Becker's ASC Review

33 ORTHOPEDICS 10 years of orthopedic surgeon pay By Alan Condon O rthopedic surgery dropped from the top spot in Medscape's highest- paid physician specialties in 2021, but has been consistently among the top three highest earners. Here's how orthopedic surgeon pay has changed over the past 10 years, according to Medscape's Physician Compensation Report 2012-2021. 2021 Plastic surgery: $526,000 Orthopedics: $511,000 Cardiology: $459,000 2020 Orthopedics: $511,000 Plastic surgery: $479,000 Otolaryngology: $455,000 2019 Orthopedics: $482,000 Plastic surgery: $471,000 Otolaryngology: $461,000 2018 Plastic surgery: $501,000 Orthopedics: $497,000 Cardiology: $423,000 2017 Orthopedics: $489,000 Plastic surgery: $440,000 Cardiology: $410,000 2016 Orthopedics: $443,000 Cardiologists: $410,000 Dermatologists: $381,000 2015 Orthopedics: $421,000 Cardiology: $376,000 Gastroenterology: $370,000 2014 Orthopedics: $413,000 Cardiology: $351,000 Urology: $348,000 2013 Orthopedics: $405,000 Cardiology: $357,000 Radiology: $349,000 2012 Radiology: $315,000 Orthopedics: $315,000 Cardiology: $314,000 n The OIG's ASC joint-venture opinion By Laura Dyrda T he HHS Office of Inspector General issued a favorable opinion approving a joint-venture ASC arrangement between physicians, a management company and health systems last month. The management company will own 8 percent of the center and provide consulting services while the health system and group of eight orthopedic and neurosurgeon investors would each own 46 percent. In a blog post, Bartt Warner, director of compensation arrangements at VMG Health, wrote that much of the OIG's April 29 decision relies on the health system's certifications and outlined several safeguards to mitigate risk. Becker's covered the initial news May 3, and here are 10 more details: 1. New physician owners can invest directly, but not through a pass-through entity. 2. The facility's real estate will be owned by the health system, physicians and management company. 3. The health system and real estate company can enter into space and equipment leases and services arrange- ments with the ASC. 4. Physicians are required to meet the one-third rule to meet ASC safe harbor provisions, and the manage- ment company will oversee compliance. The orthopedic surgeons will derive one-third of their income in the previous fiscal year from ASC-qualified procedures, while the neurosurgeons will not. 5. The physicians will rarely refer patients to each other. The estimated case volume referred between owners should be less than 1 percent under the arrangement. 6. Investors will provide patients with a written notifica- tion of their ownership in the ASC when making referrals. 7. The health system and management company can't encourage referrals to the center. 8. The health system's affiliated physicians will receive fair market value compensation, which won't be related to the volume or value of referrals to the center or physician investors. 9. The ASC's owners will receive distributions and capital contributions proportional to their ownership interest. 10. New ASC investors will not be given ownership based on past or future case volume or value of referrals to the center. n

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