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  • Contract renegotiation - Radiology

    I'm a private practice radiologist (15 years out of residency) in a small MO town (population around 10k). Hospital is located approximately 45 min from a larger metro area with a population of 300k.

    I am one of 3 radiologists. We provide full radiology coverage to the hospital and surrounding clinics / nursing homes from 7AM to 9:30PM, work 1 in 3 weekends, and have 1 radiologist cover the night shift when possible. Otherwise, we have VRAD coverage after 9:30PM weekdays and after 5 PM on weekends.

    One of the 3 radiologists just gave notice. Radiologist recruiting in the larger metro area 45 min away has been poor. Recruiting in our rural town is going to be very difficult.

    We are hospital employees with a base salary and wRVU bonus. We have recently discovered that despite increased productivity / wRVU in 2019 compared to 2018, gross salary was less in 2019 than 2018. This looks to be secondary to how our wRVU bonus is structured (not an intentional hospital error).

    Overall, the hospital is good to work for and I enjoy my colleagues; however, we have several upcoming hurdles with the loss of 1 rad.

    If I decide to stay, myself and the other remaining radiologist want to review our contract status. To my knowledge, he has nearly the same contract as myself (except that he receives a medical director stipend).

    For the last 5 years, our wRVU bonus was set at $49.50 / wRVU. However, because of how the scale is actually structured (12 month rolling average) I have averaged $47.60 / wRVU. In 2019, my wRVU total was 11,600 (sure to increase in 2020 with the departure of 1 rad).

    We don't perform any vascular work or mammography. Practice is a mix of standard diagnostic radiology and procedures (including CT / US guided biopsies). I would estimate that we are approximately 90% diagnostic and 10% non-vascular IR.

    Taking out the impending doom of not having a 3rd radiologist, I'm trying to evaluate our compensation structure. The data I have available currently is listed below.

    Diagnostic Radiology and Interventional Radiology mean salary / wRVU respectively:
    2017 Sullivan Cotter - $55.88 (Diagnostic Radiology only)
    2012 MGMA (Southern region) - $49.58 and $45.49
    2012 MGMA (Nationwide) - $53.57 and $62.16
    2015 AMGA (Southern) - $52.33 and $70.19

    Questions:
    1) Does anyone have more recent MGMA data for radiologists? I think our wRVU bonus is structured from the 2012 Southern MGMA Diagnostic Radiologist mean.
    2) What is a reasonable $ / wRVU to shoot for given our case mix, rural location, and experience?

    Thanks in advance for the advice.
    Chad


  • #2
    I would just have your contract reviewed by one of the WCI recommended companies and get the current year MGMA data. They can also give you an idea of where your contract stands in comparison to others they've reviewed.

    Comment


    • #3
      A bit confused. You say private practice, but you're employed?

      How about health insurance, malpractice, 401k or other benefits? Where those items come from could change interpretation as to whether your compensation is excellent or fair or poor.

      Also have to admit I'm ignorant. How is wRVU different than RVU?

      My private group bills pro fees only and we track RVUs. Is that the same as wRVUs for an employed physician or is there some conversion or something else different?

      Comment


      • #4

        https://www.mgma.com/about/state-aff...n-each-section
        Your specifics in MO are really tough to translate to MGMA Southern Region. Probably best to use one of the contract reviewers or a healthcare attorney out of St. Louis, Mo. Just make sure they have MGMA data. Your risks on wRVU’s is if they replace #3 mid contract. Good luck.
        The RVU has three components: physician work, practice expense and malpractice.
        https://www.physicianspractice.com/r...u-compensation

        Comment


        • #5
          Originally posted by jacoavlu View Post
          A bit confused. You say private practice, but you're employed?

          How about health insurance, malpractice, 401k or other benefits? Where those items come from could change interpretation as to whether your compensation is excellent or fair or poor.

          Also have to admit I'm ignorant. How is wRVU different than RVU?

          My private group bills pro fees only and we track RVUs. Is that the same as wRVUs for an employed physician or is there some conversion or something else different?
          Interesting that you get paid by RVU. wRVU seems like the standard method for most practices in terms of physician reimbursement.

          "Medicare establishes an RVU for each CPT code to determine reimbursement. The RVU has three components: physician work, practice expense and malpractice. The physician work RVU, or wRVU, is a "neutralized" way to quantify and compare the productivity of physicians because it eliminates variables such as fee schedules or geographical costs."

          Comment


          • #6
            Originally posted by xraygoggles View Post

            Interesting that you get paid by RVU. wRVU seems like the standard method for most practices in terms of physician reimbursement.

            "Medicare establishes an RVU for each CPT code to determine reimbursement. The RVU has three components: physician work, practice expense and malpractice. The physician work RVU, or wRVU, is a "neutralized" way to quantify and compare the productivity of physicians because it eliminates variables such as fee schedules or geographical costs."
            Note I did not say that we "get paid by RVU".

            We bill professional fees I assume like any other private practice radiology group, and internally track "RVUs" though I admit I do not know specifically what the "RVU" is that we track. I've never made much use of it other than trending over time and as a measure of comparison for how much work each of us is doing, along with number of procedures and gross amount billed.

            Comment


            • #7
              Answers to your questions are 1. Yes, I have 2019 MGMA data. And 2. The most reasonable rate per wRVU is one that fairly aligns compensation and productivity. The industry standard was previously start with the Median. But the number that results in the closest relationship between compensation and productivity can range between the 40th and 65th percentiles of the market depending on the specialty.
              Jon Morris, JD, MBA - Founder/Principal
              www.mdcompadvisor.com

              Comment


              • #8
                Originally posted by jacoavlu View Post

                Note I did not say that we "get paid by RVU".

                We bill professional fees I assume like any other private practice radiology group, and internally track "RVUs" though I admit I do not know specifically what the "RVU" is that we track. I've never made much use of it other than trending over time and as a measure of comparison for how much work each of us is doing, along with number of procedures and gross amount billed.
                Probably you are tracking wRVU

                OP: what is the payor mix in your rural area? A lot of MCD/MCR? Consider that as well when looking at your conversion factor. At least from the hospital's perspective.

                1:2 weekend call, no thanks!

                Comment


                • #9
                  To me having the 3rd rad leave matters a lot because of the evening/weekend/holiday coverage issue. Even if the volume after hours is light you are still on. You can't go anywhere. That kind of coverage is not reflected by RVUs.

                  My group covers a small hospital that uses Vrad for prelim reads and they are significantly increasing their prices for all modalities this year (10-25%). They don't even offer that good of a service (mediocre TATs) and we are not planning on renewing them. If your telerad service is asking for that kind of payment boost I wouldn't be shy asking for a similar increase.
                  Last edited by zlandar; 02-18-2020, 06:31 PM.

                  Comment


                  • #10
                    Originally posted by jacoavlu View Post
                    A bit confused. You say private practice, but you're employed?
                    Sorry. My mistake. Was trying to indicate non-academic practice. I'm hospital employed.

                    Originally posted by jacoavlu View Post
                    How about health insurance, malpractice, 401k or other benefits? Where those items come from could change interpretation as to whether your compensation is excellent or fair or poor.
                    Although not as good as a typical private practice, I have health insurance through the hospital. Hospital pays for malpractice. Have 403b and governmental 457b. I can contribute a total of $36k annually to hospital plans.

                    I get $4k annually for CME.

                    Comment


                    • #11
                      It wouldn’t hurt to have another offer in hand.

                      Comment


                      • #12
                        Originally posted by Tim View Post
                        https://www.mgma.com/about/state-aff...n-each-section
                        Your specifics in MO are really tough to translate to MGMA Southern Region.
                        https://www.physicianspractice.com/r...u-compensation
                        Just curious. Why do you say that this is hard to translate to MGMA southern region?

                        Some more detail:
                        I was a partner in one of the private practices in the 300k metro area that I referenced that is 45 min away from my current hospital. I was there until that radiology group imploded. Prior to implosion, we hired Radiology Business Solutions to perform a review of our practice. This was done in early 2014. When evaluating our compensation, RBS referenced MGMA data from the southern region. However, they suggested that the practice not use data from the southern region (secondary to limited number of practices which provided data). Instead, they stated that production data from the overall U.S. was a more accurate and fair representation of the region.

                        Comment


                        • #13
                          Originally posted by childay View Post

                          OP: what is the payor mix in your rural area? A lot of MCD/MCR? Consider that as well when looking at your conversion factor. At least from the hospital's perspective.

                          1:2 weekend call, no thanks!
                          I'm not privy to payor mix being I'm a hospital employee. I suppose that I could ask during negotiations. I'm sure we have a higher Medicare percentage when compared to the 300k metro area 45 min away.

                          I'm not doing 1:2 weekend call. The hospital will have to agree to use either locums or a teleradiology service to cover some of the weekends until we find a 3rd. If they won't agree to that, I'll be looking for work elsewhere.

                          Comment


                          • #14
                            Originally posted by zlandar View Post
                            To me having the 3rd rad leave matters a lot because of the evening/weekend/holiday coverage issue. Even if the volume after hours is light you are still on. You can't go anywhere. That kind of coverage is not reflected by RVUs.

                            My group covers a small hospital that uses Vrad for prelim reads and they are significantly increasing their prices for all modalities this year (10-25%). They don't even offer that good of a service (mediocre TATs) and we are not planning on renewing them. If your telerad service is asking for that kind of payment boost I wouldn't be shy asking for a similar increase.
                            We use VRAD currently. Prelim reads.

                            Prior to the 3rd giving his notice, we were looking at adding a 4th. Hospital was considering hiring a 4th rad (effectively eliminating rad bonus beyond our base salary), having us cover all nights, and getting rid of VRAD.

                            Only 2 rads is untenable. Hospital will have to go to either locums coverage or VRAD final reads prior to hiring a 3rd (which will probably take a while).

                            Comment


                            • #15
                              Your wRVU rate is a few dollars below the MGMA median (the most commonly used starting point for building compensation models). At your level of production, a well-aligned compensation plan should produce approximately $620,000 of compensation. Do you get paid for any of the call coverage you provide?
                              Jon Morris, JD, MBA - Founder/Principal
                              www.mdcompadvisor.com

                              Comment

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