Negotiating Contract - Facility Fees?

[HandFellow]

My understanding is that when I do this procedure in the office, I collect my professional fee (a few RVU) while the hospital system who owns the office building collects a facility fee (many RVUs). The facility fee is ostensibly for the mortgage, equipment, office staff, etc. For whatever reason, this code is heavily weighted towards the facility fee. But without me doing the procedures no one is going to collect much of anything.

HandFellow - I follow what you are saying. But this procedure only makes up 20% or less of my practice. I need the hospital for the rest of the work that I do.

Hopefully this is making some sort of sense. It's amazing how many moving parts these things have.

you don't need the hospital for what you do. that's the fallacy of doctors losing control of medicine and being controlled by hospital systems. The hospital needs you much more than you need it.

[ACN]

Negotiate a service line contract where you keep X% of the procedure you do or a flat rate for the year. This is very common in private practice ortho and hospitals.

[ENT Doc]

Why don’t you ask for more of a conversion for your wRVUs?

Welcome to the ludicrous world of medical payments, where somehow the hospital gets paid a disproportionately larger amount for performing the same service. And then underpays you. And call themselves non profits.

[HandMan]

My understanding is that when I do this procedure in the office, I collect my professional fee (a few RVU) while the hospital system who owns the office building collects a facility fee (many RVUs). The facility fee is ostensibly for the mortgage, equipment, office staff, etc. For whatever reason, this code is heavily weighted towards the facility fee. But without me doing the procedures no one is going to collect much of anything.

HandFellow - I follow what you are saying. But this procedure only makes up 20% or less of my practice. I need the hospital for the rest of the work that I do.

Hopefully this is making some sort of sense. It's amazing how many moving parts these things have.

[HandFellow]

If you are interested in the facility fee, don't join the hospital group and go private and open a surgery center.

[ENT Doc]

What do you mean when you say “facility fee”? Do you mean what the facility is paid under OPPS? Or do you mean the PE/Malpractice RVUs that are collected as opposed to your Work RVU for the procedure?

[jfoxcpacfp]

Have you discussed your idea with the prospective employer? Sounds like a really nice negotiating point, especially with the wait list and dearth of qualified physicians. Don't see any down side to laying it on the table - is there one?
ps - realize this d/n answer your original question, hope someone else who can will take it.

[HandMan]

Hi everyone!


I am a surgical sub-specialist a few years out of fellowship who is starting to look at new opportunities. Right now, I have an offer as an employed doc from a large national Health care organization. It’s for two years guaranteed salary then switches to pure wRVU model. Conversion factor of 55.

I perform almost all of my procedures in the hospital with one notable exception, a mostly lifestyle procedure which I do in the office in a regular exam room. The issue is that the CPT code reimburses a couple of RVUs for physician work, and 10X as much for the facility fee. The practice collects 3-4K each time I do the procedure, then turns around and pays me 55X4 = $220. Has anyone been able to successfully negotiate a portion of these facility fees? Or should I just ask them increase the conversion factor and let it all even out that way?

The employer tells me they have a 6 month waiting list of patients who need this procedure, and it seems like no one else is consistently doing them in the area. I wouldn’t mind doing up to 4 to 5 per week, but the wRVU structure incentivizes me to do more like 0-1 and spend my time in the hospital instead. I’m trying to think of ways for all parties to benefit.

thanks!