how should i split profit

[TIVAndy]

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hey guys

quick question to all members seasoned in business side of things. i'm working full time but thinking about adding a weekend/late hour side gig. i'm talking to a surgeon who wants to keep certain procedures in house. he does have a surgery center. i'm thinking about going there 1 day per week to see some internal referral pts and do some procedures.

1. i will take no base salary
2. i will cover my own malpractice
3. he will provide MOB, staff, procedure room/surgery center, EMR..
4. obviously i'm taking risk for the consult/procedure

in this case what do you guys think is a fair split of profit? I was thinking i want to take 60% from the profit, but do you think i should aim for more or am i being too greedy?

any feedbacks appreciated.

thanks!

 

[lobelsteve]

You get 100% of pro fee. He keeps rest.
It will not cover your malpractice.

 

[paindoc007]

Negotiate for some portion of the facility fee, even if it’s small . Doing shots in an ASC and just getting pro fee will not be worth your time

 

[NOSfan]

Let him bill for everything, including your professional fees.

You get paid based upon wRVU production via 1099.

Cheers

 

[lonelobo]

Negotiate for some portion of the facility fee, even if it’s small . Doing shots in an ASC and just getting pro fee will not be worth your time

You legally can't get any facility fee, if you are not an owner of ASC

 

[jsaul]

You legally can't get any facility fee, if you are not an owner of ASC

this is correct. The easiest way of doing is this to for you to bill your professional fees and you keep all of that and he keeps the facility fees. Many pain docs do this arrangement in my area

 

[Ducttape]

Get shares of ASC.

 

[BobBarker]

You can have him bill for everything and take a day rate 1099.

 

[pastafan]

You can have him bill for everything and take a day rate 1099.

Make sure the day rate has parameters on the number of procedures you are required to perform or state that you control scheduling.

 

[paindoc007]

You legally can't get any facility fee, if you are not an owner of ASC

Interesting, didn’t know that.

Then I second the wrvu thing via 1099

 

[gdub25]

Agree with RVU being your best bet. You can’t collect facility fees legally unless you own a percentage of the faculty and distributions can only be made based on the percentage you own. 5% ownership would equal 5% of total profits. You’d also have to buy in to the facility which would cost you money and it would likely take you a long time to get a return on that investment. If you only keep your professional fee you won’t make much money, only get about $80-90 per ESI. The beauty of an RVU system in this situation is that you can, in a way, still get a piece of the facility fee. If he will give you a high enough dollar amount per RV you do you will end up getting paid more for an epidural then you would if you only kept your professional fee and that little bit of extra money will be coming out of the facility payment. This is a completely legal way of doing things however there are fair market values on what is considered a reasonable RVU amount.

 

[Dr. Ice]

this is correct. The easiest way of doing is this to for you to bill your professional fees and you keep all of that and he keeps the facility fees. Many pain docs do this arrangement in my area

This works for a part time or moonlighting gig but not if you only have access to asc and not office fluoro and are not getting any of the facility fee for the work you churn out there

 

[TIVAndy]

thank you for the reply. what wRVU rate is usually appropriate?

 

[EtherBunny]

thank you for the reply. what wRVU rate is usually appropriate?

It's pretty simple. Calculate the number of average wRVUs that would anticipate generating at the ASC per hour based on your procedural efficiency, the expected turnover times at the ASC, your typical case mix, etc. Then ask yourself how much you would like to earn per hour as a physician? What's a "fair" hourly compensation for your work? Just to put things in perspective: many lawyers charge $300 or more per hour. The average anesthesiologist in the OR probably earns around $170-180 per hour. I'm an interventional pain physician--currently employed at a hospital--and I earn anywhere from $230 to $400 per hour, depending on what I'm doing. Once you determine your hourly rate, you just divide that number by the average wRVUs that you would expect to generate and you'll have your conversion rate. Piece of cake.

 

[jsaul]

This works for a part time or moonlighting gig but not if you only have access to asc and not office fluoro and are not getting any of the facility fee for the work you churn out there

you CANNOT GET FACILITY FEES unless you are an owner of the ASC. Its as simple as that. Physicians are not meant to get facilty fees. as the name says it is for the facilty, I keep getting all these new docs graduating who think they are somehow entitled to the facility fees just by doing procedures at a facilty. they just dont get it

 

[Dr. Ice]

you CANNOT GET FACILITY FEES unless you are an owner of the ASC. Its as simple as that. Physicians are not meant to get facilty fees. as the name says it is for the facilty, I keep getting all these new docs graduating who think they are somehow entitled to the facility fees just by doing procedures at a facilty. they just dont get it

Agreed. What I meant was that docs who do work in and bring a significant volume to an asc should be offered shares otherwise it doesn’t make sense unless they have access to office space for the procedures as well

 

[gdub25]

It's pretty simple. Calculate the number of average wRVUs that would anticipate generating at the ASC per hour based on your procedural efficiency, the expected turnover times at the ASC, your typical case mix, etc. Then ask yourself how much you would like to earn per hour as a physician? What's a "fair" hourly compensation for your work? Just to put things in perspective: many lawyers charge $300 or more per hour. The average anesthesiologist in the OR probably earns around $170-180 per hour. I'm an interventional pain physician--currently employed at a hospital--and I earn anywhere from $230 to $400 per hour, depending on what I'm doing. Once you determine your hourly rate, you just divide that number by the average wRVUs that you would expect to generate and you'll have your conversion rate. Piece of cake.

This is not really the way it works. RVU value is something that is standardized across the country and used by just about all hospital systems to value the work of physicians. There are fair market value ranges and it would be wise to stay within those parameters. I think in the southern region $87/RVU is the 90th percentile, so I would shoot for that.

As for physicians not being meant to get any part of the facility fee...I disagree. I am part owner of an ASC and we have worked out deals like the one I described above with doctors and it works out well for both parties. For example, pay the doc $90/RVU. He does better than if only collecting professional fee and we do well because we make money on the cases that he brings and he’s incintivised to keep bringing cases because he’s making more money. Again, he’s not really getting any of the facility fee directly but he’s getting more money than just collecting his professional fee, and that extra money is coming from the payments to the facility.

 

[Ducttape]

you are part owner. dynamics change as soon as you are owner of any degree.

he cannot directly get facility fees.

if you want to overpay him out of your own pocket, however, that is perfectly legal.

 

[nvrsumr]

Since you have no say over how busy you will be on the day you see his patients in his ASC I would just charge a flat rate per day and cap the number of cases.

 

[jsaul]

This is not really the way it works. RVU value is something that is standardized across the country and used by just about all hospital systems to value the work of physicians. There are fair market value ranges and it would be wise to stay within those parameters. I think in the southern region $87/RVU is the 90th percentile, so I would shoot for that.

As for physicians not being meant to get any part of the facility fee...I disagree. I am part owner of an ASC and we have worked out deals like the one I described above with doctors and it works out well for both parties. For example, pay the doc $90/RVU. He does better than if only collecting professional fee and we do well because we make money on the cases that he brings and he’s incintivised to keep bringing cases because he’s making more money. Again, he’s not really getting any of the facility fee directly but he’s getting more money than just collecting his professional fee, and that extra money is coming from the payments to the facility.

I am pretty sure this is not legal. You cannot pay someone from the earnings of the facilty for referrals (having the doc to procedures there)to the facilty . You can call it RVU or whatever ( I know nothing of RVUs I deal in real money in and out) but its still paying for referrals and that's illegal, be careful-- you may get a whistleblower lawsuit filed especially if you do medicare at your ASC. just sayin

 

[gdub25]

RVU is completely legal and used in nearly every employment model in the country by hospitals. Check the fair market values for your region through MGMA or Sullivan (the two biggest national survey companies) and as long as you’re within FMV ranges there is no problem.

 

[drusso]

you are part owner. dynamics change as soon as you are owner of any degree.

he cannot directly get facility fees.

if you want to overpay him out of your own pocket, however, that is perfectly legal.

Stark laws prohibit overpaying MD's in exchange for referrals, But, hospitals do this all the time.

 

[drusso]

I am pretty sure this is not legal. You cannot pay someone from the earnings of the facilty for referrals (having the doc to procedures there)to the facilty . You can call it RVU or whatever ( I know nothing of RVUs I deal in real money in and out) but its still paying for referrals and that's illegal, be careful-- you may get a whistleblower lawsuit filed especially if you do medicare at your ASC. just sayin

You are absolutely right.

 

[DODOCSS]

You are absolutely right.

Mayo: Doctor gets vindication - and $12 million

 

[drusso]

Mayo: Doctor gets vindication - and $12 million

"Reilly's take from the settlement: $12 million, minus cuts to Uncle Sam for taxes and his attorney."

This is why reform needs to start on the inside the HOPD-employed MD's. They know all the details of how the deals are structured, the pressures to minimize "revenue leak" from their systems, etc. And, they can stand to make a lot of money by being a credible whistle-blower. Fingers crossed.

 

[jsaul]

RVU is completely legal and used in nearly every employment model in the country by hospitals. Check the fair market values for your region through MGMA or Sullivan (the two biggest national survey companies) and as long as you’re within FMV ranges there is no problem.

you are not a hospital. You are a physician owned ASC. I have seen whistleblower lawsuits filed and won in cases like this. There are many people out there looking quick money from the feds to be a whistleblower

 

[Ducttape]

"Reilly's take from the settlement: $12 million, minus cuts to Uncle Sam for taxes and his attorney."

This is why reform needs to start on the inside the HOPD-employed MD's. They know all the details of how the deals are structured, the pressures to minimize "revenue leak" from their systems, etc. And, they can stand to make a lot of money by being a credible whistle-blower. Fingers crossed.

Except that he was never in the system from what I can see, and Broward did not admit wrongdoing.

In addition, there are at least 2 other significant legal actions involving Broward Health, including one involving a fired CEO who was blamed for kickback schemes, and the favorable contracts they got for knowing Rep Gov Scott....