Doctors Employed by Hospitals Earn More than Independents...Implications for Pain?

[lobelsteve]

drusso has gleaned this based off of his years of negotiating the best possible $/RVU contract with his local hospital.

Negotiated with Centeno about a lower percentage franchise fee.

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[jwalker12]

Suburban. My numbers are boosted because I have an NP and I get credit for all their wrvus. Plus it’s a mature full practice with a two month wait so busy

But you are correct. I see a lot of patients. In the wrvu system it’s all about volume not necessarily complex procedures

How many patients per day and procedures per week?

 

[Ronin1]

How many patients per day and procedures per week?

35-40 encounters 3 days a week of which 10-12 are fluro guided spine procedures. Another 1/2 day of office when I see about 20.

 

[drusso]

drusso has gleaned this based off of his years of negotiating the best possible $/RVU contract with his local hospital.

How would you do it? The Price Is Right style?

--DPR

 

[so55b]

35-40 encounters 3 days a week of which 10-12 are fluro guided spine procedures. Another 1/2 day of office when I see about 20.

very similar practice set up to mine. I don't get any rvu credit generated by my NP tho other than set supervision credit each year. How much RVU credit do you get from midlevel? maybe percentage?

 

[Ronin1]

very similar practice set up to mine. I don't get any rvu credit generated by my NP tho other than set supervision credit each year. How much RVU credit do you get from midlevel? maybe percentage?

Probably 15% overall. I do put in all the procedures and send all the meds so really they act as a super scribe

 

[clubdeac]

35-40 encounters 3 days a week of which 10-12 are fluro guided spine procedures. Another 1/2 day of office when I see about 20.

How are you cranking out that many patients in a day. Teach me your ways

 

[Ronin1]

It’s no magic. Lots of staff who I treat well. My nurses do most of the documentation. I mainly do the PE and A/P. Procedure wise I just try to be efficient. Good staff to handle all phone calls etc. you personally have to be the motor though. My partner sees maybe half of my volume in the same time

 

[jwalker12]

How are you cranking out that many patients in a day. Teach me your ways

Agreed, need to learn this.

I find one big thing that takes time is thoroughly reading through the MRI and notifying patients of the incidental findings which I am not sure why radiologists cant just put in one line in their report.

 

[stsa84]

It’s no magic. Lots of staff who I treat well. My nurses do most of the documentation. I mainly do the PE and A/P. Procedure wise I just try to be efficient. Good staff to handle all phone calls etc. you personally have to be the motor though. My partner sees maybe half of my volume in the same time

How long are your clinic visits? Start/stop times in the morning and afternoon? Do you chart as you go or catch up at the end of the day? Do you pre-chart ahead of time? Do you put in orders, or tell your staff to order?

 

[SSdoc33]

Agreed, need to learn this.

I find one big thing that takes time is thoroughly reading through the MRI and notifying patients of the incidental findings which I am not sure why radiologists cant just put in one line in their report.

dont call patients to have a chit chat about their MRI results.

that is a time sink that doesnt pay you squat

 

[Ronin1]

How long are your clinic visits? Start/stop times in the morning and afternoon? Do you chart as you go or catch up at the end of the day? Do you pre-chart ahead of time? Do you put in orders, or tell your staff to order?

I have 15 minute slots. With double booking all the time as well. During procedure times I also have follow up slots booked as well. Start @8 out the door by 430 most days. Patients get roomed by ma for vitals. Nurse does hpi/ros/meds. I preview scans then eval patient make plan and the document the note after the patient is seen. I don’t like charting in the room. I put in all orders etc. templates in a good emr makes all this easy.
I don’t call patients. They follow up for imaging, MBB fu, etc. lots of easy quick visits out there.

 

[clubdeac]

I have 15 minute slots. With double booking all the time as well. During procedure times I also have follow up slots booked as well. Start @8 out the door by 430 most days. Patients get roomed by ma for vitals. Nurse does hpi/ros/meds. I preview scans then eval patient make plan and the document the note after the patient is seen. I don’t like charting in the room. I put in all orders etc. templates in a good emr makes all this easy.
I don’t call patients. They follow up for imaging, MBB fu, etc. lots of easy quick visits out there.

I think having a nurse document history and ROS would be a game changer. Unfortunately here they and the admin say it’s beyond their scope and won’t let us use them. I spend so much damn time documenting. I’d get a scribe but I’m against paying for one on just principle

 

[jwalker12]

Do most of you find having a scribe is more work? I hear mixed reviews. Some say it takes more time to read and edit the note subsequently than having done it yourself from the start.

 

[BobBarker]

Ros doesn’t have to be done.

 

[Ronin1]

I just review their HPI and make sure there is nothing in it that would prompt an insurance denial. I rarely edit it

 

[Doctodd]

The IM group at the hospital near me just had their contract non-renewed after 15+ years. Just like that they have to scramble.

 

[Status Sciaticus]

Ros doesn’t have to be done.

It isnt a component of the note thats required to be considered complete for billing? Have those people who say 10-14 point ROS been BSing us all along?

 

[RoloTomassi]

It isnt a component of the note thats required to be considered complete for billing? Have those people who say 10-14 point ROS been BSing us all along?

Used to be but E&M rules changed

 

[BobBarker]

I haven’t done a ROS myself ever. I just had a super vague default set up for years and years. I haven’t done one period in several years.

 

[TIVAndy]

scribe - if used correctly helps tremendously. with a scribe i can probably see 50% more patients - yes i still need to edit notes later but i don't have to use clinic time to do the documentation. 80% of the note will be done if i leave it with my scribe. overall see more pts during clinic time and work on notes later

 

[GatorCHOMPions]

35-40 encounters 3 days a week of which 10-12 are fluro guided spine procedures. Another 1/2 day of office when I see about 20.

For me the cap is irrelevant. I’m at about 12000 wrvu annual using the old numbers. This will go to approximately 14000(the cap) this year with the new values supposedly. I’m going to
Drop another 1/2 day a week so down to 3 1/2 days. Good income to work ratio.

What percentage are opioid refills? Average MME? In my saturated part of the country it seems nearly impossible to reach 10k+ RVU without at least 35-40% med management. Must have a really nice referral network without much competition, too.

 

[cowboydoc]

What percentage are opioid refills? Average MME? In my saturated part of the country it seems nearly impossible to reach 10k+ RVU without at least 35-40% med management. Must have a really nice referral network without much competition, too.

That's not right at all. I do minimal opioids (50 pts., mostly low dose q90 day visits handled by PA), bread and butter procedures, work 4 days a week, am relatively slow and chatty in the office, but do q15minute procedures 2-3 half days a week 30-35/week. This is right about 10k RVUs.

Getting good referrals and training your referral sources is key. My "hit" rate for procedures/referral is really high. It sure helps when half come from neurosurgery/ortho. Accepting a ton of junk from PCPs is a receipe for burnout.

 

[GatorCHOMPions]

That's not right at all. I do minimal opioids (50 pts., mostly low dose q90 day visits handled by PA), bread and butter procedures, work 4 days a week, am relatively slow and chatty in the office, but do q15minute procedures 2-3 half days a week 30-35/week. This is right about 10k RVUs.

Getting good referrals and training your referral sources is key. My "hit" rate for procedures/referral is really high. It sure helps when half come from neurosurgery/ortho. Accepting a ton of junk from PCPs is a receipe for burnout.

Are you in a saturated market? Your last point is on point. I'd say the majority of mine are junk PCP types. Fortunately I'm fairly burnout proof coming from the hellscape that is emergency medicine.

 

[cowboydoc]

Are you in a saturated market? Your last point is on point. I'd say the majority of mine are junk PCP types. Fortunately I'm fairly burnout proof coming from the hellscape that is emergency medicine.

I'd say I'm in a relatively underserved market. I'm sure that helps a ton. I appreciate that makes a big difference, as well as the "need" to take on opioid patients to get referrals is probably a necessary evil, particularly in highly saturated markets.

Even then, "coaching" your referring sources on appropriate patients pays huge dividends. Most of the area PCPs still refer to neurosurgery out of the gate, but the few I've gotten through to send mostly appropriate consults my way.

Also, time in an area can be helpful. Repeat customers, particularly the repeat RFA crowd, greatly improves efficiently in gobbling up those RVU pellets.

 

[Ronin1]

I’d echo the time in the area. I have a ton of repeat business and patient to patient referrals