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Q about New Offer w/ Salary + RVU (i'm new to RVU's)- HELP


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I'm a Family Practice PA w/ 4 yrs of experience. Taking a job at a site approved by the National Health Service Corp for Loan Repayment (HPSA Score of 14). The job is a 2 yr contract (w/ 90 day out clause for any reason) which offers the following:

Base Salary: $100,000 

RVU's-> min RVU expectation= 3800. Compensation for this baseline level of RVU production is $93,600 paid bi-weekly. All salary bonuses are paid monthly. Monthly RVU minimums 317. All bonuses will be paid at $22 per RVU over this expectation. If the provider reaches 4500 RVU's in 1 calendar yr they will be paid and extra $4500 and compensation will increase to $23 per RVU. RVU's are based on E/M & CPT codes. For the first year, the PA is exempt from min. expectation of 341 RVU's and will be given an additional $6400 annual compensation pain in monthly acts on the 2nd pay period (in addition to productivity salary plan will increase to 341 RVU's Monthly.     ???? (it states RVU of 3800 then refers to it later as 341) ??? this is confusing. 

CME: $3000/yr

Vacation/Sick/PTO: 4 wks

Malpractice: Covered by Employer + Tail

M-F work week, 4 wknds/year on rotation

Health/Dental/Vision/Life

Retirement: 403b

**I'm overall happy with the offer...however, the RVU structure is new to me. Is this RVU structure reasonable? thought? concerns? At my previous job my base salary was $95k + Quarterly Bonus structure based on performance which equaled out to $108k/yr. Does this offer seem better $$? or about the same? (overall package is better than what I currently have). But the RVU structure is confusing. Any advise?

Edited by Daughter of the KING
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To keep things as simple as possible, I will give a most basic example.

Let's say you see nothing but established patients in a family practice setting, and every one of those patients is a simple 99213 code, with no procedures (think typical URI symptoms, exam, buh-bye).

2017 CMS fee schedule for wRVU for a 99213 has a value of 0.97

To meet minimum expectations on your contract of 3800, you would need to see 3918 (3800/0.97) patients per year.  If you want to break it down, that's an average of 327 patients per month, and if you work twenty days per month, that comes out to about 16 patients per day.  That is what earns you your base salary.

Anything above that number, either by volume of patients, higher EM codes, or additional CPT codes with the visit (you put a splint on a wrist, did an I&D, etc.) earns you more RVUs.  Remember though, the additional bonus structure only starts once you have hit your minimum 3800, and only pays for RVU above that number.  If you are seeing 18 patients a day, that means an extra 40 patients per month, or 480 patients per year.

So, an extra 480 patients per year puts you at 4280 patients (3800+480).

The extra 480 at an RVU value of 0.97 (we're still using the basic 99213 for every patient) gives you 466 total additional RVUs for the year.  Since you haven't hit the upper threshold of 4500 that you stated, those 466 RVUs are paid at the $22 per RVU rate, which comes out to a $10,252 bonus for the year.

Substitute patient numbers and RVU values to play around and figure potential earnings.

Clear as mud, huh?

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Look into the penalty for leaving your NHSC loan repayment contract too. That 90 day out is with the practice. The loan program breach of contract penalty is extremely punitive. If you left that job within your contract period you would be required to find another position in an NHSC site that they approve of or be in violation of the contract and owe the outstanding loan balance back (time promised minus time worked) plus a penalty based on the remaining time on your contract times a multiplier times the remaining money owed. It is potentially tens of thousands of dollars more than you were granted by them. 

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Here I got it for you

 

“In the unlikely event that you are unable to complete your service commitment and you have not received a waiver, you will be placed in default and will be required to pay back an amount equal to the sum of the following: 1) the amount of the loan repayments paid to you representing any period of obligated service you have not completed, 2) $7,500 multiplied by the number of months remaining in your service commitment for full-time clinical practice ($3,750 for half-time), and 3) interest on the above amounts. This amount will be a minimum of $31,000 and must be paid within 1 year from the date of default.”

 

If you got $20,000 for 2 years and left after 1 year and couldn’t find an acceptable replacement position you’d owe  (10,000 + (7500 x 12)) x interest. That’s $100,000 plus interest.....  they determine if you get an acceptable replacement position and they determine whether to grant you a waiver while seeking that other job. 

 

This is a ball and chain in the form of loan repayment, be sure you are happy at that job before you accept the governments money n

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