Negotiate with knowledge and watch out for pitfalls with billing and side hustles.
The stereotype out there is that doctors “make a ton of money.” And it’s true that physicians can net a good yearly salary. But often the “base salary” isn’t where doctors make most of their income and isn’t as high as people think. Investments in ambulatory surgery centers or other microhospitals, extra pay through on-call or medical director agreements, or ancillary services, are common. Sometimes the additional services outside the doctor’s day job are where the real money comes in. But how can a physician avoid the pitfalls found within fraud and abuse statutes, and how can a doctor reduce the threat of a risky investment going sour? Nothing in life is completely risk free, but in this article, I’ll discuss four things doctors need to know when they are trying to make additional income.
Doctors are notorious for either undervaluing themselves or shooting too high. Don’t guess. When negotiating for any job, a provider should review the Medical Group Management Association (MGMA) numbers of salaries of a particular specialty in a particular region and know the ranges so that when discussing salary with a potential employer, they can push for market value. And always try to get a sign-on bonus. Often just by asking, a physician can increase his or her salary by a decent percentage because what was offered, for example, 45% of MGMA, when the provider really should be paid anywhere from 60% to 70% in this tight market. Knowledge is power, and physicians should never be afraid to ask for what they are worth.
Whether it’s an investment in a surgery center or a joint venture with a lab, these agreements are tricky and can easily put you in a situation where you are in the crosshairs with federal regulators. You cannot trust anyone who says, “This has already been vetted by legal.” Unless you have had your own health care attorney review a deal, don’t trust anyone. Remember: If it’s too good to be true, it probably is. If you are a medical director, you need to keep logs and hours worked and base your income on an hourly or monthly flat rate. Be cautious about being paid on commission or any money in exchange for referrals. It will save you a lot of time later to have a health care attorney review a deal now.
This may soundlike a funny way of making more money, but often you are underbilling or don’t realize something is even collectable without a thorough review. Hire someone to come review your billing and coding practices, see if you are leaving money on the table, and find out if there is a safe way to generate revenue that you haven’t even thought of. And if you are coding and billing incorrectly, you want to know that as well, so you don’t commit such errors for years and have to refund the government later at a high cost. An auditor who you hire is a great asset. It’s much better than a government auditor taking a look at your charts and telling you what you are doing wrong.
Hiring a physician’s assistant or nurse practitioner can make you extra money and can be a boon to your practice. Not only can you make money by paying them a flat-rate salary and keeping the collections they bring in, which are often much higher and thus creating additional revenue, but it’s a great extension of your practice and helps your patients. You can work with, supervise, and even train an advanced practice registered nurse (APRN) to work with you in a similar practice style so that your patients have another caring person they can see when they need clinical help.
Doctors all want to make a good living, and they do. But health care practitioners need to be mindful that side hustles can be troublesome given the myriad of fraud and abuse rules and regulations out there. Make money, but try to do it as safely as possible.
Amanda Hill is an Austin, Texas-based health care attorney and founder of Guard My Practice, an online video platform for doctors in 15-minute weekly sessions guiding them through complicated subjects with ease, such as contract negotiations, fraud and abuse issues, employment conflicts, the basics of setting up a practice, and more.