biggest misconceptions about private practice.

[coprolalia]

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How does one separate this from just working more per FTE? Even if their billing efficiency is average, if they do many more cases than the median, it seems they are likely to bill more than the median. What do you think?

An FTE is an FTE. The amount of work that person does, whether it's 30 hrs/wk or 70 hrs/wk, is still one person billing. So, in a sense, what you're saying is correct: the more they work, the more they bill. However, an FTE is, generally, averaged to 40 hours.

The "efficiency" factors into it by collecting what's billed, which is where many practices lose out (e.g., non-payment by clientele, poor payer mix, losing case records, etc.). This is what I think of as "efficiency", more so than how much one works.

Of course, you have to ask MilitaryMD about this. His practice was the one selected, not mine.

-copro

 

[MDEntropy]

An FTE is an FTE. The amount of work that person does, whether it's 30 hrs/wk or 70 hrs/wk, is still one person billing. So, in a sense, what you're saying is correct: the more they work, the more they bill. However, an FTE is, generally, averaged to 40 hours.

The "efficiency" factors into it by collecting what's billed, which is where many practices lose out (e.g., non-payment by clientele, poor payer mix, losing case records, etc.). This is what I think of as "efficiency", more so than how much one works.

Of course, you have to ask MilitaryMD about this. His practice was the one selected, not mine.

-copro

I agree with you, for the most part, regarding your definition of efficiency which is why I think the unit chosen here seems less than ideal. That is, unless FTE is standardized. In anesthesia it usually isn't. So the average unit per FTE at the surgery center may be much less than at the hospital with moderately busy trauma center and some L&D, but the average unit collected per hour worked may be much greater at the surgery center. I am saying unit collected as opposed to dollars collected because I don't want to add the complexity of payor mix.

By the way, one small thing I don't agree with is that payor mix, by definition, will affect this efficiency. It could, but surprisingly some government payors that pay well below market rates are very easy to collect from. They just don't give you very much. The unit chosen by MGMA removes payor mix from the equation by choosing units not dollars. It is possible that a particular payor could be notoriously difficult to collect from and if your practice had a robust method of dealing with this issue that could translate into increased efficiency. But usually it amounts to properly billing for all the work that was done and chasing down everyone who doesn't pay.

Anyway, I read (past tense) your quote as his practice works very hard and as a result they probably make a lot of money. But I also sensed the implication that they have a method of collecting well. The latter may be true, they may collect well, but I don't think the indicator mentioned is evidence of that. The "here" link doesn't really seem to go anywhere other than a general MGMA page.

 

[militarymd]

I agree with you, for the most part, regarding your definition of efficiency which is why I think the unit chosen here seems less than ideal. That is, unless FTE is standardized. In anesthesia it usually isn't. So the average unit per FTE at the surgery center may be much less than at the hospital with moderately busy trauma center and some L&D, but the average unit collected per hour worked may be much greater at the surgery center. I am saying unit collected as opposed to dollars collected because I don't want to add the complexity of payor mix.

By the way, one small thing I don't agree with is that payor mix, by definition, will affect this efficiency. It could, but surprisingly some government payors that pay well below market rates are very easy to collect from. They just don't give you very much. The unit chosen by MGMA removes payor mix from the equation by choosing units not dollars. It is possible that a particular payor could be notoriously difficult to collect from and if your practice had a robust method of dealing with this issue that could translate into increased efficiency. But usually it amounts to properly billing for all the work that was done and chasing down everyone who doesn't pay.

Anyway, I read (past tense) your quote as his practice works very hard and as a result they probably make a lot of money. But I also sensed the implication that they have a method of collecting well. The latter may be true, they may collect well, but I don't think the indicator mentioned is evidence of that. The "here" link doesn't really seem to go anywhere other than a general MGMA page.

All you got to do is join the organization, and you will have access to the Volumes of data stored.

As for a FTE...it's simple...it is what ONE person/anesthesiologist does in a particular organization. How many hours is that?

We all know that we (anesthesiologists) cannot control our productivity (other than pain specialists like mille).

 

[deleted126335]

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[coprolalia]

"Efficiency" Has another meaning, Depends to a large extent on the productivity (utilization) of the ORs. The OR that has a case or two in the am, followed by a multi hour gap and starts up again @4pm is a different animal than the one that has cases booked all day. The anesthesiologist that works in the latter will be far more productive (efficient) per hour worked than the former.

True. But, the hospitals also suffers if there are too many cases that go after hours and utilization is off. So, the incentive is to actually end early as opposed to over-book or run late, which causes the OR's to run later with high-premium back-up staff and/or overtime kicking in.

Actually, if you're generally doing cases where you get good start-up units and you and your surgeon work efficiently, you can make more money by turning faster and ending sooner anyway... and everyone is also happy.

That is the model of efficiency we should all strive for.

-copro