Trying to establish an office based practice

DrCabral3074

Full Member
Apr 8, 2020
11
3
  1. Attending Physician
    I am in a competitive city. A hospital system has just been built a new hospital with an attached medical office building and they don't have a pain practice. The hospital is known to do joint ventures and partnerships with physicians. I need help in determining what would be the best model to establish a pain practice at a hospital/office building that would be mutually beneficial. I am considering the following models (ordered from high to low ).

    1-Hospital office in the medical building with a procedure room where the hospital provides staff, base salary, and bonus after a set number of wRVU's (after 6000 RVUs, $60/RVU).

    2-Hospital office in the medical building with procedures in the hospital, where the hospital provides staff base, salary, and bonus after a set number of wRVU's.

    3-Physician owned private office in the medical office building where I provide staff and then conduct procedures in the hospital and they provide a base salary and bonus after a set number.

    4-Join a physician group affiliated with the hospital and become an employee and maybe a director of the service.

    There is a second office building slated for the future which is detached from the hospital. If one were do establish a practice, I envision you could put an ASC in the second building and either own it or go in as a JV with the hospital.

    My desire is to have staff hiring and practice control so we can provide high-quality pain management without the opioid and procedure overutilization traps of private practice. I would also like the safety being with a large organization where there is safety in numbers. It would be nice to have equity as well but, I don't know of a model that allows this when working with a hospital with the exception of the JV with ASC.

    I have the following questions:
    Are there other models that you know work with hospitals that allow the potential for equity?
    What is recommended for the base salary?
    How much wRVU for pain management $50, $60, $70?
    After how many wRVUs does one set a bonus?

    Any assistance one can lend would be deeply appreciated.
     

    ragnathor

    Full Member
    10+ Year Member
    Jan 10, 2007
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    1. Attending Physician
      Regarding wRVU/salary, there are no "recommendations" but if you have access to MGMA data that would help. wRVU is around $65-$70ish depending on region. Median for pain physicians is ~6600 wRVU. Depending on what you expect to product and how you want your upside or downside to be, plug in some numbers and that can help steer you toward what model/bonus structure you may desire. For example:

      350k base + $50/wrvu after 6500
      300k base + $70/wrvu after 6000


      at 6000 wRVU: option 1 wins by 50k

      at 8000 wrvu: option 2 wins by 15k
       

      DrCabral3074

      Full Member
      Apr 8, 2020
      11
      3
      1. Attending Physician
        Thank you for your great insight!

        An orthopedist with the same hospital system just established a multispecialty ASC in another medical office building and the hospital system purchased 51%, with the other 49% of shares being distributed amongst physicians who buy-in. Do hospitals do Joint Ventures with pain practices? Establish single-specialty ASCs for pain management with the Hosptial system and physician owning different percentages.

        Are there other models that allow physicians to develop an equity or sell a practice when affiliated with a hospital?

        Lastly, where can one find MGMA data for pain management?
         
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        deleted993114

          Glad you're thinking about your options, but your headline is making me unreasonable angry. Try not to do the 8th-grade-all-caps-and-multiple exclamation-points-to-get-attention please.

          I think I am the mental equivalent of a 6th grader, so I am okay with it.

          It REALLY (those darn caps) depends on :
          a. how much money you want to make
          b. what lifestyle you want
          c. does the hospital have a complete referral base (you can survive on their referrals alone)
          d. what the ACO penetration is (ACOs would prefer a cheaper location, such as office) vs hospital expected profit.

          Being an employee has no overhead and more potential safety, but you sacrifice independence.

          If you are associated with the hospital and there are other entites in the area, you will not get referrals from those competing entities

          Make sure you have a spine group as your referral source- PCP referral bases have a lot of garbage.

          $350K base + RVU bonus? Okay on either coast on in Arizona. Should be at least $500K base in the Midwest/southeast. A bad payer mix would be $50 per RVU above 6500. A good payer mix would be $75 per RVU.
           

          DrCabral3074

          Full Member
          Apr 8, 2020
          11
          3
          1. Attending Physician
            I think I am the mental equivalent of a 6th grader, so I am okay with it.

            It REALLY (those darn caps) depends on :
            a. how much money you want to make
            b. what lifestyle you want
            c. does the hospital have a complete referral base (you can survive on their referrals alone)
            d. what the ACO penetration is (ACOs would prefer a cheaper location, such as office) vs hospital expected profit.

            Being an employee has no overhead and more potential safety, but you sacrifice independence.

            If you are associated with the hospital and there are other entites in the area, you will not get referrals from those competing entities

            Make sure you have a spine group as your referral source- PCP referral bases have a lot of garbage.

            $350K base + RVU bonus? Okay on either coast on in Arizona. Should be at least $500K base in the Midwest/southeast. A bad payer mix would be $50 per RVU above 6500. A good payer mix would be $75 per RVU.

            The hospital was just built this year and is in the process of adding groups in a new MOB. They have medical group that will occupy the MOB which will have PCPs. A private orthopedic group will occupy a floor in the new MIB and I believe has exclusive rights to conduct ortho procedures at the hospital. They have a spine surgeon and pain physician in the ortho group but, it remains to be determined if they will conduct a lot of spine cases at the hospital or at their other locations. I also suspect the pain physicians will not conduct cases a the hospital or MOB but at their other ASC affiliated with the ortho group.
             
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