Announcement

Collapse
No announcement yet.

Family Medicine salary negotiaion and compensation

Collapse
X
Collapse
First Prev Next Last
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #16
    Originally posted by Thedirtychemist View Post

    Haha, I have had those letter suggesting that I bill too many 99214s, but as you said - I serve a rural, complex, geriatric population. I have spoiled my patients - but to a mutual advantage. I don't limit how many problems they want to talk about - and usually "oh by the ways" become 99214s. The trick is to document and capture the services. I had made catch phrases through the EMR. My organization internally audits all the time as well.

    I get a lot of.. "Doc, look at this spot on my arm." - becomes a skin lesion problem
    "Doc, what do you think is the best way to lose weight?" - becomes a weightloss/obesity problem.

    We put in a lot of time and invest a lot of ourselves towards our patients. Without them, we have no career - but every minute we give as medical advice is billable.

    I grew up loving pokemon - gotta catch em all!
    Yeah we internally code too. The coder and I have a good relationship and she tells me I bill appropriately . Admin cannot seem to understand that and they do not like anything that falls outside of averages. It does not cause me any trouble because I am not milking the system.
    Yes I do take care of mot of the problems most of the time. There are a few people that need to be routinely cut off. And there are a few issues I like to have a separate appointment for but it is a rarity.

    I wish more docs would actually bill correctly and that would help raise what is average. I feel way more people under bill then over bill.

    Comment


    • #17
      Only 10k to supervise a PA? Does the PA increase your productivity at all? How much is the PA bringing in and getting paid?

      Comment


      • #18
        Originally posted by childay View Post
        Only 10k to supervise a PA? Does the PA increase your productivity at all? How much is the PA bringing in and getting paid?
        I believe our PA is getting around 105k. The PA does not increase my productivity. 9k is the current offer for PA supervision.

        I have heard of models which use a percentage of the PA/NP's productivity as the compensation for supervision. Would you guys mind sharing those models?

        Comment


        • #19

          FP non- OB in midwest. In office 3 full days per week. 2 day in Nursing Homes (6 facilities as Medical Director). I have embedded NP in all 6 NH buildings and 1 in the office- all are shared between multiple Doctors. We are paid $7.50/wRVU for supervision/cosign on each encounter. Unless the PA/NP is running their own panel or your management only requires review of a certain percentage of encounters- I bet you are getting underpaid for their work (why else would they agree to add another PA?). Recommend you review the wRVU numbers the PA/NP performed over the last few years and see how you the above compensation would work in comparison to using your current pay model.

          Given your level of wRVU avg 7700 = 90%ile per MGMA for FY 2018-19 you should look/ask for either a higher wRVU conversion factor or a bonus structure. For FY 2019-20 MGMA 90%ile = 6790. In the link below I share our compensation program for wRVU's bonus structure. For my direct patient care in office and nursing home last year I made about $400,000 on 7,655 wRVU- given our bonus structure. With NP supervision add about $70,000 ($7.50/wRVU supervision). This does not include the pay as a Medical Director in the Nursing Homes- for which I am paid separately as a 1099.

          I code a lot of 99214 but our internal review supports my documentation as appropriate for my level of coding for the last 15+ years of practice. Probably should code more 99215- but the internal audit that this triggers is way too much work for the extra 0.61 wRVU it would generate. Based on recent practice update that takes into account the medical complexity of my patients with an adjustment factor multiplied by the number of patients in my practice I have one of the more complex patient populations in our group. When I have Medical Residents/Students I emphasize the importance of learning how to code and document not only is it good care but it allow you to get paid for the work you are actually doing.

          http://www.whitecoatinvestor.com/for...n-compensation

          Comment


          • #20
            Originally posted by aCMD View Post
            FP non- OB in midwest. In office 3 full days per week. 2 day in Nursing Homes (6 facilities as Medical Director). I have embedded NP in all 6 NH buildings and 1 in the office- all are shared between multiple Doctors. We are paid $7.50/wRVU for supervision/cosign on each encounter. Unless the PA/NP is running their own panel or your management only requires review of a certain percentage of encounters- I bet you are getting underpaid for their work (why else would they agree to add another PA?). Recommend you review the wRVU numbers the PA/NP performed over the last few years and see how you the above compensation would work in comparison to using your current pay model.

            Given your level of wRVU avg 7700 = 90%ile per MGMA for FY 2018-19 you should look/ask for either a higher wRVU conversion factor or a bonus structure. For FY 2019-20 MGMA 90%ile = 6790. In the link below I share our compensation program for wRVU's bonus structure. For my direct patient care in office and nursing home last year I made about $400,000 on 7,655 wRVU- given our bonus structure. With NP supervision add about $70,000 ($7.50/wRVU supervision). This does not include the pay as a Medical Director in the Nursing Homes- for which I am paid separately as a 1099.

            I code a lot of 99214 but our internal review supports my documentation as appropriate for my level of coding for the last 15+ years of practice. Probably should code more 99215- but the internal audit that this triggers is way too much work for the extra 0.61 wRVU it would generate. Based on recent practice update that takes into account the medical complexity of my patients with an adjustment factor multiplied by the number of patients in my practice I have one of the more complex patient populations in our group. When I have Medical Residents/Students I emphasize the importance of learning how to code and document not only is it good care but it allow you to get paid for the work you are actually doing.

            http://www.whitecoatinvestor.com/for...n-compensation
            That seems like a very high salary for FP, congrats. just curious, are you working crazy hours or it's pretty much 9-5?

            Comment


            • #21
              Originally posted by GastroMastro View Post

              That seems like a very high salary for FP, congrats. just curious, are you working crazy hours or it's pretty much 9-5?
              No crazy hours. Seeing patients on M,T,W 8a-5p- 20-25 per day in office and Th, Fr 6am- 2p in NH (About 90% are new admission from the Hospital/Acute rehab- sick/complex, etc.). Ensuring patients follow up for Physicals, Medicare AWW visits, TCM visits and chronic care visits. Coding and documentation is critical. Compensation is about 60% office work and 40% NH work. We have 2 different bonus structure: 1. Productivity- which added about $40,000 to my salary last year.
              2. Quality Metrics/Citizenship/Patient satisfaction/etc that added about $15,000 last year.

              Comment


              • #22
                Since you are a high RVU provider. Ask for a high $/RVU tier above say 75% average RVU treshhold. Fixed costs largely paid for so you should be getting more.

                If you're self employed you get every dollar over fixed cost is profit.

                Comment


                • #23
                  aCMD Peppy
                  I really hope OP reads the link you provided.
                  Your advice to laid out the compensation plan for your group in great detail. Actually, I wish Peppy would provide feedback on how things worked out. After 18 years, you are probably at the top of the food chain of your group. The base is the same and if your production doesn’t meet the goals, you owe money back on the draw. Your response was an example of a fair structure that rewards production and allows additional compensation for additional services.

                  Comment


                  • #24
                    aCMD Peppy Tim

                    Everyone, thank you for the responses. There's a lot of info to digest! I am thoroughly looking at that compensation model , aCMD . Thanks for sharing.

                    I will be responding more thoroughly very soon.

                    On a side note, does anyone have the latest MGMA survey data that they are able to share, more specifically for Family Medicine, NO OB/ Family Medicine (NO INPATIENT)

                    Comment


                    • #25
                      Obtaining the MGMA data is difficult as it is available to members- you can join as an individual for $399 but you are limited to the amount of data you have access to vs. the organizational membership.

                      http://www.mgma.com/membership/types...ual-membership

                      http://www.mgma.com/membership/types...nal-membership

                      To my knowledge the MGMA numbers do not breakdown to level you are requesting (I do not do inpatient work either). As part of our bonus program we are provided the wRVU %iles at the beginning of the Fiscal Year (FY) so we know our goals. For FY 19-20 wRVU for FP No OB: 75th%ile = 5667, 90th %ile= 6790.

                      Comment


                      • #26
                        So today I learned that I can bill for Certification of home health services when we review and sign form 485. It does not seem like a lot of work since I am already reviewing and signing it. I just need to document it and put in a charge.

                        Does anyone else do this?

                        Comment


                        • #27
                          Originally posted by Lordosis View Post
                          So today I learned that I can bill for Certification of home health services when we review and sign form 485. It does not seem like a lot of work since I am already reviewing and signing it. I just need to document it and put in a charge.

                          Does anyone else do this?
                          Nice catch. I'll look into that. Also, apparently there is a charge that you can put in for every INR that you review.. even if it's normal.

                          I'll try to find that too.

                          Comment


                          • #28
                            Can someone provide a list (with the codes) that I can check off the boxes as needed for my first PCP visit?
                            Face it, if I can check the box on 15 items in 30 minutes my visit will be much more productive for the doc. My goal is to be MVP, most valuable patient. Beats the heck out of, can you check this and that? Thank you.

                            Forgot to ask about the “forgetfulness” or dementia stuff. Put it on my tab.

                            Comment


                            • #29
                              Lordosis — yes you can submit initial and recertifications for home health. At my organization it’s a manual (eg lots of revenue lost) process. FPM has a good series on money you could be leaving on the table. You can also submit for smoking cessation and phq-9 or gad7 or Vanderbilt. — there is a standardized screening instrument code. Some plans don’t cover and then the ridiculous charge master fee goes to the patient. (3 minutes of smoking cessation is $25 here).

                              Comment

                              Working...
                              X