thegenius

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Do we even have many EDs left with no MLPs? All of the places I've worked in the SE have MLPs with limited oversight. I think if I was a partner in a SDG and could help craft the perfect environment, I'd push for an MD only practice. I wouldn't care if I had to see additional 4s and 5s.

I part time at a Kaiser in NorCal and there are no PA's there. Staffed only my MDs.
 
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thegenius

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At my place they typically increase my pay 30-50%. I get RVU credit for all the patients I see. On my own I typically see around 20-25. If I have a quick PA (or 2) they can add 30 patients to my RVUS, and I'll get credit for 50+ patients on a shift. Not a bad chunk of change, and worth the risk of supervising them. At least they discuss every patient with me and we review labs/imaging prior to DC.

So you get 100% of the RVU's you see.
How do you calculate how much RVU's you get for the patient seen by PAs? Or do you even assign RVU's in that case or is there some other way? Are you directly compensated or is your pay augmented some other way (like the RVU multiplier is augmented?)
 

GeneralVeers

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So you get 100% of the RVU's you see.
How do you calculate how much RVU's you get for the patient seen by PAs? Or do you even assign RVU's in that case or is there some other way? Are you directly compensated or is your pay augmented some other way (like the RVU multiplier is augmented?)

It's complicated, but we get a spreadsheet every month with every doctor's RVU productivity and total RVUs produced. Our midlevels are paid a base rate (a very generous $100/hr) . Their salaries come out of the entire group pot of money that we get every month. The remaining money is distributed to the physicians based on their total RVU production for the month. I've calculated it out so that any patient seen under my name, even by the midlevels gets me $75.

Obviously this system opens things up to bad behavior among doctors, but we have strict rules on which patients are seen by what docs, and which midlevels are assigned to which doctor.
 
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thegenius

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I see so your pay is increased not necessarily by how many patients are seen by PA *under your supervision*, but rather how many pt's you see. That is...for example...if an MD sees 10-15/shift producing little RVUs, and the PAs on that shift see 30, the MD will not make that much extra because they themselves are not producing a significant number of RVUs
 

GeneralVeers

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I see so your pay is increased not necessarily by how many patients are seen by PA *under your supervision*, but rather how many pt's you see. That is...for example...if an MD sees 10-15/shift producing little RVUs, and the PAs on that shift see 30, the MD will not make that much extra because they themselves are not producing a significant number of RVUs

No the opposite. The more patients both of us see the more money I make. I get $75 in my pocket for every patient I see, and $75 in my pocket for every patient seen by a PA/MLP under my supervision.
 

thegenius

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Oh ok...so you guys, or your billing company, or whomever keeps specific track of the MD's signing the PA charts.

If an MD only wants to work with some PA's and not others...for whatever reason...do you allow that? What if an MD doesn't want to be a supervising physician ever, do you allow that?

yes I can see how there might be abuse...asking the midlevels to pick up every single low acuity case to increase the MD pay.

Part of the reason why I'm asking these questions is that our hospital is dumping our TH contract and we are all becoming employees under the hospital's foundation, and we are trying to sort out this stuff. Nice to hear how other groups deal with this.
 

GeneralVeers

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Oh ok...so you guys, or your billing company, or whomever keeps specific track of the MD's signing the PA charts.

Yes. Each MLP chart is assigned to a physician, usually the one on shift with them.

If an MD only wants to work with some PA's and not others...for whatever reason...do you allow that? What if an MD doesn't want to be a supervising physician ever, do you allow that?

We are not allowed to pick the MLPs unfortunately. It's random to make things fairer. Not working with an MLP is not an option.

Part of the reason why I'm asking these questions is that our hospital is dumping our TH contract and we are all becoming employees under the hospital's foundation, and we are trying to sort out this stuff. Nice to hear how other groups deal with this.

If the hospital is doing your billing, it is going to be important for you to know how you are getting paid. Most hospital-employed physicians I know are hourly and not productivity based. If you are productivity based, make sure the hospital give you an idea of how much you are getting paid per RVU of productivity. Theoretically your salaries should increase if they are dumping TH as you are getting rid of a whole level of management that would no longer be needed. It needs to be open and transparent.
 

thegenius

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If the hospital is doing your billing, it is going to be important for you to know how you are getting paid. Most hospital-employed physicians I know are hourly and not productivity based. If you are productivity based, make sure the hospital give you an idea of how much you are getting paid per RVU of productivity. Theoretically your salaries should increase if they are dumping TH as you are getting rid of a whole level of management that would no longer be needed. It needs to be open and transparent.

We are in the middle of negotiations and so far it seems to be very fair and we will be getting a nice raise, all other things being the same. Our group wants to continue to be 100% RVU and the foundation is happy with that model. I think the hospital plans on doing the coding and billing as well..which makes me nervous. I don't know how much experience they have, if any, coding ER charts. But they plan on abstracting us from the billing part, our pay will not be tied to whether they collect on the billing. So the hospital is taking the risk with that. We haven't talked yet about how we plan on dealing with the PAs though...and this definitely needs to be sorted out.
 

GeneralVeers

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We are in the middle of negotiations and so far it seems to be very fair and we will be getting a nice raise, all other things being the same. Our group wants to continue to be 100% RVU and the foundation is happy with that model. I think the hospital plans on doing the coding and billing as well..which makes me nervous. I don't know how much experience they have, if any, coding ER charts. But they plan on abstracting us from the billing part, our pay will not be tied to whether they collect on the billing. So the hospital is taking the risk with that. We haven't talked yet about how we plan on dealing with the PAs though...and this definitely needs to be sorted out.

So if the hospital is paying you a fixed rate regardless of whether or not they collect from patients, then you need to have a set $/RVU that the hospital is paying you. Most places I work that amount is typically $30-$35.
 

thegenius

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So if the hospital is paying you a fixed rate regardless of whether or not they collect from patients, then you need to have a set $/RVU that the hospital is paying you. Most places I work that amount is typically $30-$35.

That's correct....the estimate now is $30/RVU, which is a 36% raise from what we used to get with TH. It hasn't been finalized yet but it will probably be very close to that.

But if their coding results in an small reduction of RVU per chart, then we will lose some money. What is the average RVU/pt at your shop? Ours is 4.03 I believe (from 2018 data). That is all ER visits, we don't separate out the fast track ones vs high acuity ones.
 

GeneralVeers

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That's correct....the estimate now is $30/RVU, which is a 36% raise from what we used to get with TH. It hasn't been finalized yet but it will probably be very close to that.

But if their coding results in an small reduction of RVU per chart, then we will lose some money. What is the average RVU/pt at your shop? Ours is 4.03 I believe (from 2018 data). That is all ER visits, we don't separate out the fast track ones vs high acuity ones.

Ours is a bit over 4 RVU/pt. I'm usually at about 3.96 because I don't do big workups or admit BS. Some of our docs who "play the game" can get it up to 4.5 RVU/pt and make a lot more money.
 

thegenius

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Ours is a bit over 4 RVU/pt. I'm usually at about 3.96 because I don't do big workups or admit BS. Some of our docs who "play the game" can get it up to 4.5 RVU/pt and make a lot more money.

Ok that's good...so it's about the same. We have a few that can average in the 4.3/4.4 range as well...one guy here says he offers > 3 minutes of smoking cessation to everybody he sees (if they smoke)....I wonder if he actually gets RVUs for that.
 
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