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What is avg productivity (amt collected, not just amt biled) or family med doc, outpt only, seeing about 25 pts a day 5 days a wk w/ avg amt of procedures mainly joint injections
500K?
500K?
I know FPs/PCPs that have in fact gone to straight cash only and cut out insurance/medicare/medicaid.... for that very reason. I know some in rural areas that have cut the overhead more by purchasing a small conversion van and running out of their van and/or doing living room visits.....Let me see if my math is right here:
25 pt/day
5 days/week
48 weeks/year (should I include more vacation time?)
= 6,000 patient visits per year.
$500,000 collected/year divided by 6,000 patients/year =
$83.33 collected per patient visit.
Why not save TONS of overhead, headache, time, and energy and simply charge each patient $80?
Hell, with the savings, charge $50...
Am I missing something?
exactly.....The overhead in FM is high largely because of all of the insurance-related B.S. (billing, prior auths, etc.)...
....go cash-only, your overhead percentage will likely be less than the usual 50-60%....
A letter sent by one doc to her patients. Worth reading:
http://corner.nationalreview.com/post/?q=ZjY3ZTg2ODNhYTg4ZDUyNjlmNTBmYWI0YmY2YTQ0YTI=
I am not in any way recommending price fixing, etc... However, if you/your practice feels a rate of reimbursement is "unfair" or innappropriate, you walk.... It's like buying a car. I never know what the guy before me paid....it is illegal for physicians to talk about their insurance contracts, so no one really knows what everybody else is getting reimbursed, and if you don't know that how do you know what to ask for?...
Some final points... because I think physicians like to be manipulated into believing they "have no choice". So, let me put it into some perspective.......I think a few barriers for physicians to do what you say are..
"Well, I have all this debt".... So, what makes you different? Default. Half the country defaulted on their homes/mortgages! Why are you special?
That's fine.... get a low paying job, file the hardship papers, pay what you can, etc.... My point is, you can fall behind/~default. You do NOT have to use the outstanding debt as an excuse to why you must stay in a bad practice reality. The other thing is.... take a mortgage, pay student student with some of mortgage funds, etc.... there are ways to seperate that debt from "student loan" status to something else before you default/fall behind/etc....Really Bad Idea. Student loans aren't the same as mortgages. If you default on your student loans, all you'll do is rack up penalties, and the government will come after you. Even bankruptcy won't get you out of it.
http://www.finaid.org/loans/default.phtml
So, I am obviously using the term "default" improperly... My point is you can fall behind, call make some payments (not necessarily full payments), etc.....YourLink said:http://www.finaid.org/loans/default.phtml
do not make any payments on your federal student loans for 270-360 days and do not make special arrangements with your lender to...
...generally requires demonstrating that you made a good faith effort to repay the debt, that you will not be able to maintain a minimal standard of living and still repay the debt (usually using the lowest monthly payment under any of the repayment plans, typically income-contiengent or income-based repayment)...
1. to Digit:I don't think there's really any need for going that far Jack...
Again, though...I have to ask why everyone isn't just bailing on "The System" and going Cash Only? ......The argument that should be made is this: if it costs X to obtain a medical education, then Y in income is required to justify X. Y is the return on X; if Y is insufficient, never invest in X.
Pay me.
ForPerspective said:...In 2004, there were about 216 million people in the US who were able to vote. Out of these people, only about 126 million actually voted. (58%) The 2004 elections had the largest percentage of people who voted since 1968...
I would love to hear thoughts from those who have actually negotiated w/ insurance companies... is there room for negotiating, or is it a take it or leave it kind of thing? Blue Dog?
What % of productivity is good salary for graduating FM resident to join large, multi-specialty group?
So, BD has provided some info. Others too... To your question above, it is an individual decision based on business calculations. Those calculations are not particularly difficult or complex and have been laid out in the earlier replies:...How do you know what is good reimbursement and what is bad if you don't know what the going rate is? Your comparison to negotiating w/ insurance companies was buying a car... but there are resources like Kelly Blue Book/Edmunds/talking to others that bought same car that tell you what the "going rate" is on buying a car. Is there such a resource for reimbursement w/ a particular insurance company?...
What is avg productivity ...amt collected...outpt only...25 pts a day 5 days a wk w/ avg amt of procedures...500K?...that seems about right.That's in the ballpark.
Let me see if my math is right here:
25 pt/day
5 days/week
48 weeks/year (...vacation time?)
= 6,000 patient visits per year.
$500,000 collected/year divided by 6,000 patients/year =
$83.33 collected per patient visit...
So, you need to see around 6k patients a year at around $80 COLLECTED (i.e. reimbursed) per patient for your business to receive $500k/yr. You subtract 50-60% for overhead = operating costs. This would include rent/utilities, staff costs (i.e. salaries/benefits/etc...), business insurance costs, etc... what is left is yours.The overhead in FM ...the usual 50-60%...
So, BD has provided some info. Others too... To your question above, it is an individual decision based on business calculations. Those calculations are not particularly difficult or complex and have been laid out in the earlier replies:
So, you need to see around 6k patients a year at around $80 COLLECTED (i.e. reimbursed) per patient for your business to receive $500k/yr. You subtract 50-60% for overhead = operating costs. This would include rent/utilities, staff costs (i.e. salaries/benefits/etc...), business insurance costs, etc... what is left is yours.
You thus need to decide, based on your business model, are you willing to accept ~$80/patient, and 6k visits to earn what is left? Its not complicated math. If you want more, you negotiate more, etc... It will be a balance between what you will be willing to bear (i.e. you CHOOSE to accept) and what the market will bear (i.e. market CHOOSES to pay). That is about the "kelly Blue Book".....
Why not reduce your overhead though? By only accepting cash, overhead would no longer be 50-60%, and you could probably charge less than $80 and still make a good salary. Check out Blue's buddy The Village Doc (can't find the link, but I'm Blue has recently posted it, and I'm sure he would again).
I'm afraid Healthcare Reform will eliminate this niche, as everyone is going to have insurance, and insurance companies are going to be required to provide certain benefits- so I worry if this niche will still be around by the time I finish my time in the military.
So ya,
I've always like the cash based stuff for clinic visits - it makes sense to me and I suspect there is a pretty good niche for it in large cities with a good population of the working uninsured- Houston comes to mind.
I'm afraid Healthcare Reform will eliminate this niche, as everyone is going to have insurance, and insurance companies are going to be required to provide certain benefits- so I worry if this niche will still be around by the time I finish my time in the military.
That is all,
Smiley.
Why not reduce your overhead though? By only accepting cash, overhead would no longer be 50-60%, and you could probably charge less than $80 and still make a good salary. Check out Blue's buddy The Village Doc (can't find the link, but I'm Blue has recently posted it, and I'm sure he would again).
Why not negotiate directly with your patients, rather than the pain in the ass insurance companies?
Because I have insurance, and under the new law, my preventive services will be FREE for me (no copay, my insurance company pays the MD). Why would I pay you $80 cash when I can go see someone who will take my insurance?
If you look at examples accross the globe.... from Latin America to Canada or to Europe, etc... numerous "socialized" care systems.... so called, "free-care" systems. yet, in those countries plenty of folks paying premiums and extra costs to obtain care outside of the "free-care" systems. And, don't take my word for it... research it, look it up. There are all sorts of information sources you can look at.... if even nothing more then intensive web searches. Also, as noted with Mass, we have some hints at domestic information. There have been some very telling anectdotal stories about "free care". Places that initially provided high end comprehensive coverage for employees with no co-pays/low co-pays (i.e. some university med ctrs) saw an almost immediate overwhelming of their systems...especially their PCPs' offices. This was dramatically reversed when co-pays and/or other restrictions were added.Because I have insurance, and under the new law, my preventive services will be FREE for me (no copay, my insurance company pays the MD). Why would I pay you $80 cash when I can go see someone who will take my insurance?...Because you won't be able to find a doctor otherwise. Between the physician shortage, the millions of newly insured, and covered preventive care...good luck finding a doctor that will see you when you want to be seen.
I think a lot of people are willing to pay a reasonable fee ...if it means access to a doctor when you want/need it...
...Expect >6 month waiting times, as we've seen in Mass. (which had the highest # of docs per capita in the nation when they enacted their similar universal coverage plan).
I doubt many Americans will be willing to tolerate the delays and/or limits on care that arise from increasing levels of, for lack of better term, "socialized" system.
Probably worse... it will be worth LESS then what you pay. The largest denier of healthcare/etc IS medicare/medicaid...."Free" healthcare will be worth exactly what you pay for it.
you don't pay insurance companies $5-8K/year. Instead, you pay $10-20k/year additional taxes.... not very free. But, probably less "care" then what you enjoy now.