Job Questions

[georgiamd]

I am currently hospital employed in the midwest. I get compensated 65/wrvu. This year I will do about 7800 rvus. No equity offered. Working hard, but reasonable. There is an hour commute each way, cannot move closer for family reasons.

I have been approached about a job closer to home, non-compete not an issue. It is an ortho group. Will be offered a chance to buy into the asc as an equal partner as the ortho doctors. They have a traditional partnership for the group which I don't think I would be involved in.

Compensation is a percentage of collections minus overhead. The payor mix is pretty good, according to non-involved parties. Coming from the rvu model, I feel like I don't even know what questions to ask. I know the payor mix is very important in this model, so I need to ask about that. What other compensation questions do I need to ask to better understand potential pay, besides what is my overhead.

Any help would be appreciated and ballpark figures would be helpful to even get my research started.

Thanks.

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[willabeast]

What is the overall collection rate, in other words, money collected as a percentage of amount billed. When i was in private practice doing OR anesthesia our collection rate was pretty high. I would give you a number but that was a long time ago. Working and not getting paid for the work can be tiresome.

 

[georgiamd]

What is the overall collection rate, in other words, money collected as a percentage of amount billed. When i was in private practice doing OR anesthesia our collection rate was pretty high. I would give you a number but that was a long time ago. Working and not getting paid for the work can be tiresome.

Thank you. That's good info to find out.

 

[callmeanesthesia]

Find out about procedure space - if all your procedures are done in the ASC but it’s set up for orthopedic surgery they may not be able to handle the patient throughput of an interventionalist.
Also when do you get to buy in to the ASC, and will you have in-office procedure space? If you have to do all your procedures at the ASC but don’t get a share, your income will take a huge hit because you only get reimbursed the professional fee.

 

[Ronin1]

I am currently hospital employed in the midwest. I get compensated 65/wrvu. This year I will do about 7800 rvus. No equity offered. Working hard, but reasonable. There is an hour commute each way, cannot move closer for family reasons.

I have been approached about a job closer to home, non-compete not an issue. It is an ortho group. Will be offered a chance to buy into the asc as an equal partner as the ortho doctors. They have a traditional partnership for the group which I don't think I would be involved in.

Compensation is a percentage of collections minus overhead. The payor mix is pretty good, according to non-involved parties. Coming from the rvu model, I feel like I don't even know what questions to ask. I know the payor mix is very important in this model, so I need to ask about that. What other compensation questions do I need to ask to better understand potential pay, besides what is my overhead.

Any help would be appreciated and ballpark figures would be helpful to even get my research started.

Thanks.

You need to be clear regarding what the overhead is and what is attributed to you. You can get in the hole quickly if you are expected to have an equal share of overhead as an ortho. And don’t look at the ASC as a guaranteed windfall. Most likely you could do better with a majority of in office procedures

 

[DOctorJay]

What is the overall collection rate, in other words, money collected as a percentage of amount billed. When i was in private practice doing OR anesthesia our collection rate was pretty high. I would give you a number but that was a long time ago. Working and not getting paid for the work can be tiresome.

what's considered a good collection rate?

 

[TIVAndy]

what's considered a good collection rate?

OR anesthesia and surgical CPT bill and collection rate is different. typical collection rate for pain is around 30%. it's not that you won't be paid 70% of time, it's rather you ask for 100 dollars and they give you 30 dollars for your work.

 

[HouseofPain]

So I made this exact move awhile back - hospital to ortho group. You need to get your expenses in writing. Get you previous year EM and procedure codes and get them to run the numbers. Mine were outlined in the contract and except for maybe the first year you should get 100% of your collections minus your expenses. I have my direct expenses related to everything I need to practice (malpractice, my staff, supplies, my base salary, health ins, retirement, etc). You should have fixed expenses (rent, utilities,etc). I also have an additional prorated expense category which includes front office staff, billing, coding, etc based on patient count. All of your expenses should be around 50-55% of your gross collections once you get rolling. I do majority of my procedures in office. If you want a share in the ASC you are going to have to do a good volume to support your share. They won’t offer it if you’re not bringing anything to the table which makes it a little difficult when you first get going. You want to get your collections up as quick as you can and that is best done in the office setting due to SOS. The trade off is you work harder and make more in this setting. You are your own boss and as long as you have have an business mindset it’s very rewarding. You also have a never ending referral source. I had a hell of a lot more time off at the hospital with good pay but hated going to work dealing with administrators, etc. If you just want to get paid and show up it may be better to stay in the hospital. I will say that when I get my average monthly wRVU payment based on the various insurance carriers it’s crazy compared to the current rates at the hospital

 

[hyperalgesia]

It's tempting to want to work at your max capacity and max efficiency. This is what we learned to do our whole lives. But this drive should be weighed against the reality that our healthcare system does not reward efficiency as much as it rewards hospitals and their employees.

You can work very hard and very efficiently and work overtime in a office/ASC setting churning out RVUs and make less than the hospital employee who goes home at 5 after doing his mandatory hospital harassment training and data entry.

 

[HouseofPain]

It's tempting to want to work at your max capacity and max efficiency. This is what we learned to do our whole lives. But this drive should be weighed against the reality that our healthcare system does not reward efficiency as much as it rewards hospitals and their employees.

You can work very hard and very efficiently and work overtime in a office/ASC setting churning out RVUs and make less than the hospital employee who goes home at 5 after doing his mandatory hospital harassment training and data entry.

I can only speak from my experience. I would not recommend joining a non-hospital position that was based on wRVU. If you’re going to work off of wRVU stay in the hospital. If your going outside of the hospital to me it has to be a eat what you kill model with ownership(and you better know what your expenses are before you sign). I traded hospital headaches and some vacation time for a higher income, ownership, with the same daily work hours. I get why some like the hospital. It wasn’t for me and I’m much happier where I am now.

 

[hyperalgesia]

I can only speak from my experience. I would not recommend joining a non-hospital position that was based on wRVU. If you’re going to work off of wRVU stay in the hospital. If your going outside of the hospital to me it has to be a eat what you kill model with ownership(and you better know what your expenses are before you sign). I traded hospital headaches and some vacation time for a higher income, ownership, with the same daily work hours. I get why some like the hospital. It wasn’t for me and I’m much happier where I am now.

I'm gonna back pedal. In my area, the pay is actually similar between hospital and private docs.

My observation is similar to yours. Different kind of headaches.

 

[georgiamd]

is it hard to find percentiles for gross collections, like the Rvu data?

 

[Ferrismonk]

Yes. This is HIGHLY variable by the payor mix/location.

 

[georgiamd]

If the ortho group has a single specialty asc, can anesthesia pain do procedures

 

[TIVAndy]

If the ortho group has a single specialty asc, can anesthesia pain do procedures

don't think single specialty is defined as law.. but may be state dependent. besides, lot of spine/joint injections would be ortho anyways..