Professional fees and neuromod

[pmr10]

Hello, I'm in a practice where about 50% of my collections goes towards overhead (tiered though so this drops down to about 30-40% if I produce enough).

I am interested in doing neuromodulation (PNS and SCS trials) in office. However, I was told that if I do this, the materials costs for the kits would come out of my professional fees. Is this common practice?

I was also told that if I do this in an ASC setting, the materials costs will not come out of my professional fees. But of course, the professional fees are substantially lower.

Any advice is much appreciated! A situation like this was never explicitly stated in my contract.

Thanks!

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[Agast]

How much are they charging for the kit? You should make about $3500 for placing 2 leads in office for a Medicare patient. Profit margin favors in-office trials

 

[Painologist]

Leads only cost about $100/piece. You come out very far ahead. Even if you add in materials (drapes, sutures, etc), not more than another $100.

 

[Analgesia108]

Agree about lead costs - If you have no ownership in the ASC, there wont be much left if they take it from your 'professional' ...
office is better

 

[callmeanesthesia]

I pay for my leads in office. Still comes out way ahead vs ASC. Tell the reps other doctors you know are getting the leads for $100 - Nevro told me $300 initially but I’d read on here $100, so I told them I knew other doctors were paying $100. They had me sign some form to request a price match.

 

[pmr10]

Thank you everyone. PNS in particular is not very profitable - especially SPRINT, in the office setting. Nalu trials look really good from a reimbursement standpoint since the leads are quite cheap. Is that consistent what people are experiencing?

 

[pmr10]

Agree about lead costs - If you have no ownership in the ASC, there wont be much left if they take it from your 'professional' ...
office is better

Yeah definitely. I'm still early on so trying to build up credibility for ASC shares in the future so figure doing these in the ASC isn't a bad thing (especially for SCS). PNS, though, might be a different thing altogether since the SPRINT kits are quite pricey.

 

[drusso]

The juice/Vig is on the facility fee side for implants. The manufacturers design their pricing models for the highest-paying site of service (SOS). So, it would help if you focus Zen-like concentration on getting a piece of that action. If you're in a HOPD you're going to have to play a game of chicken with some night-school MBA/state-school sociology major hospital admin about explaining your Physician Enterprise Value as justification for more juice on your comp. Implants print money for hospitals and you're nobody's hoe.

 

[geauxg8rs]

The juice/Vig is on the facility fee side for implants. The manufacturers design their pricing models for the highest-paying site of service (SOS). So, it would help if you focus Zen-like concentration on getting a piece of that action. If you're in a HOPD you're going to have to play a game of chicken with some night-school MBA/state-school sociology major hospital admin about explaining your Physician Enterprise Value as justification for more juice on your comp. Implants print money for hospitals and you're nobody's hoe.

This is when they like to invoke anti kickback… we can’t legally overpay… blah blah blah

 

[SpineandWine]

Hello, I'm in a practice where about 50% of my collections goes towards overhead (tiered though so this drops down to about 30-40% if I produce enough).

I am interested in doing neuromodulation (PNS and SCS trials) in office. However, I was told that if I do this, the materials costs for the kits would come out of my professional fees. Is this common practice?

I was also told that if I do this in an ASC setting, the materials costs will not come out of my professional fees. But of course, the professional fees are substantially lower.

Any advice is much appreciated! A situation like this was never explicitly stated in my contract.

Thanks!

There is no such thing for office procedures as “professional fees”- it’s billed as lump sum.
Very odd that it comes out of prof fees in ASC unless you collect facility- makes only sense to do it in office then.

Re cost, depending on volume of practice, can negotiate it to almost free for leads/kit- they make most of their money on implants

 

[drusso]

This is when they like to invoke anti kickback… we can’t legally overpay… blah blah blah

 

[Ferrismonk]

This is when they like to invoke anti kickback… we can’t legally overpay… blah blah blah

While technically true, there are a million ways to get paid by the hospital in non-direct ways. Do they need a medical director of something somewhere? How about a bonus for something "extra" that you did for the company? Speaking fees? As long as it's not a you-did-this-billing-so-we-pay-you-this arrangement, you're likely fine.

 

[SgtThunderfistMD]

Just trying to understand this as I am HOPD employed and may be negotiating my next contract soon. If I try to say I deserve more $/RVU because they are making more in PEV/facility fees, they can say that violates anti-kickback? Then I counter saying there are more creative ways to increase my compensation to be more concordant with my overall value to the hospital?

 

[drusso]

Just trying to understand this as I am HOPD employed and may be negotiating my next contract soon. If I try to say I deserve more $/RVU because they are making more in PEV/facility fees, they can say that violates anti-kickback? Then I counter saying there are more creative ways to increase my compensation to be more concordant with my overall value to the hospital?

Correct. They will tell you that there are all kinds of reasons why they can't pay your more money--Stark, Kickback, etc. These are all BS excuses. They can't pay you more on VOLUME for what you do, but they can pay you because you're a great gal. They can pay you because they have a big heart. They can pay you more because they respect and honor you. They need to pay you more and pay you differently.

 

[BobBarker]

Make sure you are being compensated for supervising the midlevels first. That is the path of least resistance if you are
not currently. Do not accept something paltry like $5000.

 

[DrMDAware]

My unsolicited advice is to make sure they pay you in a way that doesn’t make you have a big shiny target on your back for jealous people. For example, I know people who have an average salary - or so it seems. Thing is on the back end they have what Drusso is referring to and that’s some extra pay. Maybe the money goes (legally) into a column that others don’t see. This is the way.

 

[drusso]

Just trying to understand this as I am HOPD employed and may be negotiating my next contract soon. If I try to say I deserve more $/RVU because they are making more in PEV/facility fees, they can say that violates anti-kickback? Then I counter saying there are more creative ways to increase my compensation to be more concordant with my overall value to the hospital?

Please be aware that there are only two ways any employer can pay you: They can pay you to work, and they can pay you NOT to work.

The "pay you to work" component is the regulated part of compensation. They have to pay to work within various parameters be they MGMA, Fair Market, RVU, etc.

The "pay you NOT to work" component is the wild west. There are no regulations on how they can pay you NOT to work. Ask the for the moon.

 

[DoYouEvenLiftBro]

On this same note, our PP contract is 50/50 but turns out they slipped in this “technical component” “TC” for in office fluoro procedures

So instead of 50/50, the employer takes anywhere from 50-82% off the top for the TC then we split 50/50 after that. We caught that scs was trial was 80% and asked them to take that off, which they did. Fluoro hip was 82% so now just do everything US etc

The TC per month for us come out to 7-20k depending on the month and we feel that should be split with us

I know there’s a TC for asc/hopd have you ever heard about applying that for in office? We’re thinking it’s a “carve out” and want to renegotiate (also, all of our lawyers missed this, they said it was some fancy foot work wording….)

 

[GoBeers]

On this same note, our PP contract is 50/50 but turns out they slipped in this “technical component” “TC” for in office fluoro procedures

So instead of 50/50, the employer takes anywhere from 50-82% off the top for the TC then we split 50/50 after that. We caught that scs was trial was 80% and asked them to take that off, which they did. Fluoro hip was 82% so now just do everything US etc

The TC per month for us come out to 7-20k depending on the month and we feel that should be split with us

I know there’s a TC for asc/hopd have you ever heard about applying that for in office? We’re thinking it’s a “carve out” and want to renegotiate (also, all of our lawyers missed this, they said it was some fancy foot work wording….)

straight up sounds like sneaky BS

 

[mid|ine]

I'm getting Boston Infinium for $50/lead and Medtronic for less then that. The leads are not a significant cost for in office trials. There is more overall profit in an ASC, but the owners of the ASC make that profit.

 

[pmr10]

Would really appreciate some insight here from the hive.

1) What are the facility fees for two level lumbar RFA and two level cervical RFA are at the ASC?

2) Also, what is the facility fees are for two PNS leads (64555 x2) in the ASC?

I'm trying to figure out if it makes financial sense to do more peripheral nerve stimulation as opposed to RFA.

I see the pros and cons of both, but I'm just wondering if it makes a difference from the revenue standpoint.

From a pro fee standpoint, PNS with two leads seems to generate more than two level RFA.

Thank you in advance!

 

[Billy Jack]

Thank you everyone. PNS in particular is not very profitable - especially SPRINT, in the office setting. Nalu trials look really good from a reimbursement standpoint since the leads are quite cheap. Is that consistent what people are experiencing?

It’s designed to only work in the HOPD.

 

[Ducttape]

Would really appreciate some insight here from the hive.

1) What are the facility fees for two level lumbar RFA and two level cervical RFA are at the ASC?

2) Also, what is the facility fees are for two PNS leads (64555 x2) in the ASC?

I'm trying to figure out if it makes financial sense to do more peripheral nerve stimulation as opposed to RFA.

I see the pros and cons of both, but I'm just wondering if it makes a difference from the revenue standpoint.

From a pro fee standpoint, PNS with two leads seems to generate more than two level RFA.

Thank you in advance!

you can look at the ASIPP numbers to what medicare pays, and then add accordingly.

Fee Schedules - American Society of Interventional Pain Physicians

2021 to 2023 Fee Schedules 2023 Proposed Physician Fee Schedule | IPM Codes 2023 Proposed ASC Fee Schedule | IPM Codes 2023 Proposed HOPD Fee Schedule | IPM Codes 2022 Final Physician … Fee Schedules Read More »

asipp.org

imo, what you should be determining is not what pays better but what is the more appropriate treatment for a patient.

 

[Orin]

It’s designed to only work in the HOPD.

That's really more for specific to SPR/Bioventus pricing.

Nalu/Curonix are more like conventional SCS pricing with the IPG code adding on revenues. Their trial hardware isn't pricey.