid so much ostensibly in large portion by Medicare and Medicaid dollars. Good luck.

 

[jdh71]

We’re going to jail for accepting a high income? Bro loosen up a lil

If I may ask what exactly is your specialty . . . Bro

 

[deleted171991]

And you're not getting that if the government finds out the hospital is paying way outside FMV they will sue the hospital for tens if not hundreds of millions of dollars.

I doubt they can, if the hospital can prove that they had trouble finding somebody to do the job for less. AKA market forces.

Anyway, that's the hospital's problem, not the employee's. The employee should ask for the Moon. If you don't ask, you shall not receive.

 

[deleted171991]

Try that response to the US attorney asking you why you are getting paid so much ostensibly in large portion by Medicare and Medicaid dollars. Good luck.

Please show us a precedent at 600K, or at any salary for critical care.

To prove kickback in critical care they would have to prove that one ordered unreasonable or excessive studies or consults or lengths of stay. Any competent intensivist, especially one who never orders studies not required by the critical illness (vs something that could be done outpatient elsewhere), should not qualify. In the era of bundled pay, hospitals have the incentive to minimize expenses, not the opposite.

Here's our homework for the weekend:

https://www.gpo.gov/fdsys/pkg/USCODE-2014-title42/pdf/USCODE-2014-title42-chap7-subchapXVIII-partE-sec1395nn.pdf/

"(5) Physician recruitment
In the case of remuneration which is provided by a hospital to a physician to induce the physician to relocate to the geographic area served by the hospital in order to be a member of the medical staff of the hospital, if— (A) the physician is not required to refer patients to the hospital, (B) the amount of the remuneration under the arrangement is not determined in a manner that takes into account (directly or indirectly) the volume or value of any referrals by the referring physician, and (C) the arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse"

In the end, it's up to the lawyers to interpret the law. It's the hospital's job to get a third-party valuation from an experienced and qualified healthcare valuation consultant, but it's the OP's job to get a good healthcare employment lawyer.

Also, please consider the cost of locums. The OP should be well within the law if he asked for a package equal to the cost of a locum tenens physician in the area. That should still be fair market pay.

 

[VA Hopeful Dr]

I doubt they can, if the hospital can prove that they had trouble finding somebody to do the job for less. AKA market forces.

Anyway, that's the hospital's problem, not the employee's. The employee should ask for the Moon. If you don't ask, you shall not receive.

The hospital has to prove FMV, not the government.

Please show us a precedent at 600K, or at any salary for critical care.

To prove kickback in critical care they would have to prove that one ordered unreasonable or excessive studies or consults or lengths of stay. Any competent intensivist, especially one who never orders studies not required by the critical illness (vs something that could be done outpatient elsewhere), should not qualify. In the era of bundled pay, hospitals have the incentive to minimize expenses, not the opposite.

Here's our homework for the weekend:

https://www.gpo.gov/fdsys/pkg/USCODE-2014-title42/pdf/USCODE-2014-title42-chap7-subchapXVIII-partE-sec1395nn.pdf/

"(5) Physician recruitment
In the case of remuneration which is provided by a hospital to a physician to induce the physician to relocate to the geographic area served by the hospital in order to be a member of the medical staff of the hospital, if— (A) the physician is not required to refer patients to the hospital, (B) the amount of the remuneration under the arrangement is not determined in a manner that takes into account (directly or indirectly) the volume or value of any referrals by the referring physician, and (C) the arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse"

In the end, it's up to the lawyers to interpret the law. It's the hospital's job to get a third-party valuation from an experienced and qualified healthcare valuation consultant, but it's the OP's job to get a good healthcare employment lawyer.

Also, please consider the cost of locums. The OP should be well within the law if he asked for a package equal to the cost of a locum tenens physician in the area. That should still be fair market pay.

That paragraph you quoted is relocation bonus. OP already works there so that's not applicable. The part you want is this:

(2) Bona fide employment relationships
Any amount paid by an employer to a physician
(or an immediate family member of such
physician) who has a bona fide employment relationship
with the employer for the provision
of services if—
(A) the employment is for identifiable
services,
(B) the amount of the remuneration under
the employment—
(i) is consistent with the fair market
value of the services, and
(ii) is not determined in a manner that
takes into account (directly or indirectly)
the volume or value of any referrals by the
referring physician,
(C) the remuneration is provided pursuant
to an agreement which would be commercially
reasonable even if no referrals were
made to the employer, and
(D) the employment meets such other requirements
as the Secretary may impose by
regulation as needed to protect against program
or patient abuse.

I agree with asking for a lot, just be prepared to not get it. I like the locum comparison idea, seems like an easy way to determine FMV.

 

[jdh71]

Please show us a precedent at 600K, or at any salary for critical care.

To prove kickback in critical care they would have to prove that one ordered unreasonable or excessive studies or consults or lengths of stay. Any competent intensivist, especially one who never orders studies not required by the critical illness (vs something that could be done outpatient elsewhere), should not qualify. In the era of bundled pay, hospitals have the incentive to minimize expenses, not the opposite.

Here's our homework for the weekend:

https://www.gpo.gov/fdsys/pkg/USCODE-2014-title42/pdf/USCODE-2014-title42-chap7-subchapXVIII-partE-sec1395nn.pdf/

"(5) Physician recruitment
In the case of remuneration which is provided by a hospital to a physician to induce the physician to relocate to the geographic area served by the hospital in order to be a member of the medical staff of the hospital, if— (A) the physician is not required to refer patients to the hospital, (B) the amount of the remuneration under the arrangement is not determined in a manner that takes into account (directly or indirectly) the volume or value of any referrals by the referring physician, and (C) the arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse"

In the end, it's up to the lawyers to interpret the law. It's the hospital's job to get a third-party valuation from an experienced and qualified healthcare valuation consultant, but it's the OP's job to get a good healthcare employment lawyer.

Also, please consider the cost of locums. The OP should be well within the law if he asked for a package equal to the cost of a locum tenens physician in the area. That should still be fair market pay.

Hate the game not the player. I don’t have to show you or anyone else anything. I’m simply telling you how it is. You can’t get paid that much as a base seeing 6-12 post op CV patients per day.

The arrangements a hospital makes with a locums company is a different thing than the amount that eventually gets paid to the locum *doing* the work. Locum contracts made with individuals are not offered at wild ass compensation rates over long periods of time.

I’ve dealt with a good healthcare employment lawyer. As I am not one myself. The good healthcare employment lawyer after being paid a total small five figure amount was not able to argue past the fair market value for base salary based on the commonly found tables. There is no leverage. Walking isn’t even leverage. There is room to negotiate up to about the 66-75%ile if they are in an “undesirable” or hard to recruit to location. You can negotiate a lower production threshold whereby you will begin making money on the work you do in an eat what you kill manner. You cannot ask for any wild ass number per RVU for production. You will have to go again back to the tables. You can negotiate higher quality bonuses but all of that is potentially at risk. You can negotiate ONE time bonuses/pay outs like contract renewal and or loan paybacks (but even those have to be reasonable).

The hospitals valuation expert if you insist on getting one will not tell the hospital they need to pay you 600k. You can even hire your own and they won’t tell you that either.

The only way to make 600k as an employed Intensivist and people do this regularly enough is to WORK for it.

 

[martvubo]

I'm not trying to stir the pot, just trying to understand how they arrive at what FMV is (for Stark law purpose)...

If the hospital is trying to recruit to fill the position at 90th percentile and fails, doesn't that indicate that FMV for the position they're trying to fill is above 90th? Like if nobody wants to do it at 600k, and they offer 610k and someone takes it, isn't that the most direct form of price discovery (increase offer until there's a taker)?

 

[jdh71]

I'm not trying to stir the pot, just trying to understand how they arrive at what FMV is (for Stark law purpose)...

If the hospital is trying to recruit to fill the position at 90th percentile and fails, doesn't that indicate that FMV for the position they're trying to fill is above 90th? Like if nobody wants to do it at 600k, and they offer 610k and someone takes it, isn't that the most direct form of price discovery (increase offer until there's a taker)?

There are tables with compensation, MGMA being the most famous.

FMV is about the WORK not the *job* largely because of the way physicians bill as fee for the individual service. Simply being unable to pay FMV for the work of a job that no one will take isn’t an excuse to pay a physicians too much more to do the SAME work.

 

[martvubo]

There are tables with compensation, MGMA being the most famous.

FMV is about the WORK not the *job* largely because of the way physicians bill as fee for the individual service. Simply being unable to pay FMV for the work of a job that no one will take isn’t an excuse to pay a physicians too much more to do the SAME work.

I guess my question was more along the lines of "why is the national average FMV relevant to a job where MGMA salary is not adequate to attract an employee to come meet an otherwise unmet medical need"? Middle-of-nowhere, Iowa has a healthcare market, and what's fair there likely won't match what's fair in Manhattan because the supply and demand of physician services are different. If it costs too much to convince a physician to come to Middle-of-nowhere, is the legislature's answer to that just "well then I guess they'll die untreated"? That may actually be the answer-- you tell me since you have experience here: what is Middle-of-nowhere's alternative option since they aren't allowed to pay enough?

 

[jdh71]

I guess my question was more along the lines of "why is the national average FMV relevant to a job where MGMA salary is not adequate to attract an employee to come meet an otherwise unmet medical need"? Middle-of-nowhere, Iowa has a healthcare market, and what's fair there likely won't match what's fair in Manhattan because the supply and demand of physician services are different. If it costs too much to convince a physician to come to Middle-of-nowhere, is the legislature's answer to that just "well then I guess they'll die untreated"? That may actually be the answer-- you tell me since you have experience here: what is Middle-of-nowhere's alternative option since they aren't allowed to pay enough?

You are focusing on *practical* irrelevancies.

What is the fundamental difference about the medical work it takes to write a basic/general CABG POD#2 note in LA versus western Oklahoma??

 

[martvubo]

You are focusing on *practical* irrelevancies.

What is the fundamental difference about the medical work it takes to write a basic/general CABG POD#2 note in LA versus western Oklahoma??

I'm not asserting that there's a difference in the medical care or documentation provided. Milk in Wisconsin is the same as milk in Hawaii but it only costs $8/gallon in one of those places because that's the price the market supports.

If a hospital is able to pay an intensivist more than billing for their services actually brings in, and the alternative is that the hospital doesn't have an ICU because nobody will work there for a lower price, why is that above-MGMA salary not the fair value for that market?

 

[chessknt]

There are tables with compensation, MGMA being the most famous.

FMV is about the WORK not the *job* largely because of the way physicians bill as fee for the individual service. Simply being unable to pay FMV for the work of a job that no one will take isn’t an excuse to pay a physicians too much more to do the SAME work.

Mgma and other salary surveys frequently don't have enough data to evaluate rural markets. I checked 2019 and 2018 data and not enough reported for Midwest non-metro positions to generate a number. I think a compelling argument could be made that these salary survey numbers are not applicable to remote areas.

It is also unreasonable to assume that 2 weeks of 24h call work is baked in to the metro numbers with more than a single provider.

 

[jdh71]

I'm not asserting that there's a difference in the medical care or documentation provided. Milk in Wisconsin is the same as milk in Hawaii but it only costs $8/gallon in one of those places because that's the price the market supports.

If a hospital is able to pay an intensivist more than billing for their services actually brings in, and the alternative is that the hospital doesn't have an ICU because nobody will work there for a lower price, why is that above-MGMA salary not the fair value for that market?

You will have to ask a US attorney

Don’t think I don’t understand your point. I understand it well. It’s just irrelevant.

 

[jdh71]

Mgma and other salary surveys frequently don't have enough data to evaluate rural markets. I checked 2019 and 2018 data and not enough reported for Midwest non-metro positions to generate a number. I think a compelling argument could be made that these salary survey numbers are not applicable to remote areas.

It is also unreasonable to assume that 2 weeks of 24h call work is baked in to the metro numbers with more than a single provider.

Again. All valid points but largely irrelevant as NO. ONE. CARES.

Maybe you can be the guy that sues about it all.

 

[lunaire]

Lots of interesting points here... I actually was not aware of the Stark law and its implication in this issue.

I agree that 6-12 patients a day is not worth 600k. I think I am currently billing about 500-750k per year, with actual reimbursement a fraction lower than that. We'll need two of me, so 1.2M per year for CC staffing. Quite a significant upfront loss.

I do bring significant indirect value to the hospital; primarily from reduction in morbidity and LOS, also from reducing operative delay and cancellation. I doubt that this can be quantified easily, or applied to this case.

Anyway, I've made my offer to the admin. 90th percentile MGMA plus bonus/bennies. Let's see what happens.

 

[bigdan]

Atta boy. I don't know what 90th percentile is, but if they want you in that role, you're worth it.

The part I don't get about the Stark stuff (and I'm not arguing for it or against it or for paying anyone more or less or whatever) is:
1. if you're in house CCM, you're working. I'm Anes CCM. I don't really have any "RVU target", and am obviously biased, but why is the attending cardiac surgeon at home "working" when he writes "I was available at the time of the fellow's note", but I'm not working when I am up all night rounding on patients, guiding care, answering RN questions, trending labs & vitals, but not billing CC/writing CC notes?
2. how do you account for stuff you can't bill (or bill much for) in terms of "proving value"? I know/hope all physicians are serially checking on patients and picking up little details/trending changes/etc, but (I think) CC physicians do it more frequently and consistently in large part because they're always physically in the ICU.
3. why is it okay (or even preferable) to pay 6 physicians $400,000 PLUS pay each of them benefits/retirement/CME/etc instead of paying 4 guys $600,000?

Lunaire: let us know how things play out. Kudos for aiming high, and good luck!

 

[deleted171991]

There are tables with compensation, MGMA being the most famous.

FMV is about the WORK not the *job* largely because of the way physicians bill as fee for the individual service. Simply being unable to pay FMV for the work of a job that no one will take isn’t an excuse to pay a physicians too much more to do the SAME work.

Respectfully, I think your are wrong. It's fair MARKET value, as in job market. If you as a hospital can't find a job taker at 600K, and you can prove it, than the FMV is at least 600K. That's also why they have the rule about relocation incentives that I quoted. Anyway, there are lawyers and FMV companies that consult on this.

Also, if your understanding of the rule were correct, then physician salaries in an area could never rise, only stay the same or go down, which is ridiculous. The hospital can always pay an incentive for relocation which is not limited by FMV.

And laws and their interpretations are tested in court. So it's more than relevant if there isn't any precedent in critical care or at 600K.

Btw, why the 90th percentile? OP should ask for the 99th.

 

[jdh71]

Respectfully, I think your are wrong. It's fair MARKET value, as in job market. If you as a hospital can't find a job taker at 600K, and you can prove it, than the FMV is at least 600K. That's also why they have the rule about relocation incentives that I quoted. Anyway, there are lawyers and FMV companies that consult on this.

Also, if your understanding of the rule were correct, then physician salaries in an area could never rise, only stay the same or go down, which is ridiculous. The hospital can always pay an incentive for relocation which is not limited by FMV.

And laws and their interpretations are tested in court. So it's more than relevant if there isn't any precedent in critical care or at 600K.

Btw, why the 90th percentile? OP should ask for the 99th.

Respectfully, I know I’m correct. There doesn’t need to be any precedent per each individual specialty and that will never happen. I suppose you could be the first guy to sue an employer hoping for a better FMV interpretation by the federal courts waiting years for that to play out while likely not working the job you were working and the real possibility of being effectively black balled behind the scenes by employers but until THAT happens, I’m telling you what current hospital attorneys and US attorneys see this.

OP can currently charge to the top of that 99%ile hill, as you suggest, and die if he wants.

 

[Merely]

Respectfully, I know I’m correct. There doesn’t need to be any precedent per each individual specialty and that will never happen. I suppose you could be the first guy to sue an employer hoping for a better FMV interpretation by the federal courts waiting years for that to play out while likely not working the job you were working and the real possibility of being effectively black balled behind the scenes by employers but until THAT happens, I’m telling you what current hospital attorneys and US attorneys see this.

OP can currently charge to the top of that 99%ile hill, as you suggest, and die if he wants.

I thought I was the only one that disagreed with you turns out I’m in the majority lol

 

[jdh71]

I thought I was the only one that disagreed with you turns out I’m in the majority lol

If you know how to read good, you can see there was a lot of disagreement in this thread and more than a little exasperation about that this is the way it is.

The problem is that disagreement and the number of disagreers is about as relevant as a dick on a picnic table. I’ve told you the way the federal government sees this. Until such a time as someone sues and gets a new interpretation this is the reality we all have to deal with. Don’t shoot the messenger.

What is your specialty again?

 

[NicMouse64]

It you know how to read good, you can see there was a lot of disagreement in this thread and more than a little exasperation about that this is the way it is.

The problem is that disagreement and the number of disagreers is about as relevant as a dick on a picnic table. I’ve told you the way the federal government sees this. Until such a time as someone sues and gets a new interpretation this is the reality we all have to deal with. Don’t shoot the messenger.

What is your specialty again?

Your argument makes sense. No one is going to feel bad for the poor doctor who charges medicare (taxpayers), makes 600k+, and then the federal government prosecutes this doctor.

 

[VA Hopeful Dr]

Your argument makes sense. No one is going to feel bad for the poor doctor who charges medicare (taxpayers), makes 600k+, and then the federal government prosecutes this doctor.

Except that's not what anyone here is talking about. If you work hard enough and bill enough in professional services to earn 600k, the government is fine with that from a Stark prospective. I'm FM. Let's say I make $50 per patient I see. If I see 15,000 patients/year, that gets me to 750k. That's WAY above average for my specialty. But if I can prove that I'm just that busy and that's why the hospital paid me that much, the Feds would be OK with that.

What they are not OK with is the hospital paying you more because of anything else - performing surgery at the hospital, sending all of your labs/pathology to the hospital, referring your patients to hospital-employed doctors. Stuff like that.

If you are a not-terribly-busy CC doctor who is getting paid WAY more than the vast majority of CC doctors, the government is going to want to know why. If you and the hospital don't have a good answer, then you both get sued.