payor mix

[Hamhock]

I don't want to highjack the useful thread, "things to look for in a job", but this is realated of course.

In that thread and others, a "good payor mix" is mentioned.

Is there an objective way to evaluate this?

Where does one get the information? Who does one talk to about this?

How would one payor mix be compared to another?

HH

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[Birdstrike]

I don't want to highjack the useful thread, "things to look for in a job", but this is realated of course.

In that thread and others, a "good payor mix" is mentioned.

Is there an objective way to evaluate this?

Where does one get the information? Who does one talk to about this?

How would one payor mix be compared to another?

HH

Key questions to ask:

A-What percent of patients have private insurance?

B-What percent of patients have Medicare/Medicare-replacement plans or exchange plans that pay at medicare rates?

C-What percentage of patients have Medicaid?

D-What percentage of patients have no insurance?


The greater the percentage of A>B>C>D the better, in that order. You're going to collect a greater percent of your charges as you progress from D to A. More A & B = more money available to pay you. More C & D = less money available to pay you.

You can get this information from whoever is billing and collecting for the group. To compare, you need to compare those numbers to national and state averages when compared to other EDs. The group billing and coding people probably have that info. If not, you could likely get it from ACEP .

 

[Groove]

Honestly, this information should be fairly transparent. I wouldn't work for anyone that could answer such a basic question as "What's your payor mix?" and couldn't tell me % uninsured/self pay/medicare/medicaid, etc.. Ultimately, if they told me the payor mix sucks then my next question would be if they were receiving a hospital subsidy. I usually ask all of the above anyway.

 

[The White Coat Investor]

Don't expect them to necessarily be able to rattle them off off the top of their head, but I know my "no-pay" is in the 17-19% range and that private insurance is around 50%. I'd have to look up the rest. But that shouldn't be hard to find. Doesn't matter so much if you will be an employee indefinitely, but if this is a partnership job, that's pretty important info about your future income.

 

[Old_Mil]

C-What percentage of patients have Medicaid?

When it comes to payor mix, this is the one critical question to ask. If it is significantly below normal - great. If it is above the national average, look out. That's because this is the one group that consistently overuses the ED compared to others.

 

[Birdstrike]

When it comes to payor mix, this is the one critical question to ask. If it is significantly below normal - great. If it is above the national average, look out. That's because this is the one group that consistently overuses the ED compared to others.

Also much more litigious.