Baffled by CXR fees.

[Weinberg Angle]

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[colbgw02]

Haha - when I read a plain film, I see around $6-7 pre-tax. No radiologist gets paid $36 for a CXR pro fee.

There are probably a number of factors at play, many if which are too complex for me to understand or explain. Some of it is probably as a cash customer you have no leverage - the way an insurance company might - to negotiate the price down. Another factor likely has to do with the patient mix. If the clinic sees a lot if charity cases or Medicaid patients, then it'll charge you more to make up for lost income elsewhere.

 

[colbgw02]

BTW, the technical fee isn't just for the radiographer. It's also for the machine, the safety requirements (lead equivalents in the walls), and administrative costs like ACR accreditation that many insurance companies now require for reimbursement.

 

[shark2000]

No way. Some insurance companies pay that number for a CT.

If you are lucky, you get paid 5 bucks to read a CXR.

Your case is very different. But for inpatient medicare, the charge a global (technical + Professional) fee of 50 bucks for a 2-4 view X ray. If they are lucky, they get paid 25-30 bucks.

For CABG the story is like this: For everything altogether, from the moment that the patient calls the ambulance and steps into the hospital with Chest pain to the moment that he/she is discharged, medicare has a bundled payment. It includes any kind of procedure (CABG, post op care, tubes, devices, .... ), consults, imaging (stress test, cardiac cath, multiple CXRs, CTs,.... ) and post op care. The hospital charges individuals item by item about 100K, however the medicare pays 28K bundled.

 

[Weinberg Angle]

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[Weinberg Angle]

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[tco]

Last week, ED doc ordered head CT on guy who came in with spider bite on left ring finger. When I arrived in the morning and inherited the pt, I asked him, why did they do a head CT? He looked baffled.

If there's one thing you can be sure to get if you go to the ED, it's a spider bite...Wait...No...

 

[shark2000]

We hospitalists need to stop ordering: CT Chest without contrast (gets done), then oops, DDimer came back 0.88, so start IV fluids and order stat CT chest w contrast. Patients must be as baffled as I was, when they get the hospital bill.

Last week, ED doc ordered head CT on guy who came in with spider bite on left ring finger. When I arrived in the morning and inherited the pt, I asked him, why did they do a head CT? He looked baffled.

With all my respects for you, you were not there in the middle of the night. It is very very easy to look at the end result and find out what was indicated and what was not.

Are you saying that a patient with a minor spider bite was kept in the ED over night, was admitted to the hospital and came to the hospitalist service?? Are you sure it was only a spider bite in the ring finger?

 

[Weinberg Angle]

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[badasshairday]

Yes, that's the way it goes in the hospital I work at. ED admitting everything under the sun, and the nocturnist taking it because it is easier to admit than to fight the admission. Apparently he was admitted for "sepsis", he did have a low grade fever of 101 F, WBC of 12, and HR of 105 at presentation. BUT he was a 32 y/o male with no past medical history and actively working a full time job. He did have a hx of community MRSA. I examined him at 10 AM and he was out the door before noon, on 7 day course of abx. The ED can admit, but I will not keep pts longer than needed.

Maybe I should have ordered MRI left ring finger to r/o osteo? Would that study need contrast?

The secret to short length of stays: Easy discharge procedures and followup arrangements, which is the case where I work.

So why did they get the head CT?

 

[Weinberg Angle]

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[Staradmiral]

US healthcare fees. In other FIRST WORLD countries you can pay $20 out of pocket for a chest x-ray. I once paid out of pocket for a CBC (in another country) and it cost $5.

 

[tco]

US healthcare fees. In other FIRST WORLD countries you can pay $20 out of pocket for a chest x-ray. I once paid out of pocket for a CBC (in another country) and it cost $5.

I'm interested in the breakdown of the fees. Who gets the money? Is it a fact of overcharging those that can pay so that the hospital can cover losses of those who can't or don't pay?