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Two more large practices up for sale
Posted by Unknown Member on January 13, 2021 at 11:22 am[font=”dialog”][size=”4″][link=https://www.radiologybusiness.com/topics/healthcare-economics/simonmed-lucidhealth-radiology-exploring-sales]https://www.radiologybusi…iology-exploring-sales[/link][/size][/font]
medvidr replied 3 years, 8 months ago 17 Members · 63 Replies -
63 Replies
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Unknown Member
Deleted UserJanuary 13, 2021 at 12:08 pmRP may bite on Lucid and or Simonmed. They are already in Ohio and AZ and seem to have an unlimited supply of cash for acquisitions but not radiologist compensation. LOL
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Unknown Member
Deleted UserJanuary 13, 2021 at 1:26 pmThese entities already pay rads low. In order to profit, i.e. sell at a higher multiple, RP needs to pay rads lower.
How low can you go?-
The lower limit of what corporates pay is what a rad would take. If job market goes bad, then well see primary care salaries (or worse) since many markets have few other options these days. Look at telerad and the pathetic rates.
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Unknown Member
Deleted UserJanuary 13, 2021 at 3:04 pmDrad,
Have you actually ever done tele?
If you’re a fast reader and have the proper platform, you end up doing really, really well. I do better now than any PP group I was in when younger. Some people want the hospital setting, good from them. I sure as hell am never going back to all the headaches and hassles/interruptions.
Like anything in life, don’t judge something you don’t have any experience in.-
Unknown Member
Deleted UserJanuary 13, 2021 at 3:44 pm
Quote from Voxeled
Drad,
Have you actually ever done tele?
If you’re a fast reader and have the proper platform, you end up doing really, really well. I do better now than any PP group I was in when younger. Some people want the hospital setting, good from them. I sure as hell am never going back to all the headaches and hassles/interruptions.
Like anything in life, don’t judge something you don’t have any experience in.
How well are you doing? 350k? 400k tops
How many RVUs do you do?-
20 bucks an rvu or so. 20k rvus is 400k before taxes and expenses. That really stinks. And during the worst hours also. Not sure how you can think that is good?
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Quote from Drrad123
20 bucks an rvu or so. 20k rvus is 400k before taxes and expenses. That really stinks. And during the worst hours also. Not sure how you can think that is good?
Would that include health insurance, CME, PTO, 401K etc?
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What does this say about Lucid? Do they believe their value is at its peak?
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Its not what you make but what you keep.
If one pays tax on one 150 out of 400, and the rest is deductions or profit sharing plan , then thats the equivalent of making 600k.
Throw in no state income tax potentiallyIt may be along those lines.
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No one should be reading 20k rvus. And if you are then you better be making at least a million. Your career will be over soon from burnout, malpractice suits, or suicide,
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Quote from Drrad123
No one should be reading 20k rvus. And if you are then you better be making at least a million. Your career will be over soon from burnout, malpractice suits, or suicide,
this. amen-
EBITDA of 60 and 75MM.
480 to 900 MM range for sales…
Wonder if the physicians leading will go for an MBO or BIMBO offer? That would be a real tell on the model.
Still, I wonder how much of the profit growth comes from reducing rad reimbursement and how much comes from increased efficiencies (decreased costs, organic growth, etc)?
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Unknown Member
Deleted UserJanuary 13, 2021 at 9:24 pmSooner than later they will pay 5 bucks/RVU. Stupid.
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it comes from reducing physician cost mostly
sometimes, contracts/reimbursement can be improved through re negotiation.
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Unknown Member
Deleted UserJanuary 13, 2021 at 9:40 pmI am close to the end of my career and luckily financially independent.
However, I feel for the new graduates. The future is very uncertain. On one hand the field is being infiltrated by corporate left and right and on the other hand AI is just behind the door.
It is hard to not be worried about the future.
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Lol. if we have negative interest rates, why not take the $ per RVU model negative as well?
I will read those films for -$5 for RVU! Do I hear -$10 per RVU?
sorta reminds me of fake elections, and $40K per bit of air if you catch my drift…
like I now say, my logic is of no use in this new world reality
so, without any useful skill to chart this new course,
I will take -$20 per RVU haha
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Quote from NYC
EBITDA of 60 and 75MM.
480 to 900 MM range for sales…
[b]Wonder if the physicians leading will go for an MBO or BIMBO offer?[/b] That would be a real tell on the model.
Still, I wonder how much of the profit growth comes from reducing rad reimbursement and how much comes from increased efficiencies (decreased costs, organic growth, etc)?
Can you clarify?-
Unknown Member
Deleted UserJanuary 14, 2021 at 5:23 amWho would want to buy an all out patient practice like Simon? I thought private equity wanted hospital contracts and rad labor, not depreciating assets and aging mri and ct machine.
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Unknown Member
Deleted UserJanuary 14, 2021 at 7:12 am
Quote from Sir Read Alot
Who would want to buy an all out patient practice like Simon? I thought private equity wanted hospital contracts and rad labor, not depreciating assets and aging mri and ct machine.
It’s so weird to see that written.
It used to be, all everyone wanted was out patient imaging.
Hospital contracts were for suckers and fools.
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The powers that be need to start cutting residency spots. Under supply is our only leverage in the future.
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Unknown Member
Deleted UserJanuary 14, 2021 at 9:38 am[Deleted by Admin]
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^^ what does few tele people doing 700k mean? That they own the company and make money off others? That they kill themselves working all year non stop? More then likely, at 20/rvu, most wont come close to the that and will produce more then most.
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Unknown Member
Deleted UserJanuary 14, 2021 at 9:46 am[Deleted by Admin]
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Unknown Member
Deleted UserJanuary 14, 2021 at 9:53 am[Deleted by Admin]
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^^ definitely not typical or attainable for 99%+. Expect to make a crappy salary, bad hours, and read high volumes.
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Unknown Member
Deleted UserJanuary 14, 2021 at 9:59 am[Deleted by Admin]
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I work in small 12-15 PP group and we have a difficult time recruiting for decent paying job, benefits, average work etc. Most people wanting the lifestyle that remote work brings or subsidized academic type job making decent money reading barely anything at all.
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Unknown Member
Deleted UserJanuary 15, 2021 at 8:36 am
Quote from Dozer
I work in small 12-15 PP group and we have a difficult time recruiting for decent paying job, benefits, average work etc. Most people wanting the lifestyle that remote work brings or subsidized academic type job making decent money reading barely anything at all.
Decent pay in an undesirable area with long partnership track may be the reason.
It is always hard to recruit to rural/undesirable areas. -
Unknown Member
Deleted UserFebruary 26, 2021 at 9:47 amAny updates as to whether or not either of these groups found a buyer yet?
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Quote from sandeep panga
Quote from TheSLACman
fast readers + 4 weekend days a month. dont kill themselves. work about 54 hours a week with no evenings. the ones i know who kill themselves make >1 mil
Just to highlight this for anyone that may be interested. To make >$1M at the RP/vRad/corp telerad rate of $20/RVU means reading >50,000RVU.
At $25/RVU (higher than RP/vRad/corp telerad pay but still terribly low) that is >40,000RVU, another number many would consider unsafe.So you’re talking about telerads working for a private practice or perhaps a more boutique radiologist run teleradiology group earning higher than the corporate rate, or are you saying there are rads reading >50k RVU?
I could easily knock out >40k RVU/yr, if I simply signed off about 75% of my cases using a normal macro and not look at the images[:D] -
There is precedent for rads buying back their practices. Unfortunately I think the valuations are so high at the moment, I doubt it will happen. In fact, if it did, I would wager it would be a lower range of multiples suggesting very little external interest in our space… Considering the mountains of money and low interest rates, I am not sure this is the case though there are headwinds for PE in medicine and radiology. I think the buyers will be from among the usual suspects, but some health systems and payor would make interesting new entrants.
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Unknown Member
Deleted UserJanuary 15, 2021 at 7:12 am
Quote from NYC
There is precedent for rads buying back their practices. Unfortunately I think the valuations are so high at the moment, I doubt it will happen. In fact, if it did, I would wager it would be a lower range of multiples suggesting very little external interest in our space… Considering the mountains of money and low interest rates, I am not sure this is the case though there are headwinds for PE in medicine and radiology. I think the buyers will be from among the usual suspects, but some health systems and payor would make interesting new entrants.
I have not heard of rads buying back their practices from private equity. Care to mention any examples?
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Back to the rvus, are vrad telerads reading 20k wRVUs a year to make a decent salary? Yes, I know more efficiency but that is still insane volume.
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I used a multiplier range of btw 8 and 12x for the 2 EBITDA values in article. Too lazy to apply range to each.
Management Buy Out. Buy In Management Buy Out. MBOs are when current management buys control of business. Bimbo is hybrid of new and old management buying control. [link]https://www.investopedia.com/terms/m/mbo.asp[/link]
The “leading physicians” and other members of management team could always buy the practices though they would need substantial financial resources.-
Unknown Member
Deleted UserJanuary 14, 2021 at 10:50 am
Quote from NYC
I used a multiplier range of btw 8 and 12x for the 2 EBITDA values in article. Too lazy to apply range to each.
Management Buy Out. Buy In Management Buy Out. MBOs are when current management buys control of business. Bimbo is hybrid of new and old management buying control. [link=https://www.investopedia.com/terms/m/mbo.asp]https://www.investopedia.com/terms/m/mbo.asp[/link]The “leading physicians” and other members of management team could always buy the practices though they would need substantial financial resources.
Why does this matter? Do you think there is a possibility of rads taking back their reading fees?
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Unknown Member
Deleted UserJanuary 14, 2021 at 11:27 am
Quote from docholliday126
WOW…SimonMed…things must be worse than I thought
This is surprising to you? SimonMed has been a horrible place to work for a long time.
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Well I thought they had the scale and infrastructure to compete in today’s market. Will the consolidation phase end up in a duopoly (i.e. the lab space, Quest/Lab Corp) or something? Not sure…
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Quote from Drrad123
No one should be reading 20k rvus. And if you are then you better be making at least a million. Your career will be over soon from burnout, malpractice suits, or suicide,
I agree that telerads is inferior and I’d personally only do it if I had exhausted all the other onsite possibilities available to me. For a below average candidate, teleradiology is not a terrible job.
But you do understand 20k RVU per year is not a crazy unattainable dangerous reading rate like you ardently suggest. These are bread and butter mainly ER studies that tele mainly reads. Reading 20k RVU per year of that is like reading 13k RVU of more complex subspecialty studies. And that is why the rate per RVU telerads offers is low (amongst many other factors).
Also, how would you expect someone to earn 1 million dollars when reading 20k RVU in a year? How would a partner in a group earn this? The average reimbursement/revenue I’ve seen for groups is $50/RVU. 20k RVU would bring in about $1,000,000 of revenue, which you then subtract the practice expenses, benefits, and retirement contributions from. And you have to factor in that these are the easy RVUs, so if 1 partner were reading 20k RVU from the ER and the other subspecialty complex studies at 13k a year, I would think it is fair they split the pot of revenue they both make because the amount of effort is of close value (so the ER partner would be making less $/rvu then the partner reading the lower volume more complex cases). Just a simplified example.-
^^ thank god those are prelim reads because even reading bread and butter at 20k rvus or more is dangerous for many during dead of night. I saw the prelims for a major company and there were non stop egregious misses.
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Unknown Member
Deleted UserJanuary 15, 2021 at 10:22 am[Deleted by Admin]
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Unknown Member
Deleted UserJanuary 15, 2021 at 10:23 am[Deleted by Admin]
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Quote from TheSLACman
for example today was good shift (lot of negative traumas, simpler ER cases, mostly prelims) and did about 2300 in the first 7 hours. last 2 hours just chilling and reading the occasional CXR or stone study that comes in.
done at 2pm, weekend off. life could be worse…
Shhhhhh!!!!! It heresy on these threads to say you can earn 500K a year (and get taxed at a 200k level), work less days than in PP, live anywhere you want, with no commute, spend more time with one’s family, and not do mammo or procedures by choosing telerads. You will upset the folks at the top of their private practice gilds who post on here and depend on new foot soldiers at the bottom rungs. Please be reticent about your experiences or risk getting angry backlash!!!
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Unknown Member
Deleted UserJanuary 15, 2021 at 11:11 am[Deleted by Admin]
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Unknown Member
Deleted UserJanuary 15, 2021 at 12:11 pmI know a guy that knows a guy that does telerad for envision and says he makes $500 an hour. Productivity based compensation.
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Quote from Sir Read Alot
I know a guy that knows a guy that does telerad for envision and says he makes $500 an hour. Productivity based compensation.
20-25 RVUs an hour?
Is he an All-NBA performer or a bench warmer with good stamina, quick release, and a bad coach?
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Unknown Member
Deleted UserJanuary 15, 2021 at 12:19 pm
Quote from TheSLACman
for example today was good shift (lot of negative traumas, simpler ER cases, mostly prelims) and did about 2300 in the first 7 hours. last 2 hours just chilling and reading the occasional CXR or stone study that comes in.
And i can prelim liek 4-5 ER CTs before reading one complex outpatient case
done at 2pm, weekend off. life could be worse…
How many cases? cross sectional and x ray separated
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20k is definitely reasonably attainable for a subset of rads, particularly if they are getting RVU efficient cases and not stuck with a lot of X-rays, barium, procedures, consults, etc.
The problem is…this is only true for a small group of rads and many either don’t know or don’t care they are not in this subset.
Lebron James can go out and score 25-30 a night no problem. If you ask the last guy on the bench to do the same thing, it’s going to get ugly. Unfortunately, most places don’t have a coach to pull someone out of the game (in fact, often they actually encourage it).
When you get paid per shot attempt, people are going to take their shots. You don’t get paid more to read the case correctly.
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Unknown Member
Deleted UserJanuary 15, 2021 at 10:27 am[Deleted by Admin]
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Quote from TheSLACman
Also tele has a very robust QA system. almost 70% of your cases are overread or peer-reviewed internally. eveyone has a chart of misses, evals, data on how accurately they read. anyone rushing through and being wreckless gets fired (know a few)
Based on the jobs I have had (about 3-4) since training, the quality of tele-rads is variable but usually decent. Some of the “prelims” are actually on par with our day reads in terms of thoroughness/quality. I occasionally see misses but these tend to be soft, part of it is when the dictating rad is clearly reading out of their subspecialty/comfort zone
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Quote from Radsoxfan
When you get paid per shot attempt, people are going to take their shots. [b]You don’t get paid more to read the case correctly. [/b]
Great point. Given endless rounds of reimbursement cuts, if one can assume this mind-sight and avoid litigation then all the power to them. The ethics (eg. patient care) of this however are a lot more complex.
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Quote from jd4540
Quote from Radsoxfan
When you get paid per shot attempt, people are going to take their shots. [b]You don’t get paid more to read the case correctly. [/b]
Great point. Given endless rounds of reimbursement cuts, if one can assume this mind-sight and avoid litigation then all the power to them. The ethics (eg. patient care) of this however are a lot more complex.
While true, even more technically true is that someone is getting paid for the risk of reading a study. Note that this definition throws away entirely any qualifications on how long someone should take (which would be debatable). Sad, but true.
The larger point that there has been an increasingly greater incentive, or pressure, to read fast is undeniable – yes of course. My feeling is that if med mal went away and you gave people time and the carrot was no longer there, they wouldn’t mind taking reasonable time to read studies; they’d actually prefer it like most sane people would without perverse incentives.-
The MBAs skimmers must love this thread and are laughing all the way to the bank. They must love 20k rvu reading Rads who are paying for their second home and mistress as they steal 50-60% of their money.
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^^ and whats amazing is that those reading 20k wRVUs think its a good thing and proves how good and fast they are. That those cases are easy ER except they miss the incidentals like renal mass. That theyre making 400k (before taxes, benefits and expenses) for reading 20k wRVUs during the worst hours.
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The problem is not reading 20k RVUs — some can do it. The problem is [i]having[/i] to read 20k RVUs to make what you should be making for reading 11-12k RVUs. Therein lies the problem.
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Quote from ChuckI
The problem is not reading 20k RVUs — some can do it. The problem is [i]having[/i] to read 20k RVUs to make what you should be making for reading 11-12k RVUs. Therein lies the problem.
While I usually go with to each their own, accepting/validating these rates is problematic for the field. -
I still dont understand why rads accept these garbage rates. Tele companies like vrad will continue to low ball us if we continue to say yes. We are the problem here.
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Unknown Member
Deleted UserJanuary 16, 2021 at 6:45 pmPeople want to live in desirable metros
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Unknown Member
Deleted UserJanuary 16, 2021 at 6:45 pmWell, what can you do if you work for one of these outfits and are stuck in town for family reasons? You have a very long non-compete and even if you didn’t – your options would be to work for the competing Radpartners group offering the same pay or go teleradiology and work for Vrad (which I know, is now one in the same.) After a few years and a few kids, the labor market is not that mobile.
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Quote from Sir Read Alot
I know a guy that knows a guy that does telerad for envision and says he makes $500 an hour. Productivity based compensation.
So he reads 25 RVU an hour, got it. Would you let him read your mother’s scan?
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