APDoc

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Have any of you guys heard of being in a multispecialty group and getting charged overhead based on clinic space used and patient volume? We were previously splitting overhead 70% fixed and 30% based on collections, and now the group is making a switch to 60% fixed and 40% based on clinic space used and patient volume.

Unfortunately with being a busy pain doc who sees a lot of patients I'm not really excited about the changes. I'm in a group with ortho and neurosurgery and none of them see the number of patients myself and my other pain partner do, and they are convinced we use substantially more overhead than them. The practice already has a high overhead (over 4 million per year) for a 10 doc group.

Do any of you guys have experience with similar compensation formulas to this or is this an unusual way of assigning overhead in a 10-15 doc multispecialty group? If it's different how does your group divide it up?

Thanks!
 

Ligament

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For you guys with in office fluoro suite, if you do not have a recovery or pre-op room, how do you maintain fast turnover? I would assume no IV sedation? Walk them in, do procedure, walk them out to lobby for check out, store them in a clinic exam room if you need to watch them with a weak extremity? Do you place IVs routinely?
 

NJPAIN

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For you guys with in office fluoro suite, if you do not have a recovery or pre-op room, how do you maintain fast turnover? I would assume no IV sedation? Walk them in, do procedure, walk them out to lobby for check out, store them in a clinic exam room if you need to watch them with a weak extremity? Do you place IVs routinely?
Are looking to exit the ASC??
 

lobelsteve

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For you guys with in office fluoro suite, if you do not have a recovery or pre-op room, how do you maintain fast turnover? I would assume no IV sedation? Walk them in, do procedure, walk them out to lobby for check out, store them in a clinic exam room if you need to watch them with a weak extremity? Do you place IVs routinely?
Yes. No iv unless scs or kypho or stellate. Put on monitor in exam room if needed. No sedation in office. Thats why there are asc or hopd.
 

Pacman27

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No, I'm staying at the ASC, but also thinking of putting a c-arm in the office for patients that cannot afford ASC self pay rates or deductibles.

IV's only for kypho, SCS, stellate, disco's. So usually one patient every 2 to 3 week if that gets a IV. I have IV stuff and other vital things I hope never to use ready to go

I have a clinic exam right next my procedure room. Patients wait 10 to 15 min on average

I understand ASC's from a monetary point of view, but never made sense to me to sedate someone for mbb's or esi's. Patients that have been put to sleep for ESI's before and come to me are in shock they were put to sleep for an ESI. A husband was so livid he was ready to file a malpractice claim against the previous treating doctor ( I did talk him out of it) for not giving his wife the option of no sedation for an ESI
 

nvrsumr

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Patients like the option of "sedation". I did po xanax for a couple years and satisfaction rates higher and hassles lower on 2mg versed now. Half get and half dont. Pays enough to cover but thats all.
 

drpainfree

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Patients like the option of "sedation". I did po xanax for a couple years and satisfaction rates higher and hassles lower on 2mg versed now. Half get and half dont. Pays enough to cover but thats all.
do you use 2 of versed only or add fentanyl, too? how do you deal with the security issues of keeping versed and fentanyl (if you use them) in office? safety box?

xanax is doing okay, but i can see some really anxious patients might need quick onset of versed and strong anterograde action of iv benzo. had a patient who did an TESI at ASC with "anesthesia", got very upset with me not using "anesthesia" for SIJ, unusual, but does happen. When it does, I'd rather have them not able to recall the procedure, at the least.
 
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APDoc

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It appears my initial question has been taken another direction.

Anyone have any insight into my initial overhead question? Really appreciate anyone's help or insight.

Thanks!
 

Pacman27

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It appears my initial question has been taken another direction.

Anyone have any insight into my initial overhead question? Really appreciate anyone's help or insight.

Thanks!

I think you need to do a careful analysis of the numbers and break it down to what it is that you use and what your partners use. How may FTE's for you, procedure supply cost, warranty cost, Utilities (should be split evenly for the most part), rent etc...

I doubt there is one answer that fits all to the current equation. Something else to consider is patient acquisition, who is bringing in the patients the pain docs or the surgeons. If the answer is pain docs, then you may have more leverage
 

Ligament

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It appears my initial question has been taken another direction.

Anyone have any insight into my initial overhead question? Really appreciate anyone's help or insight.

Thanks!
Sorry to hijack your thread
 

ampaphb

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lobelsteve

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Word "routine" implies that occasional use for anxious patients is perfectly acceptable

Sent from my SAMSUNG-SM-G920A using SDN mobile
Define occasional.

oc·ca·sion·al
əˈkāZHənl/
adjective
  1. occurring, appearing, or done infrequently and irregularly.
    "the occasional car went by but no taxis"
    synonyms: infrequent, intermittent, irregular, sporadic, odd, random; More
    • (of furniture) made or adapted for use on a particular occasion or for irregular use.
      "an occasional table"
    • (of a literary composition, speech, religious service, etc.) produced on or intended for a special occasion.
      "he wrote occasional verse for patrons"
 

ampaphb

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define occasional: not routine