Dermatology - Average Collection Per Encounter

[jfoxcpacfp]

Good for you and please continue to keep us posted! I’m sure many new derms will be interested, along with CPAs who have derm clients (hint hint). Be sure to keep track of your mileage and that your CPA calculates whether “actual” expense or mileage will be more beneficial now and projected in the future, rather than just dumping the decision in your lap. I’m referring to the 2 days/wk you drive to the rural clinic, not your main commute. Stick with the plan, don’t go nuts with the money. Think long game, not day-to-day bank balance and collections. You’ll be happy you did in 10 years.

[ddoc79]

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.

Those are my collections. I take home a percent (mid 40s) of my collections. For my first full 12 months, I was at 1.1 mil in collections. However that included several slower months at the beginning as my schedule was filling.

[oslerweber]

d

[ddoc79]

I believe a good range for wRVU's per derm encounter is about 1.8-2.2 depending on how much skin cancer you see vs medical derm. Assuming the practice/hospital has updated to the 2021 cms E&M then 99214 is 1.9 wRVU's, 99213 is 1.3, then with 25 modifiers LN2 and biopsy is ~0.7 each etc. MGMA 2021 nationwide median for wRVUs is $65, so that would come to a range of $117 - $130 per patient in reimbursement to the physcian (not collections.. collections would be much higher, likely double this). If you are very procedure heavy then even higher. If you work at one of the several private equity biopsy mills I had the displeasure to interview at then even higher again.

Keep in mind this is not collections - this is reimbursement to the physician based on work RVUs. So if your collections are $170, but then you only get 45% of that, then you are only being paid $76.50 per encounter, correct? This is a very bad deal (equivalent to an RVU rate of about ~$40/wRVU - which is below 10th percentile. I found this to be the case with all the private equity jobs I interviewed with - you work hard and will make good money, but you are paid way under value for the amount of work you are doing. I instead signed with a hospital that pays me $70 per wRVU, to average closer to $120-140 per patient in physician reimbursement.

I interviewed at numerous places in the Midwest. Some were very rural, some private equity and some private practice. Of note, I did not interview at a "hospital system". I was never presented a contract with an RVU structure. I was given a $150,000 signing bonus check that literally changed my life and my family's life. Far from a bad deal. Your numbers are correct, I make around $80 per encounter at 6500-7000 encounters per year. Where the F are these offers for $140 per patient? And if they exist, how are these practices staying afloat? I've been practicing for almost 2 years and I feel that I have a decent understanding of cash flow of a derm practice. If a practice pays a physician $140 per patient visit, there isn't any money left over to pay any overhead. I have dozens of peers who signed similar or lower contracts than myself, mix of private practice and private equity in various parts of the country. Show me the job that pays $140 per patient at 40 patients per week 5 days a week 46 weeks per year and I'll take it. Do you have links? If no links, does anyone actually have proof that this job exists? Anyone can write words on a website for a job offer. Have you received the checks?

[ddoc79]

I believe a good range for wRVU's per derm encounter is about 1.8-2.2 depending on how much skin cancer you see vs medical derm. Assuming the practice/hospital has updated to the 2021 cms E&M then 99214 is 1.9 wRVU's, 99213 is 1.3, then with 25 modifiers LN2 and biopsy is ~0.7 each etc. MGMA 2021 nationwide median for wRVUs is $65, so that would come to a range of $117 - $130 per patient in reimbursement to the physcian (not collections.. collections would be much higher, likely double this). If you are very procedure heavy then even higher. If you work at one of the several private equity biopsy mills I had the displeasure to interview at then even higher again.

Keep in mind this is not collections - this is reimbursement to the physician based on work RVUs. So if your collections are $170, but then you only get 45% of that, then you are only being paid $76.50 per encounter, correct? This is a very bad deal (equivalent to an RVU rate of about ~$40/wRVU - which is below 10th percentile. I found this to be the case with all the private equity jobs I interviewed with - you work hard and will make good money, but you are paid way under value for the amount of work you are doing. I instead signed with a hospital that pays me $70 per wRVU, to average closer to $120-140 per patient in physician reimbursement.

You signed? Have any checks been deposited in your account? Have you seen volume or are you seeing 10 patients per day? What is your staffing like? 1 assistant or 3 assistants? Is your malpractice and health insurance covered? What EMR are you using?

[JK]

I interviewed at numerous places in the Midwest. Some were very rural, some private equity and some private practice. Of note, I did not interview at a "hospital system". I was never presented a contract with an RVU structure. I was given a $150,000 signing bonus check that literally changed my life and my family's life. Far from a bad deal. Your numbers are correct, I make around $80 per encounter at 6500-7000 encounters per year. Where the F are these offers for $140 per patient? And if they exist, how are these practices staying afloat? I've been practicing for almost 2 years and I feel that I have a decent understanding of cash flow of a derm practice. If a practice pays a physician $140 per patient visit, there isn't any money left over to pay any overhead. I have dozens of peers who signed similar or lower contracts than myself, mix of private practice and private equity in various parts of the country. Show me the job that pays $140 per patient at 40 patients per week 5 days a week 46 weeks per year and I'll take it. Do you have links? If no links, does anyone actually have proof that this job exists? Anyone can write words on a website for a job offer. Have you received the checks?

Agree with above. As a fellow Derm I make around just under $80 per encounter (East Coast) as well and that's higher than most of my gen Derm colleagues. I agree that I'm not sure how the math works out at $140 per patient unless they are taking a loss and making it up elsewhere (path, Mohs referrals, higher facility fees, etc...). But if it is true, then kudos to you for finding a unicorn job!

[AR]

I agree that I'm not sure how the math works out at $140 per patient unless they are taking a loss and making it up elsewhere

I've heard that some people get there by taking biopsies of everything. I mean everything.

[JK]

I've heard that some people get there by taking biopsies of everything. I mean everything.

…or that.

[ENT Doc]

I interviewed at numerous places in the Midwest. Some were very rural, some private equity and some private practice. Of note, I did not interview at a "hospital system". I was never presented a contract with an RVU structure. I was given a $150,000 signing bonus check that literally changed my life and my family's life. Far from a bad deal. Your numbers are correct, I make around $80 per encounter at 6500-7000 encounters per year. Where the F are these offers for $140 per patient? And if they exist, how are these practices staying afloat? I've been practicing for almost 2 years and I feel that I have a decent understanding of cash flow of a derm practice. If a practice pays a physician $140 per patient visit, there isn't any money left over to pay any overhead. I have dozens of peers who signed similar or lower contracts than myself, mix of private practice and private equity in various parts of the country. Show me the job that pays $140 per patient at 40 patients per week 5 days a week 46 weeks per year and I'll take it. Do you have links? If no links, does anyone actually have proof that this job exists? Anyone can write words on a website for a job offer. Have you received the checks?

I don’t think they’re saying the physician is being PAID $140/patient. That’s what the hospital collects. Physician gets paid a portion of that.

[Fugue]

I don’t think they’re saying the physician is being PAID $140/patient. That’s what the hospital collects. Physician gets paid a portion of that.

No, his post stated $140 in reimbursement to the physician. He stated total collections were likely double that.

I actually think oslerweber is correct. When I looked at hospital jobs, they were offering about $65 per wRVU at the high end of the scale. But this was before the 2021 coding changes, when the associated wRVUs attached to E/M visits were much lower than they are now. I had to double check his numbers, because I do not work in a RVU system either. Unless hospitals made some adjustments to the contracts they are offering since I last interviewed, then the coding system changes of 2021 really benefited those that work in an RVU system.

For what it’s worth, the biopsy mills that I know of in my area are all private practice associated. I recommend not painting with a broad brush.

There are positives to not working in a hospital system. I prefer the derm specific EMR that comes with working in private practice, as well as not having to take inpatient call. So there are some positives to not being in a hospital system, but his numbers add up. If I leave this job, I’ll have to take another look at the hospital systems.

[Fugue]

I interviewed at numerous places in the Midwest. Some were very rural, some private equity and some private practice. Of note, I did not interview at a "hospital system". I was never presented a contract with an RVU structure. I was given a $150,000 signing bonus check that literally changed my life and my family's life. Far from a bad deal. Your numbers are correct, I make around $80 per encounter at 6500-7000 encounters per year. Where the F are these offers for $140 per patient? And if they exist, how are these practices staying afloat? I've been practicing for almost 2 years and I feel that I have a decent understanding of cash flow of a derm practice. If a practice pays a physician $140 per patient visit, there isn't any money left over to pay any overhead. I have dozens of peers who signed similar or lower contracts than myself, mix of private practice and private equity in various parts of the country. Show me the job that pays $140 per patient at 40 patients per week 5 days a week 46 weeks per year and I'll take it. Do you have links? If no links, does anyone actually have proof that this job exists? Anyone can write words on a website for a job offer. Have you received the checks?

I work in a situation very similar to you. However, I did actually interview at hospital systems. His numbers are accurate. I thought it was more common to see conversion factor in the 50s, but I did see $65 on the higher end of the range. I suspect hospitals collect more and may also charge facility fees, perhaps oslerweber has more insight into how hospitals still make a profit.

your numbers are accurate for private practice/private equity, usually in derm there is about 40% overhead and so private equity takes the difference. This may vary depending on lasers and high-end equipment. But I believe his numbers are also accurate for hospital systems.

[bills328]

I am part owner of a private derm practice in a medium sized city.

Our general dermatologists collect $139-141/per visit. Our PAs collect $114-128/per visit.

Certainly the insurance mix and # of biopsies could affect these numbers somewhat. I think our insurance mix is reasonable and we biopsy appropriately.

There is no way we could pay the MDs/PAs $140 per visit. Paying 45% of collections to MDs is more or less where the practice breaks even.

[Dr.D]

I am part owner of a private derm practice in a medium sized city.
Paying 45% of collections to MDs is more or less where the practice breaks even.

Do you have a MOHS surgeon in your practice?
Do derm practices owned by MOHS surgeons pay more than 45% of collection to dermatologists employed in their practice, and cover practice total overhead expenses from MOHS reimbursement? The practice does not make any money directly from a general dermatologist's collection, but a general dermatologist screens 35-40 patients a day and provides a steady flow of patients for MOHS.

[oslerweber]

I am part owner of a private derm practice in a medium sized city.

Our general dermatologists collect $139-141/per visit. Our PAs collect $114-128/per visit.

Certainly the insurance mix and # of biopsies could affect these numbers somewhat. I think our insurance mix is reasonable and we biopsy appropriately.

There is no way we could pay the MDs/PAs $140 per visit. Paying 45% of collections to MDs is more or less where the practice breaks even.

Do you have negotiated reimbursement rates on par with large non-profit hospital systems in an affluent semi-rural midwest city? Do you charge facility fees? Are you a 340B hospital with massive markups on all of your pharm? Do you make money when I refer to rheum, optho, allergy, order all my labs, technicaly and professional path, etc? You cannot compare a hospital system to a private practice.

[oslerweber]

d