Patient Volumes

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Patient Volume

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    134
thegenius said:
She'll be in soon enough. When she poops on herself for the third time.
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Or throws a PE.
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I hope these patients don’t die. For their sake an ours. These patients are dad will not be repeat visitors to the ED so we may receive a permanent reduction in volume such as 10 or 20% even when this resolves
 
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KnuxNole said:
Honestly, I’m shocked numbers are so down, if anything I would imagine them
To be higher. I mean, you can’t close an ER and who knows when things will get better with this new disease
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Nobody should be shocked numbers are down. A very large percentage of ER visits in this country are completely unnecessary. ACEP, private groups, and hospital admin love all of these well paying unnecessary visits though. And we all know the dirty little secret that FSEDs were set up with the explicit purpose of taking advantage of these patients.

"Burnout" is a result of being faced with this ridiculousness everyday and having to deal with the constant gaslighting about how things are really good and not as terrible as we think they are. Many of us signed up to be emergency specialists and dont enjoy playing social worker or primary care hand holder. Yes it is sad that people need PCPs and assistance with managing their lives. That's not our job though and its killing the speciality trying to deal with all of this crap on a daily basis.

What people are feeling now is a sense of actual purpose and a call to action requiring our years of training as emergency specialists. We have been granted an opportunity to put aside so much of the BS that we have known was BS for so long and focus on taking care of actual sick patients; and we can act as real as doctors, as leaders, and use our experience and training to make the incredibly important and difficult decisions that require the expertise of an emergency physician and that actually matter. It's amazing what this has done for morale.
 
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Believe it or not our numbers in NYC have also been down about 25% so far this month.
 
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but how's the acuity there? still worse, or is that going down too?
 
our ED volumes are roughly half of normal, hospital is at 60% capacity - admits as a percentage of visits is the same - thus we obviously people we felt sick enough to admit are staying home.

Salaried workers (RN, myself, RT, etc) are having forced PDO - all good, not cutting our pay, just making us use vacation time, although we can't go anywhere. The MD's are 100% RVU/Democratic Group- and they are basically working shorter shifts (~6 hours at times) and paychecks obviously going to be reduced.
 
Yo my numbers are so low that I am wondering if COVID is really going to hit non-metropolitan areas so much ... I work out in the boonies
 
Acuity is slowly going down and we are doing probably half as many intubations compared to last month.
 
So slow on the weekends they will probably be more cuts in May if you think doctors are burned out watch as they have all these payments and make half their income
 
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Brigade4Radiant said:
So slow on the weekends they will probably be more cuts in May if you think doctors are burned out watch as they have all these payments and make half their income
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hearing the giant local anesthesia group is telling their docs 50% pay cut to start and no guarantees it will ever go back. what will happen if it stays this slow with all the new grads coming out next summer?
 
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Dr Mantis Toboggan said:
hearing the giant local anesthesia group is telling their docs 50% pay cut to start and no guarantees it will ever go back. what will happen if it stays this slow with all the new grads coming out next summer?
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We've started our discussions of voluntary furloughs, then forced shift reductions, then layoffs. Democratic group.
 
40-50 percent drop in volume at my shop. Saw 5 patients today in 12 hours. This is ridiculously unusual. Usually my average day was 20 patients. But I'm hourly so I'm liking the change in pace. Still making the same money as before, just seeing ridiculously less patients. They can't possibly decrease the physician hours from current levels. We have physician 24 hour coverage. 12 hour MLP coverage is now gone until daily volumes don't go above 40 daily - right now 20-35 range. Used to average around 55. Busy days we would get 70-85 a day.
 
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Our volume has dropped even further to 40% across the board at all our sites. We are on second round of shift reductions. We're a SDG so trying to balance our the shift reductions to people who can volunteer and so far avoiding furloughs, benefit cuts (which is good because Im technically below contract minimum hours now). I imagine working for a CMG right now is going to suck as they no reason to protect their staff.
 
swamprat said:
do u think that is just related to the change in guidance that we shouldn’t be intubation these patients early anymore
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Yeah that probably did play a role but at the same time we are definitely seeing less COVID patients.
 
Groove said:
I worked 8 hours last night and saw 11 people. I really hope this is not the new norm. Otherwise, we're screwed.
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Especially with the huge number of residency programs. Our demand as physicians will plummet if volumes don't recover and we keep churning out new grads.

I used to think i had a good 4-6 years before the surplus of new grads affected our specialty. But if this goes on, our specialty is really screwed.
 
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Groove said:
I worked 8 hours last night and saw 11 people. I really hope this is not the new norm. Otherwise, we're screwed.
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Why would it be?

Right now all the non-emergent patients are staying home but do you think COVID is going to cure their crazy that tells them its OK to go to the ED at 2am with 18 years of chronic back pain that needs to be figured out right now"?
 
VA Hopeful Dr said:
Why would it be?

Right now all the non-emergent patients are staying home but do you think COVID is going to cure their crazy that tells them its OK to go to the ED at 2am with 18 years of chronic back pain that needs to be figured out right now"?
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See, this is my barometer as to how we're now on the other end of the Covid "peak" in my area.
We're starting to see the frequent fliers and problem children trickle back in after 4-6 weeks of not being seen at any of our sites.
 
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VA Hopeful Dr said:
Why would it be?

Right now all the non-emergent patients are staying home but do you think COVID is going to cure their crazy that tells them its OK to go to the ED at 2am with 18 years of chronic back pain that needs to be figured out right now"?
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I hope not... Other day we had a slight uptick in volume and I picked up a CC of “Foreign body in vagina”.... I smiled, leaned back in my chair, elbowed my partner and said “I think things might be getting back to normal!”
 
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Groove said:
I hope not... Other day we had a slight uptick in volume and I picked up a CC of “Foreign body in vagina”.... I smiled, leaned back in my chair, elbowed my partner and said “I think things might be getting back to normal!”
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I had 10 young female patients show up all at once yesterday. All had complaints of Vajajay problems, flank pain, or abdominal pain. I haven't seen any of these patients in weeks.
 
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Mr. Hat said:
It really is concerning I have to admit, but I wonder how much pay can really be cut in the long term. It seems like there would be some degree of self correction. For instance, if my pay got cut 50% (like the anesthesia group mentioned above), I'd quit on the spot. We're a single income household, and loss of that much pay would mean we'd have to sell our house and change our lifestyle quite a bit. So if I'm going to lose my lifestyle anyway, why on earth would I keep killing myself working nights and weekends and holidays? If EM became a 150K per year job, I'd much rather just find some M-F 8-5 gig, whether in medicine or not, for 75K or 100K (shouldn't be too hard with a doctorate level degree), transition my student loans to IBR, and just enjoy a normal middle class life without constant sleep disruption and missing family events. I'd imagine plenty of other people would do the same. And if enough people did that, then hospitals will have no chance but to pay more in order to attract doctors back....

But maybe I'm wrong and maybe we're all screwed. I hope not.
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Because of Covid things are harder everywhere what exactly would you do?
Urgent care isn’t even not hiring people.
There isn’t a high demand for anything other than masks.
These 75k-100k gigs were pre Covid now you work remotely. Doctors will work because their lifestyle demands it. Regardless of what you do those loans are still there.
 
TooMuchResearch said:
We've started our discussions of voluntary furloughs, then forced shift reductions, then layoffs. Democratic group.
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How does an SDG lay off people? You mean buyouts?

Groove said:
I hope not... Other day we had a slight uptick in volume and I picked up a CC of “Foreign body in vagina”.... I smiled, leaned back in my chair, elbowed my partner and said “I think things might be getting back to normal!”
Click to expand...

I'm curious if my experience is normal or not. I've never had a CC of 'vaginal FB' bear out. Mind you, I've seen plenty of vaginal foreign bodies. Just never had a patient who came in complaining of one actually have it.
 
Volume has been creeping back up at the two ED's I work at. Yeah, don't think people are going to just keep waiting for much long...
 
I know this forum is small sample size overall, but I wonder what the survivability is for this in terms of SDG vs CMG vs hospital employee. I work for a CMG and so far the changes have come fast. We hourly reduced and are also taking rate cut. Have been told we're pouring money down the drain, "but we'll get thru this." Had a senior group member recently tell me that we'd be out of business already if we were still an SDG.

Seems that hospital employed would be the preferable model right now. If not true, then why?

Sent from my Pixel 3 using Tapatalk
 
bikERdoc said:
I know this forum is small sample size overall, but I wonder what the survivability is for this in terms of SDG vs CMG vs hospital employee. I work for a CMG and so far the changes have come fast. We hourly reduced and are also taking rate cut. Have been told we're pouring money down the drain, "but we'll get thru this." Had a senior group member recently tell me that we'd be out of business already if we were still an SDG.
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Excuse my ignorance on this subject but by what mechanism would this cause SDGs to go out of business? The way I understand it a democratic group is composed of equal partners and then possibly some newer associates who are making a fixed rate likely below their own billing. It seems in an eat-what-you-kill shop there be a collective understanding that the net take-home over the next few months will be lower than normal and a hiring freeze may be necessary until volumes come back up. Considering you don't have a large salaried office staff to keep on payroll like an outpatient practice I guess I don't understand why a group would have to give up their hospital contract.
 
bikERdoc said:
I know this forum is small sample size overall, but I wonder what the survivability is for this in terms of SDG vs CMG vs hospital employee. I work for a CMG and so far the changes have come fast. We hourly reduced and are also taking rate cut. Have been told we're pouring money down the drain, "but we'll get thru this." Had a senior group member recently tell me that we'd be out of business already if we were still an SDG.

Seems that hospital employed would be the preferable model right now. If not true, then why?

Sent from my Pixel 3 using Tapatalk
Click to expand...
The Harsh Reality of Running a Small Democratic Group From The Inside

It doesn't matter if you're a hospital employing docs, an SDG or CMG, when there's a big drop in you revenue stream, you have to cut expenses to quickly to survive. In most cases, employee salaries are the biggest expense that can be adjusted quickly. An SDG can do it as easily as a CMG or a hospital.

I work for and help run a 45 provider, physician owned multi-specialty group. We used to have a hospitalist contract and multiple ED contracts. In one very harsh year, we lost both our biggest ED contract and our hospitalist contract. It caused us a 70% drop in revenue. A lot of people thought "the ship was going down." It was. This happened at the same time I was appointed to the Board of Directors. My first meeting, I was handed a sheet of paper with the names of employees and their salary next to it. We were told by the CEO and CFO, "Your assignment is to decide who we fire. The total amount of salaries must equal 70% of our expenses or we're all out of jobs within 4 months." Most of the people on the list were very good employees and good people.

It was a stark introduction to the business aspect of EM and medicine in general. I sat there and checked names on a list, whom I thought had the greatest combination of high salary and expendability. Multiple mid level office staff got axed. One of them was the CFO to assigned us the task. It was horrible, helping decide who had to lose their jobs, by no fault of their own, to keep the company alive. We didn't do it out of spite or "corporate evil." If we avoided laying of 70% of the company to be 'socially compassionate' the result would be 100% of the company would lose their jobs. This all had to happen because the new hospital CEO decided he wanted cheaper CMG labor and didn't want to deal with our SDG anymore, after 25 years. We made the cuts and we survived. It took 8 years for the company to re-expand back to it's pre-contract loss size. We're now bigger than before. If we hadn't made these harsh and stark decisions, the group would no longer exist and we'd all work for either a hospital CEO or CMG.
 
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Torsion said:
Excuse my ignorance on this subject but by what mechanism would this cause SDGs to go out of business? The way I understand it a democratic group is composed of equal partners and then possibly some newer associates who are making a fixed rate likely below their own billing. It seems in an eat-what-you-kill shop there be a collective understanding that the net take-home over the next few months will be lower than normal and a hiring freeze may be necessary until volumes come back up. Considering you don't have a large salaried office staff to keep on payroll like an outpatient practice I guess I don't understand why a group would have to give up their hospital contract.
Click to expand...

I don't think anyone is talking about giving up contracts. The notion that was passed to me by a senior partner is that we could not have withstood the storm of a major downturn like our Big brother CMG can. I don't fully subscribe to that notion for the reasons you mentioned. Provided that you can pay your employees something, then I don't see why the business couldn't float for a while on downturn. Partners who were making >300/hr should be able to handle a bad few months if necessary.

I have a buddy who said his SDG applied for the Fed loans, which appear to be now depleted. Wonder if they got one. That was basically free money provided they didn't fire anyone during Corona.

I don't personally subscribe to the idea that a big corporation is any safer than a smaller SDG. My group got bought out 3.5 yrs ago and I'm still not thrilled with it. Been slowly waiting for things to improve, but they really haven't. Add to that the hundreds of millions we owe in private equity, if anything a CMG seems less safe in a major downturn...

Birdstrike said:
Yeah, the whole "your hospital systems will be collapsing like Italy" was bulls**t.

The Harsh Reality of Running a Small Democratic Group From The Inside

It doesn't matter if you're a hospital employing docs, an SDG or CMG, when there's a big drop in you revenue stream, you have to cut expenses to quickly to survive. In most cases, employee salaries are the biggest expense that can be adjusted quickly. An SDG can do it as easily as a CMG or a hospital.

I work for and help run a 45 provider, physician owned multi-specialty group. We used to have a hospitalist contract and multiple ED contracts. In one very harsh year, we lost both our biggest ED contract and our hospitalist contract. It caused us a 70% drop in revenue. A lot of people thought "the ship was going down." It was. This happened at the same time I was appointed to the Board of Directors. My first meeting, I was handed a sheet of paper with the names of employees and their salary next to it. We were told by the CEO and CFO, "Your assignment is to decide who we fire. The total amount of salaries must equal 70% of our expenses or we're all out of jobs within 4 months." Most of the people on the list were very good employees and good people.

It was a stark introduction to the business aspect of EM and medicine in general. I sat there and checked names on a list, whom I thought had the greatest combination of high salary and expendability. Multiple mid level office staff got axed. One of them was the CFO to assigned us the task. It was horrible, helping decide who had to lose their jobs, by no fault of their own, to keep the company alive. We didn't do it out of spite or "corporate evil." If we avoided laying of 70% of the company to be 'socially compassionate' the result would be 100% of the company would lose their jobs. This all had to happen because the new hospital CEO decided he wanted cheaper CMG labor and didn't want to deal with our SDG anymore, after 25 years. We made the cuts and we survived. It took 8 years for the company to re-expand back to it's pre-contract loss size. We're now bigger than before. If we hadn't made these harsh and stark decisions, the group would no longer exist and we'd all work for either a hospital CEO or CMG.
Click to expand...

Thank you for that perspective. That's exactly what I was hoping to see here.

Curious what others are experiencing right now in SDG and hospital employed setups. Paycuts?
 
bikERdoc said:
I don't think anyone is talking about giving up contracts. The notion that was passed to me by a senior partner is that we could not have withstood the storm of a major downturn like our Big brother CMG can. I don't fully subscribe to that notion for the reasons you mentioned. Provided that you can pay your employees something, then I don't see why the business couldn't float for a while on downturn. Partners who were making >300/hr should be able to handle a bad few months if necessary.

I have a buddy who said his SDG applied for the Fed loans, which appear to be now depleted. Wonder if they got one. That was basically free money provided they didn't fire anyone during Corona.

I don't personally subscribe to the idea that a big corporation is any safer than a smaller SDG. My group got bought out 3.5 yrs ago and I'm still not thrilled with it. Been slowly waiting for things to improve, but they really haven't. Add to that the hundreds of millions we owe in private equity, if anything a CMG seems less safe in a major downturn...



Thank you for that perspective. That's exactly what I was hoping to see here.

Curious what others are experiencing right now in SDG and hospital employed setups. Paycuts?
Click to expand...

I’m the president of an 8 doc SDG. Our situation is pretty much what you described earlier. We’re definitely not in a worse situation than a CMG and I have a hard time seeing your partner’s line of reasoning that an SDG couldn’t survive this. We don’t have the administrative bloat of a CMG, so if anything we are safer and can operate leaner. All of us know that lower volumes equals lower revenue equals lower payroll for a few months. On the positive side, we have all been making a lot more than we would have in CMGs so we’re all in a good position to weather the low payrolls. We applied for the PPP and got approved so that should be helping offset some of the pain as well.
 
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It’s still freaking dead in our ER.

I was one of a few PAs who got to stay on but at half the hours I normally work. The others got furloughed until... who knows when. Our docs also got their shifts cut by several hours. None of us are making our RVU target to be eligible for bonuses so extra insult there.

Today I saw seven patients in eight hours. Malaise, nausea, and syncope in an old lady. Flank pain that turned out to be ureterolithiasis. Old man with cystitis. 18 year old fall off ATV. Old lady with right leg swelling who had a DVT and PE. Old man who felt a lump in his throat for three weeks. And girl who came in with a hangover. That was my day.

Anyone else notice that they’re just as busy with the reduced volume? Part of it is because usually my patients are sicker or more high maintenance, but part of it is because I am using the extra time to get better histories and exams, document better, just be more meticulous in general. It’s kinda nice.
 
Hercules said:
I’m the president of an 8 doc SDG. Our situation is pretty much what you described earlier. We’re definitely not in a worse situation than a CMG and I have a hard time seeing your partner’s line of reasoning that an SDG couldn’t survive this. We don’t have the administrative bloat of a CMG, so if anything we are safer and can operate leaner. All of us know that lower volumes equals lower revenue equals lower payroll for a few months. On the positive side, we have all been making a lot more than we would have in CMGs so we’re all in a good position to weather the low payrolls. We applied for the PPP and got approved so that should be helping offset some of the pain as well.
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Which bank did you use for ppp?

Chase has been annoyingly terrible with ppp applications -_-
 
turkeyjerky said:
I'm curious if my experience is normal or not. I've never had a CC of 'vaginal FB' bear out. Mind you, I've seen plenty of vaginal foreign bodies. Just never had a patient who came in complaining of one actually have it.
Click to expand...

It was actually a condom that her boyfriend had "lost down there". She was too obese to get it out herself. She was beyond happy when I pulled it out with those plastic forcep thingies. She goes "Did you get it?! Did you get it?!!!!!!" I grabbed it with the forceps and brandished it up in the air and go....."SUCCESS!" She said "Yes!!!!" and starts fist pumping the air. It got a good chuckle from me and the nurse.

The weirdest related case I had was a psych patient who had a radical hysterectomy and kept grabbing leaves from the yard and stuffing them in her vagina. I did the pelvic exam and start pulling out fetid, rotting leaves. It was the craziest thing. I called the OB/GYN on the phone and he immediately goes "Let me guess....you found grass and leaves in there." She was apparently psych and wanted to sabotage the recovery, I guess?, and had intentions on suing him for....I dunno what. She kept denying that she had put anything there and claimed he had botched the surgery and that's why I was finding leaves in there. Her argument didn't even make logical sense. Anyway, I put the leaves in a specimen container and sent it down to pathology. I'm sure the pathologist had fun with that one. Can't make this stuff up.
 
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cyanide12345678 said:
Which bank did you use for ppp?

Chase has been annoyingly terrible with ppp applications -_-
Click to expand...

BBVA for our Emergency group. Funds went into our account yesterday. BB&T for the urgent care. Loan docs are signed with them and expect funds in account within next 1-2 days.
 
Birdstrike said:
The Harsh Reality of Running a Small Democratic Group From The Inside

It doesn't matter if you're a hospital employing docs, an SDG or CMG, when there's a big drop in you revenue stream, you have to cut expenses to quickly to survive. In most cases, employee salaries are the biggest expense that can be adjusted quickly. An SDG can do it as easily as a CMG or a hospital.

I work for and help run a 45 provider, physician owned multi-specialty group. We used to have a hospitalist contract and multiple ED contracts. In one very harsh year, we lost both our biggest ED contract and our hospitalist contract. It caused us a 70% drop in revenue. A lot of people thought "the ship was going down." It was. This happened at the same time I was appointed to the Board of Directors. My first meeting, I was handed a sheet of paper with the names of employees and their salary next to it. We were told by the CEO and CFO, "Your assignment is to decide who we fire. The total amount of salaries must equal 70% of our expenses or we're all out of jobs within 4 months." Most of the people on the list were very good employees and good people.

It was a stark introduction to the business aspect of EM and medicine in general. I sat there and checked names on a list, whom I thought had the greatest combination of high salary and expendability. Multiple mid level office staff got axed. One of them was the CFO to assigned us the task. It was horrible, helping decide who had to lose their jobs, by no fault of their own, to keep the company alive. We didn't do it out of spite or "corporate evil." If we avoided laying of 70% of the company to be 'socially compassionate' the result would be 100% of the company would lose their jobs. This all had to happen because the new hospital CEO decided he wanted cheaper CMG labor and didn't want to deal with our SDG anymore, after 25 years. We made the cuts and we survived. It took 8 years for the company to re-expand back to it's pre-contract loss size. We're now bigger than before. If we hadn't made these harsh and stark decisions, the group would no longer exist and we'd all work for either a hospital CEO or CMG.
Click to expand...

On that list you were handed, was there also a column of how much money each employee earns to help the company?

As long as most of management got cut too, I'm OK with that story.

How did you manage not to cut yourself?
 
thegenius said:
On that list you were handed, was there also a column of how much money each employee earns to help the company?

As long as most of management got cut too, I'm OK with that story.

How did you manage not to cut yourself?
Click to expand...
Very good questions. The quick explanation is that not only did management get cut, it was almost entirely management that got cut. One reason is that in a physician group, the providers generate the revenue. Management does not generate the revenue, it only manages the revenue, once it's created. The other thing that allowed that, is the Board of Directors was 100% physicians, as opposed to a non-physician Board which I'm sure would have been in full "save our selves" mode.

The more detailed explanation is this: Before any of this happened, we were a 40 provider group. The process started when the hospital CEO dumped our biggest ED and hospitalist contracts. That right there effectively resulted in 25 of our providers getting "fired," not by any of us, but by the hospital CEO. So, it wasn't like no docs got hurt in the process. Many did.

The next phase was for the remaining docs to decided how to keep the company afloat with less than half the docs but 100% of the overhead and expenses. If no changes were made, we'd run out of cash reserves and be bankrupt, all out of jobs in a couple of months.

Absolutely, how much money each employee earned for the company, was a factor. In physician groups, you have two columns. Column 1 is the providers, who generate income by their work. Without them, there are no collections, no income, no dollars to pay anyone anything. Then you have everyone else, in Column 2. All the way down from the non-clinical CEO, CFO, administrators, office managers, billers to the nurses. None of these people can directly generate any charges, collections or dollars for a physician group on their own. They help generate the revenue, manage it, collect it and protect it, but by themselves cannot generate it with a physician's name on the bill. In other words, you layoff a doc and company revenue drops by $500,000. You layoff a office manager who no longer has an office to manage and your revenue drops by $0.

How did we manage not to cut ourselves as physicians? We already lost over half our docs and were left with twice the unneeded support staff. It made sense to right size the company by evening that out and releasing support staff we no longer needed. Laying off more docs who generate revenue, when we already forced to lose 50% of our docs by a hostile hospital CEO action, and keeping employees we didn't need and have no doctor revenue with which to pay their salaries, would have made no sense. That wouldn't have been the equivalent of adding more weight into an already sinking ship. We needed to bail water out to stay afloat.

The one doc that did take a cut, and to his eternal credit proposed his own pay cut, was our physician CEO at the time, who straight up recommended we cut his pay by 40%. We did. We also let the (non-physician, non-revenue generating) CFO go completely. We went from being a company that could afford a full time, 6 figure CEO and CFO, to one that couldn't afford a full time CEO, and couldn't afford a CFO at all.

When things are good, in business, they're good. But when they go bad, it's really bad.
 
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Here's the thing.
Texas has not been hit very hard, for our population.
That being said, the TMA, a group of >50,000 docs did a survey of their members. Of the returned surveys:
Polling on revenue loss was shocking:
- 24% said revenue decrease 75 – 100% . Another 50% said drop of 50%.
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EM will rebound, if only because many offices will be closed.
 
Dr.McNinja said:
Here's the thing.
Texas has not been hit very hard, for our population.
That being said, the TMA, a group of >50,000 docs did a survey of their members. Of the returned surveys:

EM will rebound, if only because many offices will be closed.
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I'm down 23% from March which was a fairly typical month for this time of the year. Next month may be closer to 50% down, but it's too early to know for sure. Either way, I'll get through it. I consider myself lucky I have a job at all, since many of my neighbors who are in the tourism or service industry are hit even harder. Also, I consider myself lucky so far (knock on wood) that neither I nor anyone in my family has knowingly gotten the 'rona, as of yet.
 
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Re SDGs keep in mind that they got 6.2% of 2019 Medicare deposited to them about 2 weeks ago. For most thats about 7500/doc. Might be more depending on MLPs. On top of that the PPP money which is basically 20k per doc.. So at an SDG the govt just gave each doc 27k and in most places volumes have only been down for a month but it seems longer.

The issue for Envision and many other CMGs is that they are heavily leveraged And they are much more than just EM staffing companies. Keep in mind they have hospitalists, intensivists and of course their ASCs which have rent, lights and a ton of admin people they need to pay.

Their scale is their down fall. My group has no rent to pay and we are super lean with only 1 non clinical person on our payroll.

We also got a discount from our med mal carrier which helps.

There are a few buckets of money still out there but are small. Also HHS announced they will bepaying out another $20B so it all adds up.

My point is if our volume was 0.. the feds have gifted each of our docs about 27k.. thats not a bad month.

EF
 
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EctopicFetus said:
Re SDGs keep in mind that they got 6.2% of 2019 Medicare deposited to them about 2 weeks ago. For most thats about 7500/doc. Might be more depending on MLPs. On top of that the PPP money which is basically 20k per doc.. So at an SDG the govt just gave each doc 27k and in most places volumes have only been down for a month but it seems longer.

The issue for Envision and many other CMGs is that they are heavily leveraged And they are much more than just EM staffing companies. Keep in mind they have hospitalists, intensivists and of course their ASCs which have rent, lights and a ton of admin people they need to pay.

Their scale is their down fall. My group has no rent to pay and we are super lean with only 1 non clinical person on our payroll.

We also got a discount from our med mal carrier which helps.

There are a few buckets of money still out there but are small. Also HHS announced they will bepaying out another $20B so it all adds up.

My point is if our volume was 0.. the feds have gifted each of our docs about 27k.. thats not a bad month.

EF
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I also think this is A wonderful lesson to residents and newbie docs.. Make sure you have cash on hand to sustain the drop. Most of my docs who are 10 years out have 100k in an emergency type fund which is maybe 50/50 stocks and bonds. This allows for liquidity in a time of scarcity yet leaves enough invested in normal times to get some growth. This works not only for pandemics but personal emergencies. It takes a while to save that up but should be something people work towards. IMO 100k is a bit high but between my non-retirement non long term brokerage accounts I probably have a similar amount. Mama EF and I like to have different accounts for different goals. In the end they are there for an emergency though which I would argue is all that matters.
 
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EctopicFetus said:
Re SDGs keep in mind that they got 6.2% of 2019 Medicare deposited to them about 2 weeks ago. For most thats about 7500/doc. Might be more depending on MLPs. On top of that the PPP money which is basically 20k per doc.. So at an SDG the govt just gave each doc 27k and in most places volumes have only been down for a month but it seems longer.

The issue for Envision and many other CMGs is that they are heavily leveraged And they are much more than just EM staffing companies. Keep in mind they have hospitalists, intensivists and of course their ASCs which have rent, lights and a ton of admin people they need to pay.

Their scale is their down fall. My group has no rent to pay and we are super lean with only 1 non clinical person on our payroll.

We also got a discount from our med mal carrier which helps.

There are a few buckets of money still out there but are small. Also HHS announced they will bepaying out another $20B so it all adds up.

My point is if our volume was 0.. the feds have gifted each of our docs about 27k.. thats not a bad month.

EF
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How much that that 27K per doc is essentially grant money as opposed to the advanced payments that have to be paid back? Because at least one round of these medicare goodies, comes back out of future payments.
 
Birdstrike said:
How much that that 27K per doc is essentially grant money as opposed to the advanced payments that have to be paid back? Because at least one round of these medicare goodies, comes back out of future payments.
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All of it. So the PPP is 2.5x 8,333.. Since wages are capped at 100k per year which is 8,333 per month.. so 2.5x that is about 20k.

The Medicare grant money aka the HHS stimulus was a grant at 6.2% of 2019 Medicare (not advantage) payments. In my group and most others that worked out to about 7-8k per person. Now keep in mind the percentage of straight Medicare varies greatly.

The Medicare advance payment I didn’t include but is smart to take because it can help level off a dramatic income drop. Like you said it is a loan with good terms up front and then a very high 10.25% interest rate.

For those who might not now the way it works is they will give you 3 months of Medicare (non advantage) payments up front. They give you those funds within 1 week of applying.

Then after 120 days they pay you 0 in Medicare money and as you submit claims they basically let you work off the debt. If there is more money owed at the end you can either pay it off or they start charging you interest at 10.25%.

So yeah.. 27k per doc as a grant/gift.
 
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EctopicFetus said:
All of it. So the PPP is 2.5x 8,333.. Since wages are capped at 100k per year which is 8,333 per month.. so 2.5x that is about 20k.

The Medicare grant money aka the HHS stimulus was a grant at 6.2% of 2019 Medicare (not advantage) payments. In my group and most others that worked out to about 7-8k per person. Now keep in mind the percentage of straight Medicare varies greatly.

The Medicare advance payment I didn’t include but is smart to take because it can help level off a dramatic income drop. Like you said it is a loan with good terms up front and then a very high 10.25% interest rate.

For those who might not now the way it works is they will give you 3 months of Medicare (non advantage) payments up front. They give you those funds within 1 week of applying.

Then after 120 days they pay you 0 in Medicare money and as you submit claims they basically let you work off the debt. If there is more money owed at the end you can either pay it off or they start charging you interest at 10.25%.

So yeah.. 27k per doc as a grant/gift.
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Thanks. I'm going to have a discussion with our group CFO and COO later today, before our upcoming board meeting, about all of this. It's a lot of information coming quick.
 
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Birdstrike said:
Thanks. I'm going to have a discussion with our group CFO and COO later today, before our upcoming board meeting, about all of this. It's a lot of information coming quick.
Click to expand...
Sent you PM. Happy to discuss more if you need. Get that $$$. Lord knows we pay enough in taxes.
 
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