Need some RVU job advice

[paindoc007]

I won’t speak to worth ethic of “laziness” of anyone, just stating what I know. Im fortunate to work in a place with little competition, and I have a midlevel which makes my average census per day 27-30 very managemable for me

Yes if you do a 2 level bil lumbar facet mbb thats 3.7. But 3 levels (l2-5) is 5. And in the cervical spine (such as bil c3-6) it’s 6.
So to use the example of 4 esi/hour multipled out is strange as that’s the least lucrative, based on wrvu, of pretty much everything we do.

---

Members don't see this ad.

 

[lobelsteve]

its called being a needle jockey.

technically, by doing 4 procedures per hour, all ESI, 8 hours a day, 4 days a week, 48 weeks a year, one gets 11059 wRVU per year.
since there is a 1% chance of vasovagal reaction, do conscious sedation on all of them, and can add 1536 wRVU for grand total of 12,595 wRVU per year.


and best part, dont have to say a word to a patient.... ever...

I actually enjoy talking to patients.

 

[Ducttape]

I won’t speak to worth ethic of “laziness” of anyone, just stating what I know. Im fortunate to work in a place with little competition, and I have a midlevel which makes my average census per day 27-30 very managemable for me

Yes if you do a 2 level bil lumbar facet mbb thats 3.7. But 3 levels (l2-5) is 5. And in the cervical spine (such as bil c3-6) it’s 6.
So to use the example of 4 esi/hour multipled out is strange as that’s the least lucrative, based on wrvu, of pretty much everything we do.

You cannot do 3 levels bilaterally per CMS rules. Lumbar or cervical.

 

[lobelsteve]

You cannot do 3 levels bilaterally per CMS rules. Lumbar or cervical.

Sure you can. Just cannot get paid to do it.

 

[wmc24]

Anyone have the 2018 mgma anesthesia pain data with all of the variables? Also any chance of academic mgma information? Appreciate Any help in advance

 

[paindoc007]

You cannot do 3 levels bilaterally per CMS rules. Lumbar or cervical.

Hmm..did not know that..

 

[Yo GabbaPentin]

??? I do plenty of bilateral 3 levels and get payed for it.

 

[paindoc007]

??? I do plenty of bilateral 3 levels and get payed for it.

Yea...interested to see what others say here. If I was doing something we weren’t getting paid for, my hospital biller folks would have said something to me by now...

 

[Ducttape]

check your medicare LCD. last I checked, 2 levels bilat was the max.

 

[EtherBunny]

For Medicare (if I remember correctly), you can do more than two levels bilaterally for diagnostic blocks (max of 3 levels). However, you can only do 2 levels bilaterally for the RFA.

 

[paindoc007]

Well most of us do unilateral rfa i’d Imagine

And what would be the point in blocking L2-5 but only ablating L3-5? Just makes no sense

 

[SSdoc33]

Well most of us do unilateral rfa i’d Imagine

And what would be the point in blocking L2-5 but only ablating L3-5? Just makes no sense

you'd imagine incorrectly

 

[SSdoc33]

Yea...interested to see what others say here. If I was doing something we weren’t getting paid for, my hospital biller folks would have said something to me by now...

right. those billing folks in the bowels of a gigantic hospital billing department never miss anything. im sure they are all well-versed on the minutiae of pain medicine billing criteria

 

[paindoc007]

you'd imagine incorrectly

I said most, not all. If you always bilateral rfa, that’s fine. But that’s not typical.

 

[paindoc007]

Though out of curiosity, you ever get ataxia with ton bilateral rfa? That’s what I was always concerned about

 

[SSdoc33]

Though out of curiosity, you ever get ataxia with ton bilateral rfa? That’s what I was always concerned about

i do the TON unilaterally.

but id say 75% of my RFs are bilateral

some docs dont do bilateral b/c they get paid more to do it one side at a time. not saying either way is "right", just that a lot of us do bilateral RFs

 

[Ferrismonk]

For what it's worth, I was trained bilateral 3-level MBB x2 then Bilateral 3-level RFA. Not sure how he got paid.

I do bilateral 3-level Facet/MBBx2, then single 3-level RFA on left, then single 3-level RFA on right. Assuming that's appropriate for the patient of course. Pretty sure I get paid for this.

 

[ziggyziggy]

Yes. Never had any problem.

Though out of curiosity, you ever get ataxia with ton bilateral rfa? That’s what I was always concerned about

 

[ziggyziggy]

For what it's worth, I was trained bilateral 3-level MBB x2 then Bilateral 3-level RFA. Not sure how he got paid.

I do bilateral 3-level Facet/MBBx2, then single 3-level RFA on left, then single 3-level RFA on right. Assuming that's appropriate for the patient of course. Pretty sure I get paid for this.

I do the same. Except, I will do bilateral RFA if I am following 1 or 2 joint bilateral MBB.

 

[drrosenrosen]

My Medicare LCD (Noridian) only allows 4 facet procedures per area (lumbar vs cervical) per rolling 12 month period. In other words, if you do two mbb and unilateral RF x2, you'd better hope for your patient's sake that you get 12 months relief out of it.

 

[nvrsumr]

My Medicare LCD (Noridian) only allows 4 facet procedures per area (lumbar vs cervical) per rolling 12 month period. In other words, if you do two mbb and unilateral RF x2, you'd better hope for your patient's sake that you get 12 months relief out of it.

Do they require MBB x 2?

 

[drrosenrosen]

Yes

 

[FacetogenicPain]

I would also appreciate some input guys. Thanks in advance for your opinions.

My situation: Still in fellowship, current offer is a 75% procedure/ 25% clinic setup. $50/wRVU with a mid 400s guarantee. Terrible, Bad, good, great, epic?

 

[Ferrismonk]

I would also appreciate some input guys. Thanks in advance for your opinions.

My situation: Still in fellowship, current offer is a 75% procedure/ 25% clinic setup. $50/wRVU with a mid 400s guarantee. Terrible, Bad, good, great, epic?

The money is good, but a good job isn't all about the money. I make less than that but have much more control over what I do and to whom.

 

[EtherBunny]

I would also appreciate some input guys. Thanks in advance for your opinions.

My situation: Still in fellowship, current offer is a 75% procedure/ 25% clinic setup. $50/wRVU with a mid 400s guarantee. Terrible, Bad, good, great, epic?

Bad. Avoid this job. $50/wrvus is really low. After your first year guarantee runs out, you’ll be working your ass off to generate enough wrvus. Look for $60 or higher wrvus values.

$50/wrvu...that’s just plain ridiculous.

Also, how on earth will you see enough patients in clinic to be in the procedural suite 75% of the time? That makes no sense. Clinic generates the procedures.

 

[pastafan]

Also, how on earth will you see enough patients in clinic to be in the procedural suite 75% of the time? That makes no sense. Clinic generates the procedures.

Probably employs a bunch of midlevels to write opioids and order procedures to be done. Shots for pills.

 

[Ducttape]

how are they giving you the guarantee of mid 400s?

at $50/wRVU, you would have to be doing 9000+ wRVU per year. that puts you in the upper echelon of proceduralists pain physicians. seems like a needle jockey?

of course, if you are starting out and are broke with tons of debt, might not be a bad starting job with the expectation that you will move on in 1-2 years to open your own practice.....

 

[BloodySurgeon]

Apologies for ignorance, finishing fellowship and looking at jobs now. Confused why this is a bad deal if he is guaranteed mid 400s. Salary in my area is 300-350k +\- rvu bonus.

Not sure how each rvu salary bonus is set up but thought it was you get a $/RVU after you hit a certain quota for the year.

I have a few interviews lined up with places I really like and good practice set up. Base salary is non-negotiable, but rvu incentive can be. I was wondering what you guys thought is a good goal for the rvu bonus and how does it work.

from reading this thread I’m assuming average practitioners rvu per year is ~6k and negotiated contracts is $45-60/rvu after reaching approximately ~7-10k rvu per year. Is that correct?

If this is true it’s better to negotiate the quota threshold than the actual $/RVU.

 

[BobBarker]

6000 RVU is part time.

 

[clubdeac]

Apologies for ignorance, finishing fellowship and looking at jobs now. Confused why this is a bad deal if he is guaranteed mid 400s. Salary in my area is 300-350k +\- rvu bonus.

Not sure how each rvu salary bonus is set up but thought it was you get a $/RVU after you hit a certain quota for the year.

I have a few interviews lined up with places I really like and good practice set up. Base salary is non-negotiable, but rvu incentive can be. I was wondering what you guys thought is a good goal for the rvu bonus and how does it work.

from reading this thread I’m assuming average practitioners rvu per year is ~6k and negotiated contracts is $45-60/rvu after reaching approximately ~7-10k rvu per year. Is that correct?

If this is true it’s better to negotiate the quota threshold than the actual $/RVU.

I wouldn’t work for $60/wRVU. Close to 70 is competitive

 

[EtherBunny]

I wouldn’t work for $60/wRVU. Close to 70 is competitive

man, I would love to get close to $70/wrvu. I’ve never come across any positions that offer it though. What state are you practicing in?

 

[lobelsteve]

I am under $60

 

[cowboydoc]

I wouldn’t work for $60/wRVU. Close to 70 is competitive

YMMV. $70 is solid in most parts of the country. Some areas will lean on you for less than $60.

 

[clubdeac]

man, I would love to get close to $70/wrvu. I’ve never come across any positions that offer it though. What state are you practicing in?

NC

 

[Ligament]

some docs dont do bilateral b/c they get paid more to do it one side at a time. not saying either way is "right", just that a lot of us do bilateral RFs

Technically, we are ripped off. We get paid LESS for doing bilateral at the same time.

 

[SSdoc33]

Technically, we are ripped off. We get paid LESS for doing bilateral at the same time.

well, if you add up both sides in separate visits, then yes, i agree.

but, you still get pain more to do a bilateral than unilateral at a single visit.

i already have all the stuff out. the patient is on the table. adding on the other side only takes me a few more minutes. the dollar value/unit time spent is still greater if you do both at the same time. if you are hurting for patients or not that busy, then bringing them back to do each side does make sense.

 

[Ducttape]

does it though?

purely from a financial standpoint, which I do not consider when deciding what to do, the extra 5 min per RFA could add up... for example, 4 of these bilateral might mean 1 more procedure slot for and RFA on a separate patient.... it gets hazy imo.