In evaluating surgical practices, the goal should be that when you accept a position, you have a thorough understanding of how quickly your clinic and surgical practice will build, and the types of cases you should expect. In your investigation, you will need to determine how many full-time equivalent (FTE) surgeons are in the primary service area and if the supply of surgeons meets the demand. Many times, we are able to see an outmigration of procedures, by patients that have follow up care locally, but did not have their procedure locally. If there is a competing hospital, or group, you should determine what percent of the market share each group has, and the referral patterns coming from primary care.
In clinic, we will need to see if there is adequate patient volume, typically 25+ patients a day, at least 2-3 days a week. What percent of office visits result in a procedure? If you are joining other surgeons, are they willing to share referrals with you? If you are fellowship trained, what percent of general versus subspecialty can you do from the start, and/or build up to? How many exams rooms do we have in total, and when will each surgeon be in the office, and in the operating room. How is the group using advanced practice providers in the delivery of care? What is the marketing plan for your practice to the primary care referral base?
If it’s a private group, properly using it’s available space and staff, will lower their percentage of overhead per physician. Explore any ancillary revenue opportunities including ownership in an ambulatory surgery center or imaging center. If partnership is offered, make sure you understand the terms and structure, the buy in/buy out terms, investment and ROI. Which EMR does the practice use and is it integrated with the local hospital?
Determine the payor mix, especially for a private practice setting. Many times, in private practices, the most senior physician has the best payor mix, and the most junior physician the less favorable payor mix. Along with patient volume, this will help better determine your income potential. If you are in an employment model with RVU, understanding the payor mix will assist you in determining if the RVU reimbursement rate is reasonable.
At the hospital, several factors come into play in your evaluation of the practice. Is there support for your service line coming from administration? The utilization of current block time, and how it is allocated to the new surgeons. Is the block specialty related, or does each physician have their own block? Are there any full day blocks or just afternoons? For each case, how does the hospital allocate staff, and their level of experience. When do the first cases start? How are add on’s handled? Does the hospital have the latest equipment and which vendors do they use for supplies you need? How is the anesthesia care structured with MD/CRNA’s? A meeting with the OR Director should provide clarity to the above questions. Is the radiology equipment up to date? Which EMR does the hospital use? Understanding the payor mix at the hospital, will provide you valuable insights to the types of patients/cases you may see.
How does the call schedule really work? Is it paid? Do the current surgeons get called appropriately, if a patient (including trauma) presents in the ED? How many times do you have to come in to see a patient? These call questions, and many others, should be confirmed by asking your future surgical and ER colleagues.
The discussion above highlights a good starting point of information to you should have to assist in your decision. For additional insights on evaluating surgical practice opportunities, give Pacific Companies a call.