Gasworks Job of the week.

[Justice4all]

That’s why it’s important to rotate call and pick your own cases. And ortho trauma ends up being some of our best lineups because of the blocks.

Does the block increase the case value significantly? Sorry to sound like a newb

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[nimbus]

Does the block increase the case value significantly? Sorry to sound like a newb

Yes, significantly.

For example an ankle fracture is worth 3 base units. However, an adductor canal saphenous nerve block adds 7 units, a popliteal sciatic nerve block adds 7 units, and ultrasound guidance adds 2 units to each block. So you end up going from 3 startup units to 21.

 

[AdmiralChz]

That’s why it’s important to rotate call and pick your own cases. And ortho trauma ends up being some of our best lineups because of the blocks.

Really? Our ortho trauma is a lot of government insurance and self-pay. We don’t do many blocks bc those specific docs always argue/worry about neurovascular compromise. It’s a lot of intertrochs and hemis though so N/A.

Our surgeons are nice but exceptionally slow, and often work well into the night. It’s a pretty miserable room.

It wouldn’t make a huge difference in that poor paying population anyway. In states like California with miserable government insurance it would be even worse. Plus if you are doing cases under block as the intraoperative anesthetic you can’t double-bill. Unless you claim it’s a GA and the block is done for post op pain management (what most do).

 

[nimbus]

Really? Our ortho trauma is a lot of government insurance and self-pay. We don’t do many blocks bc those specific docs always argue/worry about neurovascular compromise. It’s a lot of intertrochs and hemis though so N/A.

We are pooled unit so payor doesn’t matter and our ortho trauma docs love blocks.

 

[AdmiralChz]

We are pooled unit so payor doesn’t matter and our ortho trauma docs love blocks.

Not everywhere is averaging out units, unfortunately. Especially for new hires.

 

[nimbus]

Our surgeons are nice but exceptionally slow, and often work well into the night. It’s a pretty miserable room.

Ours are nice and not fast either. Plus they have good taste in music. So I pick their room at every opportunity. Once they are blocked and asleep (because slow) they are chill cases just clocking units.

 

[deleted162650]

ultrasound guidance adds 2 units to each block.

They’ll only pay you the U/S guidance fee once even if used for 2 separate blocks.

 

[nimbus]

They’ll only pay you the U/S guidance fee once even if used for 2 separate blocks.

I don’t know. My group is pretty conservative in awarding USG units. For example we can’t and don’t get credit for 76942 with our tap blocks. But we still get credit for 76942 for each of the peripheral blocks. When enough payors stop paying for each of those, I’m sure we’ll get a memo saying we can only bill 76942 once.

 

[chocomorsel]

That’s why it’s important to rotate call and pick your own cases. And ortho trauma ends up being some of our best lineups because of the blocks.

Only way to make it fair

 

[Mman]

Only way to make it fair

the fairest way of all is to split the call and workload evenly and then split the money evenly

 

[Hoya11]

the fairest way of all is to split the call and workload evenly and then split the money evenly

thats what we do

 

[deleted162650]

the fairest way of all is to split the call and workload evenly and then split the money evenly

The problem with that is that it disincentivizes production and lends to people trying to do as little as possible during the day. It also doesn’t account for differences in daily schedule intensity. Sure it usually averages out over time, unless you have a few select people doing the schedule and playing favorites.

 

[dchz]

Not everywhere is averaging out units, unfortunately. Especially for new hires.

the fairest way of all is to split the call and workload evenly and then split the money evenly

The problem with that is that it disincentivizes production and lends to people trying to do as little as possible during the day. It also doesn’t account for differences in daily schedule intensity. Sure it usually averages out over time, unless you have a few select people doing the schedule and playing favorites.

If one wants to game the system, one can do so no matter the system. After all these are people that have been through medical school. Kinda LOL to me. But once that person is in my group. It won't be so funny anymore.

Those of you in large groups. How many bad apples does it take to ruin a system? 1%? 15%? 50%?

 

[chocomorsel]

the fairest way of all is to split the call and workload evenly and then split the money evenly

Splitting workload completely evenly is hard to do. You never know what kinda cases arise.
However splitting the call evenly is easy. And making the call person have first dibs on the rooms makes it fair. The call person can have the room with the most units. Then the money gets pooled regardless of insurance then paid out.

 

[deleted162650]

If one wants to game the system, one can do so no matter the system. After all these are people that have been through medical school. Kinda LOL to me. But once that person is in my group. It won't be so funny anymore.

Those of you in large groups. How many bad apples does it take to ruin a system? 1%? 15%? 50%?

Yes, any system can be gamed. That part is true. Certain systems however, can be more easily and thoroughly gamed than others.

Having quality partners will always be more important than the specific system your group chooses to run.

How many it takes to ruin the system is a complicated problem. It’s going to depend on the size of the group and the system in question. There’s only so much damage one can do in a blended unit eat what you kill system where everyone gets to pick their lineup for the day (and you have to get really creative to do it - but it’s still possible). Even then, 5% bad apples gets really annoying. Now take a system like Mman’s where there’s just one bad apple, but he’s the one writing the schedule everyday, and that can be enough to make it completely miserable.

 

[Mman]

Splitting workload completely evenly is hard to do. You never know what kinda cases arise.
However splitting the call evenly is easy. And making the call person have first dibs on the rooms makes it fair. The call person can have the room with the most units. Then the money gets pooled regardless of insurance then paid out.

We are an ACT practice so everybody has multiple rooms and over years and decades the workload averages out as evenly as possible. If someone is sitting around with nothing to do, they get to pick up another room. If somebody else is overwhelmed and busy they can pawn one off. And everybody shares in making the daily schedule.

 

[deleted162650]

And everybody shares in making the daily schedule.

That part is key to making it fair.

 

[caligas]

That part is key to making it fair.

but what about a group of 50? Can’t have 50 schedulers.

 

[chocomorsel]

but what about a group of 50? Can’t have 50 schedulers.

Why not? Or you train a secretary to group the cases and then have the call taker take the room with the most unit.
Hopefully secretary doesn’t get corrupted but if the schedule is transparent, people can see.

 

[Southpaw]

but what about a group of 50? Can’t have 50 schedulers.

the group can vote on 4-5 schedulers and replace them if there is perceived unfairness.

 

[Southpaw]

I’ve worked in RVU blended unit - it’s a great model provided everyone is fair (no abuse and no consistent silly request nonsense which puts the senior guys in high RVU rooms all the time). I’ve also worked in the communist model (one big pot and everyone takes an equal share). It’s fine. Again all the partners need to be of similar mindset because there’s no doubt the communist model incentivizes working as little as possible.

there’s no perfect model - groups (especially PP) just need to be selective and make sure they’re recruiting the right people. If they do that it doesn’t matter what the model is, all will be fine.

 

[deleted162650]

but what about a group of 50? Can’t have 50 schedulers.

Can have the call guy make the schedule, or can have each person pick according to their spot in the call lineup (that's a little cumbersome with a big group). Or as mentioned above, have a small group of schedulers, or even one guy is fine provided he is a standup guy, and can replaced by vote at any time.

 

[Arch Guillotti]

If someone is sitting around with nothing to do, they get to pick up another room. If somebody else is overwhelmed and busy they can pawn one off. And everybody shares in making the daily schedule.

That's great until you have a partner who doesn't pick up cases. If you have a board runner who can force the issue that's one thing but we all know the guy who absolutely won't do more work than necessary.

 

[coffeebythelake]

That's great until you have a partner who doesn't pick up cases. If you have a board runner who can force the issue that's one thing but we all know the guy who absolutely won't do more work than necessary.

You've described academics perfectly

 

[Arch Guillotti]

You've described academics perfectly

Been there done that. Happens in PP also. Not uncommonly an old fart.

 

[nimbus]

That's great until you have a partner who doesn't pick up cases. If you have a board runner who can force the issue that's one thing but we all know the guy who absolutely won't do more work than necessary.

Been there done that. Happens in PP also. Not uncommonly an old fart.

That’s one of the upsides of eat what you kill. Everyone has different priorities. Some want to go home as early as possible every day. Others want to maximize their income. With the right mix of people, it can be very harmonious with everybody getting what they want.

 

[Mman]

That's great until you have a partner who doesn't pick up cases. If you have a board runner who can force the issue that's one thing but we all know the guy who absolutely won't do more work than necessary.

nobody has the option of not doing the work. I mean you'd pretty much be out of work by the weekend. All for one and one for all means if you don't play by the rules you will immediately be dealt with. I mean why would someone else take your rooms to ever let you go home if you won't do the same?

 

[Arch Guillotti]

I mean why would someone else take your rooms to ever let you go home if you won't do the same?

Great question!

 

[chocomorsel]

We are an ACT practice so everybody has multiple rooms and over years and decades the workload averages out as evenly as possible. If someone is sitting around with nothing to do, they get to pick up another room. If somebody else is overwhelmed and busy they can pawn one off. And everybody shares in making the daily schedule.

You can’t Havel lazy people in a practice like this. Plenty will try to game the system and act “overwhelmed” and have reasons whey they can’t pick up a room and always want to go home early. Some adults just want to shirk responsibility and do as little as they can get away with. I have experienced being dumped on. Not fun.

 

[vector2]

You can’t Havel lazy people in a practice like this. Plenty will try to game the system and act “overwhelmed” and have reasons whey they can’t pick up a room and always want to go home early. Some adults just want to shirk responsibility and do as little as they can get away with. I have experienced being dumped on. Not fun.

Only way to do it is late person and/or board runner gets to be dictator for the day and MDs pick up whatever rooms they’re told to. As the day winds down, people get relieved in a specified order at a specified time assuming rooms are breaking at a normal clip. And if everyone is rotating through all the daily positions, eventually the workload will balance itself out.