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Dermatology - Average Collection Per Encounter

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  • #31
    Originally posted by oslerweber

    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.
    Unfair playing field, seems better to be a worker benefiting from the rigged game than have equity in a traditional PP. Is your actual work going to be in some outpatient clinic thats just owned by the hospital?

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    • #32
      Originally posted by Turf Doc

      Unfair playing field, seems better to be a worker benefiting from the rigged game than have equity in a traditional PP. Is your actual work going to be in some outpatient clinic thats just owned by the hospital?
      yes, and my contract specifies no call or consults in the hospital.

      It is a rigged game but I personally would ultimately prefer PP for the equity, no income ceiling (ie dealing with suits and stark law b.s.) and the freedom to do as I please which is priceless. Maybe someday.

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      • #33
        Yes it’s a rigged game. Even simplistically for a level 4 new patient you can find the hospitals charge, probably right around $400, assume they collect 1/3 of that, and that’s pretty much what they’ll pay the physician even at wrvus in the upper 50s.

        As others have mentioned, that revenue is peanuts for what they make on the total encounters and ancillaries.

        They also get to call themselves not for profits and pay CEOs 8 figures. Research funding. Tax advantages. The list goes on

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        • #34
          Originally posted by oslerweber

          It is a rigged game but I personally would ultimately prefer PP for the equity, no income ceiling (ie dealing with suits and stark law b.s.) and the freedom to do as I please which is priceless. Maybe someday.
          FWIW, I think you're definitely doing it the right way. Spend a few years learning the business side and honing your clinical skills to the point that you're mostly on autopilot. Also save up some money. Once you have accomplished all of that, starting a private practice is much, much more likely to succeed.

          A lot of people do set out with that plan, but the comfort of just staying employed and cashing easy checks is too great, so they don't make the leap. It seems like whichever of those paths you choose it will be fine.

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          • #35
            Originally posted by oslerweber

            yes, and my contract specifies no call or consults in the hospital.

            It is a rigged game but I personally would ultimately prefer PP for the equity, no income ceiling (ie dealing with suits and stark law b.s.) and the freedom to do as I please which is priceless. Maybe someday.
            What is your EMR? How many assistants do you get? How do you know your schedule will fill? It took me many months to get up to 30 completed visits per day and my area has pretty high demand. At the beginning, I had no show/cancellation rate of 20-25% some days. Now it’s about 10%, 18 months in.

            I should specify that to get to 30 completed visits per day average, you’ll need a template of 45 for months. And my practice sends text reminders days before.

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            • #36
              Originally posted by ddoc79

              What is your EMR? How many assistants do you get? How do you know your schedule will fill? It took me many months to get up to 30 completed visits per day and my area has pretty high demand. At the beginning, I had no show/cancellation rate of 20-25% some days. Now it’s about 10%, 18 months in.

              I should specify that to get to 30 completed visits per day average, you’ll need a template of 45 for months. And my practice sends text reminders days before.
              these are some more drawbacks of not working private is less control of your situation. ALL of the hospitals I negotiated with refuse to specify # of assistants in the contract, because it sets them up for potential breach. They told me they'd start with 2 MAs and potentially an RN but would adjust based on demand. I asked for 3 MAs and 3+ rooms in the contract but they won't commit. However this is why to me it was important to have a strong base salary, so that worst case they paying me 625k for 2 years and they have more skin in the game to keep me productive. I interviewed with 7 FM/IM PCPs who will funnel me patients, I don't think I will have a problem being busy but there is expected ramp up. Regardless at $72 rvu rate I only need to see 19.29 patients per day to break even, really can't lose. (625,000/72/2.0 rvu per patient/ 45 weeks / 5 days per week). EPIC is the EMR.

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              • #37
                Originally posted by oslerweber

                these are some more drawbacks of not working private is less control of your situation. ALL of the hospitals I negotiated with refuse to specify # of assistants in the contract, because it sets them up for potential breach.
                Private practice also you have no control over the situation unless you are a partner. You have no more say in PP as an employee. In fact, PP you are at the mercy of the couple partners (unless they are large group). In hospitals, things are more streamlined just due to the nature of the large organization. PP is great if you find the right group, otherwise you paying sweat equity for nothing in the end.

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                • #38
                  Originally posted by AR

                  FWIW, I think you're definitely doing it the right way. Spend a few years learning the business side and honing your clinical skills to the point that you're mostly on autopilot. Also save up some money. Once you have accomplished all of that, starting a private practice is much, much more likely to succeed.

                  A lot of people do set out with that plan, but the comfort of just staying employed and cashing easy checks is too great, so they don't make the leap. It seems like whichever of those paths you choose it will be fine.
                  Solo PP is a risky proposition. Not only because you have no bargaining power with insurance but they knowingly abuse payment to small PP because they don't have resources to go after them. Add to that all the load of having to do everything yourself from hr, to billing to patient care, and if you are the breadwinner it's a hard pill to have little income for a few years and yet work all kinds of hours. Sure more upside once you are settled but getting there is quite hard!

                  Comment


                  • #39
                    Originally posted by matia

                    Solo PP is a risky proposition. Not only because you have no bargaining power with insurance but they knowingly abuse payment to small PP because they don't have resources to go after them. Add to that all the load of having to do everything yourself from hr, to billing to patient care, and if you are the breadwinner it's a hard pill to have little income for a few years and yet work all kinds of hours. Sure more upside once you are settled but getting there is quite hard!
                    I think this is specialty dependent. Dermatology is probably one of the easier ones to pull it off on, since one is not dependent on a hospital and can offer a lot of services (i.e. cosmetic) that won't involve haggling with payers. Nevertheless, you're right. It is hard. For the wrong person, it's a bad choice. But for the right one, it can be a great move.

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