Please help. PP -> HOPD

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JLE85

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Long time lurker, I really appreciate hive mind. Leaving current practice to take a hospital position with 415k base with productivity bonus set at around 5000 RVUs with every additional RVU being compensated at around $30.00. Being used to the collections model, is this fair? Compensation will be reviewed at committee at >75% MGMA. Is this pretty standard?

Really appreciate help.

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Long time lurker, I really appreciate hive mind. Leaving current practice to take a hospital position with 415k base with productivity bonus set at around 5000 RVUs with every additional RVU being compensated at around $30.00. Being used to the collections model, is this fair? Compensation will be reviewed at committee at >75% MGMA. Is this pretty standard?

Really appreciate help.
Most of the hospital go by MGMA median which is around 450K with 6500 threshold, so your base and threshold looks fair but below standard. But 30 per RVU is below par by any means.
 
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Thanks for feedback. I guess all things considered need to figure out what fair would be and I honestly have no idea. 5000 wRVU seems like a reasonable target. Also not sure what 75th percentile MGMA is currently is either.
 
Thanks for feedback. I guess all things considered need to figure out what fair would be and I honestly have no idea. 5000 wRVU seems like a reasonable target. Also not sure what 75th percentile MGMA is currently is either.
2019 MGMA non anesthesia pain 75%ile: comp 600k, wRVU 8727, comp:wRVU $95 (not sure how this is calculated)

2018 MGMA anesthesia pain
75%ile: comp 685k (hospital)
 
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Long time lurker, I really appreciate hive mind. Leaving current practice to take a hospital position with 415k base with productivity bonus set at around 5000 RVUs with every additional RVU being compensated at around $30.00. Being used to the collections model, is this fair? Compensation will be reviewed at committee at >75% MGMA. Is this pretty standard?

Really appreciate help.

Why are you leaving private practice?
 
Long time lurker, I really appreciate hive mind. Leaving current practice to take a hospital position with 415k base with productivity bonus set at around 5000 RVUs with every additional RVU being compensated at around $30.00. Being used to the collections model, is this fair? Compensation will be reviewed at committee at >75% MGMA. Is this pretty standard?

Really appreciate help.
That’s not a bad base. Is it big city?
 
415k for 5,000 wRVUs puts you at $83/wRVU which is a generous place to start

your incentive to produce above that is obviously declining as they're trying to make some money off of you after you ramp up production. they're playing the long game on you with this contract.
6,976 wRVUs is 50th percentile. at your current offer you'd make $474,280 which is $68/wRVU (basically the median $/wRVU valuation).
8,979 wRVUs is 75th percentile. you'd make $534,370 which is $59.50/wRVU (just below the 25th percentile $/wRVU conversion - typical hospital asking you to produce at 75th percentile and pay you at the 25th).

just tell them you'd like the median $/wRVU valuation ($70/wRVU) above your 5,000 wRVU threshold and see what happens. if they balk, see if you can decrease your base for a higher $/wRVU valuation so you are making more once you're busy.
 
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This is an awesome part time job. If your lifestyle can handle that base salary, work 3 days a week and enjoy your free time (or do a side hustle.) No reason to do a single thing over 5000 RVU.
 
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This is an awesome part time job. If your lifestyle can handle that base salary, work 3 days a week and enjoy your free time (or do a side hustle.) No reason to do a single thing over 5000 RVU.
In HOPD land, this won't work if it's a 1FTE position = 4.5 days/wk, >.75FTE at most places to keep full benefits
 
In HOPD land, this won't work if it's a 1FTE position = 4.5 days/wk, >.75FTE at most places to keep full benefits
Reasonable point. You can do any number of things while at work that are either enjoyable or profitable while being “present” 4 days and easily doing 5000 rvu. If they are micromanaging how you schedule pts., etc. that’s a completely different issue.
 
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If they are micromanaging how you schedule pts., etc. that’s a completely different issue.
That is the stated reason for existence of clinic admin in HOPD land, Nowadays you rarely find a clinical person filling any mid managerial position, unless you believe an MA without a college degree who is half your age qualifies
 
In HOPD land, this won't work if it's a 1FTE position = 4.5 days/wk, >.75FTE at most places to keep full benefits

Reasonable point. You can do any number of things while at work that are either enjoyable or profitable while being “present” 4 days and easily doing 5000 rvu. If they are micromanaging how you schedule pts., etc. that’s a completely different issue.
Can you not use your other two days of the week as "administrative days" or work in some committee job for extra pay within the hospital?
 
Can you not use your other two days of the week as "administrative days" or work in some committee job for extra pay within the hospital?
FTE is defined as face to face time spent with patients. Committee work is voluntary & non-compensating and admin time is nonbillable work hours, so the answer is no. If you are not billing then you are not generating income for HOPD or PP and you are dead weight. Way back when I was in PP, 5 full days/wk with .5day on a weekend for extra procedures was pretty typical. In HOPD 4.5 days/wk with .5day admin, in academia 4 clinic days/wk with .5day admin and .5day lectures/meetings/grand rounds/teaching
 
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FTE is defined as face to face time spent with patients. Committee work is voluntary & non-compensating and admin time is nonbillable work hours, so the answer is no. If you are not billing then you are not generating income for HOPD or PP and you are dead weight. Way back when I was in PP, 5 full days/wk with .5day on a weekend for extra procedures was pretty typical. In HOPD 4.5 days/wk with .5day admin, in academia 4 clinic days/wk with .5day admin and .5day lectures/meetings/grand rounds/teaching
So is there another way OP can just hit the 5000 cap and cruise after that since the differential above the 5000 isnt that much?
 
FTE is defined as face to face time spent with patients. Committee work is voluntary & non-compensating and admin time is nonbillable work hours, so the answer is no. If you are not billing then you are not generating income for HOPD or PP and you are dead weight. Way back when I was in PP, 5 full days/wk with .5day on a weekend for extra procedures was pretty typical. In HOPD 4.5 days/wk with .5day admin, in academia 4 clinic days/wk with .5day admin and .5day lectures/meetings/grand rounds/teaching
Maybe for you, but there are paid committees and tons of admin money for docs. Board position, medical directorship, etc.
 
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for a standard clinical contract, there will not be money given for administrative duties. I'm not paid a penny for all the meetings ive been at.


however, one can sign a contract that is part clinical and part administrative, to lobel's point. case in point, a colleague of mine works 2 clinical days a week in ER and the rest of time is administrative.
 
for a standard clinical contract, there will not be money given for administrative duties. I'm not paid a penny for all the meetings ive been at.


however, one can sign a contract that is part clinical and part administrative, to lobel's point. case in point, a colleague of mine works 2 clinical days a week in ER and the rest of time is administrative.
Negotiate more time off. Have them allow you to do work on the side during vacation. You can offer to pay your own malpractice for any side work ( the Locums should
Pay anyway) and have it be outside your area so it isn’t infringing on non compete area.

you can review claims for insurance company if you don’t want to leave your house. You can do expert witness, you can just take vacation.
But negotiate more
Time off. Don’t work for free
 
Maybe for you, but there are paid committees and tons of admin money for docs. Board position, medical directorship, etc.
For admin & directorship positions yes, but my reading of this post was this is a standard HOPD position without any of those additional duties
 
Long time lurker, I really appreciate hive mind. Leaving current practice to take a hospital position with 415k base with productivity bonus set at around 5000 RVUs with every additional RVU being compensated at around $30.00. Being used to the collections model, is this fair? Compensation will be reviewed at committee at >75% MGMA. Is this pretty standard?

Really appreciate help.
I'm interested in your experience in PP and what you exit process looks like. Can I PM you?
 
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for a standard clinical contract, there will not be money given for administrative duties. I'm not paid a penny for all the meetings ive been at.


however, one can sign a contract that is part clinical and part administrative, to lobel's point. case in point, a colleague of mine works 2 clinical days a week in ER and the rest of time is administrative.

large HOPD systems forbid this directly within their contracts and through noncompetes - for example Kaiser stipulates that they can confiscate any and all earned income outside of Kaiser and they can terminate you.
 
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large HOPD systems forbid this directly within their contracts and through noncompetes - for example Kaiser stipulates that they can confiscate any and all earned income outside of Kaiser and they can terminate you.

I don't think that's legal. Slavery is against the law.
 
large HOPD systems forbid this directly within their contracts and through noncompetes - for example Kaiser stipulates that they can confiscate any and all earned income outside of Kaiser and they can terminate you.
I had a private practice contract placed in front of me which said the same thing. I insisted it be removed before signing which it was.
 
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415k for 5,000 wRVUs puts you at $83/wRVU which is a generous place to start

your incentive to produce above that is obviously declining as they're trying to make some money off of you after you ramp up production. they're playing the long game on you with this contract.
6,976 wRVUs is 50th percentile. at your current offer you'd make $474,280 which is $68/wRVU (basically the median $/wRVU valuation).
8,979 wRVUs is 75th percentile. you'd make $534,370 which is $59.50/wRVU (just below the 25th percentile $/wRVU conversion - typical hospital asking you to produce at 75th percentile and pay you at the 25th).

just tell them you'd like the median $/wRVU valuation ($70/wRVU) above your 5,000 wRVU threshold and see what happens. if they balk, see if you can decrease your base for a higher $/wRVU valuation so you are making more once you're busy.
DOCTORJAY: Where did you get these numbers from? Any screen shot of mgma data? have done a search and can't find... trying to revise our comp plan for our group and this is EXACTLY the data I'm looking for...
 
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DOCTORJAY: Where did you get these numbers from? Any screen shot of mgma data? have done a search and can't find... trying to revise our comp plan for our group and this is EXACTLY the data I'm looking for...

90th percentile wrvus is 12,191

The numbers I posted are what my network shares with me

Median blended $/wRVU is $70
25th percentile is $61 if I remember correctly.

Blended means MGMA, Sullivan cotter, and AMGA data
 
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you have Kaiser right in your backyard so go ahead and prove me wrong. and you cannot be possibly be that naive...

I guess I'd have to see the language or have it reviewed by an attorney. But, it strikes me like this is a situation where I'd tell someone to go pound sand. Just because someone proposes something doesn't mean you have to agree to it.
 
I guess I'd have to see the language or have it reviewed by an attorney. But, it strikes me like this is a situation where I'd tell someone to go pound sand. Just because someone proposes something doesn't mean you have to agree to it.

The problem is when people blindly sign these nefarious contracts. If you don’t know not to sign this or remove the language, well looks like you agreed to it. Then what?
 
I guess I'd have to see the language or have it reviewed by an attorney. But, it strikes me like this is a situation where I'd tell someone to go pound sand. Just because someone proposes something doesn't mean you have to agree to it.

I don't disagree with you but just making OP and others aware that boiler plate, non-negotiable contracts are standard fare for large HOPD's (HCA, Kaiser, Providence, Sutter, Dignity...), VA's, and Academia. Try to negotiate beyond FTE and salary or have a contract attorney try to change language and they will walk away and pull the offer without hesitation and you have zero chance once that happens
 
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30 for each RVU is laughably low. That would mean an Interlaminar Epidural is worth approx $50. Also, keep in mind, if you are on a base for 2 years and then productivity, expect the first year to be great, the second year to have admin breathing down your neck to "work more" and threatening to "cut your pay." Also, you'll have precisely no control over that bureaucracy. Oh and those fabulous 8 week vacations? Take them, let me know how it works out, especially if you're the only pain guy or one of two. It's a scam, they never want you taking those vacation weeks. After year one, I had a talk with admin about my vacation time, and year two I was being told that just because I have it, doesn't mean I have to use it. And a "provider" has to be available for the patients. I laughed and said no, I'll be taking what's in my contract.
 
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I don't disagree with you but just making OP and others aware that boiler plate, non-negotiable contracts are standard fare for large HOPD's (HCA, Kaiser, Providence, Sutter, Dignity...), VA's, and Academia. Try to negotiate beyond FTE and salary or have a contract attorney try to change language and they will walk away and pull the offer without hesitation and you have zero chance once that happens

So what is the strategy in that case? If you are told that the “core document” cannot be changed do you suggest not making any attempt to change language as that might trigger withdrawal of the offer? Is a contract attorney’s advice to “ try and they can say no” not good advice?
 
So what is the strategy in that case? If you are told that the “core document” cannot be changed do you suggest not making any attempt to change language as that might trigger withdrawal of the offer? Is a contract attorney’s advice to “ try and they can say no” not good advice?
“They will never move you back.” Try negotiating with someone who doesn’t see you as an equal and instead as a commoditized service and tell me how it goes.
 
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30 for each RVU is laughably low. That would mean an Interlaminar Epidural is worth approx $50. Also, keep in mind, if you are on a base for 2 years and then productivity, expect the first year to be great, the second year to have admin breathing down your neck to "work more" and threatening to "cut your pay." Also, you'll have precisely no control over that bureaucracy. Oh and those fabulous 8 week vacations? Take them, let me know how it works out, especially if you're the only pain guy or one of two. It's a scam, they never want you taking those vacation weeks. After year one, I had a talk with admin about my vacation time, and year two I was being told that just because I have it, doesn't mean I have to use it. And a "provider" has to be available for the patients. I laughed and said no, I'll be taking what's in my contract.
LOL they can go fvuk themselves. Got a problem? Hire a second physician to cover those 'pain emergencies'
 
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“They will never move you back.” Try negotiating with someone who doesn’t see you as an equal and instead as a commoditized service and tell me how it goes.

Other than having your own practice which in this climate I ( clinician >> businessman) find so difficult, who will treat you as an equal? A group of surgeons? A group of PCPs?
 
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LOL they can go fvuk themselves. Got a problem? Hire a second physician to cover those 'pain emergencies'
That's pretty much what I said. It was great, and then right before my contract was about to end, gave my notice. No way would I ever work like a slave or dog. I'm a trained, professional physician and I know my worth and value.
 
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Excellent question.

I’m hoping for an excellent answer; however, I fear that the answer is no one. In fact, I don’t even know that among your true peers in a pain medicine group you will feel valued. When you’re expected to see a patient every 15 minutes and do 5 procedures an hour what value do you have as a professional? You’re just a machine with 10 fingers and a heart beat.
 
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I’m hoping for an excellent answer; however, I fear that the answer is no one. In fact, I don’t even know that among your true peers in a pain medicine group you will feel valued. When you’re expected to see a patient every 15 minutes and do 5 procedures an hour what value do you have as a professional? You’re just a machine with 10 fingers and a heart beat.
I'd imagine they would value and respect someone who is bringing in a comparable amount of money. If youre bringing in more or equivalent revenue to them, hit em with that BDE.
 
Start your own practice if you want to be valued.

Otherwise get one of the many 600k hospital pain jobs with 10 weeks vacation everyone on this board seems to have and punch a clock

just saw a hospital employed old school pmr job advertised locally with max salary of 117k…
 
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Start your own practice if you want to be valued.

Otherwise get one of the many 600k hospital pain jobs with 10 weeks vacation everyone on this board seems to have and punch a clock

just saw a hospital employed old school pmr job advertised locally with max salary of 117k…
Agree with above, though the 10 weeks of vacation Is for anesthesia jobs not pain. I’ve never seen a pain job with 10 weeks of vacation.

That old school PMR job must be the one I’ve seen advertised everywhere for Denver recently.

they could save a lot of advertising money if they would just provide appropriate physician compensation for that job.
 
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The 10 weeks was tongue in cheek -the sdn lake wobegon effect -Everybody has an above average job in a great location
 
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