wRVU update

[Momentum70]

I just ran across something I thought was strange and wanted to know if others have experienced this before I decide what to do. My pay is all wRVU based at a single conversion factor. So basically total up all my wRVUs and multiply by one number and thats my pay. No salary or other things except for a quality/misc bonus that can be up to $10k per year so its a small factor.

We were told all about the new coding rules and have followed them which means I have a lot less level 3s then I used to have and a few less level 2s. With the higher wRVU amounts i calculated I would actually get a small pay increase. However when my numbers didnt match I asked the hospital for breakdown of all encounters and saw they were paying me on old smaller wRVU numbers but the descriptions were the new ones. They said they have decided to stay with older wRVU amounts with no plans of changing for this year. How is this possible? I looked through my contract and nowhere does it even mention which year they use for wRVU amounts. Anyone else run into this?

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[DMBandFan86]

No. I guess that’s why they say have a good contract lawyer review everything, but I doubt they would catch that. Seems like everywhere is trying to cut physician wages and this is some shady way of doing it in my opinion.

 

[sloh]

Jfc, they are always trying to screw us over.

 

[lobelsteve]

They will never love you back.

drusso

 

[j4pac]

A contract lawyer wouldn’t have been able to catch that. It reinforces the fact that if they want to screw you…they can. At this point you have a choice…make it a deal and be prepared to move on, or live with it.

I have a love one that had something similar happen, but only worse. The contract gross annual salary was listed, and it stated that she was going to work x number of days per week at 0.8. Those scumbags ended up giving her 80% of the total contract. The contract was reviewed by a great contract lawyer, but it is really difficult to anticipate what could go wrong before it does. After the fact, the contract lawyer said that we could fight it, but would we want to? Our answer was no because it was the middle of COVID without many other great employment options.

I’m hopeful that non-competes go away which will hopefully allow employers to be more ethical…and perhaps employees will want to work for an employer because it’s a good job, opposed to an employee simply being trapped into a job

 

[RangerBob]

A contract lawyer wouldn’t have been able to catch that. It reinforces the fact that if they want to screw you…they can. At this point you have a choice…make it a deal and be prepared to move on, or live with it.

I have a love one that had something similar happen, but only worse. The contract gross annual salary was listed, and it stated that she was going to work x number of days per week at 0.8. Those scumbags ended up giving her 80% of the total contract. The contract was reviewed by a great contract lawyer, but it is really difficult to anticipate what could go wrong before it does. After the fact, the contract lawyer said that we could fight it, but would we want to? Our answer was no because it was the middle of COVID without many other great employment options.

I’m hopeful that non-competes go away which will hopefully allow employers to be more ethical…and perhaps employees will want to work for an employer because it’s a good job, opposed to an employee simply being trapped into a job

Come to CA! Non competes are not enforceable here. Also really low malpractice rates.

Plus ocean/mountains and great weather.

Unfortunately not so great COL/taxes…. And the earth can’t make up its mind on whether it’s going to dehydrate us, flood us in a giant monsoon, or get it over with the “Big One” and just shake loose

 

[Momentum70]

Come to CA! Non competes are not enforceable here. Also really low malpractice rates.

Plus ocean/mountains and great weather.

Unfortunately not so great COL/taxes…. And the earth can’t make up its mind on whether it’s going to dehydrate us, flood us in a giant monsoon, or get it over with the “Big One” and just shake loose

HAHA, I left california for this job in texas and instantly had a pay bump from the income taxes I saved and each month expenses are less. Of course you are correct, this crap would have never passed in california.

I just heard back from a lawyer I had review my contract and they could not find any justification for them doing this in my contract, but there is a section of the contract where I agree to abide by the facilities policies. I had assumed this meant things like documentation, dress codes, etc but could also apply to this I was told. Advice I was given was to determine exactly the cost they were cheating me, and then determine if that amount was worth fighting. Im assuming they are doing this to all doctors as I have spoken with 2 of my colleagues here and they found out it was happening to them also. Pretty shady and underhanded of the company but I suppose many of the corporations are like that.

 

[lejeunesage]

Can you afford to walk away?

 

[j4pac]

HAHA, I left california for this job in texas and instantly had a pay bump from the income taxes I saved and each month expenses are less. Of course you are correct, this crap would have never passed in california.

I just heard back from a lawyer I had review my contract and they could not find any justification for them doing this in my contract, but there is a section of the contract where I agree to abide by the facilities policies. I had assumed this meant things like documentation, dress codes, etc but could also apply to this I was told. Advice I was given was to determine exactly the cost they were cheating me, and then determine if that amount was worth fighting. Im assuming they are doing this to all doctors as I have spoken with 2 of my colleagues here and they found out it was happening to them also. Pretty shady and underhanded of the company but I suppose many of the corporations are like that.

I remember while I was in private practice, there was a change in Medicare billing and my employer was upfront in saying that they weren’t sure if it would help or hurt me, so for that reason they froze the wRVU compensation. I’m sure it worked to my detriment slightly, but I was appreciative that they were upfront with me and even had me sign a new contract with a timetable of the upcoming changes. I get it…this is a business…but we’re professionals and shouldn’t be treated like horse crap. Treat us with a little bit of respect and appreciation. It’s not THAT hard

 

[Momentum70]

I remember while I was in private practice, there was a change in Medicare billing and my employer was upfront in saying that they weren’t sure if it would help or hurt me, so for that reason they froze the wRVU compensation. I’m sure it worked to my detriment slightly, but I was appreciative that they were upfront with me and even had me sign a new contract with a timetable of the upcoming changes. I get it…this is a business…but we’re professionals and shouldn’t be treated like horse crap. Treat us with a little bit of respect and appreciation. It’s not THAT hard

That is one of the most bothersome things, I only found out because another physician I know that watches his RVU like a hawk warned me and then when I did my calculations I noticed it was off. Speaking to the medical director at our IRF, they had no idea and were not told of this decision by those in the C Suite down the road. They were obviously trying to hide it.

 

[Momentum70]

Can you afford to walk away?

I can and I just did, joining the SNF side and away from IRF for now as I have a crappy noncompete that prevents me from going to other IRF, its smaller town so would need to drive 2 hours to work at another IRF. Unrelated or related note, the hospital is replacing me and another PMR position they pulled offer from a few months ago with IM hospitalists with 20 hours CME they are credentialing as "rehab doctors" because apparently this is all they need for medicare to bring in the $$$$$

 

[j4pac]

I can and I just did, joining the SNF side and away from IRF for now as I have a crappy noncompete that prevents me from going to other IRF, its smaller town so would need to drive 2 hours to work at another IRF. Unrelated or related note, the hospital is replacing me and another PMR position they pulled offer from a few months ago with IM hospitalists with 20 hours CME they are credentialing as "rehab doctors" because apparently this is all they need for medicare to bring in the $$$$$

You made the right decision. Trust is the most important component of any relationship, and they ruined it.

FYI…my loved one’s employer eventually went on to threaten a lawsuit against her when she left saying she broke her non-compete. She moved to a practice 15 miles a way (the non-compete said 10 miles). Their argument was that they had a different practice within the radius (even though that wasn’t the office she was working). They told her she had to stop working immediately and they wanted her to submit a list of all encounters at her new practice so that they can go after that money. Fortunately my wife’s new employer said “hell nah”…and threatened a counter suit. It wasn’t until then that we were free.

Looking back, she was making $116,000/year because of the 0.8 of $145k. Today she is earning 90th percentile of her specialty…so if I had to guess, she was probably making about a third of what she deserved to make under the original employer. Nuts.

I say all that to say that unfortunately there are employers that will be trying to take advantage of you. Women are incredibly vulnerable…and honestly, if it wasn’t for me, my loved one could very well still be making a third of what she’s owed. I’d also be careful about your non-compete. If they were willing to sneak thief you…they’d be the same type of employer who will try to find a way to sue you over the non-compete. The $700 we spent on a contract lawyer was possibly the best financial decision I have made in my life.

 

[sloh]

I can and I just did, joining the SNF side and away from IRF for now as I have a crappy noncompete that prevents me from going to other IRF, its smaller town so would need to drive 2 hours to work at another IRF. Unrelated or related note, the hospital is replacing me and another PMR position they pulled offer from a few months ago with IM hospitalists with 20 hours CME they are credentialing as "rehab doctors" because apparently this is all they need for medicare to bring in the $$$$$

Yikes. Not a good sign

 

[DMBandFan86]

Wow that was a fast turnaround. Best of luck in the new job. I had some friends go directly to SNF contacts and the initial % revenue the company took back was high. How is your contract set up or are you independent?

I believe the requirement is 2 or 3 years of rehab exposure to be a rehab physician. I am not aware of a CME requirement to be a rehab physician. I have never had to turn in CME to any facility. But I’m not looking at the Medicare requirements currently. BTW, that is a Medicare requirement. Other insurances don’t necessarily have that provider requirement.

I think most people change jobs at least once in the first few years out of residency. I have done it once. I could also complain about my current employer, but I don’t think I’ll ever get a perfect balance of ideal pay vs other benefits. Have you done independent contracting? From what you have said I think you’d like that best.

 

[Zendo]

Yikes. Not a good sign

What incentive do hospitals have to replace physiatrists with internists? I assume they get the same pay for doing the same job.

 

[drusso]

They will never love you back.

drusso

 

[Momentum70]

What incentive do hospitals have to replace physiatrists with internists? I assume they get the same pay for doing the same job.

I'm guessing the hospitalists cost them less money? Our "non profit" is very concerned with having all the beds filled at all times regardless of the rehab need or suitability, or at least thats my experience since there was a new person put in charge.

 

[j4pac]

I'm guessing the hospitalists cost them less money? Our "non profit" is very concerned with having all the beds filled at all times regardless of the rehab need or suitability, or at least thats my experience since there was a new person put in charge.

Most eat what they kill, so I’m not sure that’s the case… because the collections/wRVUs work the same whether it’s a PM&R or IM physician. It may be a preference based on practicality. If the employer had a PM&R doctor that referred literally everything to IM, then the employer might be trying to cut out the middle man. Under that arrangement, if the employer could only hire one or the other, the PM&R doc is referring is way out of a job.

 

[Momentum70]

Most eat what they kill, so I’m not sure that’s the case… because the collections/wRVUs work the same whether it’s a PM&R or IM physician. It may be a preference based on practicality. If the employer had a PM&R doctor that referred literally everything to IM, then the employer might be trying to cut out the middle man. Under that arrangement, if the employer could only hire one or the other, the PM&R doc is referring is way out of a job.

The wRVU rate they pay IM is less than the single factor conversion they pay PMR, recently found this out also

Throw in the fact they have decided to pay at the lower wRVU numbers and they are making even more money. Per one of my colleagues in the IM department, they have a lot of foreign IM on visas or in some way tied to hospital that makes them easy to take advantage.

 

[j4pac]

The wRVU rate they pay IM is less than the single factor conversion they pay PMR, recently found this out also

Every employer is different. There is no mandate that says that a PM&R doctor should make more than an IM doctor. Perhaps the employer thinks that a PM&R doctor is less likely to take the $/wRVU rate that can be offered to an IM doctor. If that is the case, then certainly a PM&R doctor has to demonstrate value relative to the cheaper IM option.

 

[lejeunesage]

What incentive do hospitals have to replace physiatrists with internists? I assume they get the same pay for doing the same job.

This is an excellent question, and I ask myself that every day.