wRVU negotiations

[thefootguy]

Currently pushing back and attempting to negotiate with Admin regarding decreases to $/RVU for Podiatry in 2023. This was initially done to reflect implementation of CMS wRVU changes. However, they also claim that they were overpaying us and made additional changes to $/RVU to better reflect median benchmark data for all providers. The $/RVU for PCPs went up and the $/RVU for select surgical specialties went down.

Has anyone successfully negotiated the RVU conversion factor with employers based on benchmark data percentile productivity? I’m projected to be at the 90th percentile based on productivity, however, my compensation will fall considerably short.

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[Feli]

Did they recently hire? If they are cutting pay for DPMs despite massive inflation, they obviously just know they have a ton of applications. That will be a tough one if it's a large system like Sutter or something.

I would just use your own data, attendance, metrics if you had productive years recently. That's your best shot, particularly if it's a hospital or system with only a few pods.

 

[Pronation]

Man that is really disconcerting to hear. I’ve not really heard of much of this happening in the past. I guess it was inevitable for them to start picking up on how insanely over saturated podiatry is. Would you mind sharing your current RVU comp and what they are proposing to drop it down to?

 

[Retrograde_Nail]

Currently pushing back and attempting to negotiate with Admin regarding decreases to $/RVU for Podiatry in 2023. This was initially done to reflect implementation of CMS wRVU changes. However, they also claim that they were overpaying us and made additional changes to $/RVU to better reflect median benchmark data for all providers. The $/RVU for PCPs went up and the $/RVU for select surgical specialties went down.

Has anyone successfully negotiated the RVU conversion factor with employers based on benchmark data percentile productivity? I’m projected to be at the 90th percentile based on productivity, however, my compensation will fall considerably short.

I’m 90% percentile in productivity and I’m making $53 per RVU. I have a meeting coming up because I want my RVU to go up to $60. We have more rural DPMs in the system who are making $62-65 (tiered). I’m at the major tertiary referral center of the system and get dumped on relentlessly by these rural DPMs who magically disappear every Friday afternoon and weekend and just transfer patients to the city.

What data are you presenting to make your arguments?

 

[Feeter]

Same happened to me when it was time to renew contract. I was unsuccessful at negotiating and eventually found different a job that made more sense to me.

They use several data set to make their decision. Due to such variability in scope, experience and skills often times podiatrist who are doing broader scope surgery get stuck getting paid what forefoot podiatrist do due to these data sets not being granular enough.

I would start looking for a better job if that is possible and use that as a leverage to negotiate. Obviously get all your partners and allies behind you before you enter this meeting that way you have some leverage. Get all your data regarding RVUs before you go to this meeting. If you produce 90th percentile then you should get paid 90th percentile.

 

[Feeter]

Does anyone have general data for MGMA 2023?

Last one I looked at was $55 was the median.

 

[air bud]

I’m 90% percentile in productivity and I’m making $53 per RVU. I have a meeting coming up because I want my RVU to go up to $60. We have more rural DPMs in the system who are making $62-65 (tiered). I’m at the major tertiary referral center of the system and get dumped on relentlessly by these rural DPMs who magically disappear every Friday afternoon and weekend and just transfer patients to the city.

What data are you presenting to make your arguments?

Yeah you at least have reasonable argument on that other people in the system are higher

 

[air bud]

Does anyone have general data for MGMA 2023?

Last one I looked at was $55 was the median.

I honestly still have no idea how 55 is the median. I understand median vs mean too.

 

[Pronation]

I honestly still have no idea how 55 is the median. I understand median vs mean too.

Same, but I can only count up to 10 toes, and I’m starting to get rusty counting beyond 8ish toes because I rarely have to count beyond that. Thank you.

 

[Hybrocure]

I thought they were called RBU’s

 

[thefootguy]

Did they recently hire? If they are cutting pay for DPMs despite massive inflation, they obviously just know they have a ton of applications. That will be a tough one if it's a large system like Sutter or something.

I would just use your own data, attendance, metrics if you had productive years recently. That's your best shot, particularly if it's a hospital or system with only a few pods.

No recent hires. I was the last Podiatrist onboarded and only one who does RRA pathology.

This is a smaller health system and easier to get face time and communicate with CMO and CEO.

I have been fortunate to get them to agree to run a new tiered formula that follows production levels rather than aligning so closely with mean data; however, they said they would need to apply this to all specialties and see the financial impact.

 

[thefootguy]

Man that is really disconcerting to hear. I’ve not really heard of much of this happening in the past. I guess it was inevitable for them to start picking up on how insanely over saturated podiatry is. Would you mind sharing your current RVU comp and what they are proposing to drop it down to?

I was previously at mid to high 50s in a tiered model.

The proposed model with change this to high 40s and low 50s.

They have a compensation consultant from Sullivan Cotter they are working with.

This has everything to do with the Medicare (CMS) Physician Fee Schedule Changes that affects E&M codes wRVU values that was initially proposed in 2020 but fully adopted until this year. But then, additional adjustments were made to bring PCPs up closer to the median compensation that resulted in negative impact on Podiatry and less so on a few others specialties.

 

[thefootguy]

I’m 90% percentile in productivity and I’m making $53 per RVU. I have a meeting coming up because I want my RVU to go up to $60. We have more rural DPMs in the system who are making $62-65 (tiered). I’m at the major tertiary referral center of the system and get dumped on relentlessly by these rural DPMs who magically disappear every Friday afternoon and weekend and just transfer patients to the city.

What data are you presenting to make your arguments?

I have my own metrics/production and how my compensation would not be in line with benchmark data productivity levels that I’m at. They are essentially removing incentives to be productive.
I’m arguing my value to the system with high production, retention of RRA pathology, OR utilization, downward revenue produced from referrals and use of ancillary services, as well as facility fees.
I’m assessing the negative financial impact and how that can be justified given inflation and my value to the system.
I’m trying to get my hands on most recent MGMA to compare to Sullivan Cotter data.

 

[Retrograde_Nail]

I have my own metrics/production and how my compensation would not be in line with benchmark data productivity levels that I’m at. They are essentially removing incentives to be productive.
I’m arguing my value to the system with high production, retention of RRA pathology, OR utilization, downward revenue produced from referrals and use of ancillary services, as well as facility fees.
I’m assessing the negative financial impact and how that can be justified given inflation and my value to the system.
I’m trying to get my hands on most recent MGMA to compare to Sullivan Cotter data.

Sullivan Cotter is historically a lot lower than MGMA that is why they are using it. It’s complete crap.

 

[air bud]

This doesn't sound promising. Had a friend recently get cut from 53 to 48. He bailed. This was last straw. 60k paycut based on his production.

 

[Pronation]

Damn, $5/RVU drop is a huge hit.

 

[Retrograde_Nail]

My hospital is allowing me 3 years to make as much as I can then they are averaging it out over those 3 years and giving me 90% of that and that’s my new salary moving on. If they don’t renegotiate with me that’s the day I cut my clinic schedule down 50%.

This is where we are going

 

[Pronation]

If they don’t renegotiate with me that’s the day I cut my clinic schedule down 50%.

How do you plan on doing that? They control your clinic.

 

[Retrograde_Nail]

How do you plan on doing that? They control your clinic.

I can create new rules like changing my NP time slots from 15 min back to 30 min. Cherry picking pathology because I’m “no longer comfortable treating it”. You get the gist.

 

[SouthPod7]

I can create new rules like changing my NP time slots from 15 min back to 30 min. Cherry picking pathology because I’m “no longer comfortable treating it”. You get the gist.

But aren't you shooting yourself in the toenails because with fewer overall office visits you would have less productivity thus less wRVU and less $$$?

 

[air bud]

My hospital is allowing me 3 years to make as much as I can then they are averaging it out over those 3 years and giving me 90% of that and that’s my new salary moving on. If they don’t renegotiate with me that’s the day I cut my clinic schedule down 50%.

This is where we are going

Salary no bonus?

 

[Retrograde_Nail]

But aren't you shooting yourself in the toenails because with fewer overall office visits you would have less productivity thus less wRVU and less $$$?

Not if I am at a fixed salary based on the average of my previous 3 years of production

 

[Feeter]

Not if I am at a fixed salary based on the average of my previous 3 years of production

You may want to confirm the salary will be fixed and there are no clawback stipulations.

At my last job our base salary was set at 90% of an average of last three years production. However if you produced less than that then you owe the hospital money.

 

[Hybrocure]

You may want to confirm the salary will be fixed and there are no clawback stipulations.

At my last job our base salary was set at 90% of an average of last three years production. However if you produced less than that then you owe the hospital money.

Lmao what

That’s such a bs model considering the hospital is responsible for funneling you the patients and scheduling them. If they’re not giving you enough volume why do you owe them anything

 

[PeaJay]

I’m trying to get my hands on most recent MGMA to compare to Sullivan Cotter data.

2023 SC data

20% about 5000 RVU and 265 total comp
50% about 6800 RVU and 321 total comp
80% about 8300 RVU and 386 total comp

 

[Feeter]

Lmao what

That’s such a bs model considering the hospital is responsible for funneling you the patients and scheduling them. If they’re not giving you enough volume why do you owe them anything

That is the true productivity model. Your base is just an advance on assumptions that you'll produce close to what you did last few years. If you produce more then you get a bonus on your salary. If you produce less then they overpaid you and will be clawing it back or by reducing you future salary. We had this happen to one of our docs at my last job and they made him do weekend clinic to make up for the productivity instead of taking the money back. RVU model can suck if you get sick or injured.

 

[Feeter]

2023 SC data

20% about 5000 RVU and 265 total comp
50% about 6800 RVU and 321 total comp
80% about 8300 RVU and 386 total comp

The median annual wRVU seems like it went up! Thought it was close to 6000.

SC median ends up being 47.20 per wRVU based on above information which is far from MGMA.

 

[Pronation]

Damn 47/RVU sucks. This means you’ll only get to 3x an associate salary instead of 4x. Oh well.

 

[deleted285117]

2021 MGMA
Mean 311
Median 287

 

[BubbaWub]

Damn 47/RVU sucks. This means you’ll only get to 3x an associate salary instead of 4x. Oh well.

Still working on having my boss switch me to RVU compensation. My RVU typically goes between 3200-5500 depending on the layers of onychomycosis developed. Being reimbursed depending on the RVU usage would be very nice for my practice.

Thank you.

 

[Boba Foot]

Ya know, PP has a good amount of drawbacks but I'm glad ya'll are realizing that as a hospital employee, you are still an employee of a corporation. You are under corpo control and sooner or later, they will bone you.

 

[Pronation]

Ya know, PP has a good amount of drawbacks but I'm glad ya'll are realizing that as a hospital employee, you are still an employee of a corporation. You are under corpo control and sooner or later, they will bone you.

Yea but the hospitals still leave a good tip after they’re done boning you.

 

[icebreaker32]

Ya know, PP has a good amount of drawbacks but I'm glad ya'll are realizing that as a hospital employee, you are still an employee of a corporation. You are under corpo control and sooner or later, they will bone you.

I don't think anyone is saying it is perfect. Many on here in that setting have switched jobs.

Considering the other options it is not surprising many want those organizational jobs.

Partner in a good group. There are not too many of those opportunities either.

Associate. Occasionally it can be better than discussed on here and also it can potentially lead to ownership, but not usually. Very often it is as bad as mentioned on here or at least pretty close to it.

Owner of solo practice. Risk for accumulating debt and an unpredictable time frame it will take for both positive cash flow as well as achieving a better than associate income. Lots of non clinical tasks that are not easy such as motivating and retaining good employees.

At the end of the day most want to be compensated fairly, live in an area they consider a desirable location and have a good work life balance. With podiatry you are honestly pretty lucky to get 2 out of 3.

 

[Retrograde_Nail]

Ya know, PP has a good amount of drawbacks but I'm glad ya'll are realizing that as a hospital employee, you are still an employee of a corporation. You are under corpo control and sooner or later, they will bone you.

I would rather become a UPS driver than work in private practice. If and when my hospital career is over so is my podiatry career. It’s not worth it working in private practice

 

[deleted285117]

I would rather become a UPS driver than work in private practice. If and when my hospital career is over so is my podiatry career. It’s not worth it working in private practice

1000%

 

[Adam Smasher]

Yeah but the UPS guys are going to get all kinds of chronic back problems, unlike healthdrive doc...hey waitaminute...

 

[edog10]

Started in the hospital but working in a MSG now....best decision I have ever made! No call, more control, I did start as a partner within the pod practice ( buy into MSG in 2 years), new building opening in November and likely a surgery center within the next year. After 12 months finally seeing the rewards/collections coming to fruition. My hospital job was definitely in the top 90% of pod jobs (minus alot of sexy trauma). There is definitely a learning curve when it comes to billing but I wouldn't completely rule it out. Especially when you are barely a year in and already talking about renegotiating your contract.

 

[musson10]

Does anyone have the Sullivan survey or mgma surgery for wRVU $ compensation and the percentiles of total wRVU a year? Trying to negotiate right now thanks

 

[deleted285117]

Does anyone have the Sullivan survey or mgma surgery for wRVU $ compensation and the percentiles of total wRVU a year? Trying to negotiate right now thanks

MGMA 2021

Median - 3rd from right
Mean - far left

 

[Feli]

... My hospital job was definitely in the top 90% of pod jobs ...

Any job not doing mobile podiatry and making over $100k will be in the top 90% of pod jobs 🙂

We get what you are meaning tho (top 10% ?).

...Hospital jobs are awesome in that they have a much higher base than most PP pod jobs, but the call and admin drags can be substantial. The referrals can be good or be a real drag with endless wound/amp. Sometimes you can have the best of both worlds (make the $$ and have better schedule and ortho type pod practice) by being PP owner or MSG partner. 👍

 

[Hybrocure]

Does good paying mobile podiatry exist? Like if you can do it and make 150-200k that doesn’t sound like a bad option

 

[Feli]

Does good paying mobile podiatry exist? Like if you can do it and make 150-200k that doesn’t sound like a bad option

Nursing homes can pay ok if you set it up yourself... it can pay good/great if you set it up yourself and bill fraudulently.

I'd still call that a pretty bad job simply due to the gross and boring job quality, tho.

Cue up the best post in SDN podiatry history (imo).

...basically, anything we do (nursing home, house calls, podiatry office) can pay good when somebody's not snipping 20% or 25% or 30% or more off of your gross productivity (so 30-50+ percent of your net) and deciding your schedule, your system, your supplies, etc.

 

[GreenHousePub]

Nursing homes can pay ok if you set it up yourself... it can pay good/great if you set it up yourself and bill fraudulently.

I'd still call that a pretty bad job simply due to the gross and boring job quality, tho.

Cue up the best post in SDN podiatry history (imo).

...basically, anything we do (nursing home, house calls, podiatry office) can pay good when somebody's not snipping 20% or 25% or 30% or more off of your gross productivity (so 30-50+ percent of your net) and deciding your schedule, your system, your supplies, etc.

That post is why SDN declared me a "Verified Expert"

 

[Hybrocure]

That post is why SDN declared me a "Verified Expert"

I thought that title was for proof of ABFAS cert