SaltyDog

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So we have a couple current threads discussing what one's time is worth as a BC anesthesiologist, and current residents asking what constitutes a decent job offer. Here's an exercise for you current residents to help you better understand and have a point of reference as you start to look for jobs:

1) Do some homework and try to find out what the typical blended unit value is in your area, or the area in which you hope to practice. Ask attendings, friends, etc. Generally it'll fall somewhere in the $30-50 range, but not always.

2) Download one of the free billing apps like Abeocoder

3) Keep a notebook and figure out the billable units for every case you do for the next 6 or so months (takes literally 5-10 minutes/case)

Now you know just how much $ your work is generating, and it'll give you and idea of what you're worth. It'll give you something to reference when you field job offers that talk about $/hrs, etc. You can gather an idea of just how much money an AMC is skimming off the top. Keep in mind for an ACT practice you'll have to account for CRNA wages, etc. but for an MD only practice it's real easy to get a pretty good idea.
 

nimbus

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Don't forget to add lines and blocks. If you are doing hearts or an Ortho lineup, they add up fast.
 
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SaltyDog

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Don't forget to add lines and blocks. If you are doing hearts or an Ortho lineup, they add up fast.
And other modifiers as well (although this can get a little tricky as not all payers pay for all modifiers).
 
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Mman

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Don't forget to add lines and blocks. If you are doing hearts or an Ortho lineup, they add up fast.
also don't forget to subtract overhead. Lop off maybe 5-8% for billing, a little more for office staff, office space, etc.
 
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aneftp

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Good points. About how much money is being generated.

There are downsides as well. With ever increasing cost sharing by patients (high deductibles). Estimated 60-65% of patients share of the cost (aka when they actually get a bill that tells them to pay their share". 60-65% of those cost sharing bills go unpaid

Sad thing is hospitals and other specialities have gotten smart. It used to be everyone wanted to "bill first". But with added patient cost sharing. Everyone wants to bill last

Let's see $5000 deductible. 20% co pay up to 10k.
1. Hospital negotiated bill is $20k. So patient responsibility is $5000 plus 20% of the 15k (so $3000)

2. Surgeon bill is $4000. So insurance is automatically gonna to cut a check to surgeon office for $3200 and ask patient to pay 20% of the $4000 (aka $400)

3. Than u get a $2000 anesthesia bill (again insurance automatically cuts a check for $1600 and anesthesia company needs to collect $400.

Now if the tables are turned. The anesthesia company "bills first". So that $2000 anesthesia bill on the $5000 deductible. Patient responsible for entire $2000 anesthesia bill. Good luck collecting that $2000. You got a 35% chance of collecting that bill if anesthesia $2000 bill.

Anesthesia companies have gotten a lot smarter. Now they will bill as late as possible. It's a tried to true tactics especially out of network $200/unit billing practices in Texas.
 

Mman

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Anesthesia companies have gotten a lot smarter. Now they will bill as late as possible. It's a tried to true tactics especially out of network $200/unit billing practices in Texas.
Hospitals as a rule are not smart about their billing. Just wait til their mega facility bill goes through and the deductible will be met.
 
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GravelRider

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You can calculate what you are worth all you want, but when you work for someone, you are worth what they are willing to pay you. Do you think the workers for <insert any corporation name here> calculate their worth and then bring it to their corporate overlords? You can't have it both ways...sell out to an AMC and then complain that they aren't paying you what you are billing. When you are employed there is always going to be someone skimming off the top. There will also always be someone to do that work for the price offered.
 
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ranvier

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You can calculate what you are worth all you want, but when you work for someone, you are worth what they are willing to pay you. Do you think the workers for <insert any corporation name here> calculate their worth and then bring it to their corporate overlords? You can't have it both ways...sell out to an AMC and then complain that they aren't paying you what you are billing. When you are employed there is always going to be someone skimming off the top. There will also always be someone to do that work for the price offered.
How many cases and surgeons did you bring to the practice as a new grad? All these cases that you implement this exercise to were handed to you.

Just saying...
 
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GravelRider

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How many cases and surgeons did you bring to the practice as a new grad? All these cases that you implement this exercise to were handed to you.

Just saying...
That's my point.

And going forward, even with experience, you are worth what your employer is willing to pay you...I don't care what kind of all star you think you are. In this era of physician employment, a salary provided by an employer is how you get paid, not billing collections.
 
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SaltyDog

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That's my point.

And going forward, even with experience, you are worth what your employer is willing to pay you...I don't care what kind of all star you think you are. In this era of physician employment, a salary provided by an employer is how you get paid, not billing collections.
There are plenty of practices out there that are still private. If you are unlucky enough to be confined to an AMC only market then shouldn't you at least have a little knowledge to figure out which one is screwing you the least?? If nothing else, it'll save you some money on your monthly KY bill.

I never said anything about being a rockstar or being entitled to a certain salary. I'm just trying to help new grads realize what is a good offer and what is a dogsh!t offer since it's clear many have no idea.

I guess in your world ignorance is bliss? You just want these kids to tuck their tails and go work for the nearest AMC regardless of what they're offering? That's a pretty sad defeatist attitude.
 

ranvier

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Understanding billing and collection is very important. Find a a small OR or surgicenter and write a RFP with your buddies. It is harder than ever to be your own boss but not impossible.

Once you are on the hiring side, both perspectives become more clear.....at least for me,
 
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All these cases that you implement this exercise to were handed to you
Not quite sure I follow you. We are never really the ones bringing in our own pts. All our cases are "handed to us" by our surgical colleagues.
 

GravelRider

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There are plenty of practices out there that are still private. If you are unlucky enough to be confined to an AMC only market then shouldn't you at least have a little knowledge to figure out which one is screwing you the least?? If nothing else, it'll save you some money on your monthly KY bill.

I never said anything about being a rockstar or being entitled to a certain salary. I'm just trying to help new grads realize what is a good offer and what is a dogsh!t offer since it's clear many have no idea.

I guess in your world ignorance is bliss? You just want these kids to tuck their tails and go work for the nearest AMC regardless of what they're offering? That's a pretty sad defeatist attitude.
I never said ignorance is bliss. Follow what I say and I very much advocate for being informed and trying to break this broken system. However, most new residents do not have a choice in working for themselves anymore. The way physicians are being paid is changing. I dare some new grad who is 6 months out telling a fat cat partner or AMC CEO that they are worth more than they are being paid. He or she will get laughed at. You want power now as an employee then you have to unionize.
 
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Mman

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I never said anything about being a rockstar or being entitled to a certain salary. I'm just trying to help new grads realize what is a good offer and what is a dogsh!t offer since it's clear many have no idea.

I guess in your world ignorance is bliss? You just want these kids to tuck their tails and go work for the nearest AMC regardless of what they're offering? That's a pretty sad defeatist attitude.
I agree it is relevant to know what rate your actual labor is being billed/collected at. I hesitate to call it what you are worth, since I'm fairly conservative and ultimately believe all of our work is worth whatever someone else is paying us for it. I'm very happy with my current gig in true private practice, but if it fell apart I'd be quite content to work in the right AMC situation for a salary I felt was fair. And I do mean fair, not what I think I'm worth. It would by definition be less than what I was being billed out for/collected on behalf of, but if I felt the $$$ in my bank account were compensating me for the physical/mental job I was doing I'd be OK with that.

Ultimately we all have a different value on our time and hard work. And at some point, we all need to put food on the table and take the best offer we can find.
 

FFP

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Ultimately we all have a different value on our time and hard work. And at some point, we all need to put food on the table and take the best offer we can find.
Bold. Italic. Underlined.
 
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Agree with what GravelRider and Mman are saying. Never meant to sound entitled or encourage residents to have that attitude (maybe worth was the wrong word to use?). I just want them to be aware of the money their clinical work generates so they can evaluate job offers with some frame of reference and hopefully avoid being raped any more than necessary.

I'd be quite content to work in the right AMC situation for a salary I felt was fair.
My point is, you know what's fair because you have an intimate knowledge of your groups billing and collections. New grads aren't exposed to this, and therefore don't know what's fair. I'm just trying to help them figure that out.
 
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WholeLottaGame7

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I agree it is relevant to know what rate your actual labor is being billed/collected at. I hesitate to call it what you are worth, since I'm fairly conservative and ultimately believe all of our work is worth whatever someone else is paying us for it. I'm very happy with my current gig in true private practice, but if it fell apart I'd be quite content to work in the right AMC situation for a salary I felt was fair. And I do mean fair, not what I think I'm worth. It would by definition be less than what I was being billed out for/collected on behalf of, but if I felt the $$$ in my bank account were compensating me for the physical/mental job I was doing I'd be OK with that.

Ultimately we all have a different value on our time and hard work. And at some point, we all need to put food on the table and take the best offer we can find.
I was surprised that at my yearly review meeting, my academic institution told me exactly how much I billed for and how much I collected and how it compared to the other faculty in the group (hint: pediatrics doesn't pay particularly well). It was considerably less than my salary + benefits, but I also get protected academic time, the hours are (usually) very reasonable, and the work environment (CRNAs, surgeons, staffing ratios etc) are all pretty good, so I can't complain too much. I also appreciate the transparency of the administration. If I was making the same at an AMC working 60hrs a week supervising 3-4 rooms and taking crap from everyone, I'd be pretty perturbed.
 

sevoflurane

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Not quite sure I follow you. We are never really the ones bringing in our own pts. All our cases are "handed to us" by our surgical colleagues.
I get it and have seen it in action. For example: You work in a town with 2, 3, 4 competing groups and when you join the group across town, you bring over a busy spine surgeon a thoracic surgeon and an ENT surgeon... then all those cases go to your new PP group. This is extremely valued and are due to forged relationships that are typically maintained over years.

You should and will get special attention in this scenario as you actually are brining in new patients.

In other words, you are instantly worth way more to a group than a new grad. A new grad doesn't have that leverage. It's just business and it's how groups grow and take over regions.

Not quite the same for academics, hospital employed positions or AMCs. In PP this is valued for revenue and expansion.
 
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Stank811

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I agree 100% it is important to have a relative idea on how much income you are producing for a group. If I am producing 375k and the group pays me 300k fresh out I would be ok with this arrangement for a period of time. If I was billing 800k and the group paid me 300k I would not be ok with this arrangement and I feel most on this forum would not be excited to enter such a contract.

I do agree with the concept that if you sign onto a job that is paying you 300k then you have to own your decision. Either live with it or leave...dont complain about your situation it was your choice. But don't just believe the group is only taking 100k off the top of what you personally produced with your hard work and on the back of your certification in anesthesiology. And if you actually looked into what is being taken off the top it may be closer to 500k.

The idea that our speciality is struggling on a monetary basis and we all should expect to make 300-400k in the future is false. AMC or any group that pays new grads 275k to supervise 3:1 and work 50-60hrs a weeks is taking advantage of the uneducated individual on the business of anesthesiology and is not good for our specialty moving forward.
 

Mman

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The idea that our speciality is struggling on a monetary basis and we all should expect to make 300-400k in the future is false. AMC or any group that pays new grads 275k to supervise 3:1 and work 50-60hrs a weeks is taking advantage of the uneducated individual on the business of anesthesiology and is not good for our specialty moving forward.
I think the idea isn't that our specialty "is" struggling, I think it is the idea that it has the potentially to get catastrophically derailed financially in the medium term.

Bundled payments in and of themselves aren't a terrible idea. But when the people that make the decisions about who gets what share of that bundle start looking at CMS rates as a guide for how to divvy it up, we get cratered. Surgeons routinely get paid >50% of their private rates on CMS patients. We are under half that.
 

Stank811

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I think the idea isn't that our specialty "is" struggling, I think it is the idea that it has the potentially to get catastrophically derailed financially in the medium term.

Bundled payments in and of themselves aren't a terrible idea. But when the people that make the decisions about who gets what share of that bundle start looking at CMS rates as a guide for how to divvy it up, we get cratered. Surgeons routinely get paid >50% of their private rates on CMS patients. We are under half that.
We do bundled payments for certain procedures and during the negotiating period in setting up the bundles where at the table to establish a price point and floor. It does take educating others and additional non compensated work but it is worth it on the back end
 

Mman

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We do bundled payments for certain procedures and during the negotiating period in setting up the bundles where at the table to establish a price point and floor. It does take educating others and additional non compensated work but it is worth it on the back end
I'm well aware of how it works and we participate in some. I'm just pointing out that at the end of the day our specialty does not have much power in the negotiations and there is a potential massive downside if more and more of it gets tied to CMS rates since ours are out of proportion bad compared to everybody else in medicine.
 
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Stank811

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Our bundle rates are actually higher then some of our poor commercial rates after you calculate it out and are no where near CMS..so as always it depends.
 
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