A Tale of Two Numbers
The stipend a group earns for covering the ER
starts with the group has,
even if it might take a little digging to find them.
If you know your group's actual annual ER wRVU and collections, toggle left and enter them. If you don't, toggle right and enter your average annual partner profit distribution, number of partners, and best estimate percentage of your group's total annual wRVU attributable to ER. We'll use benchmarks and math to build the model from there.
Don't forget to slide the ER volume scale at the bottom.
Data
What the group distributes to its doctors. The known anchor.
Audit
Your distribution — ownership return above the market wage. The slice that cratered, and the slice the stipend does not fund.
Overhead here is professional-fee practice cost — about $10–20 per wRVU (billing, malpractice, staff, IT, occupancy). It excludes the imaging equipment and technical costs the hospital owns, so it runs well below an all-practice overhead figure.
Self-audit
Are the two numbers defensible? Five properties:
- Claim-line billing with POS 23 — ER origin on every claim.
- Study-level export — one row per study, joinable to billing.
- CMS wRVU map applied at the current PFS version (CY2026, CF $33.4009 non-QP).
- Reconciliation to your books — payments tie to your G/L.
- A measure you can re-run each period — not a one-off pull.
Given your stack — integrated platform / outsourced RCM / BI overlay / separate systems — getting all five is usually a toggle, an email, or a bounded job. You're already generating the data; you just may not be seeing it.
The numbers trigger an — meant to the group would otherwise absorb.
Pins
Median $50 — MGMA / SullivanCotter (band $48–52). The conservative floor.
75th $58 — justify with IR/subspecialty mix, the national radiologist shortage, or an ED-coverage premium.
Walks the headline ≈ $10.1M → $12.5M across the percentile range. Valuator sets the binding figure. The Audit drawer (○ card) shows your books' own comp/overhead.
Contract
Flexes with volume; trues up each period. Form, cadence, FMV opinion → counsel.
Stipends aren't static. They — giving the hospital a reason to , and shrinking the stipend in step.
The ER-volume lever lives on the right-hand panel — one slider drives the whole demonstration. Slide it and ER wRVU, collections, stipend, and the partner profit lines all re-compute live from two-segment P&L (collections − cost). The with-stipend line drifts gently because the stipend is FMV-priced ($62/wRVU) while the group's actual cost is $70 — the $8 above-FMV slice is a real residual the partners eat.
Notes & assumptions
Move it — ER wRVU and collections move together, yield holds, the stipend follows. Same math, both directions.
1. Collections track volume → yield holds. ER collections move in proportion to ER wRVU, so yield holds at $28 — same payer mix, more or fewer studies. Conservative; in reality collections flux on their own.
2. Avoidable cap ~30%. Only the medically-unnecessary slice can be cut — a clinical call. The necessary coverage, and its stipend, always remain. EMTALA: clinical, never about who pays.
3. Add side uncapped. Volume can grow up to 3× today (+200%). ER collects $28 against a $70 actual cost, so without a stipend the partner line plunges deep negative. The FMV-priced stipend ($34/wRVU) closes most of the gap, leaving an $8/wRVU above-FMV residual the group eats — the with-stipend line tilts down gently, not off the cliff.
Hospital
Redeploy below break-even reads as a loss, not a wash.
Reducing ER volume likewise sheds work the stipend has already — so for the group, there's no margin to lose.
The contract shifts the to the hospital — the party that wants the coverage and can fund it.
gold = CMS / public · teal = your books · counsel + valuator · arithmetic. Illustrative defaults — replace with your own. Not legal, financial, or valuation advice; benchmarks and the contract belong to counsel and a valuator. "Avoidable" means medically unnecessary, defined by clinical leadership — never by who pays.
Taylor C. Berger, Attorney · taylor@tcblaw.org