Dermatology - Average Collection Per Encounter

[ddoc79]

What is an average collection per encounter for a general dermatologist? I just started practicing out of residency. Just looking at the Medicare Physician Fee Schedule Look-Up Tool, I estimate the average collection per encounter to be ~$150. I understand this number can change depending on how many commercially insured patients you see and how many procedures you perform. I plan on seeing about 35 patients per day, 5 days per week with about 8-10 excisions per week once I build up to a full schedule in a few months. I have a base salary the first 12 months, then I move to pure collections my second year, so I'm trying to make some projections. I work for a private equity group in a rural area and do not accept Medicaid. My employer will eventually share this information with me, but won't have enough data for a few months to give me an accurate number. My projected payer mix is 60/40 commercial/Medicare. Any feedback from other derms?

[jfoxcpacfp]

Bump

[Ozarka]

Not exactly helpful but I recall seeing some presentations in 2018 regarding derm compensation using a $135 per patient encounter figure. I'm sure it is all over the board depending on location and payer mix, as well as how much cosmetics one does. If you obtain more current info then I would love to hear.

[Neurologo]

You aim to see 35 patients daily and each visit pays $150 for 15-20 min? That is a great reimbursement rate if true. What codes are you using?

[Tim]

MGMA has data on number of encounters in Table E and data on collections on Table B and compensation on Table A.
You can calculate some numbers to benchmark per encounter. The table I have is 2017. You might have access to more current.
This would be a tops down reasonableness test to confirm the bottoms up approach you are using for rates.

[bean25]

You aim to see 35 patients daily and each visit pays $150 for 15-20 min? That is a great reimbursement rate if true. What codes are you using?

Not Derm but would image they do a lot of in-office procedures with 25-modifier (skin biopsies, excisions, cryo, etc). So you are often gettin E/M and procedure code.

[pitt1166]

tangentially related, but i wonder how mohs' surgeons make their money. i know their collections are quite high, i've heard some mohs surgeons collecting around 2 million per year.

what cpt codes do they bill?

[Dermonc]

That is a busy schedule for salaried Derm. Average collection per patient is going to be highly variable based on location, patient population and insurance rate. Full time Derm is usually considered 4 days per week. I definitely wouldn’t burn yourself out seeing 35/day + excisions 5 days a week if you aren’t being compensated for it. PE is great if you have a short term horizon in a certain location but if you are planning on a long term job I would look to other opportunities.

[ddoc79]

You aim to see 35 patients daily and each visit pays $150 for 15-20 min? That is a great reimbursement rate if true. What codes are you using?

We use 992x3 and 992x4 for E&M. Skin biopsies, benign and malignant destructions with 25 modifier are the most common codes. This is how the number gets to $150.

[ddoc79]

That is a busy schedule for salaried Derm. Average collection per patient is going to be highly variable based on location, patient population and insurance rate. Full time Derm is usually considered 4 days per week. I definitely wouldn’t burn yourself out seeing 35/day + excisions 5 days a week if you aren’t being compensated for it. PE is great if you have a short term horizon in a certain location but if you are planning on a long term job I would look to other opportunities.

My base salary is solid for my area, but at 35 pts/day at 5 days a week at $150 per encounter, I would easily get a six figure bonus on top of the base salary, even with 6 weeks vacation. So the more I see, the more I make. I drive an hour to one of the offices, so I'm seeing a lot of advanced skin disease because the area is underserved - hence, lots of procedures, which I enjoy. We are having a little difficulty in getting my scheduled filled with 35 pts per day for 5 days. Been working for 1 month and we are at about 28 per day now on average, which seems slow to me compared to my residency. I'm hungry now early in my career so don't mind being really busy.

[Tim]

5x 28 = 140
4x 35 = 140
After 1 month, the encounters for a full schedule could be accomplished by efficiencies.
5x 35 = 175 So you are at 80%.

The last 20% is the hardest to achieve and maintain. I would run numbers on the 140. I would focus on the efficiency. PE will have no problem with the number of days, except to want more. They only care about 140 vs 175, maximizing encounters.
Your days are free to them. As previously mentioned, the pace may be difficult to maintain.
Another way to look at it, is “you are inefficient now”. Nothing wrong with making hay while the sun shines, but the work/life balance in finding your pace the first year or 2 is valuable. One month down. Good luck with the next 23. Newness wears off.

Just keep things in perspective.

[Fugue]

Varies greatly based on region. $120-160 generally. When I was making these calculations, I used around 130 to 140 as a safe estimate.

I guess everyone’s perspective is different. 35 a day sounds solid but not crazy busy at all. Certainly don’t think you are going to burn yourself out at 35 a day, assuming plenty of bread and butter.

[Dermonc]

Varies greatly based on region. $120-160 generally. When I was making these calculations, I used around 130 to 140 as a safe estimate.

I guess everyone’s perspective is different. 35 a day sounds solid but not crazy busy at all. Certainly don’t think you are going to burn yourself out at 35 a day, assuming plenty of bread and butter.

Sorry I meant 5 full days is more than the average Derm works around me, not the 35+excisions, which is probably about average to below.

[ddoc79]

Update for those interested...

After 8 weeks at my derm private equity job, I am doing a 4.5 day week, seeing about 150 patients per week, 7 of them being excisions. My average collection per encounter is ~$170. Most days are smooth ~8AM-4PM with a 20 min lunch. I have 2 MAs most days and some days I have 3. I'm about 50/50 commercial/medicare and my no-show rate is around 10%.

The current pace is busy but not crazy. Seems like I'll probably stay at this pace. My yearly collections could be $1.1-1.3 mil which would have me hitting all of my financial goals. I also have a 1 hr commute 2 days per week to the rural clinic. I was very nervous about this at first, but I actually really enjoy it. It's an easy drive and I listen to finance podcasts.

[ZwdermDO]

Thank you for the update. Are you saying that you are taking home 1.1-1.3 mil, or is that what you are billing and getting a percent of collections off that? Im in a similar situation as you coming out of residency in a mostly medicare rural population. Just trying to get a good idea of what i can expect.