Bonus based on Collections.

[PennPA4]

Hi guys

 

I am looking at ortho spine opportunity in Pennsylvania with salary plus bonus. Bonus is based on 30 percent of collections above 200k. The question is how achievable 200k in spine seeing patients 4/days a week and 1 day surgery assist? What pays more assist in 2-3 surgeries vs 20 patients/day.

[KMD16]

I will say first assist in surgery. Seeing pt in office which most often time are postop pts, not that much, given the buddle fees for service. Seeing more pt in office, you free up the surgeon time to operate more ( increases his volume load) which translate to more $$. In your shoes, I will negotiate for more days in the OR. If the practice needs is someone to be in the office 4days a week. Then, I would say don't put too much hope on the bonus structure. Just pretend it doesn't exist. Do not let them use the bonus structure to low ball you. Negotiate for higher base salary now. Otherwise you'll be screw. This is coming from a formal orthospine & neurological surgery PA. Good luck.

[familygal]

Would the potential employer be open to you asking them this? If they have had a PA before, they should be able to show you what the last one brought in.  The practice I work for gives me a monthly billing and collections summary which I think is the right thing to do.  I think it is only fair for them to provide this information if they are offering a bonus structure.

[KMD16]

Not too many employer will provide such information. And, when they do, the numbers are inaccurate or some information will be withheld. They own you no explanation literally. That's the mind sets. There's business side and politics side of medicine. Everyone will lie to you. I learn it the hard way after eight years. Expect to be taken advantage of as a new grad. In your shoes, I wouldn't count on or focus on bonus structure. Wouldn't accept or be guarded by promises. Everything must be written & spell out in your contract. You bring zero experience to the table as a new grad to justify getting bonus base on collection. If new grad in your area starting base is 100K, then you should negotiate at that base. Forget the bonus base on collection crap! Do not waste your time. Just my 2c.

[HospitalExec]

I'm a little late to the party, but I just want to echo KMD on being wary of the bonus structure. The question is really how are collections calculated. If you are doing the post ops or rounding on patients, the fee can be included in the bundled payment. So from the accounting perspective, you have zero collections for that work. It is all credited the physician. Maybe they have a method to credit work that doesn't directly equate into collections, but at that point they'd probably just use rvus instead.

 

 

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[ventana]

they are unbundling f/u care from the global fee soon - search the forum for the thread on this

 

Are you talking 200k per YEAR?

That better b very attainable in a surgical subspeciality - as long as you doc does not have you doing scutt work - you will need to be aware of the reimbursement issues - ie don't first assist on a patient that does not pay for PA first assist

 

The unbundling of the pre-post care could really help 

 

if your salary is 100k and you get 300k in receipts - you get another 33k - 133k is not bad

 

BUT if you salary is 70k   just walk away

 

oh yeah

5 day work weeks are tough - shoot for a 4 day week instead

[HospitalExec]

Yes, specifically Medicare, but other payors are still free to do whatever they want in relation to bundling.

 

I agree about being informed about proper coding and reimbursement, but the sentiment of "don't first assist on a patient that does not pay for a PA first assist" doesn't sit right with me. "Is it medically necessary and the best thing to do for the patient?" should be the first consideration, not if you're getting paid.

 

That isn't meant to be an attack, just my personal frustration at a compensation scheme that doesn't encourage the right things. I like % of collections in some settings, but it can be manipulated.

 

 

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[ventana]

Yes, specifically Medicare, but other payors are still free to do whatever they want in relation to bundling.

 

I agree about being informed about proper coding and reimbursement, but the sentiment of "don't first assist on a patient that does not pay for a PA first assist" doesn't sit right with me. "Is it medically necessary and the best thing to do for the patient?" should be the first consideration, not if you're getting paid.

 

That isn't meant to be an attack, just my personal frustration at a compensation scheme that doesn't encourage the right things. I like % of collections in some settings, but it can be manipulated.

 

 

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totally understand your point, but most surg PAs I know that are aware of compensation follow this

 

As well I am not in the habit of giving away my services (and can't afford to) and therefor I think it is reasonable that we not do things for free just because of insurance regs.  Might be shortsighted for me, and I might be wrong, but I have to pay my own bills and put food on my table and I can go to my car mechanic and ask for a free repair as I didn't get paid....  (BTW I make a whooping 70 as a practice owner so I am not getting rich)

[HospitalExec]

Your actions make sense based on how you are paid. The point is basically that we're still really far away from aligning the "right" thing with the most "profitable" thing.