10% cms bump for office 2026

[clubdeac]

---

Members do not see this ad.

consent and skin marking done prior to procedure. procedure is discussed ad nauseum before, so most commonly just a formality.

procedures primarily in ASC. slow, cumbersome, too many people involved, they have specific rules they are required to follow to meet ASC standards

but its my fun day. 80s and 90s alternative, unless in the mood for 90s rap or motown (noone seems to like my ska playlist). talk sports, discuss newest tik tok craze, find out what patients want for breakfast, etc.

so i go with the flow.

and i dont need the extra radiation exposure. one of the local pain docs had to stop all procedures in part due to radiation exposure.

other days of the week, as a salaried employee, i am sitting around determining which social determinant of health to document or whether a long diatribe on obesity is of any value...

Do you think that’s a better system than if you were in a pp and the employees and yourself were more incentivized to work?

 

[Ducttape]

no. it is not a better system. it is a different system.

this HOPD is not geared towards block shop and this population group does not respond nor does it need a block shop; it needs a more multidisciplinary approach.


i had the choice of joining 2 different pp interventional spine practices and chose neither of them on purpose.

 

[clubdeac]

no. it is not a better system. it is a different system.

this HOPD is not geared towards block shop and this population group does not respond nor does it need a block shop; it needs a more multidisciplinary approach.


i had the choice of joining 2 different pp interventional spine practices and chose neither of them on purpose.

I do all the above and then some

 

[Status Sciaticus]

When is everyone doing consents in their workflow and how to do this more efficiently? What slows me down the most is walking out of the procedure room to consent the patient, who of course has a million questions that may or may not be about the procedure.

Consent the day you offer the procedure. Nurses will collect the consent signature from the patient in preop and I sign in the room.

 

[Laryngospasm]

Honestly if epidurals go any lower youre better off doing occasional joint or other small injection, office visit managing non opioid meds and acting as triage for surgeon/pt/other. It’s almost to the point where I make more on my office visit days. Once that happens the risk of doing procedures is not worth it at all.

 

[drusso]

Honestly if epidurals go any lower youre better off doing occasional joint or other small injection, office visit managing non opioid meds and acting as triage for surgeon/pt/other. It’s almost to the point where I make more on my office visit days. Once that happens the risk of doing procedures is not worth it at all.

This is by design. It's not a fluke.

 

[BobBarker]

Yes, you can get your average office visit reimbursement probably up to $175.

99204/99214/some UDS quick cups/one or two DME per day/some office based injections every day.

 

[clubdeac]

Yes, you can get your average office visit reimbursement probably up to $175.

99204/99214/some UDS quick cups/one or two DME per day/some office based injections every day.

Don’t forget the g2211

 

[BobBarker]

Yes, that adds up, for sure. I talked with an older pain doc and he is doing all that we talked about and makes plenty of money with a small staff, small office, and no fluoro.

 

[hyperalgesia]

Yes, that adds up, for sure. I talked with an older pain doc and he is doing all that we talked about and makes plenty of money with a small staff, small office, and no fluoro.

That sounds appealing considering all we deal with doing fluoro procedures, not to mention the radiation.

 

[Agast]

That sounds appealing considering all we deal with doing fluoro procedures, not to mention the radiation.

Yes, except an office visit-heavy practice usually goes hand in hand with a script pad. No such thing as free lunch.

 

[DoYouEvenLiftBro]

Yes, you can get your average office visit reimbursement probably up to $175.

99204/99214/some UDS quick cups/one or two DME per day/some office based injections every day.

U have a DME license and equipment in the office?

 

[BobBarker]

Yes. Just LSO’s and tlso’s

 

[DoYouEvenLiftBro]

Oh nice, thx, we do a bunch of kyphos like ur group, it would probably make financial sense for us

Usually tell pts to try a tens/sij belt from Amazon and if it doesn’t work to mail it back b4 the 30 days (I wonder if these items make sense to carry as well)

 

[DOctorJay]

for the HOPD docs, have any of your employers mentioned anything about upcoming changes to your salary/compensation model?

we got an email from our Chariman on Saturday night to contact our state representatives to try to stop these cuts. there was verbiage in this email about taking this very seriously and expecting our salaries to decrease next year if the cuts go through.

 

[SSdoc33]

for the HOPD docs, have any of your employers mentioned anything about upcoming changes to your salary/compensation model?

we got an email from our Chariman on Saturday night to contact our state representatives to try to stop these cuts. there was verbiage in this email about taking this very seriously and expecting our salaries to decrease next year if the cuts go through.

what specific cuts? you mean the medicaid cuts with the BBB?

 

[DOctorJay]

what specific cuts? you mean the medicaid cuts with the BBB?

• 8%–10% reductions in physician payments for services provided in hospitals or ASCs.

• 2.5% efficiency adjustment applied to work RVUs for non-time-based services.

 

[buddababa]

for the HOPD docs, have any of your employers mentioned anything about upcoming changes to your salary/compensation model?

we got an email from our Chariman on Saturday night to contact our state representatives to try to stop these cuts. there was verbiage in this email about taking this very seriously and expecting our salaries to decrease next year if the cuts go through.

nothing yet, but expecting a paycut, however with facility fees unchanged, they shouldn't cut us, that's where you have leverage

 

[DOctorJay]

nothing yet, but expecting a paycut, however with facility fees unchanged, they shouldn't cut us, that's where you have leverage

I'm employed by a physician group that tells us they don't receive any of the facility fees, they all go to the hospital which is separate.

 

[buddababa]

I'm employed by a physician group that tells us they don't receive any of the facility fees, they all go to the hospital which is separate.

i had that in my first few years of practice, got screwed out of multiple six figures over years, so just went to hospital admin and broke apart

 

[mdo1738]

nothing yet, but expecting a paycut, however with facility fees unchanged, they shouldn't cut us, that's where you have leverage

I had thought I had seen somewhere that facility fees weren’t going to be unchanged, but actually increasing. Not sure if that is correct or not

Edited to add image of what AI tells me, but have not been able to find and verify the source of its info

 

[BoardingDoc]

I'm employed by a physician group that tells us they don't receive any of the facility fees, they all go to the hospital which is separate.

You should be working directly for the hospital then. Working on facility pro fees alone is a losing proposition. There's one group near me that does the same thing. One pain doc there has a base of around 325k and gets a whopping 35/rvu over like 5k rvu/yr. He says he never hits that number.

I don't blame him. I wouldn't either.

 

[DOctorJay]

You should be working directly for the hospital then. Working on facility pro fees alone is a losing proposition. There's one group near me that does the same thing. One pain doc there has a base of around 325k and gets a whopping 35/rvu over like 5k rvu/yr. He says he never hits that number.

I don't blame him. I wouldn't either.

I agree. they tell us this but we're clearly paid more than our pro fees alone.

 

[SSdoc33]

I agree. they tell us this but we're clearly paid more than our pro fees alone.

i think it is just ingrained in the culture of the hospital that that is the way it is done. any piece of the facility fees that go to the docs is less for the C-suite and other hospital operations. it is just inertia that keeps it that way. but when facility fees keep going up and pro fees keep going down, something has to change

 

[Status Sciaticus]

i had that in my first few years of practice, got screwed out of multiple six figures over years, so just went to hospital admin and broke apart

How did you start that conversation? There is a hospital near me that doesnt have a pain department, but I am interested in starting one in the near future.

 

[BobBarker]

Maybe just get privileges there and send them MRI’s and PT referrals to start with. You can do a random case that you can’t do at the ASC there also.if they don’t have a pain physician employed, and are the only one with privileges that is a good spot to be. The admin will probably show you around and introduce you to the primary care group. You will be the defacto pain doc and not lose any money on the clinic side.

 

[buddababa]

How did you start that conversation? There is a hospital near me that doesnt have a pain department, but I am interested in starting one in the near future.

I literally walked into the admin with my numbers and said, i produce this much, this is how much im getting screwed by anesthesia, take me on or i walk. That was it

 

[Status Sciaticus]

I literally walked into the admin with my numbers and said, i produce this much, this is how much im getting screwed by anesthesia, take me on or i walk. That was it

I'm lost now. So you went to a hospital admin to start a HOPD because you were getting screwed by anesthesia?

 

[buddababa]

I'm lost now. So you went to a hospital admin to start a HOPD because you were getting screwed by anesthesia?

HOPD was just them taking facility fees, while anesthesia group was providing services(on professional fee alone, with a stipend [that they kept to themselves])

 

[BobBarker]

Correct, he was part of an anesthesia group that had him doing procedures at a HOPD for pro fee only. No way to make any money doing that. So he went to the hospital and had them put him on wrvu.

 

[Ronin1]

I had the exact same kind of arrangement. The hospital was very interested in keeping the procedures when I spoke to them. They basically forced the anesthesia group to waive my noncompete so I could work for them. Turned out to be a very good financial move for me over the years

 

[Status Sciaticus]

Correct, he was part of an anesthesia group that had him doing procedures at a HOPD for pro fee only. No way to make any money doing that. So he went to the hospital and had them put him on wrvu.

Wow... what a predatory group.

Correct, he was part of an anesthesia group that had him doing procedures at a HOPD for pro fee only. No way to make any money doing that. So he went to the hospital and had them put him on wrvu.

Good for you!

 

[BobBarker]

General anesthesia docs don’t understand the business of pain/hopd. I wouldn’t call it predatory. The group didn’t make any money either. This goes back to anesthesiologists doing LESI’s between cases in the 1990s.

 

[Ducttape]

Wow... what a predatory group.

Good for you!

pretty common. youve been around a while, dont you remember back in the day, anesthesia groups would hire double certified docs to do anesthesia with a side gig of pain? the group i took over did 2 days in pain clinic rest doing gas.


also, back in the day, pain docs were able to use tactics such as bilateral 3 level tfesi or 2 level ESI or 4 level bilateral facet injections and billing each injection separately. so the pro fees were much higher...

 

[Status Sciaticus]

pretty common. youve been around a while, dont you remember back in the day, anesthesia groups would hire double certified docs to do anesthesia with a side gig of pain? the group i took over did 2 days in pain clinic rest doing gas.


also, back in the day, pain docs were able to use tactics such as bilateral 3 level tfesi or 2 level ESI or 4 level bilateral facet injections and billing each injection separately. so the pro fees were much higher...

Well i graduated in 2022 from anesthesia and 2024 from pain, but yes I have heard these stories.

Its a shame docs nowadays dont want a combo of anesthesia and pain. If I could only find a gig like that :/

 

[Laryngospasm]

Well i graduated in 2022 from anesthesia and 2024 from pain, but yes I have heard these stories.

Its a shame docs nowadays dont want a combo of anesthesia and pain. If I could only find a gig like that :/

Just get two jobs.. better security that way.

 

[A Deep Breath]

Well i graduated in 2022 from anesthesia and 2024 from pain, but yes I have heard these stories.

It’s a shame docs nowadays dont want a combo of anesthesia and pain. If I could only find a gig like that :/

in case you didn’t know, jobs with part time pain still exist. I know a recent grad with one. I’ve been offered one. Anesthesiologists seem to like the idea of building a pain group to work in their surgery center.

 

[Malayil]

in case you didn’t know, jobs with part time pain still exist. I know a recent grad with one. I’ve been offered one. Anesthesiologists seem to like the idea of building a pain group to work in their surgery center.

I can offer part time in WV

 

[BoardingDoc]

Its a shame docs nowadays dont want a combo of anesthesia and pain. If I could only find a gig like that :/

What? 2 of my co-fellows were anesthesia. Both of them are literally doing 50/50 anesthesia/pain. Different hospitals/groups. This is definitely a thing.

 

[Status Sciaticus]

What? 2 of my co-fellows were anesthesia. Both of them are literally doing 50/50 anesthesia/pain. Different hospitals/groups. This is definitely a thing.

Would be interested in learning how this is working out?
I worked my schedule into 4 days/week and am doing anesthesia on my 5th day. But ideally I'd want 2 weeks anesthesia / 2 weeks pain.

 

[BobBarker]

Why? Make more money doing 3-4 med refills per hour than doing anesthesia per hour.

 

[hyperalgesia]

Why? Make more money doing 3-4 med refills per hour than doing anesthesia per hour.

I guess it depends on the patients in both cases but monitoring a stable anesthesia patient sounds a lot better than med refills to me.

Maybe grass is greener...

 

[BoardingDoc]

Would be interested in learning how this is working out?
I worked my schedule into 4 days/week and am doing anesthesia on my 5th day. But ideally I'd want 2 weeks anesthesia / 2 weeks pain.

They're both doing 2 weeks pain / 2 weeks anesthesia, with a good amount of vacation time.

One of them really likes it and is going to be doing it indefinitely. The other one is likely going to be switching to full time pain in the next 12 months.

 

[BobBarker]

I don’t advise doing part time anesthesia unless you are just filling gaps early in pain practice/providing weekend coverage. Pain is a full time job.

 

[agolden1]

Would be interested in learning how this is working out?
I worked my schedule into 4 days/week and am doing anesthesia on my 5th day. But ideally I'd want 2 weeks anesthesia / 2 weeks pain.

I know of several jobs that do some kind of split between anesthesia and pain. None of them have this split with 2 weeks anesthesia/2 weeks pain. In my area, these jobs are run by anesthesia groups that primarily are looking for ways to attract pain trained anesthesiologists to provide OR coverage while enjoying a day or two a week of pain clinic/procedures. Typically the people who sign these jobs are people who enjoy some pain work, but also don't have the skill set/interest to see a high volume of patients, or who have been burned by predatory private practices.

The major pro is getting to enjoy a more anesthesia adjacent lifestyle with 9-14 weeks off and none of the hassles of staff management or seeing 40-70 patients a day. Con is weekend and holiday call.

 

[Status Sciaticus]

I know of several jobs that do some kind of split between anesthesia and pain. None of them have this split with 2 weeks anesthesia/2 weeks pain. In my area, these jobs are run by anesthesia groups that primarily are looking for ways to attract pain trained anesthesiologists to provide OR coverage while enjoying a day or two a week of pain clinic/procedures. Typically the people who sign these jobs are people who enjoy some pain work, but also don't have the skill set/interest to see a high volume of patients, or who have been burned by predatory private practices.

The major pro is getting to enjoy a more anesthesia adjacent lifestyle with 9-14 weeks off and none of the hassles of staff management or seeing 40-70 patients a day. Con is weekend and holiday call.

I've seen the 2 week split in academia for sure. The program I was at would split it as 0.5 FTE in each role, so hustling on the pain side past the wRVU threshold would give you additional production bonuses. I think it was $65/wRVU for anything past 4000 or 4500 wRVUs.

 

[spine1105]

It will be important to require patients come for an office visit for everything, no phone calls. G2211 on Medicare patients. Maximize the clinic revenue.

I am glad I’m on the back nine of my career. I’d hate to be starting now.

If you were to be starting now, what would you rather do? Hospital-employed or partner-track PP? Based on what I'm reading in this update, seems like the recent CMS updates favored PP.

 

[spine1105]

More of a refute to baron’s comment that straight PMR is preferable because the “pain ship is sinking”

That said, I expect Baron Samedi was also implying was that PMR pays a strong salary for a very cush job. I see his point, yet I still think that HOPD pain docs do better than that.
Several HOPD docs have posted before on this board that they make 750-800K..... working just 4 days a week. Those are better gigs than mine regarding work/life balance. Yes, I've made low 7 figures for the past 5 years, but I've also worked 5 days/week and 55 hours/week(including travel) for those 5 years. I'm sure there are a number of HOPD docs here who are paid more per hour than I am.

In what regions? Most I've heard from HOPD in the Northeast was ~600k and it was described as a "ceiling".

 

[Dr. Ice]

In what regions? Most I've heard from HOPD in the Northeast was ~600k and it was described as a "ceiling".

600k would be considered very good in the northeast. Wouldn’t say ceiling though. My 8 seconds of fluoro for rfa colleague is probably around 800k

 

[Ducttape]

the NE pays the worst. yes, 600K in the northeast is very good.