I'm a resident as well, so I don't know from experience, but it seems like a job like that would stress me out. I'd always be worrying about volumes, how fast the nursing and support staff are working, and ways that I can do extra stuff to get paid more. An RVU bonus would be nice, but 100% RVA would give me anxiety.I'm a senior EM resident deciding between a few jobs. I was offered a job from a CMG that pays their docs 100% RVU. What are the pros/cons of such a job?
That's a lot of info and assumptions packed into a pretty concise paragraph. Let's break it down Sunday Night Football style:The obvious answer is that they are offering 100% RVU because they feel it will it will be financially better for them. That should raise questions by you.
It depends a lot on the practice details. If it is low volume, it means you will be sitting their twiddling your thumbs while the ED is empty and you are not getting paid.
If it is a busy place with several physicians, it can motivate bad behavior - cherry picking, avoiding the non-RVU activities, etc., etc.
It also depends a lot on the rate per RVU. But I would always come pack to my first sentence.
I couldn't agree more with this post.I'm a resident as well, so I don't know from experience, but it seems like a job like that would stress me out. I'd always be worrying about volumes, how fast the nursing and support staff are working, and ways that I can do extra stuff to get paid more. An RVU bonus would be nice, but 100% RVA would give me anxiety.
If it was an independent group and you will be a partner soon. YESI'm a senior EM resident deciding between a few jobs. I was offered a job from a CMG that pays their docs 100% RVU. What are the pros/cons of such a job?
This is why. You're a very highly educated assembly line employee. Don't put yourself in a position where your paycheck can take a hit because of mistakes made at a higher pay grade.At a 100% RVU job you'll be very subject to the impact of people you don't employ. Nurses don't get your orders completed and the turnover rate slows? You lose money. Admitting takes too long? You lose money. Janitorial doesn't clean the room fast enough? You lose money
You can try but I doubt a CMG is gonna let you do much in the contract. Biggest thing to protect yourself is your out and having them cover your tail. I too would advise against this but if you have to then you have to. You may notice that some docs work more of a certain shift due to higher RVUs. Remember the RVU system is incredibly flawed. I could see maybe 6-10 old stable chest pain patients per hour without batting an eye. That admission is a fair number of RVUs. Depending on patient allocation you could end up doing long painful workups like abdominal pain, weak and dizzy gomers and make not nearly as much for much harder and more painful work.Thanks for the replies! I will likely have to take this job as I'm restricted geography. What kind of things should I put in my contract to try and protect myself?
Another thing do to protect yourself is to not buy a house the first year at any new job. Rent, rent, rent. That gives you the power to say,Biggest thing to protect yourself is your out and having them cover your tail.
Well, for starters...What kind of things should I put in my contract to try and protect myself?
Yep...good times.Off-topic, but I'm happy to see Old_Mil back here again. If I recall correctly, he and I were on the residency interview trail together
I finally realized Obi Wan was right.Dude... I get that you're going to Soviet Canuckistan to work. You recently posted something like "thank christ that I'm leaving this broken wasteland behind".
Expound, man. We want to hear.
This is not news and wasn't news, as far as I was concerned, when this ruling came down. There's been many lawsuits like this, in many states and many specialties. You should operate under the premise that you can get sued for any stupid, boneheaded, baseless and frivolous reason at any time. That doesn't mean they're going to win, and neither does this ruling. But when I saw this ruling, I yawned, frankly.I believe this is what he is referring too.... http://epmonthly.com/article/you-re-suing-me-for-what/
Exactly.I would not. I want a guaranteed hourly rate for when I show up. If it's not busy, I am still a warm body that they are required to have there. It's my time, and if I see 0 patients, I still want to be paid. My current setup is about 2/3 salary, 1/3 RVU which I think is decent. It's nice to know that I'm making $200+/hour surfing the internet when it's not busy.
Yeah true my contract changed but I had to stay with the group due to a signing bonus.Exactly.
Would be very cautious as a new grad taking this kind of job. I'm a 1st year attending and I'd be scared to. Not only are you just not that great at coding and documenting for the purposes of billing, but can be easily bullied into being the one to take the low volume shifts. If I took this type of job, I'd be very careful to have specific verbiage in my contract about the types of shifts I would be working.
If I'm on the overnight (I hate overnights already as it is) and volume dies at 3am, I want to be paid. I/you (in most cases) are a BC/BE Emergency Physician keeping their ED open and are extremely valuable. You should be paid for your professional time.
The hospital based coders are usually terrible at their job. I would never take an RVU job if that was the case. I would prefer someone who is an expert at EM coding, not someone who doesn’t know what they are doing.Yeah, I want to rejoice when I clear the board on a night shift, or have a slow night and can get some admin stuff done. I don't want to fear clearing the place out because no more money would be coming in. Its just a mental thing. On the other hand, it obviously does make it easier when you are getting killed. If you are would consider taking one of these jobs out of residency, I'd definitely take a coding course, and I'd look and make sure to find out who codes the charts. I can tell you independent coding groups are going to be much more aggressive about coding charts higher (getting you more rvu's) than a hospital coder because they are typically trained just in ED billing/coding.
I work in a SDG that is almost 100% RVU (other than a lathe night shift differential) and wouldn’t have it any other way. As long as it’s a completely transparent, it’s hard to argue you’re getting treated unfairly. Also, payer mix has nothing to do with RVU based payments. Your productivity should be assigned by what you bill not what you collect.When we were a private SDG, we started with 100% RVUs but then you start getting discontent with docs in poor payer mix, docs fighting for charts, docs chart watching, docs not picking up Low RVU charts.
Its a bad practice that pits docs against docs.
Payer mix is important when Hospital A has alot of insured and Hospital B has less. Where I worked, if both had the same volume, hospital A always made more $$$$.I work in a SDG that is almost 100% RVU (other than a lathe night shift differential) and wouldn’t have it any other way. As long as it’s a completely transparent, it’s hard to argue you’re getting treated unfairly. Also, payer mix has nothing to do with RVU based payments. Your productivity should be assigned by what you bill not what you collect.
CMG would be a completely different story. Anytime I moonlit with them I always demanded ridiculously high hourly rates.
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Best practice is probably where your group (hopefully a SDG) combines all revenue into the same pot and then pays out productivity based on RVUs generates regardless of the site where you generated them. This eliminates the payor mic issue. Whether hospital A or hospital B makes more money doesn’t matter if you are a separate private group that staffs both of them.Payer mix is important when Hospital A has alot of insured and Hospital B has less. Where I worked, if both had the same volume, hospital A always made more $$$$.
I too am for RVUs but you have to really give a huge night bonus b/c RVUS drop right at 2am.