Medicaid practice, production percentage

[staroceanX]

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Hello everybody:

I did a year of GPR and is now practicing in suburban area of NY State (definitely not anywhere near NYC). Having some problem with my new job so I turned to the trusty members of SDN.
I signed up for a job that offers 30% production, no base, no benefits (at least for now). Since it's a 90% medicaid office, the fee reimbursements are quite low, I find myself doing high number of procedures (often twice as many as someone working in PPO/FFS) and yield the same production at the end of the day. Another problem is medicaid patients has a high no-show rate. My production varies greatly daily, highest i got was 3k, avg probably around 2k, and low end are 1-1.5k. The low days really negate the hard work I put in during the good days and avg everything out. If you ever worked in a medicaid office you would know how many procedures you would need to do to get to 3k a day.
I know technically I'm a new grad (even though I did a year of GPR), but I still feel my pay package is low, especially because it's a medicaid office and the pay varies greatly everyday. They seemed to be very opposed to offer a base (I didn't really push it on this topic), so I'm thinking of asking for a higher percentage. I'm there full time 5 days a week and keep in mind I have no benefits (not even health insurance). Some of my other colleagues do receive benefits such as health, disability, life, malpractice, 401k, and/or paid vacations. Benefits are usually better if they work full-time. Any suggestion or opinion will help. I thank you in advance for reading.

 

[OhioDMD]

IMHO if you are not happy and the owners are unwilling to renegotiate then its time to start looking elsewhere. Examine your contract for how to terminate your relationship (I.e. how much notification you have to give time wise). If you have a non-compete clause be aware of its restrictions when you look for a new position. Most predominately Medicaid practices are run very similar to what you describe. Keep your current job and look for a better one.

 

[djeffreyt]

I agree. Don't stay if you aren't happy... that's not really the best job for you anyway. As a GPR trained dentist, you have a much wider range of skill than the pedo you are probably doing all day.

Medicaid reimbursements vary greatly state to state, although all are lower than what they should be. I work with Medicaid in Texas. A $3000 day in NY is probably like $4000 in Texas cause the pediatric dentists out here in the early 2000s lobbied to have their reimbursements raised or they said they'd drop Medicaid.

With the loans that we all have, I don't think that averaging $2000 a day and getting 30% is going to really help you pay your loans, pay your bills and living costs, and give you much to put away for savings and future investment. I'm not going to advertise all the calculations here in the forum for the world to see, but consider your fixed costs: your loans, rent, other living costs, monthly cost of disability/malpractice/medical/auto insurance, monthly breakdown of CE and licensures, etc. Figure out how much more you'd make with each 1% increase and figure out how much you need to be able to live comfortable and be able to save toward your future. In a Medicaid office, you've got to remember that it is unlikely to suddenly get better with time. It's not like a private office where as patients get to know you, they accept more treatment. In Medicaid offices that are established, patient flow isn't likely to suddenly increase and patients don't suddenly start accepting more treatment cause in general they just get everything you recommend done so long as it is covered. So ask yourself if you will be fine still making what you are making in another 3 months, another 12 months, another 3 years. If not, maybe establish yourself somewhere else and build from there now.

 

[staroceanX]

Thank you guys for your responses. I haven't officially ask for a pay increase or more benefits, i wanted to see some of the opinions of other dentists out there. I'm hoping to do that soon. Based on my pay package now, (30% production, no base, no benefits), what pay package should I ask that would be acceptable to the owners? I was thinking at least 33% production, a possible base of 400-500, and some kind of benefits (at least health, nowadays it's impossible to find an affordable individual health plan). I just didn't want to ask anything too ridiculous. Any opinion will help, thank you guys again!

 

[OhioDMD]

Assuming your office is well run i.e. the front office bills properly and gets reimbursed in a timely manner asking for 35% of collections would probably not be out of line. If you are productive you could ask for a monthly production bonus. Remember you are only as valuable to the owner as the dollars you collect. The more you bring in the better position you are in to negotiate.

 

[ziptree]

Assuming your office is well run i.e. the front office bills properly and gets reimbursed in a timely manner asking for 35% of collections would probably not be out of line. If you are productive you could ask for a monthly production bonus. Remember you are only as valuable to the owner as the dollars you collect. The more you bring in the better position you are in to negotiate.

In a well-run office, you're looking at a collections rate of 90-96%. If we take the low end of that, 90%, you have an equivalent of 31.5% of productions and at the high end, 33.6% of production. Asking for 35% of collections is only a negligible raise compared to 30% of productions, especially considering the production per patient figure.

With that said, Medicaid clinics here in Texas usually pay 35% of production and you're seeing ~20-25 patients a day.

Ask around your area and see what other associates are being compensated. I'd ask for health care benefits (~$2,500 should be enough), CE units, and paid vacation after the first year of service as well as 35% of production if that's not too far off from your market.

Good luck.

 

[luckytooth]

Hi staroceanX,

I am in a similar situation as yours and most of my friends are getting the same percentage production. With medicaid cut in most states, the situation is no better. I did i/v at couple of places but this is what the standard offer is.