Orthopedic Compensation

[supa14]

I currently work in orthopedic practice that is hospital employed. I've got 5+ years of ortho experience. My current salary is fair but my bonus compensation is insulting. I made a little over 2k in bonus last year. The hospital claims my reimbursement for my chargeable services was only $177k last year yet they can't provide me a breakdown of that number. I make $1wRVU that the physician can't bill for. PAs in ortho with my level of experience easily get 10% of their total compensation from bonus. Mine is less than 2% and the hospital has been so kind as to double mine to $2wRVU which is still insulting. The language of the contract is weird in that it says "Productivity Bonus: For each non-physician provider billable wRVU generated by you in any calendar year, and deemed necessary and appropriate by the hospital you will receive $2 per wRVU." I'm kind of getting hung up on that language because who decides what is appropriate and why am I getting robbed of my productivity and earnings? What is a "nonphysician provider billable wRVU? Thoughts please and thank you in advance!

[mgriffiths]

As an ortho PA, I have always asked why my bonus isn't based on surgical team productivity?  I do significant work that isn't billable, such as pre-op, post-op, f/u fracture care, surgical planning with schedulers, etc.  This frees time for the surgeon to increase his billing.  Also, from a purely RVU perspective, clinic is a goldmine for us (assuming we're not just seeing global period patients), while surgery is often lacking because we only earn 10%-15% or something as first assist, and that is assuming we can bill for the surgery at all.  But, again, our presence makes surgery significantly more efficient so more surgeries can be completed increasing overall revenue.

But, to get more at your question, the wording that controls your bonus is significantly convoluted, and as you suggested gives some faceless entity the power to decide "appropriate."  Why does appropriate matter?  If the insurance paid then the hospital made revenue based on your productivity.  So that would be my focus to change and then you can push to increase it transparently from there.

Last thing is to also know how your salary compares to the market.  If your salary is in the 99th percentile, then your bonus is likely to be smaller overall.  But, if your salary is 50th percentile, then your bonus should have potential to significantly increase your income.  Personally I prefer a higher salary and smaller bonus because then I don't get as caught up in RVU counting.  In my experience that leads to burnout, discontent, and the "one more patient" mentality (which can even make taking PTO a frustration).

[MsOrthoPA]

On 6/8/2020 at 10:50 AM, mgriffiths said:

As an ortho PA, I have always asked why my bonus isn't based on surgical team productivity?  I do significant work that isn't billable, such as pre-op, post-op, f/u fracture care, surgical planning with schedulers, etc.  This frees time for the surgeon to increase his billing.  Also, from a purely RVU perspective, clinic is a goldmine for us (assuming we're not just seeing global period patients), while surgery is often lacking because we only earn 10%-15% or something as first assist, and that is assuming we can bill for the surgery at all.  But, again, our presence makes surgery significantly more efficient so more surgeries can be completed increasing overall revenue.

But, to get more at your question, the wording that controls your bonus is significantly convoluted, and as you suggested gives some faceless entity the power to decide "appropriate."  Why does appropriate matter?  If the insurance paid then the hospital made revenue based on your productivity.  So that would be my focus to change and then you can push to increase it transparently from there.

Last thing is to also know how your salary compares to the market.  If your salary is in the 99th percentile, then your bonus is likely to be smaller overall.  But, if your salary is 50th percentile, then your bonus should have potential to significantly increase your income.  Personally I prefer a higher salary and smaller bonus because then I don't get as caught up in RVU counting.  In my experience that leads to burnout, discontent, and the "one more patient" mentality (which can even make taking PTO a frustration).

What is a good resource to learn the billed rate for surgeries in orthopedics. I am fairly new in orthopedics (10 months) and even newer to assisting more frequent as a first assist 2-3 times a week now. Billing is not something my program focused on and I have not found a good resource. 
 

Thank you

[mgriffiths]

On 1/2/2021 at 12:11 PM, MsOrthoPA said:

On 6/8/2020 at 10:50 AM, mgriffiths said:

What is a good resource to learn the billed rate for surgeries in orthopedics. I am fairly new in orthopedics (10 months) and even newer to assisting more frequent as a first assist 2-3 times a week now. Billing is not something my program focused on and I have not found a good resource. 
 

Thank you

I honestly don't know but I'm sure you could google billing codes by surgery...but I'm also sure there are modifiers that I'm not intimately involved in.  I use this (https://www.aapc.com/practice-management/rvu-calculator.aspx) for knowing ballpark RVUs for clinic billing.