Overhead costs?

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BobBarker said:
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.
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i am not the "head of the department." i spoke to him about it and he said i would need group consensus. i am the only one who is fellowship trained and the only one who is boarded in pain though. i am going to bring it up again at our next meeting which is next month
 
You’re at 400-415 procedures per month, which is a super large number of procedures. I don’t quite get where that number is coming from if the surgeons are putting half your procedures on the schedule while you’re putting the other half wirh minimal clinic time, but pay attention to procedures that the PAs put on your schedule.

They’re not very good at managing pain. If you’re doing that many procedures, that means you’ll be a doing ton ordered by midlevels.
 
MitchLevi said:
You’re at 400-415 procedures per month, which is a super large number of procedures. I don’t quite get where that number is coming from if the surgeons are putting half your procedures on the schedule while you’re putting the other half wirh minimal clinic time, but pay attention to procedures that the PAs put on your schedule.

They’re not very good at managing pain. If you’re doing that many procedures, that means you’ll be a doing ton ordered by midlevels.
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Yes, the surgeons and their PAs order about half. I probably don't do quite that many a month. the 2 mondays at the HOPD are maybe 12 procedures total. another 1-2 days a month i have a side hustle for some 1099 income so i can do a solo 401K so take those days away. today i only did 24 procedures, for example, as i left at 230 to get my nails done lol. some procedures at this point are pt's calling for repeats. a lot are also MBB/RFAs that are a series so filling multiple slots.
 
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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It's bull****.

There is no "facility fee" for an office-based (OBL) site of service. They are "bootstrapping" an estimate of facility overhead based on RVU components from other service sites.

There's no such thing as consensual rape.
 

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drusso said:
It's bull****.

There is no "facility fee" for an office-based (OBL) site of service. They are "bootstrapping" an estimate of facility overhead based on RVU components from other service sites.

There's no such thing as consensual rape.
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those "office based SOS" procedures possibly are being charged as HOPD procedures.
 
drusso said:
It's bull****.

There is no "facility fee" for an office-based (OBL) site of service. They are "bootstrapping" an estimate of facility overhead based on RVU components from other service sites.

There's no such thing as consensual rape.
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It's probably their way of taking a portion of his pro fee. Probably given him him 40-60% and they're taking the other 40-60%.
 
an office based procedure only pays so much. you can look at ASIPPs site for info on what is paid out for procedures.


consider that (based on 2024 numbers as i dont have access to the most recent numbers):

for office based ESI (62323) total payment is $254 including physician component.

for ASC (62323) the physician component is $96.90, with facility component of $358. total $455.

is the system really only taking in - after taking out what they are apparently "teasing out" is the physician component - $157 as the facility component? $200 less than if you did the injection at the ASC?

maybe your admin is not financially savvy....
 
Ducttape said:
an office based procedure only pays so much. you can look at ASIPPs site for info on what is paid out for procedures.


consider that (based on 2024 numbers as i dont have access to the most recent numbers):

for office based ESI (62323) total payment is $254 including physician component.

for ASC (62323) the physician component is $96.90, with facility component of $358. total $455.

is the system really only taking in - after taking out what they are apparently "teasing out" is the physician component - $157 as the facility component? $200 less than if you did the injection at the ASC?

maybe your admin is not financially savvy....
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They are not savvy. The 2 interventional guys that have been at the practice for 10+ years do their stuff at the surgery center so the professional fee is very obvious because that is the only fee. They only started doing procedures in office about 2 years ago with 2 new docs as these offices were remote from the surgery center and the reason one of the doctors before me left was that she did not know they were going to tease out the facility fee as it was not spelled out very clearly in the contract. In my opinion, they are not being malignant, they just do not really know how to handle in office procedures. When I talked with administration about it their statement was that they only reimburse physicians for personally performed work so that is why they were doing that. It is obviously not what the majority of other practices do so that is why I wanted to get feedback from the group about whether or not anyone else had this issue and what I can do in my negotiations to trying get more of my collections back into my pocket. Our ASC is currently full in terms of pain procedure suites with the 2 guys that are already there so there really is not availability to do anything else there. ASC also over an hour from my office so there's that.
 
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giddyup said:
They are not savvy. The 2 interventional guys that have been at the practice for 10+ years do their stuff at the surgery center so the professional fee is very obvious because that is the only fee. They only started doing procedures in office about 2 years ago with 2 new docs as these offices were remote from the surgery center and the reason one of the doctors before me left was that she did not know they were going to tease out the facility fee as it was not spelled out very clearly in the contract. In my opinion, they are not being malignant, they just do not really know how to handle in office procedures. When I talked with administration about it their statement was that they only reimburse physicians for personally performed work so that is why they were doing that. It is obviously not what the majority of other practices do so that is why I wanted to get feedback from the group about whether or not anyone else had this issue and what I can do in my negotiations to trying get more of my collections back into my pocket. Our ASC is currently full in terms of pain procedure suites with the 2 guys that are already there so there really is not availability to do anything else there. ASC also over an hour from my office so there's that.
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F the ASC. You’re cranking out volume and when you start doing office trials the game is over. You’re being denied those trials by incompetent doctors.
 
well, seems most prudent if you can parse out how much you are getting for each procedure, compare to what you would expect to get in rvus at ASC, then see if you are making similar at both locations and then keep on doing what you are doing.
 
It is financial self sabotage to do the most lucrative office based procedure in a HOPD with no group ownership interest.


I would make that your key point and fix that first, track how much you improved the groups financials, and use that leverage to become the dominant decision maker for the pain group.
 
I still don't get this "professional fee" determination for office procedures. Office procedures get one payment. Most places I've seen say that you get to keep x% with the other piece going to the practice to cover overhead/be profit for the practice. I guess that them assigning it some sort of "professional fee" percent is the same thing just with a different name. Either that or I'm just missing something here.

As to your overhead being "insane," why do you feel that way? It looks from your spreadsheet like you are keeping a little over 50% of your gross collections. That's very fair.
 
BoardingDoc said:
I still don't get this "professional fee" determination for office procedures. Office procedures get one payment. Most places I've seen say that you get to keep x% with the other piece going to the practice to cover overhead/be profit for the practice. I guess that them assigning it some sort of "professional fee" percent is the same thing just with a different name. Either that or I'm just missing something here.

As to your overhead being "insane," why do you feel that way? It looks from your spreadsheet like you are keeping a little over 50% of your gross collections. That's very fair.
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the office payment is "one" payment, that is correct. however, it is a bundled payment that has 3 components: physician work, malpractice costs, and practice expenses. my practice takes this one payment and breaks it down and bonuses me on only the physician component. yes, i am keeping 51% overall when you run the numbers. i am wondering if everyone thinks that is fair or not. Most other people are bonused on the full in office payment, not just the physician component. just wanting to get the groups thoughts.
 
giddyup said:
the office payment is "one" payment, that is correct. however, it is a bundled payment that has 3 components: physician work, malpractice costs, and practice expenses. my practice takes this one payment and breaks it down and bonuses me on only the physician component. yes, i am keeping 51% overall when you run the numbers. i am wondering if everyone thinks that is fair or not. Most other people are bonused on the full in office payment, not just the physician component. just wanting to get the groups thoughts.
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51% overall is very fair, and I want to add you’re doing a good number of trials that if done in the clinic would increase your collections significantly. Once you’ve done 15-20 your partners would follow suit.
 
There are three other interventional docs at my practice. Two are one hundred percent ASC. One other is more office based (but not as much as I am as he does one and a half days a week at HOPD and I am one every other week). They are looking at how much the other guys are making with specific insurances at the ASC and HOPD and “extrapolating” what the professional amount would be for me by looking at their numbers. Hi
 
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I don’t do a ton of trials, to be honest. The surgeon at my particular location isn’t too fond of them and is liberal in terms of who he will operate on. I started in September and I’ve only done maybe six or seven.
 
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giddyup said:
the office payment is "one" payment, that is correct. however, it is a bundled payment that has 3 components: physician work, malpractice costs, and practice expenses. my practice takes this one payment and breaks it down and bonuses me on only the physician component. yes, i am keeping 51% overall when you run the numbers. i am wondering if everyone thinks that is fair or not. Most other people are bonused on the full in office payment, not just the physician component. just wanting to get the groups thoughts.
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The allocation of overhead should reflect the actual overhead costs of the practice where you work and not the government-determined RVU allocations. YMMV.
 
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