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Fee for Service

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TysonCook

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Don't PM him, post your take on it for everyone. As with most questions, if one person asks a question, 10 others wanted the answer, but just didn't have the ba!!s to ask :)
 

Lumberg

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FFS here, what questions do you have? BTW, in my opinion it's hands down the best way to run a group...also the most lucrative. Reply here or PM.
 

Hawk22

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For those who work in FFS practices, what do you think about this type of option for new grads? I've heard that your first year out of residency can be a little rough getting used to everything new and that this type of practice structure may not be the best for your first job until you get a little more experience. Any thoughts?
 

Lumberg

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I'm a new attending and I've joined a FFS group. I think it's fine to start there. The challenge for new grads is to get throught the transitional period as your accounts receivable begin to accrue. Any good group takes this into account when they higher a new grad. Some will give you an hourly rate for the first six months or so, others will let you borrow money from the group (low, low interest rate ~ 1%) while you get up and running. Like anything there are good FFS groups and bad ones.

In my opinion FFS groups work best when they are fiercly democratic, so everyone knows where the $$ goes, what it is allocated for, etc. You must do a significant amount of homework when researching a FFS group re: their payor mix, billing company, insurance coverage, relationship c admin, length and strength of current contract, etc. The above factors are absolutely critical. If the above parameters are solid and you're in a busy place your salary can be easily in the mid $300-400/yr range. The rub is that things can change in a hurry and you don't have the added layer of security if you're a hospital employee or part of a large managed group. I am extremely biased against managed groups so I'll refrain from comment about their practice/business patterns.

Great way to work in EM...if you are able to find the right situation.
 

Quimby2

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I am FFS (RVU based) and a new grad...first month was tough, but it's looking good now. For Los Angeles, it seems to be one of the better deals around.
 

Jeff698

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While I realize this varies dramatically from group to group, what is the range for RVU/hour or month or year? It is helpful to try to translate $/RVU into what my check will look like.

Again, I realize I need to get specific information from each site I'm looking into, but a general range would be helpful.

Take care,
Jeff
 

southerndoc

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Yea, I can't post the actual fee schedule I was offered because I've heard it is illegal to do so (not from contract, but from federal law). I remember a physician being charged for "conspiring" with other physicians in his community by releasing his fees to managed care organizations.

At any rate, I am curious what new grads get for RVU's, what those doing it for 1 year and 5 years get for RVU's.

Also, has anyone self-incorporated as an LLC or similar corporation?
 

docB

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Here's some actual info:
I work in a pretty high acuity system and our average docs see in the 2-3 pt/hr range and we average 3-3.5 RVU/pt. Consequently we average in the ~10 RVU/HR range. Our fresh grads tend to start out at about 1 pt/hr and 2-4 RVU/PT and move up in pts/hr. The RVU/PT is primarily a function of how much/well you document so some new grads do poorly, expecially if they're not used to T sheets, and some over document and waste time by getting more RVUs per patient but seeing too few patients. The latter is bad because it clogs up the ED.

Why the actual info doesn't mean anything for you:
Your cash:RVU ratio depends on your payor mix which is different everywhere. Once you're a few months down the road your patient/hour is determined more by the ED (nurses, ancillaries, getting admits to the floor, etc.) than it is by your ability to see patients. Seeing 2 PT/HR at 5 RVU/PT (eg lots of critical care billing) is financially the same as seeing 5 PT/HR at 2 RVU/HR (eg. toe injury). So high acuity doesn't mean more $$$ than low acuity. Volume is the key.

What determines an individual physician's volume? Glad you asked. Its not just the volume of the ED. It's the volume of the ED/doc hours staffed +/- shift variations. If you are double covered you start dividing the patients among docs so you can lower your volume. You also have to take into account the shift variations. Your ED might drop off at night. Hence the night guy loses volume to the day guy.

When looking at a job like this you should be able to assume that you will be among the average producers of the group within a year. If not then there's something wrong with you or the group.

A few tips: If you're looking at a strictly eat-what-you-kill FFS group that runs double coverage ask how they deal with cherry picking. "Oh no one does that." is a bad answer. "The charts get randomly assigned to each doc by some method." is a good answer.

How do sign outs get billed. If the first name on the chart gets the billing then you can expect to get lots of shoddy signouts. If the last name on the chart gets the billing then expect to have to stay late to avoid signing out the guy you did a ton of work and procedures on just because the troponin is lagging.

Find out if the FFS is paid based on collections or billing. If it's based on collections everyone (including you) will have a disincentive to put effort into the uninsured (see the cherry picking issue). FFS based on billing is (in my opinion) a much better option. It motivates more ethical behavior and spreads the cost of the uninsured across the group.
 

southerndoc

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The job I've been offered would be staffing two hospitals (one busy, the other "less busy" -- 120k/yr and 45k/yr). The second hospital follows a system of rotating between providers. I followed the medical director around as he was seeing patients. He would look at the computer and see that Doc X saw the last patient, so it was his turn, etc.

They offer reimbursement no matter what the payor mix. Basically you are reimbursed a set amount per patient seen plus your procedures and other stuff. This amount is adjusted based on the payor mix for the entire company over all the hospitals they staff (some hospitals have a very high uninsured population).

I really liked the group, and I love the way they run things and the hospitals where I would work. Most likely I will sign with them, but I wanted more info about the whole FFS issue. Some posts here have helped, plus the PM's I've received have really been great. Two of my friends work for the same company, so talking with them has been the best resource so far.

Thanks to all for the suggestions and comments!
 

docB

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The job I've been offered would be staffing two hospitals (one busy, the other "less busy" -- 120k/yr and 45k/yr). The second hospital follows a system of rotating between providers. I followed the medical director around as he was seeing patients. He would look at the computer and see that Doc X saw the last patient, so it was his turn, etc.

They offer reimbursement no matter what the payor mix. Basically you are reimbursed a set amount per patient seen plus your procedures and other stuff. This amount is adjusted based on the payor mix for the entire company over all the hospitals they staff (some hospitals have a very high uninsured population).
Both of those situations sound ideal. Good luck!

It is interesting how many EPs I know work at more than one hospital. Is this now the rule rather than the exception? Sounds like it's time for a poll.
 

ERDR79

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Speaking of fee for service, does anyone work for EMA in SoCal? And what do you think about them? Fair group? Competitive pay? Thanks guys
 
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D

deleted109597

Both of those situations sound ideal. Good luck!

It is interesting how many EPs I know work at more than one hospital. Is this now the rule rather than the exception? Sounds like it's time for a poll.

Since this poll was reincarnated, I think this question has some merit.

I work at 4 shops regularly (at least every month). I've worked a total of 6 hospitals here in town (and surrounding).

Only 2 groups though.
 
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