Hospital asking me to sign an amendment based on 2022 CMS physician fee schedule...help?

[dillonkor]

I need your collective wisdom about how to respond to my HOPD employer decreasing wRVU based on the proposed 2022 CMS physician fee schedule which was announced back in July.

In short, midwest, HOPD of a large system, wRVU at 25 percentile with target wRVU of 8000 before generating bonus. Not perfect but I am the only FT pain guy at this HOPD, am my own "boss" with a comfortable 3-year guaranteed base salary, my wife liked the town, and it is my first job out of fellowship.

Although I just signed the contract earlier this year, the hospital is now asking me to sign an amendment to decrease wRVU by 10% effective January 1. The argument presented to me was that # of RVUs for pain medicine will increase and thus despite the decreased $/wRVU, things will actually improve for me. They specifically mention that $/wRVU payrates were below others…and the goal of the amendment is to "ensure a market based pay rate.” The email also mention how they are pleased to bring this news to me.

To me, it only seems like a 10% cut in pay, and I am less pleased to work any more than I have to. But maybe I'm missing something!

1. I can't find any source saying that # of RVUS for pain medicine will increase overall. Any ideas what this is about?
2. With the 2022 CMS fee schedule, do you anticipate increase or decrease in revenue? I didn't think it was changing much at all for pain.
3. How would you negotiate in this situation? Leaving the job for another is NOT an immediate option. I was thinking about mentioning how their wRVU was below average to start with, and it's making things worse, blahblah. But I am trying to think of a more effective way to help them feel like it's a win-win for both parties not to do this to me.

Looking forward to your wisdom

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[Ducttape]

is your lawyer involved?

if you signed a contract good for 3 years, then I would have the lawyer contact hospital admin stating that the contract was for 3 years and that you are committed to fulfilling the contract as it stands.

what they are saying is speculative and $25/wRVU is pretty crappy (but remember that is for the bonus - a lot depends on your base salary and roughly how many $/wRVU you get until you hit that 8000 base)

 

[callmeanesthesia]

Have a lawyer familiar with hospital contract negotiation draft a response for you. Best case they turn tail or come back with a better response. Worst case they threaten to terminate you for being a bad team player, and you can blame any harsh words in your response on the lawyer. Know you are worth way more to them than they are letting on though.

 

[DOctorJay]

go read "Never Split the Difference" right now

ask them to share evidence of the information they are giving you -
"It sounds like you're fairly certain my wRVUs will increase next year. Would you be opposed to sharing the source of that information with me in writing?" Play the long game and take your time. There's no rush for you assuming this is the first year of this 3 year contract. Do not let them push arbitrary deadlines on you to sign anything.

what do you mean "wRVU at 25th percentile"? is that what you're currently producing at? have they expressed any concerns with your productivity?

8,000 wRVUs is about 65th percentile productivity. your base would need to be exceptionally strong to not bonus until you hit that number.

If you're the only doc there they stand a lot to lose from facility fees if you walk. I also agree with Ducttape, have your lawyer contact them regarding fulfilling your contract. don't sign anything they hand you until you review it with your lawyer.

convert everything to $/wRVU to get a real grasp of what they're suggesting

 

[ziggyziggy]

I need your collective wisdom about how to respond to my HOPD employer decreasing wRVU based on the proposed 2022 CMS physician fee schedule which was announced back in July.

In short, midwest, HOPD of a large system, wRVU at 25 percentile with target wRVU of 8000 before generating bonus. Not perfect but I am the only FT pain guy at this HOPD, am my own "boss" with a comfortable 3-year guaranteed base salary, my wife liked the town, and it is my first job out of fellowship.

Although I just signed the contract earlier this year, the hospital is now asking me to sign an amendment to decrease wRVU by 10% effective January 1. The argument presented to me was that # of RVUs for pain medicine will increase and thus despite the decreased $/wRVU, things will actually improve for me. They specifically mention that $/wRVU payrates were below others…and the goal of the amendment is to "ensure a market based pay rate.” The email also mention how they are pleased to bring this news to me.

To me, it only seems like a 10% cut in pay, and I am less pleased to work any more than I have to. But maybe I'm missing something!

1. I can't find any source saying that # of RVUS for pain medicine will increase overall. Any ideas what this is about?
2. With the 2022 CMS fee schedule, do you anticipate increase or decrease in revenue? I didn't think it was changing much at all for pain.
3. How would you negotiate in this situation? Leaving the job for another is NOT an immediate option. I was thinking about mentioning how their wRVU was below average to start with, and it's making things worse, blahblah. But I am trying to think of a more effective way to help them feel like it's a win-win for both parties not to do this to me.

Looking forward to your wisdom

No go amigos. Sorry for the bad news but It does not look like they are negotiating. If I were you, I will start looking today and delay this negotiating (harassments) as much as you can.

Do you really think that 10% cut in your pay is a big deal for a large hospital system?

 

[thecentral09]

Have a lawyer familiar with hospital contract negotiation draft a response for you. Best case they turn tail or come back with a better response. Worst case they threaten to terminate you for being a bad team player, and you can blame any harsh words in your response on the lawyer. Know you are worth way more to them than they are letting on though.

Agree EXACTLY with this

 

[sloh]

The argument presented to me was that # of RVUs for pain medicine will increase and thus despite the decreased $/wRVU, things will actually improve for me. They specifically mention that $/wRVU payrates were below others…and the goal of the amendment is to "ensure a market based pay rate.”

Blowing smoke up your ass.

 

[DOctorJay]

show them that the market rate is $70/wRVU for the MEDIAN

 

[SSdoc33]

i think it is safe to say that your hospital is trying to give you a crappy deal....

but you really don't have as much leverage as you think. it is easy for everyone on this forum to say to do XYZ, and if administration doesnt like it then you walk. reality is different. its not that easy to just up and leave, find a new job, changes houses, schools, etc.

also, if you are 1 year out, what is stopping administration from just hiring anew grad that will accept their conditions. i have found that many really dont care all that much about the actual numbers of dollar values attached to the facility fees. i know of many departments who don't even know how much each doc is bringing in with facility fees. in a big institution, those fees go into a big pot of money and then get divided up throughout the hospital system. if one particular doc is making a big salary, it sticks out -- regardless of how much they may be generating.

in an ideal world, you would be able to have a conversation with someone who can actually see the big picture. that may not be possible.

 

[chibadriver]

I signed an addendum on a service rate when I was just starting (straight fee for service)… took years and a lot of consternation between myself and admin to get back to what I should be earning. I agree with the idea that they should present you with data supporting their argument. Overtime, I’ve decided my services are worth my higher rate. We have excellent care scores and google reviews. If they don’t value that, I don’t wanna be there.

 

[drusso]

i think it is safe to say that your hospital is trying to give you a crappy deal....

but you really don't have as much leverage as you think. it is easy for everyone on this forum to say to do XYZ, and if administration doesnt like it then you walk. reality is different. its not that easy to just up and leave, find a new job, changes houses, schools, etc.

also, if you are 1 year out, what is stopping administration from just hiring anew grad that will accept their conditions. i have found that many really dont care all that much about the actual numbers of dollar values attached to the facility fees. i know of many departments who don't even know how much each doc is bringing in with facility fees. in a big institution, those fees go into a big pot of money and then get divided up throughout the hospital system. if one particular doc is making a big salary, it sticks out -- regardless of how much they may be generating.

in an ideal world, you would be able to have a conversation with someone who can actually see the big picture. that may not be possible.

1) It takes courage to stand up for what you believe in. If you're being undervalued, you should leave. Actions speak louder than words. They will never love you back.

2) They know. They pretend that they don't know. But, they do. They know what every doc's physician enterprise value is because they need to know in order to run their business.

3) They can pay whatever they want. It just comes down to motivation and incentives.

 

[dillonkor]

Update: They backed down, for now. I was able to avoid signing the addendum to my contract after having a meeting where I expressed my concerns. It seemed as though they really had no real understanding of how it was affecting my specialty and was just making a system-wide enforcement without giving individual considerations.

 

[drusso]

Update: They backed down, for now. I was able to avoid signing the addendum to my contract after having a meeting where I expressed my concerns. It seemed as though they really had no real understanding of how it was affecting my specialty and was just making a system-wide enforcement without giving individual considerations.

...they knew. It would be business negligence for them NOT to know. They have the data. Still, good job sticking to your guns. A shining example of what can happen when you realize, "they will never love you back..."

 

[dillonkor]

...they knew. It would be business negligence for them NOT to know. They have the data. Still, good job sticking to your guns. A shining example of what can happen when you realize, "they will never love you back..."

You may be right. To me, they came across as more of incompetent administrators who really had no idea than someone who knew and trying to falsify the negative impact as positive. Either way, it was concerning, and there is no guarantee that it won't happen again next year.

 

[SSdoc33]

You may be right. To me, they came across as more of incompetent administrators who really had no idea than someone who knew and trying to falsify the negative impact as positive. Either way, it was concerning, and there is no guarantee that it won't happen again next year.

they didnt know

"never attribute to malice that which is adequately explained by stupidity."
-Hanlon's razor

Hanlon's razor - Wikipedia

en.wikipedia.org

 

[lobelsteve]

they didnt know

"never attribute to malice that which is adequately explained by stupidity."
-Hanlon's razor

Hanlon's razor - Wikipedia

en.wikipedia.org

They always know.

Never attribute to stupidity that which is adequately explained by malice.
Lobel's razor.

 

[Ducttape]

there is no malice.

 

[kstarm]

This change in $ per wRVU was also presented to us (Large Hospital system). The argument is that there will be increased reimbursement for outpatient office visits and to "maintain neutrality" they want to decrease our wRVU rate. The increased reimbursement does not pertain to procedures or inpatient work. As was stated earlier in the thread there just seemed to be absolutely no clue on their part on how our practices differ throughout our department and that some people are 90% procedures and some are 100% office visits. Nothing has been finalized and talks are ongoing. I doubt this is going to turn out in our favor.

 

[lobelsteve]

This change in $ per wRVU was also presented to us (Large Hospital system). The argument is that there will be increased reimbursement for outpatient office visits and to "maintain neutrality" they want to decrease our wRVU rate. The increased reimbursement does not pertain to procedures or inpatient work. As was stated earlier in the thread there just seemed to be absolutely no clue on their part on how our practices differ throughout our department and that some people are 90% procedures and some are 100% office visits. Nothing has been finalized and talks are ongoing. I doubt this is going to turn out in our favor.

Same here.

 

[drusso]

This change in $ per wRVU was also presented to us (Large Hospital system). The argument is that there will be increased reimbursement for outpatient office visits and to "maintain neutrality" they want to decrease our wRVU rate. The increased reimbursement does not pertain to procedures or inpatient work. As was stated earlier in the thread there just seemed to be absolutely no clue on their part on how our practices differ throughout our department and that some people are 90% procedures and some are 100% office visits. Nothing has been finalized and talks are ongoing. I doubt this is going to turn out in our favor.

Don't fall for the "Bubbling Boss" trope. They know. They don't care. They will never love you back.

 

[lobelsteve]

99213 0.97 to 1.5
99214 1.50 to 1.92

Just ask them to pay you the same on these 2 codes as per prior.

 

[Pain Applicant1]

Didn't read all of the responses so sorry if I'm repeating but a contract is a contract. That's why you sign something as it gives some type of commitment for both parties. Their issues as a business have nothing to do with you unless there was a clause in the contract saying so.

If I signed a contract with my employee for three years then that's my commitment to her. I can't come back to her and ask her to sign an addendum so I can pay her less because my cost of goods increased or my revenue decreased. That's how business operates. I'm taking the risk of the unknown and she is not so I have to deal with it, not her. In turn, I make more money than her for, in part, assuming this risk.

Same in real estate, the lease commits the landlord with the tenant. If market forces change and the fair market value significantly fluctuates, I don't have to lower the rent for the tenant, nor can I raise it until the lease is due for renewal. The courts agree with this.

 

[DOctorJay]

We're stuck with last year's wRVU values for E&M codes

 

[buddababa]

same

We're stuck with last year's wRVU values for E&M codes

same

 

[bronx43]

We're stuck with last year's wRVU values for E&M codes

Did they say until when? Our academic institution adopted 2021 E&M rates, but then just said "ok, now your wRVU target is higher but your pay is the same."

There's currently an efflux of docs, needless to say.

 

[DOctorJay]

Did they say until when? Our academic institution adopted 2021 E&M rates, but then just said "ok, now your wRVU target is higher but your pay is the same."

There's currently an efflux of docs, needless to say.

likely for the rest of this fiscal year which ends for us June 30, 2022

 

[drusso]

Did they say until when? Our academic institution adopted 2021 E&M rates, but then just said "ok, now your wRVU target is higher but your pay is the same."

There's currently an efflux of docs, needless to say.

Nothing will change until more doctors vote with their feet and walk out the door. Actions speak louder than words.

 

[DOctorJay]

Nothing will change until more doctors vote with their feet and walk out the door. Actions speak louder than words.

yes, this is the only way

 

[bronx43]

Nothing will change until more doctors vote with their feet and walk out the door. Actions speak louder than words.

I think it has hit the threshold where being employed by a system is no longer worth it. Too many negatives, and now the positives are little to none.

 

[DrSpine]

I love the plethora of excuses they come up with. I just used to laugh at them in those meetings.

 

[cowboydoc]

We're stuck with last year's wRVU values for E&M codes

Us too until 1/1/22. I’ll be a half baller with that E&M juice 😁