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Calculating wRVU rate in PP-Is this fair?

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  • #46
    I'm in a similar position as OP. I also take 50% of my collections. I'm the top producer in my practice of over 10 surgeons and while I agree we both may be getting screwed with this arrangement, I haven't pulled the trigger on leaving the practice. I do have partnership available to me, but there are some fundamental problems with the core of the practice that I do not want to buy into until they are resolved, including poor billing practice. When I did a deep dive into our billing department I found a LOT of problems with things not being coded or billed correctly. I suggest you do the same.

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    • #47
      Originally posted by TheHandGuy View Post
      I'm in a similar position as OP. I also take 50% of my collections. I'm the top producer in my practice of over 10 surgeons and while I agree we both may be getting screwed with this arrangement, I haven't pulled the trigger on leaving the practice. I do have partnership available to me, but there are some fundamental problems with the core of the practice that I do not want to buy into until they are resolved, including poor billing practice. When I did a deep dive into our billing department I found a LOT of problems with things not being coded or billed correctly. I suggest you do the same.
      I'm curious then, if you're able to calculate, what is your $/wRVU rate given you're also 50/50? And do you get a cut of ancillaries, etc or would that only be once you're a partner?

      As to the other recent responses, I'll have to wait a little bit to address the concerns/negotiate with the group (for various reasons). Overall, seems like the tone of the thread has changed recently. Initially, it was I getting screwed because if I'm in PP with no access to ancillaries/profit sharing then that's why I will come up short. Now, many are saying that the numbers have to be off. Who really knows, maybe it's both?

      I guess it would be helpful if any other PP orthos on here could give insight into their collections numbers and corresponding wRVUs. I know MGMA has this data as well but I've also heard that MGMA says you shouldn't divide across tables, etc.

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      • #48
        Data:

        Median 2020
        $619,050 compensation
        8,443 wRVU

        Median 2020
        $76 comp per wrvu
        $761,954 collections

        I asked my billers to pull my 2021 data. I'll look back this weekend on my 2020 data and see how I match up to the above.

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        • #49
          I’m private practice ortho. We don’t get paid by wRVU but our system can track it. I make over $80 per wRVU (income) counting just E&M and CPT codes. Income = collections minus overhead in my group. Plus I get approximately $300k annually in ancillary revenue with no wRVUs attached (PT, MRI, xray, splinting, etc) which my group splits evenly amongst all physicians. Outside of the perhaps standard ancillaries I have substantial call stipend and ASC income.

          So to reiterate, as I suspect you know, you are being underpaid.

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          • #50
            Originally posted by abds View Post
            I’m private practice ortho. We don’t get paid by wRVU but our system can track it. I make over $80 per wRVU (income) counting just E&M and CPT codes. Income = collections minus overhead in my group. Plus I get approximately $300k annually in ancillary revenue with no wRVUs attached (PT, MRI, xray, splinting, etc) which my group splits evenly amongst all physicians. Outside of the perhaps standard ancillaries I have substantial call stipend and ASC income.

            So to reiterate, as I suspect you know, you are being underpaid.
            Yes, I'm also private practice ortho and find it hard to believe OP is only getting around $35/wRVU. One of the following is wrong:

            1)Total collections; maybe the private equity takes the collections before they see them somehow. Maybe OP is nowhere near as busy has he/she thinks they are. Maybe the payer mix is also not as good as he/she thinks.
            2) wRVU; i know these are from the practice, but they could still be wrong.

            In my group, collections range from 800k to 1.8 million per physician. Over 1.4 million and you are waaaaaaay too busy if you ask me. . .

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            • #51
              Originally posted by JWeb View Post

              Yes, I'm also private practice ortho and find it hard to believe OP is only getting around $35/wRVU. One of the following is wrong:

              1)Total collections; maybe the private equity takes the collections before they see them somehow. Maybe OP is nowhere near as busy has he/she thinks they are. Maybe the payer mix is also not as good as he/she thinks.
              2) wRVU; i know these are from the practice, but they could still be wrong.

              In my group, collections range from 800k to 1.8 million per physician. Over 1.4 million and you are waaaaaaay too busy if you ask me. . .
              Very similar in collections (excluding ancillaries) in my group, with a couple just over 2m. Our group is like 45-50%ish overhead.

              For the OP: 15-17k wrvu gets you about $1.4m in collections in my group. Improves with better payor mix.

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              • #52
                Originally posted by ACN View Post

                Very similar in collections (excluding ancillaries) in my group, with a couple just over 2m. Our group is like 45-50%ish overhead.

                For the OP: 15-17k wrvu gets you about $1.4m in collections in my group. Improves with better payor mix.
                I agree OP's being underpaid, but not by THAT much for an associate, especially if it's a desirable metro area. Using the above numbers, collecting about $85/rvu seems pretty good, at 50% overhead means taking home 42.5 per rvu. That's 20-25% higher than OP's, but likely well within one standard deviation.

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                • #53
                  Originally posted by ACN View Post

                  Very similar in collections (excluding ancillaries) in my group, with a couple just over 2m. Our group is like 45-50%ish overhead.

                  For the OP: 15-17k wrvu gets you about $1.4m in collections in my group. Improves with better payor mix.
                  Thanks to everyone for the data.

                  Two of my partners each had a little over 16.6k wRVUs each. One had net collections of 1.1M, the other had 1.5M. So looks like this aligns with your data. However, doing the math for 50/50 take home, their $/wRVU rates come out to about 47 and 35 $/wRVUs, respectively.

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                  • #54
                    I wouldnt waste time talking to management. This is a PE shop and you're cogs in an extremely profitable wheel for the man, and they literally cannot give a single f about it. They will replace you. Find a different job.

                    You could probably double your income overnight at a hospital. I made 77/wrvu in my short hospital stint (plastics), and I assure you ortho made more.

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                    • #55
                      Academic on a fixed comp + call pay. Numbers based on Aug 31 year end. You need a grain of salt because it was first full year and all the pandemic impacts like electives an slower clinics.
                      $450 base and about $50k call.
                      6000 wRVU’s and looking at 9000 wRVU’s .
                      The 9000 will be sufficient to switch to incentive.
                      The “bonus” is the 9000 wRVU’s will also support adding a direct report PA (used how you wish and you hire and fire) in addition to a direct report MA. And getting block time.
                      That gives a range of $50-$75 with no overhead.

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                      • #56
                        Probably unnecessary to fixate too much on dollar per wRVU when the real roadblock is missing out on the other income streams you receive as a partner in a well run practice. That’s where your owners are making money off your work. Don’t miss the forest for the trees. An extra $5 per wRVU is “only” 50k if you generate 10k wRVUs.

                        You say you’re very busy.. how busy are you really though in terms of wRVU production?

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                        • #57
                          any data or anecdotes on the average collections for a PP ortho surgeon? just curious. some folks above mention some ortho PP docs collecting 2 million, is that common?

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                          • #58
                            2m high side, 900 low side

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                            • #59
                              Originally posted by pitt1166 View Post
                              any data or anecdotes on the average collections for a PP ortho surgeon? just curious. some folks above mention some ortho PP docs collecting 2 million, is that common?
                              Table B Compensation to Collections Ratio (excluding Academic) has some data. $1+ ~ for about every ortho sub-specialty at 75%, sooooooo, $2m collections would be a rare bird.

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                              • #60
                                Originally posted by legoman View Post

                                I'm curious then, if you're able to calculate, what is your $/wRVU rate given you're also 50/50? And do you get a cut of ancillaries, etc or would that only be once you're a partner?

                                As to the other recent responses, I'll have to wait a little bit to address the concerns/negotiate with the group (for various reasons). Overall, seems like the tone of the thread has changed recently. Initially, it was I getting screwed because if I'm in PP with no access to ancillaries/profit sharing then that's why I will come up short. Now, many are saying that the numbers have to be off. Who really knows, maybe it's both?

                                I guess it would be helpful if any other PP orthos on here could give insight into their collections numbers and corresponding wRVUs. I know MGMA has this data as well but I've also heard that MGMA says you shouldn't divide across tables, etc.
                                I have a very wide payer mix because I have office locations in both higher income and lower income areas. It averages out to about $70 per RVU, but it's difficult to pin it down to a straight dollar amount because of the big mix of work comp, auto, private insurance, medicare and medicaid. Last year I had about 1.5 million in total collections. Took half of that per my employment agreement. I'm sure the partners made out big on me. I see about 120-150 patients per week. About 50-60 cases per month. I feel like with my numbers I should be making more. Maybe it requires partnership, but like I said before, not quite ready for it with the way some things are currently set up with the practice. Maybe in the future.

                                EDIT: Forgot to add, I do not collect on any ancillaries. As a partner you have access to therapy revenue, but it isn't doing too hot right now. Another reason I haven't been eager to sign into partnership just yet.

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