Overheard holiday bonus complaint

[disneysteve]

Originally Posted by LBTRS

I "plan for money I don't have" each month when I do my budget...how can you not plan for money you don't have?

There is a big difference between planning for money that you have very good reason to expect, like your regular salary, and planning how you will spend a bonus that you may or may not receive and may or may not be the amount you anticipate. I think that was the point being made.

It is the same as when we advise folks not to include overtime pay in their budget because there is no guarantee they will always have those overtime hours.

[Caoineag]

Actually, I think more people should run scenarios where they lose their regular salary. They might be a bit more conservative in racking up monthly bills. I plan for money I don't have but I also plan on having no money so that I can see what the outcomes would be. Usually I use the plan in the middle somewhere.

Oh and my raises are optional just like my bonuses since its based on what our firm can afford. So I never build my budget for goals with raises accounted for. I prefer planning for the worst case scenario so things are almost always better that I thought they would be.

[thekid]

Originally Posted by disneysteve

Be glad you aren't a physician. My pay has been flat for several years. We lose purchasing power year after year. If Congress doesn't step in, Medicare is set to cut physician reimbursement by 10% in 2008 so we'll see our income drop even farther.

I've graduated 6 years ago and must admit that I have been quite lucky. At my previous employer (a large law firm - I'm a corporate attorney), I received raises between 10%-15% each year (even in bad years like 2001-2002 when the firm was simultaneously laying off attorneys) + bonuses which were preset based on billable hours. Since last year, I joined a client of the firm. The place has a collective bargaining agreement. Each year has a 3% COL raise + raise related to additional year experience. I accepted the lower pay that my new employer offered in order to gain much better working hours and a nicer work environement. I would have balked though at the thought of not getting at least COL raises. At the time of my work change, I was offered positions at two major compagnies and a government position which really interested me. All also contained at least COL raises.

I may have been spoiled without noticing it, as this is all I have experienced. I haven't been in the work force for too long though, harsher times may come. Funny how things can easily get taken for granted.

[disneysteve]

Originally Posted by Caoineag

So I never build my budget for goals with raises accounted for.

Absolutely. All planning is done based on my current income. I have no way to know when or if I will get a raise or for how much.

[LivingAlmostLarge]

Me too. I didn't even know people had Xmas bonuses. It would be awesome if DH had that.

Everything we do is under the assumption we have zero bonus, zero raise, etc. We don't even count the bonus ESPP, just what is saved in it.

[m3racer]

Originally Posted by InDebtInDC

Which do you prefer, capitation or fee-for-service?

Is this a serious question?

[m3racer]

I don't understand how one expects a holiday bonus unless you signed an employment agreement that guaranteed one.

[InDebtInDC]

Originally Posted by m3racer

Is this a serious question?

Absolutely. Why wouldn't it be?

[m3racer]

Originally Posted by InDebtInDC

Absolutely. Why wouldn't it be?

capitation= lower reimbursement (ie. contracted fees) for higher volume of patients
fee for service= being out of network and being compensated your usual customary fee

It's really a no-brainer for docs. I have yet to meet anyone in the health care field that would opt for seeing cap pts vs fee for service pts.

[InDebtInDC]

Originally Posted by m3racer

capitation= lower reimbursement (ie. contracted fees) for higher volume of patients
fee for service= being out of network and being compensated your usual customary fee

It's really a no-brainer for docs. I have yet to meet anyone in the health care field that would opt for seeing cap pts vs fee for service pts.

I don't want to steer this thread the wrong way so I'll just comment briefly.

Respectfully, "lower" and "higher" are relative terms and are dependent on the contract and what the individual physician considers to be "customary".

Both models incent physicians to reduce exam time to increase profits, but the difference is that capitation promotes prevention while FFS promotes treatment.

To rebut your assertion, I have worked with hundreds of physicians who prefer capitation over FFS. The main rationale for those physicians is that they do not want to feel like an assembly line.

Additionally, FFS does not necessarily imply customary fees. Sometimes you will receive lower than the customary fees and be forced to accept those as payment in full.

This article addresses some of the highlights: How should we pay doctors? A systematic review of salary payments and their effect on doctor behaviour -- Gosden et al. 92 (1): 47 -- QJM

I really have no preference either way. I was simply rebutting your arguments. Comments?

[mom-from-missouri]

When I worked in a mom & pop store, I got a $200 a year Christmas bonus. When they retired and closed the store, I was told I was the only one who ever gave them a thank you card for it....

When I entered the corp world, I got a ham for a few years, then we got nothing.

I never expected it or complained when I didn't get it. But, it was a nice surprise when I did get one.

[disneysteve]

Originally Posted by InDebtInDC

To rebut your assertion, I have worked with hundreds of physicians who prefer capitation over FFS. The main rationale for those physicians is that they do not want to feel like an assembly line.

Another advantage of capitation is cash flow. If I have 100 patients from Plan XYZ and I am contracted at $40/month/patient, I know I will get a $4,000 check each month no matter what. With fee for service, if I have a slow month or happen to have relatively uncomplicated patients, I can see a drop off in income even though all my overhead bills stay pretty much the same. With capitation, I also don't have as many billing hassles.

Most plans today blend capitation and FFS. We are capitated for basic care but there is still a fee schedule for procedures above and beyond what is covered by the capitation payment.

Copays are another thing that has changed for the better (for the doctor). I remember when most of my HMO patients had $2 copays. On a busy day, I might take in $80 from seeing 40 patients. Today, however, most copays are $15 or more. Seeing those same 40 patients now results in $600-800 collected in copays. And that is on top of the monthly capitation payment covering those patients.

So capitation isn't such a bad thing IMO. Sure, FFS is generally more lucrative, but it isn't perfect either. I think you'll find that most docs accept some combination of FFS and capitated plans.

[m3racer]

[quote=InDebtInDC;139841]
Both models incent physicians to reduce exam time to increase profits, but the difference is that capitation promotes prevention while FFS promotes treatment.

That's incorrect. You have less time with a pt if you're involved with caps and hmo's. You generally have more time to spend in a FFS practice.

[m3racer]

[quote=InDebtInDC;139841]

To rebut your assertion, I have worked with hundreds of physicians who prefer capitation over FFS. The main rationale for those physicians is that they do not want to feel like an assembly line.

I guess it depends who you're talking about. I assure you that surgeons do not agree with you.
Assembly line= caps and not FFS. You have it totally backwards.

[m3racer]

[quote=InDebtInDC;139841]
Additionally, FFS does not necessarily imply customary fees. Sometimes you will receive lower than the customary fees and be forced to accept those as payment in full.


Again you are wrong. FFS means the doc gets compensated according to his/her fee schedule. I guarantee this is higher than any contracted insurance reimbursement. And yes, FFS does imply the customary fee for that doctor. If the patient can't pay or accept the MD's fee than he or she can go elsewhere. It really is that simple.

[m3racer]

Originally Posted by disneysteve

Another advantage of capitation is cash flow. If I have 100 patients from Plan XYZ and I am contracted at $40/month/patient, I know I will get a $4,000 check each month no matter what. With fee for service, if I have a slow month or happen to have relatively uncomplicated patients, I can see a drop off in income even though all my overhead bills stay pretty much the same. With capitation, I also don't have as many billing hassles.

Most plans today blend capitation and FFS. We are capitated for basic care but there is still a fee schedule for procedures above and beyond what is covered by the capitation payment.

Copays are another thing that has changed for the better (for the doctor). I remember when most of my HMO patients had $2 copays. On a busy day, I might take in $80 from seeing 40 patients. Today, however, most copays are $15 or more. Seeing those same 40 patients now results in $600-800 collected in copays. And that is on top of the monthly capitation payment covering those patients.

So capitation isn't such a bad thing IMO. Sure, FFS is generally more lucrative, but it isn't perfect either. I think you'll find that most docs accept some combination of FFS and capitated plans.

just out of curiosity...are you in primary care medicine?

[disneysteve]

Originally Posted by m3racer

just out of curiosity...are you in primary care medicine?

Yes, and the advantages and disadvantages of capitation are quite different in primary care than they are in specialty care.

[Scanner]

I work right next door to a family doctor and I am not sure he likes the capitation agreements he has (I am pretty sure he is exiting a major one right now).

I think the problem is the reimbursement has a ceiling on it and overhead rises, but reimbursement doesn't. I think the low copays that go with primary care (specialists are always higher) actually hits him psychologically as DisneySteve notes.

It's hard when people come in with $5 copays and you end up with $100.00 at the end of the day to show for your work and you have a staff of 10 working under you. Even if he is paid $4000/month, there's something irresponsible about a patient handing over $5.00 and a Blue Cross Card to a doctor and saying,

"Good luck. I hope you get paid."

I'm in the specialist realm (or maybe considered "other") so I don't have that. I am just relaying the thoughts of one family doctor.

I can tell overhead is a huge issue with him as he underpays his staff ($8-9/hour) who work like the Dickens for him.

[InDebtInDC]

Again, I do not want to turn an XMas bonus thread into a different debate. Sorry.

[dmontngrey]

I work in payroll, and people whining about bonuses and raises is such a pet peeve with me. I am very thankful to have a good job that pays well. If I got a bonus, great. If not, oh well. I think one year we all got $50 Walmart cards and that was such a nice surprise. That was the only time that happened and I really don't expect it this year. I can't complain as I have received a decent raise the last two years. I am always thankful as it's higher than 3% and it's SOMETHING. Anything is better than nothing at all.

On a side note: I don't ask for much from this company, so I was not pleased when the two other people in my dept got flat panel monitors last week and I did not! This job has been killing my eyes for the past couple of years. I would never have dreamed of asking for a new monitor since the one I had worked just fine. But my eyes hurt from sitting too close!! My monitor is arriving tomorrow.
Point being: I wouldn't ask for something work related to help my job - no way would I ask for or expect a bonus of any kind! I even worked yesterday and did not ask for compensation (salaried), but I suspected it would be offered to me anyways.