Question about compensation model

[q-school]

WCInovice wrote:

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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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.

[WCInovice]

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.

[q-school]

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.

 

[childay]

Matas wrote:

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

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That was the level my hospital was concerned about as well

[jacoavlu]

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.

[Matas]

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.

[drfun]

Sean wrote:

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.

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My earlier response about typo was specific to above answer !

[drfun]

Or a typo   

[childay]

CryptoMD wrote:

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

[CryptoMD]

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.

[childay]

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

[jz]

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.

[ENT Doc]

BTW, unless they are an ACO with cost reduction sharing going on, or someone like Kaiser who has internalized their payer component, then the organization has several incentives that would look just as concerning.  To name a few:

Push providers to use consultant services in house

Have less primary care doctors and shunt people to the ED for more expensive care

Make specialists salaried but overwork them so they become more of a profit center (ding, ding)

Have patients come in for an appointment to review lab work, radiology, etc.

Hire or retain people who are known overutilizers of care given their patient population

 

[pulmdoc]

I call BS. Paying a surgical subspecialist a daily rate to be on call for a critical access hospital in a rural location is normal. Fee for service is obviously normal-it's how Medicare compensates physicians. There was no information provided that you are compensated for referrals to the facility which is an obvious no no. The only part which is potentially problematic would be the "50% of charges" which is vague. Is that before or after Medicare adjustments? If before I can see their point that a charge of $5k (you take 50% or $2500) adjusted to $600 is problematic because your pay would be higher than 100% of adjustment. If post-adjustment, of course that is fine.

I would draw a hard line in the sand on the daily rate, especially since it is presumably not your primary location. If they aren't willing to pay you to be available, then don't be available.

[Sean]

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.