Overhead costs?

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itzamemario

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In private practice what should I be paying for overhead? I'm close to signing for partnership and the current clinic could range 60-80k a month for my portion of overhead with staff, malpractice, rent etc. It seems pretty high, but this is my first go at it.
 
What % of collections? If you collect $90k, yes that is high.
 
Malpractice has gotten a lot higher. I have went from $13k to now a little over $20k. It’s over $3k for vicarious liability for me from my partner which is too much.
 
itzamemario said:
In private practice what should I be paying for overhead? I'm close to signing for partnership and the current clinic could range 60-80k a month for my portion of overhead with staff, malpractice, rent etc. It seems pretty high, but this is my first go at it.
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That is high. Who owns the building? You need a breakdown of the costs.
 
I agree that number is probably reasonable but would depend on what you're collecting as well. Our overhead is much higher but we also see a lot more patients than an average clinic and have to have a lot more staff. The result is we collect more and are ok paying a high overhead because our take home pay is better.
 
Every setup is going to be different. If you think it's high, where do you see potential to cut costs? Malpractice is fixed, rent is fixed unless you want to find a different practice that is in a smaller office, cheaper location. Do you think there's too much staff or they are overpaid?
 
RoloTomassi said:
Every setup is going to be different. If you think it's high, where do you see potential to cut costs? Malpractice is fixed, rent is fixed unless you want to find a different practice that is in a smaller office, cheaper location. Do you think there's too much staff or they are overpaid?
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Hidden costs can be in a variety categories. Prior doc/owner at my practice was spending $3k/month on "IT support" that basically wasn't doing anything, I cut that immediately (this company threatened to sue me when I cut them, probably because their free money was going to be gone). He was spending $2k/month on marketing, she wasn't doing anything and just came in once or twice a month to chat with the office ladies. Cut that immediately. He was spending about $1k/month on phone/internet, we are down to about $300/month for both now. He was letting prior office manager order supplies, spending 8-10k/month, we have it down to about 5k/month now (just took a minimal amount of effort shopping around for better prices). He was wildly over-paying our physician assistants - they are now gone and replaced with one far more reasonably-paid one.

All together, we cut costs by like 20k a month or more probably - and we are far more efficient and busier than before.

You really need to have access to the expense list - I guarantee most places are not paying attention to areas of cost cutting that can be implemented without reducing quality. Everyone needs to DOGE their practices.
 
IAmTheOne1 said:
Hidden costs can be in a variety categories. Prior doc/owner at my practice was spending $3k/month on "IT support" that basically wasn't doing anything, I cut that immediately (this company threatened to sue me when I cut them, probably because their free money was going to be gone). He was spending $2k/month on marketing, she wasn't doing anything and just came in once or twice a month to chat with the office ladies. Cut that immediately. He was spending about $1k/month on phone/internet, we are down to about $300/month for both now. He was letting prior office manager order supplies, spending 8-10k/month, we have it down to about 5k/month now (just took a minimal amount of effort shopping around for better prices). He was wildly over-paying our physician assistants - they are now gone and replaced with one far more reasonably-paid one.

All together, we cut costs by like 20k a month or more probably - and we are far more efficient and busier than before.

You really need to have access to the expense list - I guarantee most places are not paying attention to areas of cost cutting that can be implemented without reducing quality. Everyone needs to DOGE their practices.
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It's worse at hospitals.
 
hijacking this thread a bit but not too off topic - what are everyone's monthly collections? started new gig 9/2024, practice has stabilized, have meeting with CEO and CFO to go over 1st quarter numbers in a few weeks. 1st three months were 320, 159, 192. Wouldn't mind some anecdotal data from others. my last practice was 80-120 a month but I was only 3 days a week, I'm 4.5 now and more procedural.
 
Hold up…What exactly are those numbers?
 
BobBarker said:
You did $320k in your third month at a new practice?
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I started day after labor day and that was january collections. as you can see the other 2 months were not as big. another doctor left right when i came on so i inherited a large chunk of her patients from the get go.

i get charged a **** TON for overhead though, for what it's worth.
 
giddyup said:
I started day after labor day and that was january collections. as you can see the other 2 months were not as big. another doctor left right when i came on so i inherited a large chunk of her patients from the get go.
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You didn't collect 320 in one month.

I'm not even sure how that could happen in any situation.
 
MitchLevi said:
You didn't collect 320 in one month.

I'm not even sure how that could happen in any situation.
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that is on a spread sheet that I received when I asked for Q1 numbers. literally no reason to lie about this. they do end december numbers a week early so the last week of december collections would be added to jan numbers. i also took zero vacation from starting until two weeks ago so no days off in there.
 
That may be your total billing and ancillaries included or maybe they just made a mistake on your spreadsheet.
 
giddyup said:
that is on a spread sheet that I received when I asked for Q1 numbers. literally no reason to lie about this. they do end december numbers a week early so the last week of december collections would be added to jan numbers. i also took zero vacation from starting until two weeks ago so no days off in there.
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Man, they prob made a mistake or it's written out in a manner that's confusing you or something.

I'm not sure you realize what it is you're saying...320k collections in one month, especially that quickly, is completely and utterly insane.

How many procedures did you do that month?
 
unnamed (2).jpg



To flesh out this graph, I do all my procedures in a procedure suite in the office (exception - 2 days a month work at HOPD <we have no ownership in> for Intracept and SCS trials and people who want sedation for RFA). Even though office based, they only credit me for the "physician fee" portion of the total in office payment. The line that you see that says "ESI facility portion" is the rest of the in office fee (what we get total for my in office procedures minus the physician portion which is credited to me). Those "in office procedure suite facility fees" are pooled and split amongst the neurosurgeon owners and the interventional doctors - the share of that you see in the "ESI suite net income alloc" line. This is annoying to me and I want to negotiate to change it which is why I am trying to get data from others.
 
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sweet baby Jesus, how many patients are you seeing a day? How many procedures?
 
MitchLevi said:
Man, they prob made a mistake or it's written out in a manner that's confusing you or something.

I'm not sure you realize what it is you're saying...320k collections in one month, especially that quickly, is completely and utterly insane.

How many procedures did you do that month?
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I do realize what I am saying. That is why I am bringing it up. It seems very high to me as well. At my previous job I was 3 days a week 80-120K collections. I was talking to one of the new reps here (recently moved) and they mentioned another guy at a competitor practice was collecting 300K a month routinely. Didn't know if this was the norm or what was going on. Wanted to get info from others to see.
 
It is your delay in A/R. They were holding some claims back or they took a bit longer to process the first time through. Looks like they are pretty organized. I need more info on the “facility” deduction.
 
Yeah, so how many fluoro procedures are you doing per month?

Your billing is going to be substantially higher than your collections, and your collections will lag anywhere from 2-8 weeks at times.

What is the ESI facility reduction?

Are you doing procedures in an ASC?

It looks like your billing and collecting are all combined, where as at my practice they are separated into multiple buckets - ASC, ancillary, clinic, etc.
 
giddyup said:
I do realize what I am saying. That is why I am bringing it up. It seems very high to me as well. At my previous job I was 3 days a week 80-120K collections. I was talking to one of the new reps here (recently moved) and they mentioned another guy at a competitor practice was collecting 300K a month routinely. Didn't know if this was the norm or what was going on. Wanted to get info from others to see.
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A rep doesn't know what they're saying.

Billing and collecting are not the same, and I've never heard of a pain doctor "collecting" 300k per month.

That is 3.6M per year.
 
BobBarker said:
It is your delay in A/R. They were holding some claims back or they took a bit longer to process the first time through. Looks like they are pretty organized. I need more info on the “facility” deduction.
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added that info to prior post as I realized that may be confusing
 
How many pts you see per day, and how many fluoro injections per month?
 
MitchLevi said:
Yeah, so how many fluoro procedures are you doing per month?

Your billing is going to be substantially higher than your collections, and your collections will lag anywhere from 2-8 weeks at times.

What is the ESI facility reduction?

Are you doing procedures in an ASC?

It looks like your billing and collecting are all combined, where as at my practice they are separated into multiple buckets - ASC, ancillary, clinic, etc.
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Here is my exact schedule:

On procedure days, I have 39 total 15 min procedure slots in my office procedure suite. Everything takes 15 except RFA which is a 30 min slot

Monday: Procedures in office, 2 days a month at local HOPD for SCS trial and Intracept and sedation RFAs, maybe 2 Intracept and 1-2 SCS trials. 20 patients total
Tues: Clinic - around 25 patients, most new
Weds: Procedures in office
Thurs: Procedures in office
Fri: Clinic, same as tuesday

On procedure days, since i am in office, i sometimes do follow ups same day as injections and bill additional office code with modifier -25 as I didn't have a midlevel and wanted to use my clinic days for new patients. on clinic days i do some TPI and IM toradol etc. also appropriate use of G2211
 
Your neurosurgeon partners are putting procedures straight on your procedure schedule?

You're doing 120 procedures per week and 50 clinic visits?
 
Ok, I get it. There is a way to separate the physician portion even if done in office. It doesn’t come across that way on an EOB but if you take the wrvu divided by the total rvu and apply that percentage to every charge it will give you that number.

I would recommend moving your trials in office and your numbers will really pop.
 
You are doing great though with your normal total collections. The $320k is just from delayed billing and won’t happen again.
 
If most of your Tuesday clinic pts are new, and you don't have a midlevel who sees all these procedure follow ups?
 
They only gave you less than 5% of your portion of the facility portion. I wonder what that looks like getting 5% of the whole enchilada including the other interventional docs. Huge amount of money.
 
BobBarker said:
Ok, I get it. There is a way to separate the physician portion even if done in office. It doesn’t come across that way on an EOB but if you take the wrvu divided by the total rvu and apply that percentage to every charge it will give you that number.

I would recommend moving your trials in office and your numbers will really pop.
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agreed, but other interventional doctors squashed that idea. i always used to do my trials in office at my old gig but the group as a collective has to agree on it so it was me vs. 3 others
 
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MitchLevi said:
If most of your Tuesday clinic pts are new, and you don't have a midlevel who sees all these procedure follow ups?
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half of the procedures are ordered by the surgeons and their PAs so they follow up with them as many are in surgical workups. I told them I would be happy to do it but they get territorial. hired an NP for myself last month so she does mine for me now but i am very hands on
 
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giddyup said:
half of the procedures are ordered by the surgeons and their PAs so they follow up with them. I told them I would be happy to do it but they get territorial
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Are they scheduling trials and Intracept?
 
MitchLevi said:
Your neurosurgeon partners are putting procedures straight on your procedure schedule?

You're doing 120 procedures per week and 50 clinic visits?
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they order about half of them that are on my schedule. when they order them i review the patient's chart notes and imaging and myself put a note in chart with my review. if there are issues or questions i send a note to surgeon and there is a discussion.
 
giddyup said:
they order about half of them that are on my schedule. when they order them i review the patient's chart notes and imaging and myself put a note in chart with my review. if there are issues or questions i send a note to surgeon and there is a discussion.
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Good for you, especially with the trials, etc.

You need to make sure your lead is adequate. You're going to glow in the dark soon.
 
I think this looks great and you just need to figure out what the path to unlocking more of the total collections is.

Do they own the hospital also?
 
Why would the group have to agree about where the trials are done? You know from yo ur previous experience a trial hurts less than a cervical RFA for most people.
 
BobBarker said:
They only gave you less than 5% of your portion of the facility portion. I wonder what that looks like getting 5% of the whole enchilada including the other interventional docs. Huge amount of money.
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MitchLevi said:
I'd fight th
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BobBarker said:
I think this looks great and you just need to figure out what the path to unlocking more of the total collections is.

Do they own the hospital also?
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no hospital ownership. the issue that i have is that the ASC we own is FARRRRRRRRRR away from my office. my practice has multiple locations and i am in the newest one quite far away so not great for me. that's why i want to negotiate getting a larger portion of my in office "facility fee" since I dont have a great opportunity for ASC buy in. or at least see if they will let me buy into a surgery center closer to where my office is without getting their paws in it
 
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