RVU in a hospital setting

[inspire004]

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I am looking at a model, base 400k and production bonus anything above. They run about 1000 rvus a month at 40 hr work week. They propose 59 then 67 then 72 as rvu rate. I asked for facility fee, professional fee and overheads for past year. CEO says he is loosing 250 k only looking at profession side and over head.so funny I laughed with my a**, asked him, can you share facility fee, he seemed to be not interested or kind of got a little uneasy
How much would a hospital bill and generate in this situation. These guys dont want to even offer a 80 %le of mgma of professional fee. I was told they collect about 600-800 for epidural.
I found some numbers on asipps website for procedures, how much hospital collects from Medicare for new pt and followups at level 3.

 

[specepic]

You will not get a piece of the faciliy fee/non-work RVU. There may actually be rules/laws about that, perhaps someone else can comment. What part of the country are we talking?

What really matters here is what is the bonus threshold RVU wise?

 

[bedrock]

You will not get a piece of the faciliy fee/non-work RVU. There may actually be rules/laws about that, perhaps someone else can comment. What part of the country are we talking?

What really matters here is what is the bonus threshold RVU wise?

I"m fairly certain it's illegal to directly get a piece of a hospital facility fee.

You just have to calculate how much total money the hospital receives for your office visits/procedures for a month (including professional and facility fees) with your normal clinic/procedure mix, then increase the RVUs to what you think is fair to capture your share of the revenue.

 

[specepic]

So with the numbers you gave:

400000/72$ = about 5555 RVUs per year to make your base and then 72$ an RVU after that?

Depending how many pts you can see a day and how many porcedures you do an hour 12,000 RVUs a year is not impossible.

12,000 RVUs times 72= 864,000/year which would be base and bonus combines total, not too bad

my concern is they are planning on paying you a base of 400,000 and bonus you 72/rvu over a rvu threshold of 12,000 rvus or any number north of 6000 rvu's /year in which case they are planning on ___ you without the lube

🙂

Esp if you plan on botox and US in clinic you will be an rvu machine

 

[Ducttape]

I am looking at a model, base 400k and production bonus anything above. They run about 1000 rvus a month at 40 hr work week. They propose 59 then 67 then 72 as rvu rate. I asked for facility fee, professional fee and overheads for past year. CEO says he is loosing 250 k only looking at profession side and over head.so funny I laughed with my a**, asked him, can you share facility fee, he seemed to be not interested or kind of got a little uneasy
How much would a hospital bill and generate in this situation. These guys dont want to even offer a 80 %le of mgma of professional fee. I was told they collect about 600-800 for epidural.
I found some numbers on asipps website for procedures, how much hospital collects from Medicare for new pt and followups at level 3.

you will not get facilities fees. the reason he got uneasy is probably because it is never done. after all, you dont own the hospital, do you?

what is the cut off for the production bonus? $72/wRVU is phenomenal, especially since you will have to see medicare, which pays $34/wRVU.

if they let you look at the books...

i can tell you from my experience, your salary plus bonus will probably cost them $800K. A secretary and a nurse will probably run them an additional $150K. If they are leasing office space for you, that will run $90-100K. then they have to pay for expenses and other overhead, so probably it costs them $1.2-1.5 mil for you.

if you are asking for $400K salary, then % facility and wRVU... no wonder they balk. theres no way they could even break even.

 

[PinchandBurn]

I am looking at a model, base 400k and production bonus anything above. They run about 1000 rvus a month at 40 hr work week. They propose 59 then 67 then 72 as rvu rate. I asked for facility fee, professional fee and overheads for past year. CEO says he is loosing 250 k only looking at profession side and over head.so funny I laughed with my a**, asked him, can you share facility fee, he seemed to be not interested or kind of got a little uneasy
How much would a hospital bill and generate in this situation. These guys dont want to even offer a 80 %le of mgma of professional fee. I was told they collect about 600-800 for epidural.
I found some numbers on asipps website for procedures, how much hospital collects from Medicare for new pt and followups at level 3.

Hey man. Your model is similar to something I've seen😉 People on here said it was impossible. But it's not.

YOu should make sure your threshold for wRVU being at $72 is above 5000-6000. You will get htat for sure if you are busy.

I dont think they can give you cut of the facility fee. But they CAN give you a 'bonus'. Also make sure that it's blended wRVU, not cheaper for medicaid/ care/commercial. otherwise your deal looks solid. If you can I would try to bump up that salary to 500k. I bet I know what city you are in, and 500K is close to 75th percentile there.

 

[Ducttape]

Personally i think the deal he is getting is pretty darn good, depending on when the $/wRVU kivks in.
Of course, it is dependent on what else is expected and what the market is like where he is looking.

If the facility makes 12000 RVU, he has "bonus" at 6000 wRVU... He should anticipate making $440k with the business they are doing right now.

 

[inspire004]

Hi guys thanks for the info, let me clarify certain things, I do not want a share of facility fee, when I negotiate, I want them to see all the revenue streams before they bargain the wrvu number for me.
Having said that, with 1000 rvus/mth, I wanted to see if they can assures 400k guarantee and bonus
at 72/ rvu : 720k for 10 mths and 8 wks vacation. Overheads with 3 nurses, rent and billing, I don't know what the number is. As per CEO, he keeps crying like my 2 yr old for candy,that his revenue is negative 250k from only professional fee.
They would not want me to look into the facility fee.That probably is the bonus, the administration/ ceo gets for the pain clinic.
At 4 day week with, 2 procedure and 2 office days, on office day, on average they see 40-50 pts, doc sees 6-8 new and few f/u, most f/u are seen by nurses and billed level 1, most of them for med refill. This need to change. Procedures about 20-30 per day, basic and RF, no US or Botox . With about 3-4/ mth SCS.

 

[specepic]

the main issue with this job may be that the CEO is already giving you the creeps during the courtship.

I may have had too much wine tonight but I dont see what is so complex. They are going to give you a base and you will need about 6000 rvu's to make your base and after that you bonus, correct?

negotiating with hosp's reminds me of buying a car, a lot of BS back and forth and 'no way could we do better than that" until you get up to leave then the deal id sweeter. The $ per RVU they are offering is good, just firm up the threshold. I would NOT tie your pay to their costs as hosp's are terrible at cost control and you dont want that to be your problem.

you better not be interviewing for my job, make me feel better and tell me this in not in new england.

 

[Ducttape]

Hi guys thanks for the info, let me clarify certain things, I do not want a share of facility fee, when I negotiate, I want them to see all the revenue streams before they bargain the wrvu number for me.
Having said that, with 1000 rvus/mth, I wanted to see if they can assures 400k guarantee and bonus
at 72/ rvu : 720k for 10 mths and 8 wks vacation. Overheads with 3 nurses, rent and billing, I don't know what the number is. As per CEO, he keeps crying like my 2 yr old for candy,that his revenue is negative 250k from only professional fee.
They would not want me to look into the facility fee.That probably is the bonus, the administration/ ceo gets for the pain clinic.
At 4 day week with, 2 procedure and 2 office days, on office day, on average they see 40-50 pts, doc sees 6-8 new and few f/u, most f/u are seen by nurses and billed level 1, most of them for med refill. This need to change. Procedures about 20-30 per day, basic and RF, no US or Botox . With about 3-4/ mth SCS.

for most insurances, the revenue stream you comment about will be fixed. for Medicare/medicaid, you get something like 54% of the total RVUs as wRVU. 44% or so is facilities and 2% is malpractice.

that amount is fixed per each insurance. there is nothing you can change or the hospital can change.

if i were you, leave the facilities fee out of the equation completely, or you will turn them off.

btw, it sounds like the total is 1000 RVU/mo. im willing to bet you will make $ per wRVU, not total RVU. more than likely, you will be working 40 hours a week, 8 weeks vacation, and making $440K-450K.

 

[inspire004]

Not in new England, most likely I will see what there best offer is and sees how it will go

 

[inspire004]

They offered 67 and I countered with 74 for 1099, that would include just my take home. I think with the numbers they have, they can afford 450 guarantee+ bonus monthly above the base, benefits,malpractice, sign on bonus 75k and relocation 5 k for 1099 situation. Looks like they don't like to share the real numbers, the central dogma kind of deal they got.
Won't push them, but I calculated the rough figures for Medicare payment schedule from assips.
Those mother flowers are grossing way too much and want me to just ignore those numbers, just like any big cooperate bs.
Pt load is : visits 4500/ yr ,400/ mth, procedures: 2000/ yr,200 / mth, guys how much is the hospital making as facility fee, if we just assume all are Medicare.

 

[PinchandBurn]

They offered 67 and I countered with 74 for 1099, that would include just my take home. I think with the numbers they have, they can afford 450 guarantee+ bonus monthly above the base, benefits,malpractice, sign on bonus 75k and relocation 5 k for 1099 situation. Looks like they don't like to share the real numbers, the central dogma kind of deal they got.
Won't push them, but I calculated the rough figures for Medicare payment schedule from assips.
Those mother flowers are grossing way too much and want me to just ignore those numbers, just like any big cooperate bs.
Pt load is : visits 4500/ yr ,400/ mth, procedures: 2000/ yr,200 / mth, guys how much is the hospital making as facility fee, if we just assume all are Medicare.

on a 1099 w/o being a hospital employee, that's really good.

 

[Ducttape]

They offered 67 and I countered with 74 for 1099, that would include just my take home. I think with the numbers they have, they can afford 450 guarantee+ bonus monthly above the base, benefits,malpractice, sign on bonus 75k and relocation 5 k for 1099 situation. Looks like they don't like to share the real numbers, the central dogma kind of deal they got.
Won't push them, but I calculated the rough figures for Medicare payment schedule from assips.
Those mother flowers are grossing way too much and want me to just ignore those numbers, just like any big cooperate bs.
Pt load is : visits 4500/ yr ,400/ mth, procedures: 2000/ yr,200 / mth, guys how much is the hospital making as facility fee, if we just assume all are Medicare.

Honestly? IMO, prob $100-200k

 

[inspire004]

I mean how much would they make yearly for those numbers as facility fee

 

[Ducttape]

I mean how much would they make yearly for those numbers as facility fee

well, if it is 44%, then maybe 600K?


in my honest opinion they will make total, after all costs are taken out, $100-200K.

using an educated guess, im guessing the professional and facilities fees will generate total 1.5mil.



your salary 750-800K (400-450 salary, then 350-400 benefits, malpractice, health insurance, life insurance, CME, possibly some retirement, etc.)

staff costs: 150-200K (1 secretary, 2 nurses, a med tech)

rent, office space, equipment, durable goods, etc. : 100-150K

administrative costs (including salaries of admin, billing office, office manager, etc): 100K

that leaves 100-200K profit.

 

[inspire004]

Thanks duct, it was helpful, The location is not that ideal though. But it's what you make out of it

 

[inspire004]

Here what it looks like after all the hush hush
67/ wrvu, 15k sign on, 10k relocation, 3500 cme,
5k memberships, health and malpractice.
1 yr and renewal for 3 years.

 

[inspire004]

Hi guys
what will be my taxes look like and I think they can't give me any benefits and malpractice as 1099. So I think my rvu needs to compensate for that. That's what my CPA is saying, I better get a lawyer. These guys are snakes. Can't trust anything they say.
I think I will need to pay for self employment tax, federal and state tax, malpractice, benefits myself
I got to clear this upfront every thing on the table. May be start my own LLC and have exclusive contract for service.

 

[mid|ine]

How often is the pay period? 1 or 2x / month?

If its 1x/month I would ask for a monthly threshold, so if you go over 462 wRVUs/ month, anything above that is paid to you at $72/wRVU.

If its 2x/month I would ask for a monthly threshold, so if you go over 231 wRVUs/ 2 week pay period, anything above that is paid to you at $72/wRVU.

Also, make sure you get $$ for education, about $5k+.

4 wks vacation and 2 weeks education.

Your contract should also be very clear as to office hours, and if you have any control over setting the schedule.

 

[Louisville04]

I wanted to see if they can assures 400k guarantee and bonus
at 72/ rvu : 720k for 10 mths and 8 wks vacation. Overheads with 3 nurses, rent and billing, I don't know what the number is. As per CEO, he keeps crying like my 2 yr old for candy,that his revenue is negative 250k from only professional fee.
They would not want me to look into the facility fee.That probably is the bonus, the administration/ ceo gets for the pain clinic.
At 4 day week with, 2 procedure and 2 office days, on office day, on average they see 40-50 pts, doc sees 6-8 new and few f/u, most f/u are seen by nurses and billed level 1, most of them for med refill. This need to change. Procedures about 20-30 per day, basic and RF, no US or Botox . With about 3-4/ mth SCS.

Those mother flowers are grossing way too much and want me to just ignore those numbers, just like any big cooperate bs.Pt load is : visits 4500/ yr ,400/ mth, procedures: 2000/ yr,200 / mth, guys how much is the hospital making as facility fee, if we just assume all are Medicare.

I better get a lawyer. These guys are snakes. Can't trust anything they say.I think I will need to pay for self employment tax, federal and state tax, malpractice, benefits myself
I got to clear this upfront every thing on the table. May be start my own LLC and have exclusive contract for service.

Although the salary is very good, I think there is too much negative vibes about the employer in your posts. Probably better to take less money with an employer you can respect/trust.

 

[inspire004]

I got reasons to be skeptic, I think it's my intuition. But there is risk in everything we do. I just want to guard what I get paid and keep things squared upfront as much as i can and not break the deal too. It's ok but I got to weigh +/- and see if its worth my time.

I am talking to sources and getting the real scoop of the dynamics. I did my home work before I interviewed, I was just confirming what assessments I had. Well they just ignore what they like, they downsize staff and not provide a mid level and want to over work doc, well it's not a great respectful and trusting climate.

There is good administrative turnover the new CEO is 1 yr old, I was told the guys who call the shots are CFO and management team and are not good personalities. So I did not have chance to meet them, these are the guys who manage money and I was told r morally compromised when it comes to finances.
What you ignore and don't see is lost. And they want to keep you in the dark, obviously it's a culture issue, it won't change. I have to put in contract that I see things every wk.

How do I make everything transparent ? Billing and collections on physician side need to be open and timely, I think it will be tough, how do I do that and not rub the wrong people.

Once I get wrvu situated, I will lock the timely payments weekly or bi weekly and numbers match to my schedule and to lock the wrvu at least a year, exclusivity for service, need to work on building good will and trust and that needs time with administration.

Even though patient care is excellent, I think the last guy was sacked by delay in reporting the returns and he could not recover about 50k in lost rvus last year. Not sure who the board members are, it better be some physicians. The management team above the CEO are not onsite.

I will firm up the contract and see if it suits my needs, I don't want a constant battle. I think they over promised and under delivered the last guy, that is to expect with these guys

May be I have to let it go, too good to be true things always have a catch... Welcome to my dilemma... :--))

 

[inspire004]

Thanks for all the help guy, i am comparing this to 325k w2 with all benefits payed. It's an anesthesia + pain, q 3 call you take over the or at 3 pm and post call do pain, more stable. They are totally closed to books. I think they might open, but I just thought it was silly that the guys who worked there 10 years have no idea how much they make in collections and why do they get paid 325 and what there overhead were. I thought that was a joke, they said we can look into it.

 

[specepic]

is this to be an independent contractor or employee?

You are either overly skeptical/negative or this job stinks from a psychosocial perspective

Many fish in the sea

Good luck

 

[Ducttape]

your initial post implied that you were very untrusting of them from the get go, and you asked for things that are not typical in negotiations. you also asked for a LOT more than the previous guy.

now they are pulling back, still willing to work with you but being quite circumspect. they are probably very desperate for someone to take the position.

my final word of advice - dont take the position. you will never be happy, cause you didnt consider trusting them from the get go. it doesnt sound like any hospital based position is going to satisfy you.

find yourself a good private practice position where you can determine everything financial.

 

[inspire004]

Thanks for the advice, I appreciate all your feed back, I am looking at all the angles and seeing how it could work for my longterm plans.

 

[Jitter Bug]

If you haven't met the CFO or the management team who call the shots then how can you possibly know what's going on? You need to meet the people who set the criteria for which your financial performance will be judged.

You don't want to be in a position where whatever you produce for RVU's each month it's never enough and you are now seen as the reason the hospital is losing 250K a year on fees.