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Question about remuneration schemes (long post).


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I am the "senior" PA for a small group practice in E. Washington.  I have been here longer (in a single stretch) than any of the other PAs who work here - one of our PAs is senior to me but not with consecutive time.  There is one other advanced practice provider who works with us, an experienced NP.  I have been tasked with proposing a different method of determining remuneration for our advanced practice providers. 

 

Currently there is 1 contract that we use for all advanced practice providers.  It is a base salary which is on the low end of normal plus a production bonus based on collections.  This has been the same since the NP started.  We recently hired a very experienced PA and I was shocked that he signed this contract.  It's not bad for a new grad, but for someone who is beyond about 5 years or so, the risk is that we will be underpaid. 

 

There is another catch - this one contract covers our urgent care as well as our primary care advanced practitioners.  The urgent care folks produce and produce well.  My practice alone is about 9000 RVUs annually.  I am not privy to the RVUs of our primary care folks, but from what I understand it is not nearly as profitable (which makes no sense).  Our billing team is excellent - I average over 70% collections. 

 

What are some payment schemes which you have seen in primary care that work for you? 

 

Our practice is very largely an "eat-what-you-kill" type of place - the docs on the board are old school.  The board's income is dependent on what they earn for the practice plus they get some of what the advanced practitioners earn (equals about $5-10k per year per board member).   Therefore, there will never likely be a straight salary option approved by the board. 

 

How do I make it so that our primary care folks who are senior actually make what a primary care provider is worth?  I think our PC advanced practitioners are making less than $90k (I don't know for sure).  They aren't slacking - the IM NP sees 16/day, the FP PA sees 18/day at least. 

 

Any thoughts you have would be helpful.  I'm brainstorming, but my brain is tired.

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16 pts per day would equal about $460k in charges (assuming a 60% level 4 and 40% level 3 split which is normal for internal medicine).  18 pts per day would be about $500k in charges (assuming a 50/50 split between level 3 and 4 charges which would be doable in family medicine).  These would generate plenty of revenue to get our providers into the $90k range for salaries assuming 65% collections.  The question is one of why this isn't achieved. 

 

What are other ways of paying providers based on what they see which net better yields for advanced practitioners?

 

Edit: this is assuming a 4 day work week. 

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I am the "senior" PA for a small group practice in E. Washington.  I have been here longer (in a single stretch) than any of the other PAs who work here - one of our PAs is senior to me but not with consecutive time.  There is one other advanced practice provider who works with us, an experienced NP.  I have been tasked with proposing a different method of determining remuneration for our advanced practice providers. 

 

Currently there is 1 contract that we use for all advanced practice providers.  It is a base salary which is on the low end of normal plus a production bonus based on collections.  This has been the same since the NP started.  We recently hired a very experienced PA and I was shocked that he signed this contract.  It's not bad for a new grad, but for someone who is beyond about 5 years or so, the risk is that we will be underpaid. 

 

There is another catch - this one contract covers our urgent care as well as our primary care advanced practitioners.  The urgent care folks produce and produce well.  My practice alone is about 9000 RVUs annually.  I am not privy to the RVUs of our primary care folks, but from what I understand it is not nearly as profitable (which makes no sense).  Our billing team is excellent - I average over 70% collections. 

 

What are some payment schemes which you have seen in primary care that work for you? 

 

Our practice is very largely an "eat-what-you-kill" type of place - the docs on the board are old school.  The board's income is dependent on what they earn for the practice plus they get some of what the advanced practitioners earn (equals about $5-10k per year per board member).   Therefore, there will never likely be a straight salary option approved by the board. 

 

How do I make it so that our primary care folks who are senior actually make what a primary care provider is worth?  I think our PC advanced practitioners are making less than $90k (I don't know for sure).  They aren't slacking - the IM NP sees 16/day, the FP PA sees 18/day at least. 

 

Any thoughts you have would be helpful.  I'm brainstorming, but my brain is tired.

Any payment that is based on collection is problematic. Who is doing the collecting? How aggressive are they? How can you verify collections? A simple process with verification is important.

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