HOPD Employee- How busy?

[PainApp2021]

Hi everyone,

I am looking into an employed position at a community hospital. They do not currently have a pain department and I would be helping to establish it. I was told by the CEO that there would be no difficulty filling my clinic with spine pain and filling two days for procedures. I want to provide the best patient care, but at the same time I am willing to hustle and work hard. They told me they would do all the marketing for me (put me on billboards, TV, etc) in the community and drive patients from other clinics to me. While this sounds great, I am a little worried that it might not be the patient greatest type of patient. I will be expected to do some medication management, but was told it would be a "small" part of my clinic.

What is the best way to sus this place out and find out if it will actually be a good place to work? It's an underserved location and I would be one of the few fellowship trained pain docs in a large area.

Thanks for any advice

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[BobBarker]

You can be very busy and make it how you want. But most of us live/work the way I do. Plus/minus 10%. Here is how my typical day goes. Hope it provides you the info you need.

Roll in at 9:45 for 9:00 clinic in my mid series BMW. See my 3 patients that have been waiting on me, see 7 more by noon. Was hoping for about 5 no shows, but not today. Go to the hospital for lunch. Panini and sushi. Delicious as always. Get a plastic sack and fill it up with bottled drinks, hummus, sushi, and snacks for home. Run that home and play with the dog for an hour. Show up
at the hospital for 1:00 procedures at 1:30. Patient still not ready. Which is understandable since we only have 11 RN’s, 3 scrub techs, and 2 rad techs assigned to this area today. Knock out 6 procedures by 4:30. One was even a CESI! I could tell the staff was nervous since the other doc typically takes an hour on his. Total procedure time: 18 minutes, total web browsing time: a lot. Home by 5. Give hospital VP a ring on the way home and negotiate a nice monthly stipend for myself for medically supervising the PT department. That will cut into my web browsing time .01% but it will be worth it. Say hi to the wife and kids. But get suited up for an important meeting. The wife is so proud of me and she understands I have a lot of things going on. Off to Morton’s to hear about Zilretta. Home by 10. Bring my wife a dessert home that has melted into a puddle and she throws out. She has been doing keto for a year and I knew she wouldn’t eat it anyways but it is all about optics. Did notice 5 empty white claws in the trash outside that weren’t there at lunch, however. Rinse and repeat the next day. Probably take my lifted truck in tomorrow. The new StimWave rep is supposed to swing by and I hear she is just out of college.

 

[PainApp2021]

You can be very busy and make it how you want. But most of us live/work the way I do. Plus/minus 10%. Here is how my typical day goes. Hope it provides you the info you need.

Roll in at 9:45 for 9:00 clinic in my mid series BMW. See my 3 patients that have been waiting on me, see 7 more by noon. Was hoping for about 5 no shows, but not today. Go to the hospital for lunch. Panini and sushi. Delicious as always. Get a plastic sack and fill it up with bottled drinks, hummus, sushi, and snacks for home. Run that home and play with the dog for an hour. Show up
at the hospital for 1:00 procedures at 1:30. Patient still not ready. Which is understandable since we only have 11 RN’s, 3 scrub techs, and 2 rad techs assigned to this area today. Knock out 6 procedures by 4:30. One was even a CESI! I could tell the staff was nervous since the other doc typically takes an hour on his. Total procedure time: 18 minutes, total web browsing time: a lot. Home by 5. Give hospital VP a ring on the way home and negotiate a nice monthly stipend for myself for medically supervising the PT department. That will cut into my web browsing time .01% but it will be worth it. Say hi to the wife and kids. But get suited up for an important meeting. The wife is so proud of me and she understands I have a lot of things going on. Off to Morton’s to hear about Zilretta. Home by 10. Bring my wife a dessert home that has melted into a puddle and she throws out. She has been doing keto for a year and I knew she wouldn’t eat it anyways but it is all about optics. Did notice 5 empty white claws in the trash outside that weren’t there at lunch, however. Rinse and repeat the next day. Probably take my lifted truck in tomorrow. The new StimWave rep is supposed to swing by and I hear she is just out of college.

I feel like I've read this before

 

[BobBarker]

No, it is different. 😂

 

[Ronin1]

You need to make some firm parameters in what you are willing to see and or prescribe. Just say no when indicated. Use the CDC guidelines to set limits if pushed by administrators. I just had one slip through the screening process who wanted me to take over his meds, 30mg oxy q4, Xanax, soma. I just told him that’s not the way we would treat him and if he came to us we would initiate a weaning protocol and get rid of benzodiazepines and soma. Magically he went elsewhere…

 

[PainApp2021]

The reimbursement was guaranteed salary around 350k plus productivity. The productivity quoted to me was roughly $100/wRVU for 3800-4200wRVU, $70/wrvu 4200-5200wRVU, and $60/wRVU above that. One of my biggest questions is what is the best way I can determine if I will have enough volume to get 10k wRVUs? Also the decreasing price per wRVU disincentivizes me from being more productive. Is there a tactful way to negotiate a change in that?

 

[buddababa]

The reimbursement was guaranteed salary around 350k plus productivity. The productivity quoted to me was roughly $100/wRVU for 3800-4200wRVU, $70/wrvu 4200-5200wRVU, and $60/wRVU above that. One of my biggest questions is what is the best way I can determine if I will have enough volume to get 10k wRVUs? Also the decreasing price per wRVU disincentivizes me from being more productive. Is there a tactful way to negotiate a change in that?

this is terrible structure. incentive wrvu dollar rate should go up the more you do, not go down.
Just ask them for a flat wrvu dollar rate no matter how much you do

 

[DODOCSS]

The reimbursement was guaranteed salary around 350k plus productivity. The productivity quoted to me was roughly $100/wRVU for 3800-4200wRVU, $70/wrvu 4200-5200wRVU, and $60/wRVU above that. One of my biggest questions is what is the best way I can determine if I will have enough volume to get 10k wRVUs? Also the decreasing price per wRVU disincentivizes me from being more productive. Is there a tactful way to negotiate a change in that?

great deal. at 10,000wrvu = $78.8/wrvu

 

[Ducttape]

It is a little deceiving. At less than 4800 rvus, the base salary is in play. So very high $/wRVU

To your question, you can figure it out by assuming 10,000 wRVU over roughly 260 days, minus however many days off you want. I would suggest that 230 is a decent number (5 holiday days, 20 days vacation -ie 4 weeks - and 1 week cme).

Comes out to 43 wRVUs per day.

Assuming most of what we do is roughly 1.8 wrvu per encounter, that would be 24 encounters per day. Given a 10% no show rate (esp if high Medicaid), you should be scheduling roughly 27 people a day. At 8 hours, 15 min per appt. 8 to 5 with 1 hour lunch.

 

[Analgesia108]

Ensure there is no non-compete & I agree with a higher fixed $/wRVU than an inverse slab structure

 

[Ferrismonk]

I would be very clear about your medication management agreement. I 100% guarantee that the hospital marketers will tell the area PCPs you'll take over "all their pain management needs".

 

[RoloTomassi]

RVU rate should go up not down

 

[cowboydoc]

No, it is different. 😂

Still GOLD!

 

[cowboydoc]

The reimbursement was guaranteed salary around 350k plus productivity. The productivity quoted to me was roughly $100/wRVU for 3800-4200wRVU, $70/wrvu 4200-5200wRVU, and $60/wRVU above that. One of my biggest questions is what is the best way I can determine if I will have enough volume to get 10k wRVUs? Also the decreasing price per wRVU disincentivizes me from being more productive. Is there a tactful way to negotiate a change in that?

We've gone over this before, but with this structure, you're in good shape, at least from a financial standpoint. It's silly, but you are going to make decent money, or good money if you get somewhat busy. I'd try to get a flat rate RVU, or escalating, not decreasing. In this model, make sure you handle your own schedule. If you're expected to keep "full" hours, it sounds like a VA job. It otherwise looks like a job that could be done in 2-3 days a week by an average doc. (Or just on Mondays if you're @BobBarker)

If there aren't currently any pain physicians associated with the hospital or in the area, it should be pretty easy to get busy. I'd market directly to PCPs/surgeons, not the public with billboards, etc. I can't imagine having difficulty finding enough patients to fill what you'd be incentivized to see.

 

[macman]

You can be very busy and make it how you want. But most of us live/work the way I do. Plus/minus 10%. Here is how my typical day goes. Hope it provides you the info you need.

Roll in at 9:45 for 9:00 clinic in my mid series BMW. See my 3 patients that have been waiting on me, see 7 more by noon. Was hoping for about 5 no shows, but not today. Go to the hospital for lunch. Panini and sushi. Delicious as always. Get a plastic sack and fill it up with bottled drinks, hummus, sushi, and snacks for home. Run that home and play with the dog for an hour. Show up
at the hospital for 1:00 procedures at 1:30. Patient still not ready. Which is understandable since we only have 11 RN’s, 3 scrub techs, and 2 rad techs assigned to this area today. Knock out 6 procedures by 4:30. One was even a CESI! I could tell the staff was nervous since the other doc typically takes an hour on his. Total procedure time: 18 minutes, total web browsing time: a lot. Home by 5. Give hospital VP a ring on the way home and negotiate a nice monthly stipend for myself for medically supervising the PT department. That will cut into my web browsing time .01% but it will be worth it. Say hi to the wife and kids. But get suited up for an important meeting. The wife is so proud of me and she understands I have a lot of things going on. Off to Morton’s to hear about Zilretta. Home by 10. Bring my wife a dessert home that has melted into a puddle and she throws out. She has been doing keto for a year and I knew she wouldn’t eat it anyways but it is all about optics. Did notice 5 empty white claws in the trash outside that weren’t there at lunch, however. Rinse and repeat the next day. Probably take my lifted truck in tomorrow. The new StimWave rep is supposed to swing by and I hear she is just out of college.

spot on

 

[drusso]

Hi everyone,

I am looking into an employed position at a community hospital. They do not currently have a pain department and I would be helping to establish it. I was told by the CEO that there would be no difficulty filling my clinic with spine pain and filling two days for procedures. I want to provide the best patient care, but at the same time I am willing to hustle and work hard. They told me they would do all the marketing for me (put me on billboards, TV, etc) in the community and drive patients from other clinics to me. While this sounds great, I am a little worried that it might not be the patient greatest type of patient. I will be expected to do some medication management, but was told it would be a "small" part of my clinic.

What is the best way to sus this place out and find out if it will actually be a good place to work? It's an underserved location and I would be one of the few fellowship trained pain docs in a large area.

Thanks for any advice

The people who get you here won't get you there.

When re-negotiating, you'll be negotiating with people with no skin in the game. You're fungible to them.

"They'll never love you back." Why are they paying you less to do more? Why would a decent person do that?

Who can you fire?

What's the non-compete?

Corona trigger? What happens if Congress passes a site-neutral payment bill?

 

[nvrsumr]

there will never be site neutral payment @drusso

Control is more important than cost

 

[drusso]

there will never be site neutral payment @drusso

Control is more important than cost

…all it takes is an Executive Order. Elections have consequences…

 

[Timeoutofmind]

The reimbursement was guaranteed salary around 350k plus productivity. The productivity quoted to me was roughly $100/wRVU for 3800-4200wRVU, $70/wrvu 4200-5200wRVU, and $60/wRVU above that. One of my biggest questions is what is the best way I can determine if I will have enough volume to get 10k wRVUs? Also the decreasing price per wRVU disincentivizes me from being more productive. Is there a tactful way to negotiate a change in that?

Very, very excellent offer

10K RVU is a lot, you prob wont do that for several years if at all. And I dont know who wants to work that hard anyway. Not me.
7K RVU is a decent amount of work and quite manageable. On this contract they will pay you 600K. And you will get good bennies etc being employed, so maybe total comp around 650-700K.

Yes the $/RVU decreases with increasing RVUs, but in the big picture, as I typed above, the total $/RVU, even at high amounts of RVUs, is still well above national average (you are getting around $85 per RVU).

 

[painballer27]

10K RVU is a lot, you prob wont do that for several years if at all. And I dont know who wants to work that hard anyway.

Is it a lot though? I get that it takes several years to work up to, but some people here say they hit those numbers on a four day work week without too much trouble

 

[cowboydoc]

Is it a lot though? I get that it takes several years to work up to, but some people here say they hit those numbers on a four day work week without too much trouble

Not everyone runs a 4 minute mile. I double my partner’s output and some here are probably twice as fast as me. I feel I’m average or below in terms of efficiency. 9000-10000 rvu at 4-4.5 days is where I’ve settled in 8 years of practice. I worked harder to do 6-7k my first 2 years.

The wildcard with employed position is whether you have a say in the flow/staffing. I’ve become more assertive to make it work for me, and it’s made a huge difference. That wouldn’t work everywhere. I’d be labeled disruptive if I didn’t make them so much money.

 

[Ducttape]

there is a reason why 10k is not the median of HOPD physicians - it isnt easy to do.

just consider the hypothetical numbers you need to do - averaging 24 patients a day if you are doing primarily bread and butter pain - is quite a bit. mixing in big ticket procedures at a fast pace makes it easier to reach numbers, but you will still need fairly high volumes.

a block shop should have little issues making that kind of volume. if your patients are not interested, it gets a lot harder.

 

[clubdeac]

Very, very excellent offer

10K RVU is a lot, you prob wont do that for several years if at all. And I dont know who wants to work that hard anyway. Not me.
7K RVU is a decent amount of work and quite manageable. On this contract they will pay you 600K. And you will get good bennies etc being employed, so maybe total comp around 650-700K.

Yes the $/RVU decreases with increasing RVUs, but in the big picture, as I typed above, the total $/RVU, even at high amounts of RVUs, is still well above national average (you are getting around $85 per RVU).

so now I'm confused. in the MGMA and AMGA data, do the average $/wRVUs that we see include benefits? I thought it was just the straight $/wRVU value that is in one's contract and what one gets paid, not factoring in benefits. Everyone polled in the surveys would have to do some mental math to figure out their $/wRVU if that number included bennies. I for one have no idea what that number would be if I included all my benefits

 

[Ducttape]

it is not supposed to include benefits.

admin adds that in to justify low wRVU rates particularly in the NE.