Mednax

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Mman - good points. Are you sure AMCs can get higher imbursement rates from Medicare and private insurance vs a hospital employed or private group? If so, how much would u guess 5-10%?

I've read a lot over the years of how the AMCs are similar to the Enrons of the world. They got hot 5-7 yrs ago but with bundled payments fastly approaching that's likely to change just for the reasons you pointed out (Large hospital chain fighting large AMC over precious $$$). Funny to read things years ago on here and see them playing out right in front of your eyes, just as many predicted.

When do bundled payments start?

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Mman - good points. Are you sure AMCs can get higher imbursement rates from Medicare and private insurance vs a hospital employed or private group? If so, how much would u guess 5-10%?

Medicare is medicare and the payment is the same regardless. But private insurers pay AMCs a lot more than they pay you, sometimes as much as double simply because they have more bargaining power. I believe (but don't have hard proof) that Mednax gets something in the neighborhood of $130-$160 a unit from private insurers.
 
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I definitely don't know either but $130-$160 sounds very high.....but you may be correct.

As baby boomers hit, expansion of Medicare and Medicaid, growth of the healthcare exchanges I would anticipate the AMC will loose a good percentage of the private payor mix. If bundle payments start, which it sounds like is the plan, it will be a huge fight with hospital vs AMC over that payment. Then AMCs trying to undercut/bid each other for a lower slice of the pie to get the hospital contract.

Maybe hospital adminstrators are crunched for cash or don't see 5-10 yr picture but I would think they'd be trying to gobble up the anesthesia groups. Maybe they're letting AMCs carry a lot of this weight now until the day of bundled payment then just let the contract expire and regain control of anesthesia dept and 100% of bundled pay.
 
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I definitely don't know either but $130-$160 sounds very high.....but you may be correct.

I'm 100% certain they are getting > $120 a unit. I'm probably 50/50 that they get > $150 a unit. They could probably get as high as $160-170 a unit in some markets. That's the way their business model works. They can still pay pretty good salaries to physicians ($400-500K plus benefits) and rake a windfall of profit because of their high contract rates.
 
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I definitely don't know either but $130-$160 sounds very high.....but you may be correct.

As baby boomers hit, expansion of Medicare and Medicaid, growth of the healthcare exchanges I would anticipate the AMC will loose a good percentage of the private payor mix. If bundle payments start, which it sounds like is the plan, it will be a huge fight with hospital vs AMC over that payment. Then AMCs trying to undercut/bid each other for a lower slice of the pie to get the hospital contract.

Maybe hospital adminstrators are crunched for cash or don't see 5-10 yr picture but I would think they'd be trying to gobble up the anesthesia groups. Maybe they're letting AMCs carry a lot of this weight now until the day of bundled payment then just let the contract expire and regain control of anesthesia dept and 100% of bundled pay.


Which is why many groups are selling out to AMCs in record numbers. Groups can get the buyout money from the AMC and work for them as employees taking all the risk out of the equation.
 
Employment model only goes up when Doctors, i.e., you, me, continue to have short-term goals, and over-extended lifestyles.
This is the path to AMCs' conquests.

DO not undersell yourself to yourself, or to your "employers". If by doing a Fellowship, you bring more to the table, then demand more. Simple.

Choose to be an independent contractor and hire your services out to the hospital. Do your own cases. Wait until the situation reveals itself a bit more.

Bottom line: There's no easy money, life's a bitch. If you ALLOW yourself to be screwed over, then you sort of deserve it. Always remember that Anesthesiologists... are the most greedy breed I have come across. They hire CRNAs and whine that nobody respects us, and that they're replacing us etc etc. Just....... don't ever trust an Anesthesiologist... or most other Doctors especially Private Practice ones... speaking from experience. You're always going to be your only backup. Stick to your principles. Seriously. Stick to your principles. Don't compromise and it'll all be okay, for you at least.
Wow awesome post.

I agree Anesthesiologists are the greediest, saltiest, most selfish bunch and are NOT to be trusted. Period.

I keep telling everyone this and nobody frickin listens. UNITED WE STAND, DIVIDED WE FALL. And we are divided so we are easily pushed around.

Look at this board, nobody can agree to anything. I can say LESS WORK MORE MONEY and only 50 percent of people reading it will agree with this as a common goal.

And i agree with the independent contractor idea you have. Most anesthesiologist dont have the intestinal fortitude for that sort of stuff.
 
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