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50/50 or RVU?

Home Practice Management 50/50 or RVU?

  • Avatar TheHandGuy 
    Participant
    Status: Physician
    Posts: 8
    Joined: 12/08/2018

    Hello everyone. I am in an interesting position and could use some advice. I currently have clinic 3 days per week and operate 1 day per week. I am new to practice, but this has been working out well for me. As I get busier I expect to need two full OR days per week. As of now, I have a full free day every week that I feel I am essentially wasting. I have been using it to give lectures to different groups and residency programs, but a unique situation has come up. I have two different clinics asking me if I can staff a clinic for them once per week. These clinics are completely different systems. One works on a 50/50 model where I get 50% of all collections. The other is a wRVU model where I get paid about $60 per RVU. Both are non-negotiable. I tried to do the math myself and figure out what would be more beneficial for me, but they seem to come out to be pretty similar in the long run. Any advice on this? Any personal experience? I appreciate the help.

    #243614 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6186
    Joined: 01/12/2016

    Hello everyone. I am in an interesting position and could use some advice. I currently have clinic 3 days per week and operate 1 day per week. I am new to practice, but this has been working out well for me. As I get busier I expect to need two full OR days per week. As of now, I have a full free day every week that I feel I am essentially wasting. I have been using it to give lectures to different groups and residency programs, but a unique situation has come up. I have two different clinics asking me if I can staff a clinic for them once per week. These clinics are completely different systems. One works on a 50/50 model where I get 50% of all collections. The other is a wRVU model where I get paid about $60 per RVU. Both are non-negotiable. I tried to do the math myself and figure out what would be more beneficial for me, but they seem to come out to be pretty similar in the long run. Any advice on this? Any personal experience? I appreciate the help.

    Click to expand…

    They are asking you so guarantee its negotiable. Just say no thanks and move on if its not exactly what you want and worth it to you.

    I would take RVU over 50% of an opaque and non controllable collections model that will be subject to staffing, quality, and honesty in reporting. RVU you know exactly what you’re getting.

    #243615 Reply
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1862
    Joined: 02/11/2019

    Collections also are influenced by payer mix.  At least with RVU you know what you are getting.

    If you do go with the collection system you should try for better then 50/50.

    “Never let your sense of morals prevent you from doing what is right.”

    #243619 Reply
    Liked by madinat
    childay childay 
    Participant
    Status: Physician
    Posts: 1013
    Joined: 01/09/2016

    What is overhead in your current clinic?

    $60 per wRVU sounds low for a surgeon

    Edit: $60 may be low maybe not.  Do you do procedures in the office or just E&M visits?

    #243703 Reply
    Avatar TheHandGuy 
    Participant
    Status: Physician
    Posts: 8
    Joined: 12/08/2018

    Current clinic runs on a 50/50 model as well, however I get back whatever is left after expenses are taken out. I do mostly injections, X-ray interpretations, Casting, and minor procedures like simple I&Ds.

    They give $60 per rvu for all sub specialty clinics.

    Of note, the system that is rvu based is for both clinic time and OR time for those patients. The 50/50 clinic is 50/50 for clinic time, but all surgeries are billed separately through my practice so they go towards the 50/50 with return after expenses model.

    Sorry if this is confusing.

    #243734 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6186
    Joined: 01/12/2016

    Current clinic runs on a 50/50 model as well, however I get back whatever is left after expenses are taken out. I do mostly injections, X-ray interpretations, Casting, and minor procedures like simple I&Ds.

    They give $60 per rvu for all sub specialty clinics.

    Of note, the system that is rvu based is for both clinic time and OR time for those patients. The 50/50 clinic is 50/50 for clinic time, but all surgeries are billed separately through my practice so they go towards the 50/50 with return after expenses model.

    Sorry if this is confusing.

    Click to expand…

    How profitable for them. That wRVU rate looks on the low side but close for hand specialists.

    Why is your case mix so odd? Is that what you want to do or are there not many neuroplasties running around? What about trauma? I think I’d rather see the occasional spaghetti wrist or rev amp then that stuff. At least a spaghetti pays well. I know hand trauma is the worst, but if you’re not doing much and looking to be busy, no one else wants it either so its usually there for the taking.

    wRVU is almost always preferable for the above reasons already stated.

    Whats the case types you might be seeing at the new clinics and how does it compare in an wRVU/collections based ratio per time spent etc….? Will it bring a better case mix over time that makes one much more profitable, etc…

     

     

    #243739 Reply
    Liked by childay
    Avatar TheHandGuy 
    Participant
    Status: Physician
    Posts: 8
    Joined: 12/08/2018

    I do all the usual stuff as well, those are just what I do in the office setting. As far as hand call I already do that, I’m just looking for the best option to fill my one empty day each week until I get busy enough to need a second OR day.

    #243783 Reply
    Liked by Zaphod
    Avatar Dr P 
    Participant
    Status: Physician
    Posts: 55
    Joined: 08/06/2016

    If I had to choose between those two options I would probably take the wRVU model. Unless you had a good reason to believe the revenue model would be more profitable (exclusively good payors like L&I or they can produce revenue reports from previous docs).

    Another big factor is which clinic you would rather work at. Besides the payment model, all of the other intangibles need to be taken into consideration, ie. staffing, on site xray, pt volumes.

    I would also like to play the devil’s advocate a bit and ask if you really want to take this on. It sounds like you will be needing a second OR day soon, so is it worth it to set up a part-time position for possibly a short time? Additionally, does your current employer allow you to work outside of the clinic?

    Also keep in mind that if you fill up a clinic day every week with this new side gig, you will need to find time to operate on those patients as well. If you are close to filling up your current OR day every week, it will be difficult to find the time to operate on these patients. I would actually encourage you to consider taking advantage of this time as work-life balance time if that is within reason given your financial goals.

    #243818 Reply
    Liked by Zaphod, MaxPower
    Avatar TheHandGuy 
    Participant
    Status: Physician
    Posts: 8
    Joined: 12/08/2018

    Good points from everyone. Thank you all very much it gave me a lot to think about.

    #244077 Reply

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