Help with Hospital Negotiation

[drusso]

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Reposting from another list-serve. I said I would send the info back to the OP as they are not on this forum:

"Need some advice, especially from pain docs. I am in a HOPD set up right now. Every patient I see in the clinic, even for a med refill, gets billed a facility fee by the hospital. I bill my professional component which is 45% less since it is HOPD and not an office. Patients do complain about 2 bills. I am not a hospital employee. I am a private practitioner in a hospital set up where the hospital provides the space and personnel. I also do all my procedures in this hospital. I am a very big revenue generator for them. I recently invested in a surgery center where I will be doing 1/3rd of my procedures. The hospital will still be capturing the revenue for all my office visits and 2/3rd of my procedures. I moved into this hospital with a full volume of patients. I have marketed to my referral sources myself, provide conscientious care and keep my referring physicians happy.
The middle guy (VP of Operations) has been CONCERNED about losing 1/3rd of my procedure revenue! I just want to say ‘get lost’ and move to my own clinic space and do all my procedures at the surgery center. The site of service differential for E&Ms should cover my overhead and more.
If I decide to stay in this HOPD setting, I want them to sign an exclusive contract where they do not bring in more pain docs without my consent, agree to me doing 1/3rd procedures in the surgery center and give me a fair Medical Director fee. Any thoughts or suggestions?"

 

[lonelobo]

Get Out!

 

[mid|ine]

How about hospital employment? Terms to include; generous wRVU, exclusive contract, no-noncompete, clause that says if you leave hospital has to notify patients and referring physicians of new office, you keep patient records, minimum 5 years on contract, no patient satisfaction or meaningful use payments, at least 1 mid-level and billed under you (so you get wRVUs) and criteria for adding more. If you have the patients already, they could want you to stay bad enough and this could be the best way to boost income.

 

[Billy Jack]

Reposting from another list-serve. I said I would send the info back to the OP as they are not on this forum:

"Need some advice, especially from pain docs. I am in a HOPD set up right now. Every patient I see in the clinic, even for a med refill, gets billed a facility fee by the hospital. I bill my professional component which is 45% less since it is HOPD and not an office. Patients do complain about 2 bills. I am not a hospital employee. I am a private practitioner in a hospital set up where the hospital provides the space and personnel. I also do all my procedures in this hospital. I am a very big revenue generator for them. I recently invested in a surgery center where I will be doing 1/3rd of my procedures. The hospital will still be capturing the revenue for all my office visits and 2/3rd of my procedures. I moved into this hospital with a full volume of patients. I have marketed to my referral sources myself, provide conscientious care and keep my referring physicians happy.
The middle guy (VP of Operations) has been CONCERNED about losing 1/3rd of my procedure revenue! I just want to say ‘get lost’ and move to my own clinic space and do all my procedures at the surgery center. The site of service differential for E&Ms should cover my overhead and more.
If I decide to stay in this HOPD setting, I want them to sign an exclusive contract where they do not bring in more pain docs without my consent, agree to me doing 1/3rd procedures in the surgery center and give me a fair Medical Director fee. Any thoughts or suggestions?"

This is a good situation for the hospital but not the MD.

 

[BobBarker]

This is terrible for you and the patients it sounds like. Go independent and kill it at your ASC!

 

[Ducttape]

why does the hospital want to actually support you if you move 1/3 of your procedures offsite?

im willing to bet that hospital admin are probably considering hiring an employee. because 1/3 of procedures could rapidly become 1/2 to all, and they will have nothing to fill that volume.

agree with midline. your best bargain is to become an employee with good $/wRVU and benefits, or leave.

 

[hyperalgesia]

It would be really hard for the hospital to replace you with this arrangement.

Your request is more than reasonable.

It's either give me an employment offer or I'm taking my independent business elsewhere. It sounds like you have one foot out the door.

You can also pile on pressure by getting competitive offers in the area.

 

[BobBarker]

You are your own business. They will still make money off the asinine “facility fee” to pay their costs. You will still use their MRI and lab and maybe PT. I do not understand why you are not taking 100% of your procedures to the ASC now and start to work on either a much more lucrative wrvu set up or build out an office near the ASC.

 

[Disciple]

Sounds like the trade-off is free office space and staff you don't have to pay for?

Need clarification on 1 point. The professional fee is 45% less than the facility fee?, or 45% less than one would receive billing out of a private clinic?

Should be fairly easy to crunch the numbers. Costs of rent/staff vs. dividends from ASC.

 

[painfree23]

but you may lose the referrals from the hospital...thats hard to put a price on

 

[IN2B8R]

If you already have a business, why are you giving your landlord the majority of your profits?! Get an office of your own and keep your earnings. You will be better off.


Sent from my iPhone using SDN mobile app

 

[Uncovert]

Sounds like a doc I know in Baltimore. My advice is leave. Too many administrators with hands in the pot incentivized to cut costs at the indirect expense of patients and direct expense of docs.

 

[PapaDosh]

Sounds like the trade-off is free office space and staff you don't have to pay for?

Need clarification on 1 point. The professional fee is 45% less than the facility fee?, or 45% less than one would receive billing out of a private clinic?

Should be fairly easy to crunch the numbers. Costs of rent/staff vs. dividends from ASC.

My understanding of Stark Law (just went through recent compliance training with a hospital I am credentialed at) is that the hospital can not give free/reduced cost office space nor free employees in exchange for a independent physician referring proceures/MRI/PT to the hospital. In fact they had a video that specifically had a situation where the office manager asked about not paying rent for their office space for months and the physician actor stated he didn't have to because of all the revenue he generated. I would bet this physician pays for his office space and his employees and just getting screwed because he is getting 45% less on his professional fees. My advice would be to move across the street and take all your patients to the ASC that he/she has already invested in unless they have a strong desire to become a hospital employed physcian.

 

[drusso]

My understanding of Stark Law (just went through recent compliance training with a hospital I am credentialed at) is that the hospital can not give free/reduced cost office space nor free employees in exchange for a independent physician referring proceures/MRI/PT to the hospital. In fact they had a video that specifically had a situation where the office manager asked about not paying rent for their office space for months and the physician actor stated he didn't have to because of all the revenue he generated. I would bet this physician pays for his office space and his employees and just getting screwed because he is getting 45% less on his professional fees. My advice would be to move across the street and take all your patients to the ASC that he/she has already invested in unless they have a strong desire to become a hospital employed physcian.

This is why hospitals want to **OWN** MD's. Direct employment of the MD means that they can get around Stark and direct & control the MD's referrals to the hospital and its ancillaries. MD's should beware.