Sale to Private Equity, will I lose bonus?

[Taus]

Interesting. I do 4/hour injections in office fluoro. Could do more if duct-taped mouths and didn’t answer qs…

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[RoloTomassi]

I think I’m reasonably quick procedurally. Nowhere near you but sub-20 minutes for bilateral lumbar RFA for actual procedure time, and I’m pretty meticulous about placement and angulation. But it’s all the stuff around the procedure that still costs me time. Can you explain a little more about that?

I have an MA doing fluoro and moving patients in/out, and one scribing/setting up trays. So while I’m doing the procedure the scribe puts in the note template and pulls up the next patient’s chart and imaging. When I’m done with the procedure the fluoro MA gets the patient down and out of the room, the scribe drops the next procedure tray, and I sign the note and review the next patient’s chart and imaging. That usually takes about 3 minutes. The next patient is brought in, then I talk to them. Here’s what I’m guessing is making me slower, but I don’t see how to “fix” it without compromising quality: I work with 2 mid levels, so I’m meeting a decent number of these patients for the first time right then. I review their imaging and new patient note, sometimes the note from the referring doctor, and briefly examine the patient. At least a couple times a day I’ll change what procedure we are doing, or at least what levels we are doing for MBBs. If the procedure is a 2nd MBB the conversation takes about 10 seconds but if it’s someone new to me with a lot of questions it can easily be 5 minutes. I discuss the injection, then the fluoro MA helps the patient on the table while I glove up and draw meds.

Overall I’m scheduling 15 minutes for routine injections and unilateral RFs, 30 minutes for bilateral RFs, and 45 minutes for stim trial and kypho (procedure itself isn’t that long but the discussion is longer and I’m prepping and draping everything myself). 2-3 double books per half day, so 7:30-4:00 with an hour for lunch, usually 25-30 patients per day.

Bob and gdub25, suggestions for improving flow?

Too much talking. Procedure days are not for talking unless prone.

Train your mid-levels better so you trust them more and don't have to second guess their orders. I review their orders/MRI on clinic day, point out every time I change something and why. Didn't take them long to get the picture.

Procedure note should be templated in a way where it should just take a couple clicks, freeing up your scribe MA to do other things.

I don't look at MRI day of. I have just look at the order in the note to make sure it translated correctly on the schedule. I have a system of notating things like transitional levels.

30/day isn't bad considering you're doing all that.

 

[gaseous_clay]

I still want to hear the Schwarzenegger pitch on protein shakes.

 

[Ducttape]

Example, doc taking 15 minutes to do an inter laminar ESI and only able to do 20 procedures in a day is someone that you need to replace. They didn’t know this is too slow.

this statement requires a caveat - what is too slow from a business perspective is not too slow from a patient safety perspective.

 

[Doctodd]

Interesting. I do 4/hour injections in office fluoro. Could do more if duct-taped mouths and didn’t answer qs…

that's why propofol is cost effective

 

[specepic]

This isn’t dreaded news in my opinion. I’m not an expert by any means but I have some experience with private equity. Know several PE firms and have had many dinners, zoom calls, and done consulting deals with them. Have had many offers for my practice as well and gone through offers, etc. I think most fear the worst when they hear private equity and a lot of people parrot what they have heard told to them but in reality very few have actual experience with this type of deal. PE is buying the group you’re a part of because there is profit to buy. You are probably generating that profit and doing so under your current contract. They have to honor that contract as it is a contract between you and the practice they are buying. They can absolutely try to get you to sign a new one either before they buy or when your contract term is done and you can negotiate. They would be unlikely to want to buy the practice if you are the primary revenue generator and they have no assurances you’re planning to stick around so they would want to make sure your happy if that’s the case. However, if you’re just one of a handful of guys in the group then the risk is much lower if you walk and you’re absence will be easier to absorb and you’ll be easier to replace.

You have some reasons to ask some questions and I’m not saying you shouldn’t be on alert but there is a decent chance your pay doesn’t change and in a lot of cases could increase depending on the size of the PE firm, their portfolio, and pull in your particular market.

Voice of reason