Private practice guys - some insight please?

[Laurel123]

Hello,

Well, I am getting ready to finish my residency and I have some questions about private practice billing.

All the places I have looked at have a pooled unit. Which is good, I think because it prevents cherry picking. However, I got the sense that what is important is how much is paid per unit. Some places are paying $30 a unit. Is that low? How hard do you think I would have to make 250K? Honestly, I am looking more at how the group works together and the fairness, but I have to make sure that it makes up for how hard I plan to work for less money.

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[redstorm]

Hello,

Well, I am getting ready to finish my residency and I have some questions about private practice billing.

All the places I have looked at have a pooled unit. Which is good, I think because it prevents cherry picking. However, I got the sense that what is important is how much is paid per unit. Some places are paying $30 a unit. Is that low? How hard do you think I would have to make 250K? Honestly, I am looking more at how the group works together and the fairness, but I have to make sure that it makes up for how hard I plan to work for less money.

what part of the country are you in? does the group have a buy in to the accounts receivable?

30 dollars a unit is low.. out in so cal ( orange county) some groups have a contract for a blended unit of 35 dollars. and thats considered good.. Out in the northeast you can get 60- 70 dollars based on insurance carrier.. so in answer to your question It depends on a number of factors how much you make.. at the end of the year

I think the incentive system is good.. because if its all pooled.. some people tend to coast and do less work.. ( more senior people) and thats not fair..

 

[Laurel123]

what part of the country are you in? does the group have a buy in to the accounts receivable?

30 dollars a unit is low.. out in so cal ( orange county) some groups have a contract for a blended unit of 35 dollars. and thats considered good.. Out in the northeast you can get 60- 70 dollars based on insurance carrier.. so in answer to your question It depends on a number of factors how much you make.. at the end of the year

I think the incentive system is good.. because if its all pooled.. some people tend to coast and do less work.. ( more senior people) and thats not fair..

Yeah, this is the west coast. Where the houses are sky high and the pay is low. I figure I will save money on vacations because I will be living where people pay to come vacation. Well, maybe that would be Hawaii.

Anyways, I know that these places get a stipend for taking call, 30 dollars a unit and a pooled unit. In a pooled unit, how do senior people coast and earn the same amount of money?

 

[militarymd]

If they are paying you based on blended units, then it is as fair as it is going to get.

There is no fighting over cases based on insurance, however, there may be fighting for rooms based on units packed in the room.

Groups that pay you a salary while waiting for partnership.....well watch out for those.

Compensation per unit can be deceiving sometimes. Let say there is an area that pays 60 per unit, but the OR runs at 50% efficiency....compared to an area where you get paid 40 per unit, but the OR runs at 80% efficiency (industry standard)...you can see that the 40 per unit deal is better.

I would ask the group what the average take home is for the anesthesiologists based on hours spent at the hospital. (not in the or)

 

[Laurel123]

Thanks mmd

I didn't think about the efficiency. I will have to ask about that. I believe a lot of places I looked at chose rooms based on the call system in that high call got first pick. I think everything sounds pretty fair. It is lower pay for equal work, but I guess it is a sacrifice for location.

 

[militarymd]

Efficiency may have a huge impact on your day.

example 1: room with 2 cases (lets say worth $400 a piece), they are scheduled back to back, with the end of the day at 10 am.

example 2: room with 4 cases (lets also say worth $400 a piece), but there is significant down time between cases, the room closes at 7 pm

Which would you choose?

 

[UTSouthwestern]

Efficiency may have a huge impact on your day.

example 1: room with 2 cases (lets say worth $400 a piece), they are scheduled back to back, with the end of the day at 10 am.

example 2: room with 4 cases (lets also say worth $400 a piece), but there is significant down time between cases, the room closes at 7 pm

Which would you choose?

The latter just to piss on your argument.

 

[militarymd]

The latter just to piss on your argument.

Its that kind of a week.

 

[Noyac]

Efficiency may have a huge impact on your day.

example 1: room with 2 cases (lets say worth $400 a piece), they are scheduled back to back, with the end of the day at 10 am.

example 2: room with 4 cases (lets also say worth $400 a piece), but there is significant down time between cases, the room closes at 7 pm

Which would you choose?

I'll take the first room, then hit the trails for a bike ride and then come back and finish your last case.
Or better yet go troll the ER/ICU for a emergent case.

 

[UTSouthwestern]

Its that kind of a week.

Can't be as bad as mine: I rolled my ankle last Saturday right before a string of four CABG's on Saturday and Sunday and a full week of great cases, before finding out on Friday that I was walking around on a broken ankle.

It's a pretty color of purple right now and has 3+ pitting edema.

 

[Noyac]

Can't be as bad as mine: I rolled my ankle last Saturday right before a string of four CABG's on Saturday and Sunday and a full week of great cases, before finding out on Friday that I was walking around on a broken ankle.

It's a pretty color of purple right now and has 3+ pitting edema.

Dude get comfy in your chair and tell them to keep 'em coming.
Really, sorry to hear that.

Do you need some Percocet????????

 

[jetproppilot]

Dude get comfy in your chair and tell them to keep 'em coming.
Really, sorry to hear that.

Do you need some Percocet????????

Yeah, me to.

Is there an AFLAC duck walking around your house?

 

[UTSouthwestern]

Yeah, me to.

Is there an AFLAC duck walking around your house?

Don't need the AFLAC since the apartment complex is footing the bill for leaving a 3X2 foot, one foot deep hole on our community bridge. After I and a neighbor broke our ankles in it, the complex didn't even apologize for the oversight until I sent them a bill. I'm either getting full reimbursement for medical bills and time away from work or several months of free rent.

 

[UTSouthwestern]

Dude get comfy in your chair and tell them to keep 'em coming.
Really, sorry to hear that.

Do you need some Percocet????????

I've got a little too much pain tolerance for my own good. Haven't even taken Tylenol yet.

 

[Laurel123]

I'll take the first room, then hit the trails for a bike ride and then come back and finish your last case.
Or better yet go troll the ER/ICU for a emergent case.

I wonder how I get that sort of information - about how efficient and fast the groups are. Does this have to do with surgeons being fast, or the turnover being fast.

 

[jetproppilot]

I wonder how I get that sort of information - about how efficient and fast the groups are. Does this have to do with surgeons being fast, or the turnover being fast.

Both are very important, and those are the things that are very hard to get honest answers for when you're applying for a job with no lnowledge of the area/group.

Thats why you're at a big advantage concerning what kinda situation you're really stepping into if you have a mole (friend who is a cuppla years ahead of you thats in the group, friend who is a surgeon in the community, etc)...someone who is not gonna tell you only what you want to hear.

 

[militarymd]

I wonder how I get that sort of information - about how efficient and fast the groups are. Does this have to do with surgeons being fast, or the turnover being fast.

Go to the hospital, and look at the "board"...on different days.

 

[Noyac]

I wonder how I get that sort of information - about how efficient and fast the groups are. Does this have to do with surgeons being fast, or the turnover being fast.

Turn overs are important but they can only make up 10-15 minutes usually. Every hosp. in the country should be able to turn over a room in less than 30 minutes. 15 min or less is ideal. But that will only save about an hour in a room with 4 cases. More importantly, if the surgeons are slow that will kill you. In my last job (unfortunately not my current job) I could do 2 lap choles in 1 hour there, 2 total knees in 2 hours or 2 CABG's in 4hours. Whichever room you were in really boogied down there. So room turnover can't possibly make up as much time as a fast surgeon. Now, you can also do alot to help the room move fast. Don't try and wake the pt up in the room before going to the PACU. Get em breathing pull the tube/LMA and out the door. We told the CRNA's to bring the pt. to the PACU tubed and spontaneously breathing. Let the cleaning crew get started. I noticed also if a surgeon has his own PA then things move faster, but not always. Some of the surgeons I work with now have PA's and they are the slowest surgeons I have ever seen.

 

[jetproppilot]

Turn overs are important but they can only make up 10-15 minutes usually. Every hosp. in the country should be able to turn over a room in less than 30 minutes. 15 min or less is ideal. But that will only save about an hour in a room with 4 cases. More importantly, if the surgeons are slow that will kill you. In my last job (unfortunately not my current job) I could do 2 lap choles in 1 hour there, 2 total knees in 2 hours or 2 CABG's in 4hours. Whichever room you were in really boogied down there. So room turnover can't possibly make up as much time as a fast surgeon. Now, you can also do alot to help the room move fast. Don't try and wake the pt up in the room before going to the PACU. Get em breathing pull the tube/LMA and out the door. We told the CRNA's to bring the pt. to the PACU tubed and spontaneously breathing. Let the cleaning crew get started. I noticed also if a surgeon has his own PA then things move faster, but not always. Some of the surgeons I work with now have PA's and they are the slowest surgeons I have ever seen.

Nicely said.

 

[davvid2700]

i dont agree with the whole pull the tube and wake the patient up in the pacu.. Really not the safest way to practice.. I dont need the patient to be doing the jig.. but I need at least a patient who opens his or her eyes in response to name.. Plus you wont make many friends in the pacu if you let your patients emerge in the pacu. Im not saying what you described was wrong; but i personally wouldnt do it..

 

[Noyac]

i dont agree with the whole pull the tube and wake the patient up in the pacu.. Really not the safest way to practice.. I dont need the patient to be doing the jig.. but I need at least a patient who opens his or her eyes in response to name.. Plus you wont make many friends in the pacu if you let your patients emerge in the pacu. Im not saying what you described was wrong; but i personally wouldnt do it..

Your right and I guess I should be more specific here. When I extubate them deep and take them to the PAcU they are more or less awake on arrival. The stimulus of moving them over to the stretcher usualy gets them to open their eyes. Believe me, I time the emergence very close to the end of the case. They are extubated usually b/4 the end or right at the end and with sevo it takes no time to blow off. I was trying to make a point about turnovers and that you can really assist in the speed of the turnover. But I like narcs and I use them liberally. Thats another reason why my pts. don't usually emerge doing the jig. They have their eyes closed, breathing spontaneously and will open their eyes to command. Hows That. Better description I hope.

 

[jetproppilot]

Your right and I guess I should be more specific here. When I extubate them deep and take them to the PAcU they are more or less awake on arrival. The stimulus of moving them over to the stretcher usualy gets them to open their eyes. Believe me, I time the emergence very close to the end of the case. They are extubated usually b/4 the end or right at the end and with sevo it takes no time to blow off. I was trying to make a point about turnovers and that you can really assist in the speed of the turnover. But I like narcs and I use them liberally. Thats another reason why my pts. don't usually emerge doing the jig. They have their eyes closed, breathing spontaneously and will open their eyes to command. Hows That. Better description I hope.

And remember time from MAC-to-awake with des/sevo is 7-10 minutes....so I like Noyacs technique.