MGMA question

[caligas]

Not sure if this is a reasonable ask but:

Can anyone please give me a screenshot with latest MGMA average for Virginia or Mid Atlantic for MD and CRNA?

Thanks!!!

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[aneftp]

Not sure if this is a reasonable ask but:

Can anyone please give me a screenshot with latest MGMA average for Virginia or Mid Atlantic for MD and CRNA?

Thanks!!!

It doesn’t matter any more. The anesthesia market is ever changing. Last year’s data has no bearing on todays market.

My current contract 450k for what amounts to 40 hours a week plus 9 weeks off plus paid 12 holidays and free health care is good for 2023 with no overnights daytime only. It may not be good deal in 6 months

The competition next door (hospitals employed) also just upped their package to 10 weeks off (from 9 weeks) Lowered their anticipated 45 hour work week to match our 40 hour work week plus paying their docs overtime after 40 hours cause we took 3 of their docs. Their docs work a lot harder daytime than us. So their compensation is likely going to be in the 600s if they work 50/55 hours a week since they are short staff.

 

[caligas]

So how is everyone negotiating stipends with hospital? Have to show FMV somehow. Use gaswork?

 

[aneftp]

So how is everyone negotiating stipends with hospital? Have to show FMV somehow. Use gaswork?

You abandon the contract. That’s how you negotiate.

That’s what two of my friends true private practices did in the mid Atlantic. Kept the more profitable surgery center contract. Lose the hospital contract. Don’t renew it.

They had small 1.6 million subsidy. Wanted 3.5 million. Due to increasing labor cost. 40 operating locations each day. AMC been there for past 14 months. Hospital has bled though 7 million in subsidy to amc so far.

Not our problem my friends say. They go cover for the amc at $375/hr at the same hospital they abandon as private group.

It’s almost comical what happened. They make more abandoning the contract. Plus get to set their own hours.

 

[midazzoler]

You abandon the contract. That’s how you negotiate.

That’s what two of my friends true private practices did in the mid Atlantic. Kept the more profitable surgery center contract. Lose the hospital contract. Don’t renew it.

They had small 1.6 million subsidy. Wanted 3.5 million. Due to increasing labor cost. 40 operating locations each day. AMC been there for past 14 months. Hospital has bled though 7 million in subsidy to amc so far.

Not our problem my friends say. They go cover for the amc at $375/hr at the same hospital they abandon as private group.

It’s almost comical what happened. They make more abandoning the contract. Plus get to set their own hours.

Seen this repeated ad nauseam.

 

[Lecithin5]

You abandon the contract. That’s how you negotiate.

That’s what two of my friends true private practices did in the mid Atlantic. Kept the more profitable surgery center contract. Lose the hospital contract. Don’t renew it.

They had small 1.6 million subsidy. Wanted 3.5 million. Due to increasing labor cost. 40 operating locations each day. AMC been there for past 14 months. Hospital has bled though 7 million in subsidy to amc so far.

Not our problem my friends say. They go cover for the amc at $375/hr at the same hospital they abandon as private group.

It’s almost comical what happened. They make more abandoning the contract. Plus get to set their own hours.

This is an interesting consideration. Drop the money-suck hospital (unless you receive an appropriate stipend) and keep the profitable centers, and then offer locums services at the hospital you left. But is this model sustainable (assuming your PP is looking for additional work beyond the surgery centers)? At what point will the hospital not need your locums services? We are a true PP and have considered dropping the big hospital, but they account for a good chunk of our business. And I suspect the hospital will turn right around and try to poach some of our docs…

 

[IMGASMD]

This is an interesting consideration. Drop the money-suck hospital (unless you receive an appropriate stipend) and keep the profitable centers, and then offer locums services at the hospital you left. But is this model sustainable (assuming your PP is looking for additional work beyond the surgery centers)? At what point will the hospital not need your locums services? We are a true PP and have considered dropping the big hospital, but they account for a good chunk of our business. And I suspect the hospital will turn right around and try to poach some of our docs…

“Good chuck of our business”. Is it profitable? We are essentially paying to be working at this point. Unless the hospital really paying the market rate for our time, I consider we are actually losing money to be working.

There’s some lifestyle benefit when you have hospital business in your rotation, but how much does that worth is different to every one/group.

Then there’s the possibility that some of these hospital system taking over the surgicenters.

I am sure I am missing a lot of other factors.

At what point they won’t need your locum service? Not any time soon, especially with this tight market. They can be stubborn and trying to show dominance (and lose more money) by being dicks.

Poaching will happen, regardless what you do. People change jobs for money, location, lifestyle….

 

[aneftp]

“Good chuck of our business”. Is it profitable? We are essentially paying to be working at this point. Unless the hospital really paying the market rate for our time, I consider we are actually losing money to be working.

There’s some lifestyle benefit when you have hospital business in your rotation, but how much does that worth is different to every one/group.

Then there’s the possibility that some of these hospital system taking over the surgicenters.

I am sure I am missing a lot of other factors.

At what point they won’t need your locum service? Not any time soon, especially with this tight market. They can be stubborn and trying to show dominance (and lose more money) by being dicks.

Poaching will happen, regardless what you do. People change jobs for money, location, lifestyle….

The real equation is the overnight MD only in house or even beeper. What is the cost?

There is a premium to pay for these services. Ok…let the CRNA work solo overnight. Guess what. That CRNA is on the clock. They will want to maximize their weekly 40 hours. They will want to work 24 hours for that overnight shift. Or 16 hours. So you are down a CRNA the other 3.5 days since they would have worked 40 hours in 2 shifts.

The hospital has no answer for that. Pay the doc. How much? No one wants to take overnight call unless there is a benefit. Telling me I can work 16 hours (3pm-7am) and I get next day off. Well duh. I’ve worked 16 hours already. I’d rather work 8 hours daytime and be paid hourly. And if they wanted me to do overnight calls. I’d do my 24 HOURLY paid calls. That hourly rate starts at $300 and up. So hospital or private equity group paying u 500k isn’t going to cut it at $300/hr. Unless it’s 15 weeks of vacation. That will get someone to take the job. But I don’t see many 40 hour week jobs for 500k and 15 weeks off. I know of one in the south. It’s 525-550 with 15 weeks off and 40 hour average (I know the guys). Private group who recently sold out to amc 3 years ago. And amc has left the group alone to run its business. But u got to have the hospital on board with the subsidy.

 

[ERRES2288]

The real equation is the overnight MD only in house or even beeper. What is the cost?

There is a premium to pay for these services. Ok…let the CRNA work solo overnight. Guess what. That CRNA is on the clock. They will want to maximize their weekly 40 hours. They will want to work 24 hours for that overnight shift. Or 16 hours. So you are down a CRNA the other 3.5 days since they would have worked 40 hours in 2 shifts.

The hospital has no answer for that. Pay the doc. How much? No one wants to take overnight call unless there is a benefit. Telling me I can work 16 hours (3pm-7am) and I get next day off. Well duh. I’ve worked 16 hours already. I’d rather work 8 hours daytime and be paid hourly. And if they wanted me to do overnight calls. I’d do my 24 HOURLY paid calls. That hourly rate starts at $300 and up. So hospital or private equity group paying u 500k isn’t going to cut it at $300/hr. Unless it’s 15 weeks of vacation. That will get someone to take the job. But I don’t see many 40 hour week jobs for 500k and 15 weeks off. I know of one in the south. It’s 525-550 with 15 weeks off and 40 hour average (I know the guys). Private group who recently sold out to amc 3 years ago. And amc has left the group alone to run its business. But u got to have the hospital on board with the subsidy.

Problem is when time for subsidy renewal hospital says we are done. Kicks current AMC out for another

 

[caligas]

You abandon the contract. That’s how you negotiate.

That’s what two of my friends true private practices did in the mid Atlantic. Kept the more profitable surgery center contract. Lose the hospital contract. Don’t renew it.

They had small 1.6 million subsidy. Wanted 3.5 million. Due to increasing labor cost. 40 operating locations each day. AMC been there for past 14 months. Hospital has bled though 7 million in subsidy to amc so far.

Not our problem my friends say. They go cover for the amc at $375/hr at the same hospital they abandon as private group.

It’s almost comical what happened. They make more abandoning the contract. Plus get to set their own hours.

Does the anesthesia group contract to cover the locums or does everyone just do it as individuals?

 

[aneftp]

Does the anesthesia group contract to cover the locums or does everyone just do it as individuals?

What do u mean? The amc covers the locums

Of course the money for locums is really being paid from the hospital to the amc to the locums docs. That’s the flow of money train.

The hospital is on the hook for the locums the first 12-24 months.

I don’t know how these hospitals administrators agree to these same deals with these amc salesman.

It’s the same sales pitch.
1. We can provide more value to the hospital
2. We can provide more coverage
3. We have a large network of providers to makeup for any staffing problems

These amc use the same playbook.

 

[Dr. Rude]

What do u mean? The amc covers the locums

Of course the money for locums is really being paid from the hospital to the amc to the locums docs. That’s the flow of money train.

The hospital is on the hook for the locums the first 12-24 months.

I don’t know how these hospitals administrators agree to these same deals with these amc salesman.

It’s the same sales pitch.
1. We can provide more value to the hospital
2. We can provide more coverage
3. We have a large network of providers to makeup for any staffing problems

These amc use the same playbook.

It is a safe play for the hospital administrator to choose a national AMC with thousands of practitioners as opposed to a small local group.

 

[kidthor]

It is a safe play for the hospital administrator to choose a national AMC with thousands of practitioners as opposed to a small local group.

Especially because they are armed with charts and graphs that show the “synergy” to the MHA types.

 

[caligas]

What do u mean? The amc covers the locums

Of course the money for locums is really being paid from the hospital to the amc to the locums docs. That’s the flow of money train.

The hospital is on the hook for the locums the first 12-24 months.

I don’t know how these hospitals administrators agree to these same deals with these amc salesman.

It’s the same sales pitch.
1. We can provide more value to the hospital
2. We can provide more coverage
3. We have a large network of providers to makeup for any staffing problems

These amc use the same playbook.

I see. So everyone works locums for the new AMC.

So assuming the hospital was the bulk of its business, how does the original group/business survive? Presumably, they have office staff, expenses, insurance, retirement plans, yada yada.

 

[anbuitachi]

You abandon the contract. That’s how you negotiate.

That’s what two of my friends true private practices did in the mid Atlantic. Kept the more profitable surgery center contract. Lose the hospital contract. Don’t renew it.

They had small 1.6 million subsidy. Wanted 3.5 million. Due to increasing labor cost. 40 operating locations each day. AMC been there for past 14 months. Hospital has bled though 7 million in subsidy to amc so far.

Not our problem my friends say. They go cover for the amc at $375/hr at the same hospital they abandon as private group.

It’s almost comical what happened. They make more abandoning the contract. Plus get to set their own hours.

wait so what do you do with your staff that worked in the hospital contract, all let go? you can place them all in your surgery centers?

 

[IMGASMD]

wait so what do you do with your staff that worked in the hospital contract, all let go? you can place them all in your surgery centers?

I see. So everyone works locums for the new AMC.

So assuming the hospital was the bulk of its business, how does the original group/business survive? Presumably, they have office staff, expenses, insurance, retirement plans, yada yada.

You slim down, trim the fat, just like what AMC come in to do.

Hopefully you retain some profitable surgery centers. Ortho, spine, peds ent, peds dental, gi….. even eyeball I heard is okay, if you have the volume.

 

[aneftp]

wait so what do you do with your staff that worked in the hospital contract, all let go? you can place them all in your surgery centers?

The staff goes where ever they want. Not enough business in the surgery centers.

People move to other places etc.

Beauty of anesthesia practices. Especially big cities. Multiple hospitals and surgery centers to work at.

Trust me. There is a reason group practices walk away from hospital contracts. Only so much can negotiate with unreasonable hospital administrators even with 35 year history with the hospital as a private group.

 

[IMGASMD]

The staff goes where ever they want. Not enough business in the surgery centers.

People move to other places etc.

Beauty of anesthesia practices. Especially big cities. Multiple hospitals and surgery centers to work at.

Trust me. There is a reason group practices walk away from hospital contracts. Only so much can negotiate with unreasonable hospital administrators even with 35 year history with the hospital as a private group.

They lose the sight of forests from trees. Rather than focusing on how much they have to pay anesthesia, they don’t realize how a smooth running anesthesia department means to the OR and patient care. But I am just preaching to the choir.

Surgicenters certainly have their own problems, especially the ones that can’t fill the rooms, the ones that’s inefficient.

 

[nimbus]

This article alludes to the latest MGMA survey.


“Medicare reimbursement for anesthesia dropped 2 percent from 2022 to 2023 while the demand for anesthesiologists increases, according to a report from VMG Health. The anesthesiologist shortage has increased competition, leading to a 15 percent increase in anesthesiologist pay from 2021 to 2022 and 4.4 percent increase in CRNA pay, according to the MGMA 2023 Provider Compensation and Production Survey Report. Anesthesiologist compensation is now nearly $500,000 per year.”

ASCs' anesthesia issues to heat up - Becker’s ASC

Surgery center owners and administrators are keeping a close eye on the landscape as ASCs rely on anesthesiologists and anesthesia groups to perform procedures.

www.beckersasc.com

 

[Anesthesia_Guy]

Anesthesiologist compensation is now nearly $500,000 per year."

Decent STARTING salary.

 

[Dr. Rude]

Decent STARTING salary.

Location...Location...Location.

 

[BlueRug]

Location...Location...Location.

500k seems to be lower limit of starting compensation now. Look at gasworks.

 

[ERRES2288]

It’s very location dependent

 

[aneftp]

500k a year means nothing without factoring in workload.

If it’s 45 hours a week including call hours and only one weekend a month call weekends. That’s not bad with Decent supervision ratio or solo cases

The guys across town are making 475k from me. 40 hours a week no overnight calls. 10 weeks off. Sounds great right? Plus extra pay for weekends And extra work on weekdays Yet they are now short 3 docs who have left. Because of the workload.

1:4 every day. Demanding surgeons. 8-10 blocks a day. 30 gi cases a day to see just for one MD. That’s too demanding of a pace. Covering 1:4 including high acuity cases simultaneously (not hernia, knee, gyn, gen surgeon). More like lung, cabg, another Cabg with mitral valve in second heart room , and major vascular. That’s way too high acuity for one of my colleagues who’s been around the block. He lasted 2 years there

Even my friend who’s a pretty newbie all energetic 2 years out there. Super fit 32 year old. He’s burned out there now.

He’s gonna to make 600k with extra work and weekends. But not worth it. He’s doing 800k of work for 600k. Or 480k w2 base is really worth 650k of work.

 

[ERRES2288]

500k a year means nothing without factoring in workload.

If it’s 45 hours a week including call hours and only one weekend a month call weekends. That’s not bad with Decent supervision ratio or solo cases

The guys across town are making 475k from me. 40 hours a week no overnight calls. 10 weeks off. Sounds great right? Plus extra pay for weekends And extra work on weekdays Yet they are now short 3 docs who have left. Because of the workload.

1:4 every day. Demanding surgeons. 8-10 blocks a day. 30 gi cases a day to see just for one MD. That’s too demanding of a pace. Covering 1:4 including high acuity cases simultaneously (not hernia, knee, gyn, gen surgeon). More like lung, cabg, another Cabg with mitral valve in second heart room , and major vascular. That’s way too high acuity for one of my colleagues who’s been around the block. He lasted 2 years there

Even my friend who’s a pretty newbie all energetic 2 years out there. Super fit 32 year old. He’s burned out there now.

He’s gonna to make 600k with extra work and weekends. But not worth it. He’s doing 800k of work for 600k. Or 480k w2 base is really worth 650k of work.

This is so true. There are good and bad jobs at most pay levels.

 

[vector2]

1:4..... More like lung, cabg, another Cabg with mitral valve in second heart room , and major vascular.

Lol no f'ing thanks. There's no dollar figure worth that to me.

 

[aneftp]

Lol no f'ing thanks. There's no dollar figure worth that to me.

And worst of all. It’s a w2 hospital job that used to be good. They used to staff 1:2 and 1:3 for years and only recently changed to 1:4 the last 4 years.

Why? The hospital admin talks to other hospitals admin from other places and those neighboring hospitals say the other anesthesia groups staff 1:4 even with high risk concurrent cases. Guess what? Those other high risk concurrent cases are run by private group whose partners make….700-800k!!

More risk, more money.

So w2 anesthesia hospital employees admin tries to squeeze more profits if they get the same idea

It used to be a good place for 7-8 years after they kicked out Sheridan but now the hospital w2 employees are getting squeezed with ridiculous workload.

 

[Dr. Rude]

And worst of all. It’s a w2 hospital job that used to be good. They used to staff 1:2 and 1:3 for years and only recently changed to 1:4 the last 4 years.

Why? The hospital admin talks to other hospitals admin from other places and those neighboring hospitals say the other anesthesia groups staff 1:4 even with high risk concurrent cases. Guess what? Those other high risk concurrent cases are run by private group whose partners make….700-800k!!

More risk, more money.

So w2 anesthesia hospital employees admin tries to squeeze more profits if they get the same idea

It used to be a good place for 7-8 years after they kicked out Sheridan but now the hospital w2 employees are getting squeezed with ridiculous workload.

Yup. Senior hospital execs have their own invitation only listerv/discussion groups. They talk about detailed stuff like we do. They just keep it private. Wouldn’t surprise me if some of them lurk here or have assistants who do.

 

[pgg]

1:4 every day. Demanding surgeons. 8-10 blocks a day. 30 gi cases a day to see just for one MD. That’s too demanding of a pace. Covering 1:4 including high acuity cases simultaneously (not hernia, knee, gyn, gen surgeon). More like lung, cabg, another Cabg with mitral valve in second heart room , and major vascular. That’s way too high acuity for one of my colleagues who’s been around the block.

Yeah, agreed.

When I was searching for my post-Navy and hopefully final job, one group I interviewed with was 1:4 like that every day. I'd have been covering concurrent hearts plus two other rooms. 40 hour weeks, and I think either 10 or 12 wks vacation. One year partner track. Exceptionally good pay.

But I couldn't make myself do 1:4 all the time, especially with the concurrent hearts. It was still a tough job to turn down. Seemed like a really excellent and well run group, and I knew one of the partners well from Navy time.

I took a different job for quite a bit less money, though recently we got a new contract which closes much of that pay gap. I work a few more hours (avg of 47-48/wk total time in the hospital, including call) but it's mostly solo, and the times when I'm supervising the acuity generally isn't horrible.

I've previously done quite a bit of 1:4 work as a PRN employee or locums, and while it was tolerable for those brief stints and the extra checks were welcome, my mental health is worlds better in my mostly-solo job than it would've been in a high acuity 1:4 gig.

 

[gunnershow]

What parts of the country is 1:4 with hearts common? So I know to avoid them. In my neck of the woods, all hearts are solo even in practices with CRNAs.

 

[vector2]

What parts of the country is 1:4 with hearts common? So I know to avoid them. In my neck of the woods, all hearts are solo even in practices with CRNAs.

I've seen a number of practices like this in the southeast and gulf south. Tracks with the fact that supervision is very, very heavy in these regions.

 

[sethco]

I've seen a number of practices like this in the southeast and gulf south. Tracks with the fact that supervision is very, very heavy in these regions.

I've seen it in my area with non-USAP AMC practices like Northstar and Sound. It is some scary **** that I would sooner retrain into another specialty than supervise high risk at high ratios. I actually interviewed with one of the groups 10 years ago while I was in fellowship. It was q4 call, always staffing 1:4 while doing hearts, with 8 weeks of vacation. All this for a whooping 400k with crappy benefits. Times have certainly changed

 

[Dr. Rude]

I've seen a number of practices like this in the southeast and gulf south. Tracks with the fact that supervision is very, very heavy in these regions.

Midwest also.

 

[IMGASMD]

Midwest also.

One of the GI centers that my group used to cover in NE.
Talk about being a pre-op monkey. Up to 60 charts that you put your signature on every day……

 

[Anesthesia_Guy]

500k a year means nothing without factoring in workload.

If it’s 45 hours a week including call hours and only one weekend a month call weekends. That’s not bad with Decent supervision ratio or solo cases

The guys across town are making 475k from me. 40 hours a week no overnight calls. 10 weeks off. Sounds great right? Plus extra pay for weekends And extra work on weekdays Yet they are now short 3 docs who have left. Because of the workload.

1:4 every day. Demanding surgeons. 8-10 blocks a day. 30 gi cases a day to see just for one MD. That’s too demanding of a pace. Covering 1:4 including high acuity cases simultaneously (not hernia, knee, gyn, gen surgeon). More like lung, cabg, another Cabg with mitral valve in second heart room , and major vascular. That’s way too high acuity for one of my colleagues who’s been around the block. He lasted 2 years there

Even my friend who’s a pretty newbie all energetic 2 years out there. Super fit 32 year old. He’s burned out there now.

He’s gonna to make 600k with extra work and weekends. But not worth it. He’s doing 800k of work for 600k. Or 480k w2 base is really worth 650k of work.

Rough gig.....and an important reminder to know the details of your pending job.

 

[tdub878]

This article alludes to the latest MGMA survey.


“Medicare reimbursement for anesthesia dropped 2 percent from 2022 to 2023 while the demand for anesthesiologists increases, according to a report from VMG Health. The anesthesiologist shortage has increased competition, leading to a 15 percent increase in anesthesiologist pay from 2021 to 2022 and 4.4 percent increase in CRNA pay, according to the MGMA 2023 Provider Compensation and Production Survey Report. Anesthesiologist compensation is now nearly $500,000 per year.”

ASCs' anesthesia issues to heat up - Becker’s ASC

Surgery center owners and administrators are keeping a close eye on the landscape as ASCs rely on anesthesiologists and anesthesia groups to perform procedures.

www.beckersasc.com

Not totally correct. The median comp is up to 500k but median total asa units are up to 13500k. The asa $unit has declined. Strange

 

[JDMcNugent]

When referring to these compensation numbers, are you guys including salary, call pay, plus benefits like retirement contributions? Or just salary alone?

 

[partydoc]

I believe it's total comp.