So basically I'm reading up on insurance/billing/reimbursement for class and it seems like a big hassle. Is it possible to run cash or some cash in Ortho? Are there minor procedures that patients would rather just pay out of pocket for?
Cash only orthopaedics does exist, but right now it is pretty rare. Only surgeons with very mature practices in markets that can tolerate it can go cash-only. I think that in the future where the demand far outpaces the supply, cash only will become more common.
http://www.healio.com/Orthopedics/n...ices-Changing-times-call-for-extreme-measures
Above is a link to a round table discussion about cash only orthopaedics and may be an interesting read for you.
Below is the citation to another interesting article. Basically people think surgeons should be paid 10x more than that medicare reimburses them.
Foran JRH, Sheth NP, Ward SR, Della Valle CJ, Levine BR, Sporer SM, Paprosky WG. Patient perception of physician reimbursement in elective total hip and knee arthroplasty. J Arthroplasty. 2012;27(5):703-709.
Abstract: The purpose of this study was to evaluate patient perception of orthopedic surgeon
reimbursement for total hip (THA) and knee (TKA) arthroplasty. A total of 1120 consecutive
patients were asked what they believed a surgeon should be paid for performing THA and TKA. Patients were then asked to estimate what Medicare actually reimbursed for each of these procedures. On average, patients thought that surgeons should receive $14 358 for THA and $13332 for TKA. Patients estimated actual Medicare reimbursement to be $8212 for THA and $7196 for TKA. Most of the patients stated that Medicare reimbursement was much lower than what it should be. Many patients commented that given this discrepancy, surgeons may drop Medicare, which may decrease access to quality hip and knee arthroplasties.
The comments from the patients in the article are awesome.
"Many patients commented that given this discrepancy, surgeons may drop Medicare, which may decrease access to quality hip and knee arthroplasties."
It's amazing doctors are even willing to take Medicare.
That is a ridiculous amount of money to pay for a total hip or knee replacement. A surgeon should be paid for his worth and $1375 is not enough. It is a wonder that any surgeon even does it.
I feel that doctors have spent many years studying to be a doctor and spend a few hundred thousand dollars to become doctors. I feel it is an insult to pay a doctors with this much knowledge a little more than $1000 to perform surgery
If we don't start paying our doctors what they are worth there aren't going to be doctors when we need surgery.
There are a few other articles just like this one with the same conclusions. There are also numerous articles about the shortfall:
Fehring TK, Odum SM, Troyer JL, Iorio R, Kurtz SM, Lau EC. Joint replacement access in 2016: a supply side crisis. J Arthroplasty. 2010;25(8):1175-81.
Abstract
Demand for primary and revision arthroplasty is expected to double in 10 years. Coincident with this is a decreased interest in arthroplasty by residents. Retirement of arthroplasty surgeons further threatens access. This study determines if supply will meet demand. Survey data were used to calculate the 2016 workforce. Demand in 2016 was estimated using the Nationwide Inpatients Sample. Between 2008 and 2016, 400 arthroplasty specialists and 1584 generalists will enter the workforce. By 2016, 1896 arthroplasty surgeons will retire using 65 years as a conservative retirement age, whereas 4239 will retire using 59 years as a baseline retirement age. In 2016, the model estimated a procedural shortfall ranging from 174,409 (↓18.6%) using conservative retirement assumptions (age, 65 years) to 1,177,761 (↓69.4%) using baseline retirement assumptions (age, 59 years). This economic model predicts a supply side crisis that threatens patient access to specialty care. Immediate steps to stimulate supply must be taken.
Bottom line: I think cash only practices will become more viable and more prevalent in the next 15-20 years as the demand for elective (and highly desired) procedures far outstrips the supply. Unlike many other areas in medicine, this shortfall will not be able to be addressed by expanding the scope of practice of midlevels in contrast to primary care, anesthesia, ophthalmology. You will not start up a practice and do cash only, so you will take insurance/medicare for a long time before you would be able to make the transition, so you better learn to love it. Just something to think about, but if we transitioned to a single-payor system (the government), would they have the ability to force physicians to take medicare/medicaid (regardless of how much they cut reimbursement) in order to keep their medical license? I think they can and will...
(There are numerous articles on medscape about cash only practices that go more into the specifics of billing. These are mostly related to primary care though, but I found it amazing how the co-pay for medicare (20%) is actually less than the cash fee for service. So patients pay less, doctors get paid more, patients get 30-45 minutes with their doctor, no billing hassles, and everyone is happy except insurance companies.)
