Whether you join a group or hospital staff, charges and work schedules are important factors.
Understanding fee structure
You’ll likely have no say in the fee structure since it’s already established. If you’re introducing a new service or procedure, you might be asked for input, but the payers will likely have the last say. You should at least know the going rate for the 10 procedures you do most often, however, just to know that you’re adequately reimbursed.
Make sure in your job interview that you understand how new patients will be assigned on the schedule. Since your compensation may be based, in part, on the revenues and collections you generate, you need to be sure that you’re going to get your fair share of new appointments, especially if your partners are still taking them. (Also find out if you’ll have a similar number of exam rooms as your partners.)
Also, how is the payer mix, particularly Medicare or Medicaid, handled? Again, unless the practice is focused entirely on these populations—so there’s no doubt that you’ll see them—it’s important to know how these patients are distributed. Will a disproportionate number come your way? Having the same patient volume as your partners is one thing in generating revenue, but if they’re all on medical assistance or other government programs, that’s quite another. So it’s important to know the mix.
You’ll have far more input as to your work schedule. As long as you meet the basic requirements of the practice in terms of the number of patient visits, hours worked and/or shared call, you’ll likely have some flexibility for your own needs. At HealthTexas Provider Network (HTPN), for instance, some physicians have significant research obligations, so they see patients four days out of the week in the office with the fifth day free to meet those obligations.
Because the only requirement for Luis Perez, D.O., was that he works a set number of hours per week, he closes the office on Thursday afternoons so he can precept osteopathic residents in their clinic. Adding this extra stream of income has served as a great contingency plan while he’s still growing his practice.
Other physicians had warned Perez that it might be frustrating at first to fill his schedule, so he welcomed the opportunity not only to precept the doctors but also to treat nursing home veterans in nearby Sandusky.
“You always wonder, ‘Boy, am I going to make this practice grow, or will it be like this forever?’” he says. “But having a steady revenue and income on the side to cover expenses makes you feel better until your patient volume increases.”