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  • #16
    Critical access hospitals are, by definition, reimbursed at cost + 2%. Has this changed in the past few years? These hospitals are not incentivized to contain costs.

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    • #17
      Is the concern about the "compensation model" or is it a fair market value issue?

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      • #18
        I would be curious as to what compensation model they would suggest. Outside of straight salary, every single compensation model I've ever heard of (hospital employee-wise) is some sort of FFS.

         

        As a surgical subspecialist, I'd imagine they are losing a significant amount of money by offering you 50% of surgical charges. Not that they aren't still profitable but they realize in a wRVU model (which would still 'tempt you to perform unnecessary surgery' so...), they would get to keep a significantly higher % of revenue when it comes to your surgical cases. Especially since these critical access facilities get reimbursed at higher rates than those without the designation. I have a buddy in rural WI where the hospital flat out told him they expect and want him to increase surgical volume for that reason. They get paid well for surgical cases.

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        • #19


          I have a buddy in rural WI where the hospital flat out told him they expect and want him to increase surgical volume for that reason. They get paid well for surgical cases.
          Click to expand...


          Of course!  Outpt / elective surgery is what keeps a lot of smaller rural hostpitals afloat.

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          • #20
            Or a typo   

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            • #21




              OP wrote:  “I need to come up with a counter offer that is commissurate with my previous contract”…

              )  Interesting ‘portmanteau’ !!  I wonder if this wasn’t a Freudian slip, given that you’re commiserating about your pay, which you feel should be commensurate with your efforts. ?
              Click to expand...


              My earlier response about typo was specific to above answer !

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              • #22
                The notion of being incentivized to perform unnecessary surgery is pure BS - same issue would pertain to any productivity-based comp model, which is pretty standard.

                Who is covering when you're not there?

                How are they being compensated?

                How easily can you be replaced?

                If you calculated your compensation on a $/wRVU basis, how much would that be, and how does it compare to the MGMA percentile comp/wRVU data for your specialty? I could see where 50% of charges + a base rate could be greater than MGMA median/wRVU, but unless >90th percentile, the notion of a Stark issue is probably just a smoke screen to justify paying you less.

                Ultimately, your only leverage is your two feet.

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                • #23
                  How about figure out what you’ve been paid gross over some prior period (1 year, 2 years?), figure out a gross daily rate, and counter with that? Take out the “incentive” conflict.

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                  • #24


                    but unless >90th percentile, the notion of a Stark issue is probably just a smoke screen to justify paying you less.
                    Click to expand...


                    That was the level my hospital was concerned about as well

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                    • #25
                      we've had these questions come up from outliers within specialties as well.  sometimes the question is raised because someone else is > 90th percentile, and they look and they see that a division with four people have three people who are close in RVU/income, and one streaking away from the group.  sometimes the organization volunteers to return money before the audit to avoid trouble down the road.  it also is dependent on how underserved the specialty is, and how urgent it is to the mission of the hospital.  ie maintaining trauma level or something.

                       

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                      • #26
                        I think 90%ile is a good metric (the hospital has used 75th%ile in their dealings with us before)....but it's a bell curve and someone has to be on the tail of that curve.  If anyone, it's going to be a surgical subspecialist in a rural area.

                         

                        If you cannot recruit a surgical specialist for 75th%ile for years on end, then that to me is proof positive that the "fair market value" is higher than that...even if MGMA is telling you that it's "well above average" what they're offering...if they can't fill the spot then it is what it is.

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                        • #27




                          I think 90%ile is a good metric (the hospital has used 75th%ile in their dealings with us before)….but it’s a bell curve and someone has to be on the tail of that curve.  If anyone, it’s going to be a surgical subspecialist in a rural area.

                           

                          If you cannot recruit a surgical specialist for 75th%ile for years on end, then that to me is proof positive that the “fair market value” is higher than that…even if MGMA is telling you that it’s “well above average” what they’re offering…if they can’t fill the spot then it is what it is.
                          Click to expand...


                          true but as you noted earlier, the only thing that may matter is whether the hospital decides to pay or not.  if they want you there, they will pay you.  even if they really believed their claim, they could still present a working compensation model.  if they think they can get by paying less, no amount of evidence will sway them.

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