...Today I'm easily at 25-35 depending on the day....
...easily bringing in upwards of 400-500k in production. Never missed a beat or a days of work...
This is your problem right there: your revenue per visit is WAY too low. HardRoad caught it too.
I don't think I've ever brought in less than 400k in a full-time year - even first year out (when I was inefficient, didn't know billing much, didn't max out services, owner was giving me the lesser payer pts and MCAs, I was somewhat awkward and ignorant to doing procedures, etc). That also includes other years of offices that were sending out all DME (basically owned a store that I got no piece of), ones that didn't have ultrasound, skeleton-staffed with newest MA or even no MA on some days, a clinic that was mostly MCA immigrants, startup from scratch, etc. They all beat those marks. You should still
easily crush that 400k just on E&M, proc, injects, wounds, surgery.... all else the office may have for you to utilize is gravy (u/s, grafts, DME, otc, ABIs, wraps, various testing, etc etc).
With the numberts above, you also might have crap payers, you may be being cheated (or office does a spectacularly bad job billing/collection), but regardless, your revenue per visit is only like
$70 per (500k on 30pts per day 20days/mo). That is pit-i-fullllllllllllll. Did I mention you're probably being cheated? The pt volume is average or even a bit above, but the per visit collection is horse. That $70 is basically a 99213 and nothing else (imaging, DME, otc, injects, procedures, etc). That will never work in a PP - no matter how hard you do. Most groups would fire someone who was that minimally productive if they couldn't help teach them to produce more.
The recurring bad actors in PP are: low volume, low services/tools to ramp collections, low staffing, bad owner, others. Be aware.
Even in a clearly good pod PP (or MSG or ortho or anywhere), it's good to keep track of how many pts per month you see, roughly how many of each common code you do, and make sure things line up in reasonable proximity to what the collections reports you are given contain.
Always have a loose pulse on your per visit and your month/quarter/annual totals.
To keep track of your numbers, it's not hard. You don't need EMR billing access. Take MCR rough rates (depends much on locality and payer mix).
For easy math, use RVU, count MCR rate since privates are usually better and MCA worse, MCR is a fair RVUs measuring stick:
>visits 99203 = 3.3rvu, 99213 = 2.7, 99214 = 3.7
>derm 11721 = 1.3, 11730 = 3.4, 11750 = 4.7 ... 11056 = 2.5, 17110 = 3.4
>injects 20550, 20600, 64455 are all about = 1.6 (use appropriate steroid code for a few bucks more)
>xray 73610 = 0.9, 73630 = 0.8
>surgery and DME is highly variable based on area payers (be in PP in a good area, work hospital in a bad... just like MDs do)
...so, it's obviously slightly dynamic YOY, but 1.0 MCR rvu = roughly $34 today.
Collection % of what you billed out for means jack (since price billed is arbitrary). Track your rvu production vs what collections are. Assume "flub factor" of a quarter or a third of the RVUs you do won't get paid (good vs bad insurance area, copay not paid, deductibles not paid, biller skill level, procedures reduced or rejected, modifiers, random luck, etc). Don't ever settle for "well, sure you did a lot, but we were only able to collect 30% of what you billed out, so ---." Know roughly how many RVUs you did, what an RVU is worth, multiply 0.7 or so based on payer demographic... and you have a fairly good ballpark as to what your collections should be. If it's ever under 0.5 of the quarter or annual RVUs you did seeming to get paid (after you've been there for a bit), that is a red flag.
That is the breaks of PP versus hospital jobs: hospital FTE typically has far fewer ways to do RVUs themselves and gets less wRVU (but more $ for each wRVU as a reward of sorts for all the facility fees and imaging and refers the hospital gobbles up from their FTE doc ordering/sending it), but their big strength as hospital FTE is that cushy base and that their RVUs are often paid whether collected or not.
Alternatively, PP wins on many ways to produce and roughly 3x or more RVU ("non-facility RVU" for clinic) for the same procedures, potential for more per hour (esp with good payers), and generally less or no call... but collections are all that matters in PP (whereas just doing a lot of stuff makes bonus in most hospital jobs). Track the RVUs constantly, convert them for expected collections, and look for missed work you did or ways to bump your per visit averages. It even helps to track wRVU or look for more per visit in some hospital jobs, but usually only to a small degree when compared to PP.
Assuming you see as many patients as you say, are doing any decent number of proc (even C&C proc), and there is even half-decent insurance in your area, something is way off. That should be readily apparent... unless your office doesn't have xray, or nail nippers, or 15 blades, or phenol. I would imagine it does. But what's done is done.
Learn the lesson and MOVE ON. It doesn't matter what it exactly is at this point holding your annual and per visit low; look for other work or start up solo if you can do that financially and based on non-compete.
Find a better-equipped office to succeed at or start your own (if you like PP relaxed hours and gig), or find a hospital/MSG job. Don't worry about the patients; they are the responsibility of the practice - not you. Take all of the above as constructive and motivation for next situation. Good luck
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