Collections contract review - new attending

[NRT109]

Soon to be newly graduating pain fellow starting contract review.
In regards to collections models, what makes a good contract?
What percentage of collections should I be taking home?
In todays market, what would a fair collections threshold number be for a 350k base? 400k base?
Is a graded collections better or a a percentage of straight collections better?
I am looking to be a FTE and be fairly productive. PP has existing referral sources.
Looking at midwest PP groups.

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[hopefulgasman]

it makes it easier if you post the contract

 

[BobBarker]

Probably 3x base before any bonus. There are lots of associated costs with a new hire on top of the base.

 

[justAstudent]

Probably 3x base before any bonus. There are lots of associated costs with a new hire on top of the base.

Do new grads typically hit that with say a 350k base salary?

 

[BobBarker]

Do new grads typically hit that with say a 350k base salary?

It just depends on if the existing physician is going to let you see his patients or not. If the existing physician is going to let you start seeing about 30% of his patients and 30% of his referrals, yes probably. If he expects you to “build a practice”, no.

 

[MitchLevi]

Do new grads typically hit that with say a 350k base salary?

Unlikely.

It takes awhile to figure out how to be an attending and how to be efficient. Collecting what you bill takes 1-2 months as well.

 

[glapapa]

I would be mindful if most of the procedures are being done in office vs in an ASC, as the professional fees that count towards your collections will be less in the latter setting.

 

[LineEmTubeEm]

I would be mindful if most of the procedures are being done in office vs in an ASC, as the professional fees that count towards your collections will be less in the latter setting.

Since your collections at an ASC cannot be used to count towards your total collections/production bonus, what is a reasonable way to make up for that? At least this is what I've been led to believe.

 

[Ducttape]

First and foremost, always get a contract attorney to review any offers.

Salary is quite important but absolute numbers can be decieving. they should be compared to salaries of other practices in the area, not nationally.



your collections at ASC are supposed to be counted to your total work.

there is a professional fee - that is the payment for the work you do - and the professional fee - that goes to the ASC. the amount of money you get from professional fees at ASC will be less than what you might make in office, but that in office payment is usually to also pay for equipment and staff.

you dont work for free. stuff you do at ASC has to count towards your total productivity calculations.


new grads should be looking for a job with base salary, then bonus over a certain productivity level, for 2 years. after the 2 years, generally speaking, salaries are on a productivity basis solely.

 

[LineEmTubeEm]

First and foremost, always get a contract attorney to review any offers.

Salary is quite important but absolute numbers can be decieving. they should be compared to salaries of other practices in the area, not nationally.



your collections at ASC are supposed to be counted to your total work.

there is a professional fee - that is the payment for the work you do - and the professional fee - that goes to the ASC. the amount of money you get from professional fees at ASC will be less than what you might make in office, but that in office payment is usually to also pay for equipment and staff.

you dont work for free. stuff you do at ASC has to count towards your total productivity calculations.


new grads should be looking for a job with base salary, then bonus over a certain productivity level, for 2 years. after the 2 years, generally speaking, salaries are on a productivity basis solely.

I was told (maybe incorrectly) that due to Stark law I cannot be compensated based off my collections at an ASC (vs wRVU which I could be)

 

[MitchLevi]

Your ASC is not counted towards your productivity and collections. It's a completely separate bucket of money. That's how our practice is set up.

Making 1M outside the ASC probably isn't going to happen in your first yr. Expect most new attending to collect around 600-750 or so in their 1st yr. There are outliers.

Collecting 1M outside the ASC is certainly doable year two.

I had to grow my practice my first yr. I got no bonus money that yr. I spent time driving around meeting local docs, networking, etc.

 

[Ducttape]

you get professional fees or rvu pellets for the work you do at the ASC.

you cannot get facility fees. those are for the ASC itself, and make up the major portion of what patients pay.


stark law does not apply here. if your salary is dependent on productivity measures, you have to be getting something for the work you do regardless of location.

 

[LineEmTubeEm]

Your ASC is not counted towards your productivity and collections. It's a completely separate bucket of money. That's how our practice is set up.

Making 1M outside the ASC probably isn't going to happen in your first yr. Expect most new attending to collect around 600-750 or so in their 1st yr. There are outliers.

Collecting 1M outside the ASC is certainly doable year two.

I had to grow my practice my first yr. I got no bonus money that yr. I spent time driving around meeting local docs, networking, etc.

So then how are you compensated off that completely separate bucket of money from the ASC?

 

[MitchLevi]

So then how are you compensated off that completely separate bucket of money from the ASC?

Ownership - I should be more clear...Your professional fees aren't what I'm talking about.

 

[MitchLevi]

you get professional fees or rvu pellets for the work you do at the ASC.

you cannot get facility fees. those are for the ASC itself, and make up the major portion of what patients pay.


stark law does not apply here. if your salary is dependent on productivity measures, you have to be getting something for the work you do regardless of location.

The facility fees do not count towards productivity. That's the bulk of that money.

 

[GlowInTheDark]

You’ll get a base, they’ll find a way to not pay you bonus, you’ll get mad, they’ll say it gets better as partner, they’ll sell to PE who will take chunk of your revenue, your $ as a partner will never achieve what you were told, and you’ll wonder why you went into medicine in the first place.

 

[RoloTomassi]

They can give you a high percentage of your pro fee collections to offset. Just like how hospitals can give big salaries and bonuses.

 

[BobBarker]

Yes, they can give you like 80% of your pro fee. You will get maybe $70 for a CESI if they are willing to do that. Which is yet another reason routine pain procedures don’t belong in an ASC.

 

[gdub25]

While I could share my opinion on the questions at hand as others have, which will all vary depending on personal experiences, I will say that my first job was private practice and I got paid a percentage of collections. 33% of collections came to me and there was no bonus structure at all, everything was office based with no ASC. The group sent me no referrals or patients, I had to go out and get the patients myself. I hustled my butt off to have success, made 388k my first year. I would say I was outlier however, two came after me and didn’t put in the effort I did to grow and didn’t do as well the first year, took until year two for them to make above avg pain doc pay.

 

[BobBarker]

Ok, that is a definitive answer. If he could barely break 3x $350k his first year, starting from scratch, no one can in a true private practice set up.

 

[gdub25]

Yeah, Very hard to do. Collecting over 1mil year one is hard, unless like you said, the practice gives you a bunch of patients. Even then new grad would have to be pretty fast and be able to see the volume.

 

[RoloTomassi]

Remember that contracts matter a lot. Someone at a practice that does all commercial, with contracts at say 2x Medicare, can make the same doing half the work as someone doing only Medicare. So ask about payer mix and rates

 

[IAmTheOne1]

Commercial paying 2x medicare or anything above medicare really a thing? I'm so jealous and it boggles my mind that this actually happens.

Commercial pays 50-75% of medicare where I am.

 

[MitchLevi]

Remember that contracts matter a lot. Someone at a practice that does all commercial, with contracts at say 2x Medicare, can make the same doing half the work as someone doing only Medicare. So ask about payer mix and rates

That's 100% true.

We've had guys in my group that only see work comp for example. Collect about what I do while seeing way less pts than I do.

 

[bedrock]

Commercial paying 2x medicare or anything above medicare really a thing? I'm so jealous and it boggles my mind that this actually happens.

Commercial pays 50-75% of medicare where I am.

Damn.

Are you in SoCal? Southern Florida, or NYC?

Otherwise, I can’t imagine why you would accept that low of payment.

 

[hopefulgasman]

Most of you guys don’t take or see Medicaid patients correct? How does reimbursement for that compare to Medicare rates.

 

[GoBeers]

Damn.

Are you in SoCal? Southern Florida, or NYC?

Otherwise, I can’t imagine why you would accept that low of payment.

I'm in socal
PPO in network like the Blues are 60%
many HMO/IPAs are 80% or maybe 100% medicare at best.

I've heard multi-specialty groups have better rates compared to single specialty practices

 

[RoloTomassi]

Commercial paying 2x medicare or anything above medicare really a thing? I'm so jealous and it boggles my mind that this actually happens.

Commercial pays 50-75% of medicare where I am.

Yes where I am it's Medicaid<MC<commercial<WC. Most PP don't take Medicaid so MC is base level.

 

[IAmTheOne1]

I'm in SoCal and I celebrate when I get a government payer and cry when it's a PPO.

I started taking Medicaid recently - pays way better than PPOs. Almost on par with Medicare.

 

[MitchLevi]

Yes where I am it's Medicaid<MC<commercial<WC. Most PP don't take Medicaid so MC is base level.

Nothing pays like work comp, and if not for their rates I wouldn't see a work comp pt.

To add...We have a guy who virtually does only work comp now. In 2023, I had 2,123 more patient encounters and he collected more total money than I did. The money breakdown is complicated, but overall he collected more.

 

[Ducttape]

WC is very state dependent.

in my area, WC doesnt pay great and almost impossible to get procedures done.

there is a reason there is a "crisis" with doctors in this state not accepting WC.

 

[hopefulgasman]

Why does PPO pay so poorly? Can someone explain this. I thought Medicaid was the absolute worst type of insurance from reimbursement and patient type.

 

[BobBarker]

Medicaid pays very well here. Work comp pays less. I’m only going to see federal work comp going forward.

 

[bedrock]

Medicaid pays very well here. Work comp pays less. I’m only going to see federal work comp going forward.

What does your Medicaid pay relative to Medicare?

 

[BobBarker]

Basically the same. Maybe 5% less but don’t have to chase down the patient component.

 

[gaschicago]

What would the group say reasonable collections 1st full year in to practice (Jan to Dec)? How about Year 2 (Jan to Dec)?

Assuming you start within a few months after fellowship, the first few months (~July to Dec) post fellowship are hardly going to net you much especially if you have no existing patient base.

 

[drrosenrosen]

If people are going to start talking about revenue, maybe we should move this to the private forum?

 

[Dr. Ice]

If people are going to start talking about revenue, maybe we should move this to the private forum?

Why, what’s so secretive all the time

 

[bedrock]

Why, what’s so secretive all the time

Physician pay is a discussion best for the private forum, not where any patient can read it.

 

[gaschicago]

If people are going to start talking about revenue, maybe we should move this to the private forum?

Sounds good. Can we start one or PM me?

 

[BobBarker]

There can be a lot of revenue but there are a lot of costs. Every employee costs around $25/hr all in after insurance/taxes. C-arms cost $80k-120k. Kyphoplasty kits can cost up to $2000. Just like the oil change shop. There are a lot of costs besides just the oil.

 

[LineEmTubeEm]

Sounds good. Can we start one or PM me?

there's instructions on the main page but i havent heard back from moderators

 

[LineEmTubeEm]

Re-visiting this thread - there are some logistics that are confusing to me. On the topic of collections-based bonuses, how do you account for collections not coming in immediately? If they run your collections report at the end of February for that month, it will be different 3 or maybe even 6 months out as that money continues to come in. Or am I thinking about this incorrectly and it shouldn't be monthly but rather annual from the start date and just re-calculated every month?

 

[RoloTomassi]

Re-visiting this thread - there are some logistics that are confusing to me. On the topic of collections-based bonuses, how do you account for collections not coming in immediately? If they run your collections report at the end of February for that month, it will be different 3 or maybe even 6 months out as that money continues to come in. Or am I thinking about this incorrectly and it shouldn't be monthly but rather annual from the start date and just re-calculated every month?

All those details should be specified in contract so there's no ambiguity

 

[Hoya11]

Re-visiting this thread - there are some logistics that are confusing to me. On the topic of collections-based bonuses, how do you account for collections not coming in immediately? If they run your collections report at the end of February for that month, it will be different 3 or maybe even 6 months out as that money continues to come in. Or am I thinking about this incorrectly and it shouldn't be monthly but rather annual from the start date and just re-calculated every month?

They’ll probably calculate it by “Date of Entry” not “Date of service”

Meaning whatever money comes in that month , even if the procedure was 3 months ago, counts towards that months total. Whenever the collections are “entered” into their books.

It doesn’t matter when you did the procedure it just matters when the money comes in.

So for the first few months not going to be a lot until you build steady business

 

[drrosenrosen]

They’ll probably calculate it by “Date of Entry” not “Date of service”

Meaning whatever money comes in that month , even if the procedure was 3 months ago, counts towards that months total. Whenever the collections are “entered” into their books.

It doesn’t matter when you did the procedure it just matters when the money comes in.

So for the first few months not going to be a lot until you build steady business

And the nice thing about this, too, is that it turns into a pretty steady and relatively predictable stream of income once you're wound up. Since your monthly revenue is always a blend of money coming in from the past 60 days or so, you don't necessarily see as big a drop in your income if you take a vacation, for example.