Primary Care contract, guaranteed salary, and productivity bonus.

[deleted87716]

I only mention all of this because I was thinking of asking for a raise. I have a guarantee of 285,000 as you can see I far surpass that. I was thinking of getting rid of my guarantee and asking for $62 per wrvu up from 55. I do work about 45 hours a week. What do you think? The reason for high $per rvu is because I generate a lot outside my billing with xray/mri/emg.

As hard as it sounds like you're working, you should be clearing >$500K, IMO. Go for it.

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[VA Hopeful Dr]

As hard as it sounds like you're working, you should be clearing >$500K, IMO. Go for it.

Agreed. 90th percentile for FM Sports Med is just under 8000 so you're in the top 10% by production. Sports Medicine, as you point out, has way more ancillary revenue than us regular FMs with procedures. Now you can't actually say that's why you're getting paid more, but still.

 

[Bacchus]

This is why I’ve considered trying to figure out if I can financially survive a 1-year fellowship. I like sports enough that I’d consider doing it.

 

[thumbz]

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Apologize for thread hijack. This is for gen peds. I'm confused about this tier system. Shouldnt the worked rvu rate go up with higher tiers (being more productive)? I don't understand this payment structure. Could some one explain ? This is for my spouse and I doubt she will get any higher than 50th percentile; she will be happy with 230k. Is this a good offer ?

Good lord that's some John Nash style **** going on right there. I'm by no means an expert but let me take a stab at this.

Unless I'm reading this all wrong here is what they're saying:

They set your base salary at the 25th percentile, with 85% of it going to your spouse and 15% of it going to her if she hits her quality metrics (which I hate but it's life these days). Lets call that number $185k to keep my mind right.

Then, your enterprising wife works hard and hits the 50th percentile. Rather than paying her at the 50th percentile, they're going to pay her at closer to the 40th percentile because they're only giving her 10% of some of the wRVUs ($19452 instead of the $25,344 it would be if she got $44/RVU for all 576 RVUs she would have worked). Now it looks like there may be a page from the table missing as there should be a value based modifier attached to these wRVUs which I can't see, but unless that makes up all $6000 of the difference she's actually gonna get less $/wRVU for working harder. You can actually see that in Tier 1 - when you add up the productivity and quality modifiers they pay 90% of $44 instead of the full $44 for some of the wRVUs. In their example they are underpaying by $2508 for Tier 1 wRVUs because they do a 75% and a 15% modifier, so you actually won't ever earn $44/wRVU in their examples.

So in a nutshell, this employer is throwing a ton of numbers at you in a pretty table to make it look like you can hit a great salary, but at least to my eyes and a quick interpretation they're underpaying. As you move up the tiers you get to 100% of the $44 if you hit the 75th percentile, but they're continuing to use the MEDIAN wRVU value, again as a means of underpaying.

 

[Fatalis]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

But it works nicely for someone who hates their job and is locked in for a certain amount of years... see 1 or see 20 patients a day.... makes no difference.

 

[rkmoto121]

I am interviewing for first job out of residency and contract is super simple. 250K guaranteed first year then it is 100% wRVU-based with a rate of $49 per wRVU. Currently there are no physicians at the site and it would be me plus one other physician and a PA. Would this be a bad idea as first job out of residency? It worries me with no guarantee beyond first year in case it takes too long to build up patient numbers.

 

[cabinbuilder]

COMPENSATION METRICS
Specialty
Urgent Care South
Base Salary
212,800
MGMA/AMGA Survey RVUs
3,560
WRVU Threshold for Productivity Bonus
3,560
Conversion Factor
54.57

So I have to see 296.67 RVU's per month to cover my base salary. Anything over the 296.67 I get $54.57 per RVU bonus. My base pay fluctuates on the months I don't make the RVU quota (COVID) last 3 months and my pay gets cut until the number go back up again.

 

[Bacchus]

COMPENSATION METRICS
Specialty
Urgent Care South
Base Salary
212,800
MGMA/AMGA Survey RVUs
3,560
WRVU Threshold for Productivity Bonus
3,560
Conversion Factor
54.57

So I have to see 296.67 RVU's per month to cover my base salary. Anything over the 296.67 I get $54.57 per RVU bonus. My base pay fluctuates on the months I don't make the RVU quota (COVID) last 3 months and my pay gets cut until the number go back up again.

I'm assuming you're multiplying those wRVUs by 1.5X, 2.0X or even 2.5X in a FT UC setting? I think depending on where you do UC will make a difference as rural UC is going to see more 99214s whereas urban likely will see more sniffly 99213s.

Or... do you bill a lot of 99204 and 99203s because "ideally" all these patients are new (at least at some point)?

 

[cabinbuilder]

I'm assuming you're multiplying those wRVUs by 1.5X, 2.0X or even 2.5X in a FT UC setting? I think depending on where you do UC will make a difference as rural UC is going to see more 99214s whereas urban likely will see more sniffly 99213s.

Or... do you bill a lot of 99204 and 99203s because "ideally" all these patients are new (at least at some point)?

I"m not multiplying any of my numbers. Most of what I see in UC is 99213 but I have lots of procedures. Now the total number of patients I see vs what the actual RVU numbers are is about 50 each month.

 

[VA Hopeful Dr]

I"m not multiplying any of my numbers. Most of what I see in UC is 99213 but I have lots of procedures. Now the total number of patients I see vs what the actual RVU numbers are is about 50 each month.

99213 majority in urgent care? Billing for lots of URIs with no scripts?

 

[door_to_balloon_knot]

99213 majority in urgent care? Billing for lots of URIs with no scripts?

A single script or documentation of noting a patient’s other chronic conditions (I think 2 for mod. Complexity?) would bump that up to -214 for like
Typically easier to write a pocket script though in my experience.

 

[VA Hopeful Dr]

A single script or documentation of noting a patient’s other chronic conditions (I think 2 for mod. Complexity?) would bump that up to -214 for like
Typically easier to write a pocket script though in my experience.

That's pretty much exactly what I was getting at, hence my surprise at a majority of 99213s in an UC setting.