Salary as percentage of billing…

[TeslaCoil]

Does anybody know what a good salary is to pay a pain physician in terms of a percentage of how much he or she is billing?

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[RoloTomassi]

Depends on the practice's fee schedule.

 

[runfastnow]

We charge 3x Medicare rate for everything. Collect ~40% of those charges on average. 45-50% overhead coming out of the collections based on productivity sliding scale. Sounds wretched but end up taking home ~20-22% of billing in my scenario.

 

[Magnus Acus]

We charge 3x Medicare rate for everything. Collect ~40% of those charges on average. 45-50% overhead coming out of the collections based on productivity sliding scale. Sounds wretched but end up taking home ~20-22% of billing in my scenario.

*resident* I can’t tell if this type model would be good or bad.. how much could a reasonably busy new grad expect to bill?

 

[runfastnow]

Impossible to tell how busy you can be without referral source, multiple factors, etc.

Bill $2mil (no idea what wRVUs that is) = $400-420k/yr not including other benefits.

 

[Bostonspine]

Is it common to pay based on billing vs collections? I think collects based pay incentivize completion of notes, document properly and bill correctly

 

[jsaul]

It's hard to pay on billing. Usually the practice willncollect 33 percent of your billings and they give you a percentage of that 33 percent

It's better to do a collections based model. Just get paid on what the practice collects for all your encounters. Some practices may pay you 40 percent of collections

 

[Dr. Ice]

The problem with the collections based model is that you are reliant on some entity tracking the collections and also have to deal with the rate limiting factor of whether or not the insurance companies actually pay, not to mention when they pay and how much AR the practice accumulates over time.

I’ve been collections/productivity based for years and frankly am kind of fed up with it. Now I know why docs work in an rvu model . Where I live, there is a large multi-specialty group with VC backing that function with rvu payment system. Most of the docs seem pretty pleased overall with management and payment. It’s basically like working in a private practice with hospital payment structure. Can practice how you want without having to deal with bs.

I find it absurd that with good billing practices, I can bill over 225k/month and collect 30% of that, and then based on that, the practice decides to pay me.

 

[unchockey21]

If I was an employed doc working for a hospital or corporation, I’d want my pay based off of RVUs or billing because I don’t trust them to accurately code and collect. I do the work, it’s their job to get paid for it.

As a shareholder, I want my partners and any employed docs paid based on collections because I want to pay for work that’s done appropriately and properly documented.

In either model, if you’re working for someone else, you should be monitoring your own collections or billing to make sure it’s being done accurately.

 

[SC Tian]

40-60% of collection is common in my experience, it is fair for office practices, for busy pain physicians doing procedures in Asc or hopd, this is on the low end, as they don’t have profits from facility fee collections. I know practice here negotiate with 100% professional fee with working in hospital system.
RVU bases practice is not a fair model for procedure heavy pain practice as well, imo. Procedures generate way higher dollars per rvu the. Office.

 

[runfastnow]

If you're working on a RVU or collection based would recommend having office based procedure set up unless you also have ownership of ASC if procedures are 20%+ of your total patient interactions per week. Otherwise group/practice/health system is making a bunch of money on facility fees that you will never see.

Also, collections in office ESI/MBB/RF for most insurances are much better and it all goes to you - i.e. with local Obamacare product get $400 for ESI in office vs $150-$200 in ASC plus the patient has much lower co-pay and no extra facility charge. Even with paying for RN+MA+supplies in office you come out way ahead unless you are really slow.

 

[DODOCSS]

just listen to the goat herder

 

[myrandom2003]

start on unaccredited fellowship, pay $50,000.

 

[mid|ine]

Also, collections in office ESI/MBB/RF for most insurances are much better and it all goes to you - i.e. with local Obamacare product get $400 for ESI in office vs $150-$200 in ASC plus the patient has much lower co-pay and no extra facility charge. Even with paying for RN+MA+supplies in office you come out way ahead unless you are really slow.

Wow, I think all of the market place plans were paying less then medicare here so we dropped all of them.

In regards to the ASC, you need to compare the professional + facility fee if you can get ownership stake in the ASC.

 

[Dr. Ice]

Everyone here talks about being a part or an asc as if it is some mecca. It can be, but with the way things are in medicine right now, asc ownership is really not so great without hopd backing or previous undisputed contracts.

If I had to do it all over again years ago, I would have taken out a loan, opened up a small shop, minimal staff, all office bases procedures, worked out a deal with Stryker to rent an rfa machine…

To do this now would be a Herculean effort. With two young kids, in my mid 40s, just don’t have the energy to do it so will likely just be a slave to the game for the next 20 years or so. I don’t advocate it by any means, and the nicest part of my job is being able to do whatever I want. No one tells me what to do. In my former practice, I was constantly indirectly told what was expected of me and had no choice but to comply. I’m currently the only interventional doc in a medium sized ortho group, and even though there are a lot of issues, at least I do what I want, don’t have to take over “rehab guidance” for failed spine surgeries and can turf crazies to my nearest tertiary care practice, cause they “must have the answers that I don’t…”

 

[unchockey21]

Everyone here talks about being a part or an asc as if it is some mecca. It can be, but with the way things are in medicine right now, asc ownership is really not so great without hopd backing or previous undisputed contracts.

I agree that ASCs are not a sure fire money maker. But I think that’s more to do with who’s running it and how. They’re looked at as Mecca because they SHOULD be big revenue generators. Shout out site of service. I whole heartedly disagree that any ASC needs hospital backing. It’s insane to me to give a hospital at least 51% of your profits for doing mediocre admin work and not actually providing patient care. Instead of partnering with the Empire, hire an ASC management company that works for you and has an incentive to help your practice thrive. One that you can then fire when you’ve outgrown the need. We have one Ortho group in the area suing to get out of an ASC partnership with a hospital so they can open their own. One of their arguments is the hospital intentionally understaffed and made scheduling difficult at the ASC to divert more patients to the hospital ORs. There’s another group considering waiting out their 2 year noncompete so they can open their own.

I think the biggest ASC red flags are shareholders who aren’t performing procedures and ones that have too many specialties. It’s just too much overhead with all the equipment needed and staff become jacks of all trades but masters of none.

 

[lobelsteve]

I agree that ASCs are not a sure fire money maker. But I think that’s more to do with who’s running it and how. They’re looked at as Mecca because they SHOULD be big revenue generators. Shout out site of service. I whole heartedly disagree that any ASC needs hospital backing. It’s insane to me to give a hospital at least 51% of your profits for doing mediocre admin work and not actually providing patient care. Instead of partnering with the Empire, hire an ASC management company that works for you and has an incentive to help your practice thrive. One that you can then fire when you’ve outgrown the need. We have one Ortho group in the area suing to get out of an ASC partnership with a hospital so they can open their own. One of their arguments is the hospital intentionally understaffed and made scheduling difficult at the ASC to divert more patients to the hospital ORs. There’s another group considering waiting out their 2 year noncompete so they can open their own.

I think the biggest ASC red flags are shareholders who aren’t performing procedures and ones that have too many specialties. It’s just too much overhead with all the equipment needed and staff become jacks of all trades but masters of none.