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[ziggyziggy]

I’m not really sure how I could limit my patient load as it is mostly controlled by them and my clinic coordinator throws people on the schedule. I’m currently scheduling 32 on my 2 full days of clinic and 16-18 on my 2 half days. The rest is procedure time. The problem is my patients are canceling procedures as soon as they see the anticipated cost. I’ve been asking them to get me a different procedure area that is more affordable for patients because I have a lot of private insurance patients (who haven’t met their out of pocket or deductibles) who are getting charged way too much out of pocket so they keep calling to cancel their procedures. $1500 out of pocket for a 5 min injection is ridiculous. But of course the hospital is dragging in finding an alternative but they did say they are gonna work on opening an ASC.

The way they are playing it makes me want to just see patients in clinic and not do any procedures at all since they “can’t take my hospital collections into account.” But that’s not the type of pain practice I want to run.

You can keep trying with admin but in my opinion, you are wasting your time. This time will be better spent on looking alternatives. If you have to, the best you can do is to negotiate a better conversion factor for your wrvu and clinical directorship. They will never pay you any part of facility fees/ancillary etc or enterprise value .. period.

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[Ducttape]

they are not supposed to give you any money for the facilities fees. that's why they are facility fees.

for education, the RVU model being used has several components. what we can get paid for are the physician component of the RVU, or the wRVU. is what we do. the other parts of the total RVU is the facility (which typically is half of the total RVU package) and a small portion (roughly 10% ) for malpractice insurance.

when you are asking for them to pay you for the facility part, they will say that they are not able to. you cant get paid for something the facility is billing for while paying you for the procedure itself, and that's what they are saying is the Stark violation.

if you are concerned, you might ask for higher base but lower wRVU after you reach the minimum for bonus. they may consider that. that scenario is best for those docs who have a high Medicaid and charity cases.



I do not believe that they can give you 45% of facility fees in any employed model directly. they can give you a salary...

 

[PainApp2021]

I just started actually reading the emails sent to me by recruiters over the past week. Many of them are offering what seem like ridiculously high base salaries plus productivity bonuses along with relocation/stipend while in fellowship/loan repayment/25+ days PTO/etc. They are typically in what most people would consider "undesirable" locations. One recruiter I talked with yesterday had a hospital system that paid 500k base for 4.5 days of work with these extra bonuses as well, and little to no medication management. The two current physicians working there apparently take home >800k/yr, but it is in the sticks. Although I would be finishing fellowship in 2023 they would be willing to sign me as soon as I matched (after interviewing, etc).

Are there often other things about this kind of job that make it "too good to be true", or is it really just the location that ups the take home amount?

 

[drusso]

they are not supposed to give you any money for the facilities fees. that's why they are facility fees.

for education, the RVU model being used has several components. what we can get paid for are the physician component of the RVU, or the wRVU. is what we do. the other parts of the total RVU is the facility (which typically is half of the total RVU package) and a small portion (roughly 10% ) for malpractice insurance.

when you are asking for them to pay you for the facility part, they will say that they are not able to. you cant get paid for something the facility is billing for while paying you for the procedure itself, and that's what they are saying is the Stark violation.

if you are concerned, you might ask for higher base but lower wRVU after you reach the minimum for bonus. they may consider that. that scenario is best for those docs who have a high Medicaid and charity cases.



I do not believe that they can give you 45% of facility fees in any employed model directly. they can give you a salary...

Where do you think the money comes from? Do you think every dollar that they collect gets "tagged?" Ooh, this is a facility fee, this a professional fee, this one came from the lab/DME, etc. We better not mix them up!

The whole Admin trope "we can only pay you fair market value, etc" is just a distraction that physicians fall for. It's "truthy" sounding but not entirely true. They can pay you whatever they want and they can be as creative as they want about structuring it as long as it is not based on volume per se.

 

[SSdoc33]

if you are concerned, you might ask for higher base but lower wRVU after you reach the minimum for bonus. they may consider that. that scenario is best for those docs who have a high Medicaid and charity cases.

I just started actually reading the emails sent to me by recruiters over the past week. Many of them are offering what seem like ridiculously high base salaries plus productivity bonuses along with relocation/stipend while in fellowship/loan repayment/25+ days PTO/etc. They are typically in what most people would consider "undesirable" locations. One recruiter I talked with yesterday had a hospital system that paid 500k base for 4.5 days of work with these extra bonuses as well, and little to no medication management. The two current physicians working there apparently take home >800k/yr, but it is in the sticks. Although I would be finishing fellowship in 2023 they would be willing to sign me as soon as I matched (after interviewing, etc).

Are there often other things about this kind of job that make it "too good to be true", or is it really just the location that ups the take home amount?

yes, its mainly the location that drives up the salary. you are not going to find that offer in NYC, SF, Austin, chicago, etc. ironically, "desirable" locations are where you would need that money the most due to cost of living. best bet is to find somewhere in between. that way, your SO won't want to leave after 2 years, and you won't grow a beard, find an independent water supply, or have a doomsday shelter.

 

[Ducttape]

Where do you think the money comes from? Do you think every dollar that they collect gets "tagged?" Ooh, this is a facility fee, this a professional fee, this one came from the lab/DME, etc. We better not mix them up!

The whole Admin trope "we can only pay you fair market value, etc" is just a distraction that physicians fall for. It's "truthy" sounding but not entirely true. They can pay you whatever they want and they can be as creative as they want about structuring it as long as it is not based on volume per se.

actually - yes. because they track of everything to the tee that I do.


your "physician enterprise value", right?


yes they can structure a salary based on whatever they want. they could take in account facility fees as long as they don't state that your salary is based on a cut of facility fees.

 

[drusso]

yes, its mainly the location that drives up the salary. you are not going to find that offer in NYC, SF, Austin, chicago, etc. ironically, "desirable" locations are where you would need that money the most due to cost of living. best bet is to find somewhere in between. that way, your SO won't want to leave after 2 years, and you won't grow a beard, find an independent water supply, or have a doomsday shelter.

What’s wrong with facial hair?

 

[drusso]

actually - yes. because they track of everything to the tee that I do.


your "physician enterprise value", right?


yes they can structure a salary based on whatever they want. they could take in account facility fees as long as they don't state that your salary is based on a cut of facility fees.

So, let’s stop falling for the line about fair market value, Stark laws, etc. Hospitals can pay employees more or less whatever they want. They can characterize compensation all sorts of ways. They’ve got rooms full of accountants, attorneys, Human Resources professionals who can put their heads together and figure out how to juice any doctors compensation IF THEY WANT TO…but most MD/DO’s just prefer to sit in their **** and believe they are knocking on the glass ceiling. Admin let’s this this delusion thrive because it’s self-serving.

 

[PainApp2021]

yes, its mainly the location that drives up the salary. you are not going to find that offer in NYC, SF, Austin, chicago, etc. ironically, "desirable" locations are where you would need that money the most due to cost of living. best bet is to find somewhere in between. that way, your SO won't want to leave after 2 years, and you won't grow a beard, find an independent water supply, or have a doomsday shelter.

SO actually wants to live rural or underrepresented for a few years to pay off our loans quickly (~500k) as long as there are supermarkets and some restaurants available haha. I think she was not a fan of this particular opportunity because of the significant exposure to hurricanes.

 

[SSdoc33]

What’s wrong with facial hair?

you tell me:

 

[lobelsteve]

you tell me:
View attachment 339794View attachment 339795

Vs:

 

[cowboydoc]

SO actually wants to live rural or underrepresented for a few years to pay off our loans quickly (~500k) as long as there are supermarkets and some restaurants available haha. I think she was not a fan of this particular opportunity because of the significant exposure to hurricanes.

For many of these loans, "underrepresented" areas can actually be pretty great, e.g. live in the burbs and commute 20 min the opposite direction of everyone else. It certainly isn't just towns where you only have a post office and 3 bars. Post-COVID, it seems everyone has facial hair.

 

[clubdeac]

Thank you everyone for your input. I guess my point was they are using the MGMA data but I think it is for clinic based practices (the majority) vs hospital based. One of my main points was that every time I do an LESI in the hospital in an OR they are billing close to 3-4k and all I see is the 1.8 wRVU. They just kept saying they can't use the collections I've made in the hospital to negotiate because "it violates Stark law" to which I didn't know what to respond. I thought it would be fair to ask for a higher base given they are making good money off my procedural volume but they basically said they wouldn't do that unless my RVU threshold goes up (which makes me make less). I guess I should just keep my current model and ask for more compensation per wRVU?

This is exactly how it works in all hospitals. It’s crazy. You get 1.8 wRVUs for an ILESI while they bill 3-4K.

 

[drusso]

This is exactly how it works in all hospitals. It’s crazy. You get 1.8 wRVUs for an ILESI while they bill 3-4K.

 

[SSdoc33]

This is exactly how it works in all hospitals. It’s crazy. You get 1.8 wRVUs for an ILESI while they bill 3-4K.

They bill 3-4k, but it doesnt mean they collect that. What drusso conveniently fails to mention is that hospitals take a heavy medicaid population. They are not paying out an arm and a leg for an ESI

 

[BobBarker]

Hospitals get around $750 for a traditional Medicare esi. You can check and see on the ASIPP HOPD fee schedule.

 

[drusso]

They bill 3-4k, but it doesnt mean they collect that. What drusso conveniently fails to mention is that hospitals take a heavy medicaid population. They are not paying out an arm and a leg for an ESI

You can't win this argument. Nominally-non-profit hospitals have built a business model on employing MDs, juicing the vig on SOS, and pocketing the difference...I can't afford to run a charity.

Nonprofit Hospitals Fail to Fulfill Community Health Investments

Over 70 percent of private nonprofit hospitals spent less on community health investments than they received in tax breaks, according to the Lown Institute Hospitals Index.

revcycleintelligence.com

"Nonprofit hospitals failed to follow through on community health charity commitments, resulting in $17 billion in unrealized investments, according to the Lown Hospitals Index 2021 Community Benefit report."

 

[lobelsteve]

You can't win this argument. Nominally-non-profit hospitals have built a business model on employing MDs, juicing the vig on SOS, and pocketing the difference...I can't afford to run a charity.

Nonprofit Hospitals Fail to Fulfill Community Health Investments

Over 70 percent of private nonprofit hospitals spent less on community health investments than they received in tax breaks, according to the Lown Institute Hospitals Index.

revcycleintelligence.com

"Nonprofit hospitals failed to follow through on community health charity commitments, resulting in $17 billion in unrealized investments, according to the Lown Hospitals Index 2021 Community Benefit report."

You just need a better CBT therapist and more vampire facial BS.

 

[gaseous_clay]

I’m very interested if anyone can post as well. I have older info if that helps

Man, it’s amazing that ortho still makes as much as they do. I wonder if they get their reimbursement cut for their CPTs to the level that we do on an annual basis. I also wonder if insurers give them as much trouble approving elective procedures as they do for our field.

 

[painfree23]

Man, it’s amazing that ortho still makes as much as they do. I wonder if they get their reimbursement cut for their CPTs to the level that we do on an annual basis. I also wonder if insurers give them as much trouble approving elective procedures as they do for our field.

Also there’s orthos at a hospital I used to work at that do epidurals (caudals for all)…I wonder how that plays a role nationally in their numbers.

 

[deleted131481]

Also there’s orthos at a hospital I used to work at that do epidurals (caudals for all)…I wonder how that plays a role nationally in their numbers.

Seen one of these caudal procedure notes. 20cc, 160mg depo, done blind. Gave 2 days of relief.

 

[RoloTomassi]

Floating rad tech told me she saw an ortho trying to do an ESI with a textbook open on the mayo. Said he was nowhere close.

 

[callmeanesthesia]

Floating rad tech told me she saw an ortho trying to do an ESI with a textbook open on the mayo. Said he was nowhere close.

Clearly fabricated - no orthopedist would have had a textbook open…

 

[Ducttape]

I think Rolo meant to type "picturebook" instead...

 

[cowboydoc]

Does Furman have a coloring book edition?

 

[geauxg8rs]

Seen one of these caudal procedure notes. 20cc, 160mg depo, done blind. Gave 2 days of relief.

On to surgery since failed esi

 

[geauxg8rs]

Floating rad tech told me she saw an ortho trying to do an ESI with a textbook open on the mayo. Said he was nowhere close.

Nowhere close to the textbook?

 

[gaseous_clay]

They are such a bunch of frauds. The data on knee arthroscopies and rotator cuff repairs is so poor, not to mention lumbar fusions.

 

[gaseous_clay]

Clearly fabricated - no orthopedist would have had a textbook open…

Two orthos reading a textbook - a double blind study.

 

[lobelsteve]

Two orthos reading a textbook - a double blind study.

Ekg

 

[gaseous_clay]

Ekg

Doh! You’re right. Med school was a long time ago.

 

[LocusCoeruleus]

What's the difference between MGMA Non-anesthesia vs Anesthesia? I'm dually boarded in pain and anesthesia but I only do pain so my organization considers me as Pain non-anesthesia. Our entire multi-specialty group gets paid based on MGMA wRVU productivity.

Can you share the latest MGMA for Non-anesthesia and Anesthesia, thank you all

 

[docscott999]

MGMA data doesn't calculate average RVU for Anesthesia pain, but they have ASA units, income data. I can share what I have. Apparently, my org doesn't have the new data yet, as I just received the 2020 report from 2019 data. I'm happy to share, just not sure it's kosher to post?

could you send that to me please.

 

[docscott999]

MGMA data doesn't calculate average RVU for Anesthesia pain, but they have ASA units, income data. I can share what I have. Apparently, my org doesn't have the new data yet, as I just received the 2020 report from 2019 data. I'm happy to share, just not sure it's kosher to post?

These are the wRVU's that are being paid? If so I am well below and I am in the 90th percentile. Does this number also factor in other employee benefits like insurance and profit sharing?

 

[docscott999]

So what I am seeing in MGMA data, I am underpaid at $55 per wRVU in anesthesia pain

 

[PainDoc2025]

So what I am seeing in MGMA data, I am underpaid at $55 per wRVU in anesthesia pain

Renegociate to that rate during your next contract signing

 

[Nargosi]

So does anyone have 2021 comp numbers for MGMA 2020 data broken down by region? Hospital employed, southern region.

 

[Ligament]

Bumping for more recent data. Feel free to PM me if you have.

 

[drusso]

This is what hell looks like: Work more, make less...

 

[Ligament]

This is what hell looks like: Work more, make less...

View attachment 352074

Wth is this? Is this a real contract?

 

[callmeanesthesia]

This is what hell looks like: Work more, make less...

View attachment 352074

Looks like a great incentive to choose to spend more time with family. Pretty sure I could generate 6300 RVUs working 3 days a week.

 

[DOctorJay]

Wth is this? Is this a real contract?

 

[paindoc007]

Anyone who signs something like that deserves to be screwed. I have zero sympathy for anyone under that contract.

 

[Ronin1]

Anyone who signs something like that deserves to be screwed. I have zero sympathy for anyone under that contract.

Actually this is a pretty standard looking Hospital wrvu deal. Base looks to be 448. Each wrvu after meeting the 7300 threshold is worth 60. Obviously if you aren’t busy you make more per wrvu but eventually you will be cut down for poor performance.
I have a similar deal with a 7300 threshold. Higher base and wrvu bonus value though. Same principals though.

 

[cowboydoc]

Bumping for more recent data. Feel free to PM me if you have.

Sent you most recent in Feb. Newer MGMA not available as far as I know.

 

[Agast]

Sent you most recent in Feb. Newer MGMA not available as far as I know.

Share with the class?

 

[DOctorJay]

Actually this is a pretty standard looking Hospital wrvu deal. Base looks to be 448. Each wrvu after meeting the 7300 threshold is worth 60. Obviously if you aren’t busy you make more per wrvu but eventually you will be cut down for poor performance.
I have a similar deal with a 7300 threshold. Higher base and wrvu bonus value though. Same principals though.

he posted on twitter his base is 390k and he made the assumptions based off his additional bonus he received.
seems like this is the new normal from hospital employed positions though. no longer paying a set $/wRVU that is stable. it's more about metric bonuses and some small portion of productivity bonus that disincentives productivity.

 

[paindoc007]

Actually this is a pretty standard looking Hospital wrvu deal. Base looks to be 448. Each wrvu after meeting the 7300 threshold is worth 60. Obviously if you aren’t busy you make more per wrvu but eventually you will be cut down for poor performance.
I have a similar deal with a 7300 threshold. Higher base and wrvu bonus value though. Same principals though.

Nope. This is not standard or acceptable. My $/wrvu doesn’t change with my hospital. Nor would I have signed with a place that tries to pull that.

 

[Ducttape]

This is what hell looks like: Work more, make less...

the implication of your posts is that this is the modus operandi of hopd as a whole.

this is 1 pain doc's salary.

yes his salary is screwy.

but your post is misleading and deceptive.

it is not representative of the industry.



EDIT: I reviewed the graph and i have to make changes. see next post please

 

[Ducttape]

actually, when i look closely at the graph, i stand corrected.

this is a structured contract at which he is salaried up until 7300 wRVU. after 7300 wRVU, he is contracted for $60/wRVU.

his base salary is $448K, which is average.

the expectation that he signed was that he would do more then 7300 wRVU.

why should he get paid more if he is doing less work than he agreed to?