Where's th $$$ come from?

[deleted162650]

This question is for those of you with the very lucrative gigs i.e. >90% MGMA. Where does the great pay come from:

1) Are you just blessed with a great payor mix/unit value?

2) Do you primarily superivse 4:1?

3) Does your group receive large stipends/subsidies from the hospital?

4) Do you just work your ***** off?

5) Does the group have a steep/long buy-in/partner track?

6) Some combination of the above?

7) Anything else?

I'm currently in an all MD practice. Very fair structure with equal scheduling and no buy-in. Our payor mix is mediocre at best with just a small subsidy to help cover the no-pays. As a result we are right around the MGMA average for the region. Just curious as to how you guys that are killing it are doing it.

---

Members don't see this ad.

 

[climbingak]

Good payor mix with good contracts is key.
Lots of ortho with blocks helps a lot
Stipends obviously help but put you at risk. If a group is killing it, I would think asking for a stipend would just put you at even more risk.
A great situation would be an asc that does mostly ortho, spine, and ent in an area with a great payor mix and advantageous contracting with insurance companies.

 

[deleted126335]

This question is for those of you with the very lucrative gigs i.e. >90% MGMA. Where does the great pay come from:

1) Are you just blessed with a great payor mix/unit value?

2) Do you primarily superivse 4:1?

3) Does your group receive large stipends/subsidies from the hospital?

4) Do you just work your ***** off?

5) Does the group have a steep/long buy-in/partner track?

6) Some combination of the above?

7) Anything else?

I'm currently in an all MD practice. Very fair structure with equal scheduling and no buy-in. Our payor mix is mediocre at best with just a small subsidy to help cover the no-pays. As a result we are right around the MGMA average for the region. Just curious as to how you guys that are killing it are doing it.

MD only is always going to be less lucrative than supervision at a 1:3-1:4 practice.

To your list, I would add
1. Being willing to live in a place that is hard to recruit for.
2. First rate legal and financial counsel taking advantage of the people on the other side of the negotiating table. You'd be amazed how many folks negotiating multi million dollar deals shouldn't be there. Unfortunately, the pigeon at the table is usually the MD, though not always. This has disappeared for us, but we had it for a key contract.

 

[deleted162650]

Doze,

With regards to your #1, does a BFE location translate into $ in the form of a better payor mix/unit value, or is it primarliy bc the hospital ponies up some money via a subsidy to attract the MD's?

 

[BLADEMDA]

This question is for those of you with the very lucrative gigs i.e. >90% MGMA. Where does the great pay come from:

1) Are you just blessed with a great payor mix/unit value?

2) Do you primarily superivse 4:1?

3) Does your group receive large stipends/subsidies from the hospital?

4) Do you just work your ***** off?

5) Does the group have a steep/long buy-in/partner track?

6) Some combination of the above?

7) Anything else?

I'm currently in an all MD practice. Very fair structure with equal scheduling and no buy-in. Our payor mix is mediocre at best with just a small subsidy to help cover the no-pays. As a result we are right around the MGMA average for the region. Just curious as to how you guys that are killing it are doing it.

If your practice was 4:1 instead of all MD the MGMA % would be above 90%. There is nothing wrong in choosing to go "all MD" vs 4:1 but your income will reflect that decision especially in today's market where CRNAs are cheap. That said, your call could increase exponentially as 4:1 means much more call most of the time.

 

[pjl]

Supervise 2:1, otherwise yes payor mix, yes working hard, yes stipend (although fairly small), yes to good case mix. No to long steep partner track. I am half way to BFE but not quite there. Our increased unit value comes from providing care cheaper and of higher quality than the guys next to us. Meaning we have outcome data to prove it, and this is leveraged with insurance companies and drives more commercial into our system.

 

[deleted126335]

Doze,

With regards to your #1, does a BFE location translate into $ in the form of a better payor mix/unit value, or is it primarliy bc the hospital ponies up some money via a subsidy to attract the MD's?

In my experience both can be a factor, but the subsidy seems to be a bigger factor.

 

[deleted126335]

Supervise 2:1, otherwise yes payor mix, yes working hard, yes stipend (although fairly small), yes to good case mix. No to long steep partner track. I am half way to BFE but not quite there. Our increased unit value comes from providing care cheaper and of higher quality than the guys next to us. Meaning we have outcome data to prove it, and this is leveraged with insurance companies and drives more commercial into our system.

Kudos to your quality of care and being able to prove it and leverage it.

 

[pjl]

Kudos to your quality of care and being able to prove it and leverage it.

It is over a decade long project that has taken most of that to start paying dividends. I thank those "greedy money grubbing lazy 90s era anesthesiologists." This is the wave of the future in my opinion and the head start those guys gave us is a major reason for our success. Their foresight and hard work on this front is why I committed to a partnership track job, and I am glad I was given this chance.

 

[deleted126335]

It is over a decade long project that has taken most of that to start paying dividends. I thank those "greedy money grubbing lazy 90s era anesthesiologists." This is the wave of the future in my opinion and the head start those guys gave us is a major reason for our success. Their foresight and hard work on this front is why I committed to a partnership track job, and I am glad I was given this chance.

I half agree with you. The wave of the future is more protocols defining "best practices" and penalties for not following as opposed to incentives for going the extra yard. See SCIP metrics and payments for example. You will need to keep one step ahead of your competition if you want to maintain the extra payments for the same service. There will soon be someone with a whip flexing your competition down the street to perform to match what you are doing. If they fail they will look for someone who can perform. Congrats on what you have done, but you will never be able to relax if you want to maintain your extra revenue.

"Only the Paranoid Survive", or in this case prosper. A.K.A What have you done for me lately?

 

[countingdays]

7) Anything else?

Making money by keeping the billing of 'employed docs'.

 

[deleted126335]

Making money by keeping the billing of 'employed docs'.

Sad but true. The "easiest" way to do it.

 

[aneftp]

Making money by keeping the billing of 'employed docs'.

It's a two way street. Employed docs tend to work less hard. More mobile and will leave practices more often.

Higher turnover has its own costs in terms of recruiting new docs in.

You pay them enough they will stay. Underpay, than they will leave when time comes. A job , especially a w2 job usually isn't a marriage.

 

[thegasman]

1:4 medical direction, good payor mix, busy OR with lots of quick cases racking up the units

 

[countingdays]

It's a two way street. Employed docs tend to work less hard. More mobile and will leave practices more often.

Higher turnover has its own costs in terms of recruiting new docs in.

You pay them enough they will stay. Underpay, than they will leave when time comes. A job , especially a w2 job usually isn't a marriage.

Well, there are employed positions because the employee needs fixed hours and there are employed positions because the employers wants to take the employees' billing. The former used to be the majority of employed jobs. The latter is now taking over.

 

[Southpaw]

MD only, not a great payor mix, but we work hard. We have no subsidy from the hospital, and don't want one (that stuff always comes with ugly strings attached). We're right at 50th percentile for our area. All partners (very fair group, partner from day 1, etc.) are on board with wanting nothing to do with CRNAs and especially the AANA agenda.

Sure, it'd be nice to bring in the big bucks some of you talk about, but our families do fine and our kids go to private school if they need/want. I really enjoy my job in part because we feel respected by our surgeons and everyone else in our OR environment.