Updated MGMA?

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thecentral09

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Does anyone have the 2019 MGMA info representing 2018 for anes Pain? A friend had it for a different specialty so I know it’s out.
 
Is anesthesia/pain people who split time between anesthesia and pain and nonamesthesia pain just people doing 100%pain or is it for non anesthesia trained pain people?
 
I'm not entirely sure on the definition which is why I mentioned it at the bottom of my post.

I'm PM&R and then Anes Pain fellowship. Boarded in both. I believe my network views me as Anesthesia Pain. The rest of the guys in my group are all Anes with Anes Pain fellowship. We're all on the same contract. No one in my group does Anesthesia anymore.
 
My salary is nowhere near that
 
Ducttape said:
Total compensation also includes health insurance, malpractice and disability insurance, and anything contributed to retirement.
Click to expand...

Okay, add all that up and my point remains.
 
hyperalgesia said:
I am also way below these numbers. You can always trade your situation and make tons of money if you're willing to sacrifice location, setting, and work environment. It's a free country.
Click to expand...

My situation is fine.
 
how do you benefit from ancillaries in a hospital system?
 
Pain numbers look pretty low compared to a bunch of other specialities. Lower than anesthesia in some regions?
 
Does anyone know how Trump's Executive Order on hospital price transparency and site-neutral payments will effect employed-MD salaries? A lot of those juicy fringe benefits/compenation are funded out of HOPD site-of-service arbitrage schemes...

www.reuters.com

Trump to issue executive order seeking transparency on healthcare costs: Wall Street Journal

U.S. President Donald Trump plans to issue an executive order on Monday asking health insurers and doctors to disclose new details about healthcare costs, in an attempt to improve price transparency, the Wall Street Journal reported on Thursday, citing people familiar with the matter.
www.reuters.com www.reuters.com
 
drusso said:
Does anyone know how Trump's Executive Order on hospital price transparency and site-neutral payments will effect employed-MD salaries? A lot of those juicy fringe benefits/compenation are funded out of HOPD site-of-service arbitrage schemes...

www.reuters.com

Trump to issue executive order seeking transparency on healthcare costs: Wall Street Journal

U.S. President Donald Trump plans to issue an executive order on Monday asking health insurers and doctors to disclose new details about healthcare costs, in an attempt to improve price transparency, the Wall Street Journal reported on Thursday, citing people familiar with the matter.
www.reuters.com www.reuters.com
Click to expand...

We will just do $tem $ells. And lemonade stands.
 
drusso said:
Does anyone know how Trump's Executive Order on hospital price transparency and site-neutral payments will effect employed-MD salaries? A lot of those juicy fringe benefits/compenation are funded out of HOPD site-of-service arbitrage schemes...

www.reuters.com

Trump to issue executive order seeking transparency on healthcare costs: Wall Street Journal

U.S. President Donald Trump plans to issue an executive order on Monday asking health insurers and doctors to disclose new details about healthcare costs, in an attempt to improve price transparency, the Wall Street Journal reported on Thursday, citing people familiar with the matter.
www.reuters.com www.reuters.com
Click to expand...
I don't think it will affect anyone's salary but it will expose the fact that the same procedure costs 4x in the hospital what it costs in the office.

The info will be right out there for insurers and the msm to investigate and process. Not good for hospitals.
 
hyperalgesia said:
I don't think it will affect anyone's salary but it will expose the fact that the same procedure costs 4x in the hospital what it costs in the office.

The info will be right out there for insurers and the msm to investigate and process. Not good for hospitals.
Click to expand...

How can you be so certain? Why would hospitals oppose transparency?
 
Some hospitals have that info available online or via a phone call.


It won’t affect salary at all - I believe most hospital employed physicians have lower overall salaries.

The total compensation is similar as private’s because they can manipulate the “other” benefits.

You know hospitals want to control the physicians. The only way to initiate and maintain this is through $$$.
 
Ducttape said:
er my bad, not ancillaries, I specifically mean salary "benefits"
Click to expand...

I'm not worried about it. I have ASC shares and productions and I am well taken care of, plus I'm not complaining. I'm just stating a fact.
 
drusso said:
How can you be so certain? Why would hospitals oppose transparency?
Click to expand...
Oh I'm not certain an all. But I like the idea as a first step. Maybe it won't do anything.

I just don't see why insurers haven't caught on to the scam. Why don't they encourage office based procedures?
 
hyperalgesia said:
Oh I'm not certain an all. But I like the idea as a first step. Maybe it won't do anything.

I just don't see why insurers haven't caught on to the scam. Why don't they encourage office based procedures?
Click to expand...

Anti-steering laws and "any willing provider" clauses. Health plans are not supposed to steer patients to one kind of provider or another. But, this happens all the time via "benefit design" and "narrow networks."
 
I wish I could. If I had it I’d post it.
 
Any chance non-anes numbers higher 2/2 regen med more likely in those practices?
 
What I am really looking for is what is 25% percentile, median, mean, 90th% etc. contract negotiation pending
 
thecentral09 said:
Thank you!

For all of you 90th percentilers (if thats a word), approximately how many patient encounters do you have in a day to obtain 10k wRVUs?
Click to expand...

I see approx 27-30 patients a day. That’s fairly consistent regardless if if it’s a clinic or procedure day. I don’t do it alone though. I have a Midlevel, essentially functions as a fellow in office, so sees/examines and presents to me. In ASC he draws meds up and drape/prep while I’m dictating previous patient note, which works great. Since I end up seeing everyone, it’s all my wrvu. Hit about 11-12k last year
 
paindoc007 said:
I see approx 27-30 patients a day. That’s fairly consistent regardless if if it’s a clinic or procedure day. I don’t do it alone though. I have a Midlevel, essentially functions as a fellow in office, so sees/examines and presents to me. In ASC he draws meds up and drape/prep while I’m dictating previous patient note, which works great. Since I end up seeing everyone, it’s all my wrvu. Hit about 11-12k last year
Click to expand...
How many procedures a week?
 
thecentral09 said:
Thank you!

For all of you 90th percentilers (if thats a word), approximately how many patient encounters do you have in a day to obtain 10k wRVUs?
Click to expand...


I used to make $1.3 million for many years. Can't do it anymore, as developed cancer that prevents me from "busting it". I was part of a neurosurgery group. I saw about 32 patients per day and did about 22-24 procedures on those days (clinic days). I did two half days at the surgery center, where I did about 5 rfs and .5 stim implants and 1 trial (10 rfs, 1 stim impant and 2 trials each week). I had two NPs, each of which would see 20 patients per day. I paid them well, so I only made about $20K per year off them. ACO money was minimal- $10K and group annual bonus was only about $30K.

The above numbers are without embellishment. I believe that I was in an area with high reimbursement (the clinic negotiated the contracts), but high overhead ($1 million). I am pretty darn fast and I found at the end of every day I was pooped. People ask me how many RVUs I did and I have no idea, as I was not paid that way. The gal who took over my practice is only able to see 15 pts per day and do 7 procedures; once she is off her guarantee, she will go broke, as she won't be able to pay overhead, even with zero salary.

I am currently in a far easier job that I can handle. However the reimbursement is awful and it is away from family, so we are going back to the Midwest to a pretty easy job that pays double what I make here (east TN). The area is pretty, but reimbursement is terrible. Our group makes most of its money off ACO money (about $250-$300K per year); they are masters at ACOs and do far better than internists anywhere else. There is a hospital based guy near me who makes $1.2 million and does far less work than I do. He has a sweet hospital based practice with RVU based reimbursement that pays well even in a "bad payer" environment.

If I had to do it over again, I would not do the high volume practice I did for many years- too much work and I think it took a toll on my health (two cancers and two rounds of surgery/chemo). My advice to youngsters would be to seek a job that pays about $500-$600K and is pretty easy so you can enjoy your life. I have no idea which practice type (office, large group, hospital employee) is going to be "best" in the future. I do know that "islands" (centers with no competition in a 100 mile radius) have always done well and will do well. In general, the less geographically desirable areas make a lot more money. For example, if you go to North Dakota or Eastern S.D, you can make $1 million plus, but have to live there.

The ACO bit is interesting, as we have two competing issues for pain:

1. lower cost center (office) is cheaper and thus better for ACO money
2. Hospital/surgery center is higher cash (they charge more), but is also higher cost for the ACO

So it depends on which side of the fence you sit on and whether your group can (or will) pay you a bunch more for being the lowest cost provider. Who knows which way the wind will blow in the future, but we can be assured there will be change.


PS- Who the hell would want to be a dermatologist? That would be boring.
 
Hawkeye, you would have made over $2M with a pretty standard RVU/hospital deal with that kind of volume.
 
BobBarker said:
Hawkeye, you would have made over $2M with a pretty standard RVU/hospital deal with that kind of volume.
Click to expand...


Really? People always asked me how many RVUs I generated and I had no idea.

I am much happier making less money now in less of a "rat race" practice.

My goal was never to make a pile of cash, it is just what happened with the practice. My overhead was outrageous!
 
hawkeye2009 said:
Really? People always asked me how many RVUs I generated and I had no idea.

I am much happier making less money now in less of a "rat race" practice.

My goal was never to make a pile of cash, it is just what happened with the practice. My overhead was outrageous!
Click to expand...

That’s the value of an wrvu based system. Standardizes your work and gives you reference points. I see new PP docs getting hosed all the time in collection based systems, since they have no idea what work they’re generating, and therefore no idea what income is considered fair market value
 
Yes, that is true. A pretty big name pain dr took a job with a large system here locally several years ago. He reached his cap before the end of the 3rd quarter. They expected him to keep working and not to pay him. That ended things very quickly.
 
paindoc007 said:
That’s the value of an wrvu based system. Standardizes your work and gives you reference points. I see new PP docs getting hosed all the time in collection based systems, since they have no idea what work they’re generating, and therefore no idea what income is considered fair market value
Click to expand...
Collection based systems are usually physician owned groups - either single or multi specialty. They don’t get the facility fees that hospital systems can extract, so depending on how lean the practice is run, your dollars per rvu may be lower. However, there are good aspects to being a physician owner in terms of ability to get equity in real estate and overall autonomy. Also, no caps at a percentage of MGMA. You wanna work 15 hours a day and see 50 pts? Ok, you do the work and get the money.

Neither is a slam dunk all the time but one needs to be aware of getting the fruits of his/her labor.
 
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