National Spine and Pain Centers

Panacea Financial Contract Review
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GandalfTheWhite said:
How many patients do I need to see per day to roll up in a lambo?


Could you PM me what youre making with this setup as well? Thanks!

How will working at a HOPD increase your salary? To my understanding, you dont collect on the facility fee, only the professional fee.
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The HOPD owners will subsidize you and kick back some juice from the facility fee SOS differential.
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GandalfTheWhite said:
Isnt that in violation of the Stark law as Pay for Play? Didnt some dallas spine surgeons go to jail for this recently?
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They never come right out and say that. They can move money around any way they want between internal accounts. They can pay you whatever they want and call it all kinds of things: Salary, directorship, PTO, professional development, etc. One man's overhead is another man's profit. One man's trash is another man's treasure.
 
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drusso said:
They never come right out and say that. They can move money around any way they want between internal accounts. They can pay you whatever they want and call it all kinds of things: Salary, directorship, PTO, professional development, etc. One man's overhead is another man's profit. One man's trash is another man's treasure.
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Fair point. Wouldnt mind getting an extra 100K in "CME" /s
 
ateria radicularis magna said:
New grads with debt and geographic restrictions are cannon fodder for mbas, KOLs and ceos. They salivate when they see your eager faces.
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I expected this from the MBAs and CEOs but did not expect it from the KOLs rounding you up on weekend seminars! Opening my own place for sure glad the anesthesia market is so hot and can subsidize growth of a pain practice!
 
blockstar said:
I expected this from the MBAs and CEOs but did not expect it from the KOLs rounding you up on weekend seminars! Opening my own place for sure glad the anesthesia market is so hot and can subsidize growth of a pain practice!
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Great decision. The KOL is locked into a bedazzled threesome with industry and private equity. They are the beast with 3 backs. They eat new grads for breakfast, lunch and dinner. One of their primary strategies is to convert pain doctors into “pain surgeons” who never actually see patients and instead do vertizippiminutelocks ordered by the nurse practitioners. This is reality. If KOLs had a real interest in research they wouldn’t take industry money and pawn off their salesmanship as critical thinking. The only real critical thinking occurring is how to convince young doctors to implant unproven medical devices and how to convince patients unproven medical devices are “cutting edge.” Just ask for the evidence in these webinars and die laughing at the subsequent mental gymnastics displayed by the bedazzled threesome.
 
I always find it funny when KOLs talk about stim for axial pain…
 
Dr. Ice said:
I always find it funny when KOLs talk about stim for axial pain…
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Locally I’ve seen a handful of patients who had at least 2 dorsal column and a drg trial for their axial mechanical pain.
ateria radicularis magna said:
Great decision. The KOL is locked into a bedazzled threesome with industry and private equity. They are the beast with 3 backs. They eat new grads for breakfast, lunch and dinner. One of their primary strategies is to convert pain doctors into “pain surgeons” who never actually see patients and instead do vertizippiminutelocks ordered by the nurse practitioners. This is reality. If KOLs had a real interest in research they wouldn’t take industry money and pawn off their salesmanship as critical thinking. The only real critical thinking occurring is how to convince young doctors to implant unproven medical devices and how to convince patients unproven medical devices are “cutting edge.” Just ask for the evidence in these webinars and die laughing at the subsequent mental gymnastics displayed by the bedazzled threesome.
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sadly I just can’t see patients accepting those procedures unless it’s pills for pokes to keep the candy coming or they’re just uneducated and have no concept that their doctor is not a surgeon or that no surgery at all is indicated. Sad all around.

Is it one of those same few guys I see on linked in who are at some sponsored course like every weekend?
 
cowboydoc said:
But who is posting on the socials about RFA?
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I think Lobel should create an instagram account just for this very purpose. I would love that. I can picture him holding up a box of rf needles with the caption, “I can’t thank my colleagues enough for pushing the envelope on #interventionalpain, I did my first lumbar medial branch rfa and my patient walked out smiling, the future is bright for #painmedicine”
Early Christmas present ?
 
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ateria radicularis magna said:
I think Lobel should create an instagram account just for this very purpose. I would love that. I can picture him holding up a box of rf needles with the caption, “I can’t thank my colleagues enough for pushing the envelope on #interventionalpain, I did my first lumbar medial branch rfa and my patient walked out smiling, the future is bright for #painmedicine”
Early Christmas present ?
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I mean, this could go places…Imagine an account dropping a bunch of dope stuff from the 90s as if it were new. How many likes do you think a reveal for a Razr would get? Hold on to your jorts!
 
cowboydoc said:
I mean, this could go places…Imagine an account dropping a bunch of dope stuff from the 90s as if it were new. How many likes do you think a reveal for a Razr would get? Hold on to your jorts!
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I think an account putting the KOLs in their place and making fun of them would be peak comedy.
 
ya this company is trash. the practice i interviewed at, the doctors hated NSPC so much that could not wait to retire and would not even come to say hello during interview day. the guy who interviewed me was trashing the previous doctors. very sleazy ppl. did not get good vibes and the job is still open.
 
Taus said:
Locally I’ve seen a handful of patients who had at least 2 dorsal column and a drg trial for their axial mechanical pain.

sadly I just can’t see patients accepting those procedures unless it’s pills for pokes to keep the candy coming or they’re just uneducated and have no concept that their doctor is not a surgeon or that no surgery at all is indicated. Sad all around.

Is it one of those same few guys I see on linked in who are at some sponsored course like every weekend?
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Oh man! You have got to see these KOLs in action! They are amazingly convincing. Imagine yourself in a situation in which you are about to be killed, and you have to come up with something to say to convince your would-be killer to spare you. You could come up with some really good stuff given ample time. But you can’t sit there blathering and crying—you have to speak in a relatable, intelligent manner. That is the same energy and/or desperation the KOL sublimates into the sales pitch for his implant du jour. Their industry underwriters are equally impressed, and the Bennies rain down. If you are heavily invested in a surgery center and the only way to turn the crank is to implant grandmothers with some gadget, you will either quickly fail and slink off to a different sort of job, or you will learn to turn that crank like a pro. The words the KOLs use are their elbow grease. They have a massive and collective interest in leveraging language to convince people, various people—insurers, peer to peers, colleagues, patients, auditors, etc. We’ve all heard a patient with moderate-to-severe canal stenosis tell us that a surgeon told them some equivalent of, “it’s either surgery or start stocking up on adult diapers.” That’s an effective talk track! That sentence (or something like it) has created lots of millionaires. The KOL is a connoisseur of these wealth-creating sentences. Let’s ask another question for fun. How many current interventional pain physicians who are not heavily invested in a surgery center have high volume implant practices? Agree or disagree: pretty soon it’s going to get to the point where really good stim candidates can’t get stim at all because it’s been abused beyond all laws of modern physics. I’m talking way beyond axial back pain. I’m talking fibromyalgia diagnosed with some form of “causalgia” on a huge scale. It’s old news, right? Well apply the same mental yoga to the new spine gadgets. The talk tracks/wealth building sentences for “pain surgeons” to use for these gadgets are equally bombastic. Tune in to a KOL webinar any night of the week and allow your eyes to sink into the back of your head…just take it in calmly and quietly…allow the words to filter into your subconscious. Suddenly you may find yourself wanting to fuse a lot of spines.
 
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^^not to take away from your mic drop, but I know of solo docs who do a lot of stim trials and zero implants because it’s not worth their time and money to do it themselves at an ASC. They make a ton of money doing trials in office.
 
Agast said:
^^not to take away from your mic drop, but I know of solo docs who do a lot of stim trials and zero implants because it’s not worth their time and money to do it themselves at an ASC. They make a ton of money doing trials in office.
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I hear you
 
ateria radicularis magna said:
I think Lobel should create an instagram account just for this very purpose. I would love that. I can picture him holding up a box of rf needles with the caption, “I can’t thank my colleagues enough for pushing the envelope on #interventionalpain, I did my first lumbar medial branch rfa and my patient walked out smiling, the future is bright for #painmedicine”
Early Christmas present ?
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This just in: Fresh from Apollo mission, powered by Tang. This new space age digital electronic system can heat a needle electrode to 90 degrees centigrade. Removable, sterilizable temperature control knob. Pain procedure for the Z joints, a new etiology for lumbago.

Lumbago lumbago lumbagone.
 
drusso said:
They never come right out and say that. They can move money around any way they want between internal accounts. They can pay you whatever they want and call it all kinds of things: Salary, directorship, PTO, professional development, etc. One man's overhead is another man's profit. One man's trash is another man's treasure.
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true yet not quite the whole picture.

obviously, admin has to determine how much money they can bring in before paying a physician, just like in a PP doc has to see how much he makes before he takes his salary.

the misnomer is where a HOPD physician thinks he will be able to his salary adjusted based on how much facility fees he thinks are coming in.

this thought leads to doc reading your posts in to thinking "i am bringing in so much revenue, i should be seeing more of it!" its too late by then, and then the doc eventually gets so frustrated thinking they arent getting their fair share, so much so that they leave.


your contract is the key to how much money you make. have a crappy contract, you wont make as much or will have an unattainable bonus. if you have a crappy contract, you will be stuck with unsatisfactory pay. admin is not going to go around passing out extra dough just because you had a good day or month.

yes you can ask for a new contract, but its guaranteed admin will put something in that serves them well to justify paying you more, and maybe you can bargain a directorship etc.. renegotiating when the contract comes due is important, but generally admin has the upper hand here also.



so, word of advice - the bargaining before the contract (or extension) is signed is probably the most important action a physician will undertake that determines how happy they will be with the financials.
 
HOPD is an easier path to success. Usually, start with a generous salary, no start up costs, no work/time spent setting up an office, billing/prior auth taken care of, etc. Injtially, you get your salary, the hospital pays all of these costs to start up your practice, and you aren’t making any money. For two years for sure, you are coming out way ahead on this arrangement vs private practice. Once your production, exceeds your salary usually the bonus’s keep things fairly even. But if you are like me, where you always bonus a large amount then any vacation is just lost income. I work doing telemeds every vacation now it seems to keep the office flowing.

But the ceiling is lower and you can’t make money off others work. Owing my own practice, I could make money off a mid level or junior physician who is keeping my office running while I’m on vacation. Then you scale that to multiple offices, ASC, large amounts of DME and the boss doc is a KOL that is never in the office and gets to go to a conference every weekend and talk about what he does in his practice that he is never actually at.
 
BobBarker said:
HOPD is an easier path to success. Usually, start with a generous salary, no start up costs, no work/time spent setting up an office, billing/prior auth taken care of, etc. Injtially, you get your salary, the hospital pays all of these costs to start up your practice, and you aren’t making any money. For two years for sure, you are coming out way ahead on this arrangement vs private practice. Once your production, exceeds your salary usually the bonus’s keep things fairly even. But if you are like me, where you always bonus a large amount then any vacation is just lost income. I work doing telemeds every vacation now it seems to keep the office flowing.

But the ceiling is lower and you can’t make money off others work. Owing my own practice, I could make money off a mid level or junior physician who is keeping my office running while I’m on vacation. Then you scale that to multiple offices, ASC, large amounts of DME and the boss doc is a KOL that is never in the office and gets to go to a conference every weekend and talk about what he does in his practice that he is never actually at.
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You do telemed pain ? Like meds or what?
 
GandalfTheWhite said:
Fair point. Wouldnt mind getting an extra 100K in "CME" /s
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Ducttape said:
true yet not quite the whole picture.

obviously, admin has to determine how much money they can bring in before paying a physician, just like in a PP doc has to see how much he makes before he takes his salary.

the misnomer is where a HOPD physician thinks he will be able to his salary adjusted based on how much facility fees he thinks are coming in.

this thought leads to doc reading your posts in to thinking "i am bringing in so much revenue, i should be seeing more of it!" its too late by then, and then the doc eventually gets so frustrated thinking they arent getting their fair share, so much so that they leave.


your contract is the key to how much money you make. have a crappy contract, you wont make as much or will have an unattainable bonus. if you have a crappy contract, you will be stuck with unsatisfactory pay. admin is not going to go around passing out extra dough just because you had a good day or month.

yes you can ask for a new contract, but its guaranteed admin will put something in that serves them well to justify paying you more, and maybe you can bargain a directorship etc.. renegotiating when the contract comes due is important, but generally admin has the upper hand here also.



so, word of advice - the bargaining before the contract (or extension) is signed is probably the most important action a physician will undertake that determines how happy they will be with the financials.
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Every HOPD MD who has ever looked at one of their patient's EOB’s has a moral duty to ask, “Where’s this money going?” especially if your boss is a tax-exempt nonprofit or hogging up “community benefit” dollars. Some of these large physician employers have made a killing off ObamaCare and are sitting on billions of dollars in operating reserves. They can share that money with high facility fee-generating MD/DO’s any way they want. No one is telling them how or what they can and can’t do with the millions of “non-profit” dollars they’ve stashed away. They have complete control over who or what they're going to spend their resources on. But nothing happens unless you’re willing to aggressively bargain for it. The best business case to make is to say, “Show me my physician enterprise value and facility fee activity sheet." Then say, "Show me your audited IRS financial disclosures.” Then, just point to the line item that says “operating reserves.” Don’t say anything, just point and nod slowly. Let the awkward silence fill the room. It’s obvious what needs to happen next.

Moreover, some large HOPD physician employers are breaking open their piggy banks to pay 3-5X market rate for traveling nurses and locums who don't live in the community, contribute to the tax base, or support the local economy. If I found out my boss was paying some out-of-towner 4X their salary to come and in a few months of Gig work, but wouldn't crack open their wallet and bump me 15 or 20% despite the fact I'm cranking in the HOPD OR generating them literally $60/min in facility fees doing cluneal PNS cases and SIJ fusions--I'd be PISSED!
 
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drusso said:
They never come right out and say that. They can move money around any way they want between internal accounts. They can pay you whatever they want and call it all kinds of things: Salary, directorship, PTO, professional development, etc. One man's overhead is another man's profit. One man's trash is another man's treasure.
Click to expand...
I've seen this firsthand if anyone is doubting it. I know a pain guy who was given an admin job with a 6 fig salary on top of his regular collections that has zero admin duties at a NYC hospital. The only reason he got this is because he does his procedures in their facilities. All his steroid injections and more complex procedures. It's like getting a facility fee without having to pay for any of the upkeep or expenses required in office or at a ASC. Extremely lucrative. There's no contract for him to be doing his procedures there to keep the job, I'm sure that would be illegal. I'm even more sure that if he suddenly started moving his procedures to somewhere else he'd lose his admin job at the hospital. Illegal? maybe. Immoral? imo not really, MDs and DOs are already abused financially, why let the hospital keep all the facility fee juice.
 
Agast said:
^^not to take away from your mic drop, but I know of solo docs who do a lot of stim trials and zero implants because it’s not worth their time and money to do it themselves at an ASC. They make a ton of money doing trials in office.
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Is there any financial benefit then to doing perms rather than just farming them out?
 
GandalfTheWhite said:
Is there any financial benefit then to doing perms rather than just farming them out?
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If you’re not invested in the ASC? Not really. The professional reimbursement will probably be around $1000 and it will have taken 2 hours out of your day. You would have made more money doing procedures in your office or the equivalent money seeing in clinic seeing patients that will later turn into procedures so that’s the opportunity cost. Some doctors will still do it out of a sense of responsibility and ownership of the patient. If you’re hospital-employed you will get great RVU numbers out of it so it is worth it.
 
Doing your cases at an ASC is also a relationship builder to get more referrals from ortho and spine doctors, I have seen some people spread their cases to network
 
Agast said:
If you’re not invested in the ASC? Not really. The professional reimbursement will probably be around $1000 and it will have taken 2 hours out of your day. You would have made more money doing procedures in your office or the equivalent money seeing in clinic seeing patients that will later turn into procedures so that’s the opportunity cost. Some doctors will still do it out of a sense of responsibility and ownership of the patient. If you’re hospital-employed you will get great RVU numbers out of it so it is worth it.
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Do you know roughly how many rvus for trial and implant? Im rvu based but can not find any good source of rvu numbers for each procedure Im doing
 
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