RVU moonlighting offer

[Merovinge]

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Just got my first moonlighting offer and it happens to be just an adaptation of the hospital's full-time contract. My first year is fully guaranteed, but I am curious going forward how reasonable the expectations are.

RVU - 2950 for 20 hours/week. Pay at $37.21 so first year is guaranteed at $110k

Work would be inpatient rounding on weekends to cover for M-F hospitalists and also PES work. Does anyone know or have a good resource for figuring out how many RVUs inpatient/PES stuff is? 99214's are easy to figure out but this notsomuch.

Thanks!

 

[Jules A]

Its likely I'm missing something because upon quick glance this does not look like aceptable reimbursement. Exactly how many weekends will you be working to make that $110,000? In my opinion/experience weekends should garner at least a 25% premium so if you are working 0.5FTE even as a M-F gig that is way low.

I'm sure others with more knowledge will write also but the quick and dirty for me is that each CPT code is assigned an RVU equivalent. For example one of my jobs a 99222 initial hospital level II was worth 2.61 wRVUs, a 99232 subsequent hospital level II was worth 1.39 wRVUs. Those are the most common codes I use for inpatient both on the unit and in ED depending on if its initial eval or followup. Best wishes with your negotiations.

 

[SmallBird]

Just got my first moonlighting offer and it happens to be just an adaptation of the hospital's full-time contract. My first year is fully guaranteed, but I am curious going forward how reasonable the expectations are.

RVU - 2950 for 20 hours/week. Pay at $37.21 so first year is guaranteed at $110k

Work would be inpatient rounding on weekends to cover for M-F hospitalists and also PES work. Does anyone know or have a good resource for figuring out how many RVUs inpatient/PES stuff is? 99214's are easy to figure out but this notsomuch.

Thanks!

That seems like a very large amount of work for that money. Two jobs I looked at recently which were both full time were calculated on 2500-2800 RVUs. 32 RVUs per day, which is what this works out as, would be close to 30 patients per day if there were no admissions/discharges. Those would obviously generate more but concurrently take more time. Remember that the hospital is making far, far more money from the facility fee than from your collections, and should cover part of your pay from that - especially for a weekend gig!!

 

[st2205]

That seems like a very large amount of work for that money. Two jobs I looked at recently which were both full time were calculated on 2500-2800 RVUs. 32 RVUs per day, which is what this works out as, would be close to 30 patients per day if there were no admissions/discharges. Those would obviously generate more but concurrently take more time. Remember that the hospital is making far, far more money from the facility fee than from your collections, and should cover part of your pay from that - especially for a weekend gig!!

You shouldn't need 30 patients per day to generate 32 RVUs. If you do, you're working yourself to death and need to learn how to code better.

But I appreciate many people touching on the facility fee, a correction to the erroneous idea that you're only worth what the CPT codes are worth, which has been popularized to some extent.

 

[nexus73]

Are you just working weekends? I'd try to just get a flat rate so you don't have to worry about RVUs. $3-4000 per weekend.

 

[Merovinge]

Are you just working weekends? I'd try to just get a flat rate so you don't have to worry about RVUs. $3-4000 per weekend.

Great, they are actually modifying it to a more traditional moonlighting contract as we speak (non-RVU). Just waiting to see what that looks like. Thanks for the help guys!

 

[Information Underload]

RVU - 2950 for 20 hours/week. Pay at $37.21 so first year is guaranteed at $110k

As an FYI, the median psychiatrist generates annual RVU's of just around 4000 according to Becker. It seems to me that they are paying you less than half of what an average psychiatrist makes and expecting you to do 70% of the work.

http://www.beckershospitalreview.co...ician-compensation-work-rvu-by-specialty.html

This comes out to a median payment of $62 per RVU.

 

[Merovinge]

As an FYI, the median psychiatrist generates annual RVU's of just around 4000 according to Becker. It seems to me that they are paying you less than half of what an average psychiatrist makes and expecting you to do 70% of the work.

http://www.beckershospitalreview.co...ician-compensation-work-rvu-by-specialty.html

This comes out to a median payment of $62 per RVU.

Subsequent working with this place have revealed it to be a garbage deal as I was leaning towards believing.

Independently, does anyone have feelings towards OP 1099 pay for coming onto someone's private practice. I have heard 60/40 is what has been offered a lot and what I was just offered. I would have access to the office space, front desk staff, Valiant EMR/billing, and their negotiated prices with private insurances which are a bit better than other folks in town due to being affiliated with, but not part of, a large medical group in town. Does that seem to be the going rate?

 

[Therapist4Chnge]

Unless you are in a saturated area, 60/40 seems low (for your cut). Patient mix obviously will matter, as it can impact your no show rate, but I'd start with bumping up the split and going from there.

 

[Jules A]

Unless you are in a saturated area, 60/40 seems low (for your cut). Patient mix obviously will matter, as it can impact your no show rate, but I'd start with bumping up the split and going from there.

I only know two psychiatrists working this deal and they get 90%. Its considered a loss leader, the prescribers, sustain multiple therapists billing.

 

[MLT2MT2DO]

I only know two psychiatrists working this deal and they get 90%. Its considered a loss leader, the prescribers, sustain multiple therapists billing.

What role does him/her being a moonlighter play into all of this?

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[Jules A]

What role does him/her being a moonlighter play into all of this?

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Huh? The OP mentioned being offered 60/40 which I think is very low since I know two docs making 90/10 thats all. I didn't want OP or anyone else for that matter working for subpar wages and was simply adding my anecdotal information which admittedly is weak at N=2.

 

[TexasPhysician]

60% is average for resident moonlighters. Most attending levels will want to sign-off on charts to make sure prescribing is in line with their ideals. Overhead of staff, office, equipment, etc isn't cheap. Credit card fees are 2-3%. Billing requires staff or another 6-7% cut.

 

[MLT2MT2DO]

Huh? The OP mentioned being offered 60/40 which I think is very low since I know two docs making 90/10 thats all. I didn't want OP or anyone else for that matter working for subpar wages and was simply adding my anecdotal information which admittedly is weak at N=2.

As the poster qbove me posted. I was guessing the 90/10 did not apply to a non BE psychiatrist still going through residency

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[Merovinge]

60% is average for resident moonlighters. Most attending levels will want to sign-off on charts to make sure prescribing is in line with their ideals. Overhead of staff, office, equipment, etc isn't cheap. Credit card fees are 2-3%. Billing requires staff or another 6-7% cut.

I would be taking the position as an attending, I am board eligible/ will be board certified once the exam comes back.

 

[michaelrack]

I would be taking the position as an attending, I am board eligible/ will be board certified once the exam comes back.

If they are providing you with patients and giving you a good mix of payor source, 75/25 would be reasonable. If you have to market yourself or if they dump on you, would go for 85/15

 

[Merovinge]

If they are providing you with patients and giving you a good mix of payor source, 75/25 would be reasonable. If you have to market yourself or if they dump on you, would go for 85/15

Great thank you very much for the advice! I may just go for an hourly rate work for the time being as the consistent $140-150/hour seems better than the headache of establishing an outpatient population.