Declining reimbursement rate for Anes
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the bill is working its way through right now...
So what does that mean? Less salary for anes?
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If you do a lot of Medicare.
You may be able to make as much if you ramp up your practice and work twice as much.😀
So are you going to deny them health care? Its not their fault that their insurance sucks.
We treat uninsured everyday. what makes this any different?
You will always have to treat these patients unless you are at a surgery center. You could let the crna's have them all. Or you could be a hosp. employee. Or you could negotiate a stipend. Bottom line is that someone will be treating them.
This system is broken and will soon resemble the levees of New Orleans.
I tried to find the bill, but failed. Does anyone have any specifics on what procedures are being cut, actual numbers, and over how long? Just curious.
BTW, all you p u s s i e s that were on militaryMD's lazy thread barking about money and lifestyle blah blah blah.. are really eatin a nice plate O' hot steamy ones aint'ya.
Just to reiterate whats been said... ya better like what you do.
out.
😎
BTW, all you p u s s i e s that were on militaryMD's lazy thread barking about money and lifestyle blah blah blah.. are really eatin a nice plate O' hot steamy ones aint'ya.
Just to reiterate whats been said... ya better like what you do.
out.
😎
And doesn't private insurance follow Medicare?
this is precisely the problem. even with a good payer mix, there will be less money flowing into anesthesia practices. this further creates is a disincentive for anesthesia practices to hire and have crnas work directly for them (mostly because anesthesia practices cannot efficiently manage their time/guarantee that they will bill at least 6 hours per 8 hour shift/not creating an incentive "share" in the practice with crnas because we've allowed them the opportunity to be in the nether-world between nurse and doctor, demand and get exorbitant wages in comparison to what they actually do, and essentially have their cake and eat it too... but this is a different discussion).
yes, private insurance companies will inevitably try to follow suit to conform to a single-payer type model. as it now stands, what happens in reality is that md/do level anesthesiologists will not share time on private practice reimbursement cases because, in many states, even if a crna signs on the case for 10 minutes they get half the reimbursement. case splitting is no longer allowed (ie., you work for ten minutes on the case, you get paid for ten minutes). so, because crnas work for the hospital, the anesthesiology practice gets what is tantamount to punished for allowing them to sign in on a blue chip case.
and you wonder why there is bad blood?
this is why everyone needs to support the ASAPAC. we need to prevent medicare from further punishing our field. the real irony of anesthesiology is that we've, in many ways, become a victim of our own success. the perception is that "anesthesia is safe" and therefore not demanding of a highly competent, highly trained medical professional - ie, not worthy of what is perceived to be exorbitant fees in their mind.
the real truth is that our successes have allowed us to take sicker and sicker people to the operating room. what i see happening is that this practice will simply stop. no one's going to waste their time on someone who's sick as snot for chump change. too much liability exposure. they'll just either cancel or refuse to do the case... or they'll get a crna. and, the fact is, sportsfans, the u.s. population ain't getting any younger or healthier.
a lot of the time....
How true this is: My patient for today - 82 y/o DM, HTN, hyperlipidemia, renal failure, stroke, gout, Raynaud, 3 level compression fracture, wide open MR, multiple allergies, for MVR.
I'll get about $700 for this four hour case and Medicare wants to chop it down? Yikes.
anesthesiologists get paid for what they bill on a case. if you are a partner in a business, you do enough cases or you don't make any money. you are ultimately responsible for that patient's care, and you're the one who's going to have to defend what you did in front of the justice system and/or god if something goes wrong.
a nurse anethetist (as it now stands) get a salary whether or not they work a full 8 hours or if they work for 10 minutes during the day. this doesn't change. and, at the end of their shift, they get to go home no ifs, ands, or buts.
in a low volume practice, it's possible - and indeed happens - where there are periods when a crna is bringing home more money than the supervising anesthesiologist for doing less work.
you either didn't know this, or you did and you're just a jackass. at this point, i'm willing to give you the benefit of the doubt.
So again, the only counter-measure is to hire more employees at lower salary to increase volume.
So where's the breaking point?
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When it's bad enough that less people are interested in the specialty....and there is a lack of providers......
this would be followed by rises in reimbursement OR larger subsidies from hospitals or surgeons....
which is then followed by influxes of "lifestyle" pursuers....
The cycle continues until we arrive at socialized medicine........by then, I will be retired.
That's not the only model out there.....I assume you just didn't know that.
yeah, well you shouldn't continue to assume much about me... you know what they say happens when you assume. but, still i'll go ahead and presume you know well it's the predominate model, especially since your practice doesn't hire crnas.
How does the mere increased interest in Anesthesia influence the number of people entering the field? Isnt it more a matter of who is filling the residency spots (more qualified applicants) rather than how many positions are available? Unless of course program directors see the increased interest and open up 10 more spots per program, but I dont see that happening.
well, it has happened and will continue to happen. there have been more spots available each year. no reason to see this change. there is a huge shortfall of anesthesiologists, and will continue to be at least until 2015 or so. beyond that, we need to begin now to think more creatively about how we are going to maintain dominion over our profession.
Your limited awareness of the variety of practice models that exist is extremely frightening.
Not.
Well....there is a short fall of bodies to fill crappy jobs that exist on gaswork.
There is no shortage of anesthesiologists in good jobs in good locations.
pot, meet kettle. despite the fact that it's none of your business, i have a tremendous out loud laugh when i read your posts knowing where i came from and what i did before i entered the medical field as a physician. you, otoh, are the classic high-school -> military/college vs. college/military -> med school -> (maybe more military) -> current job. i laugh because you only know you own little small niche of the world and, like most overly cocky, arrogant practice stakeholders with no formal business training other than what little you've learned in your own little fiefdom, think you know how the world works now as well as how it's going to work ten years from now.
keep posting, dude. you're definitely good for laughs.
(see i can bold for emphasis too)
define good location. is it what you think is a good location?
how about job offers that my resident colleagues are getting - right now - for $400k the first year ($325k salary + $75k sign-on bonus - no strings attached). and not a gaswork job. not a scut job. sure, they're going to work, but i assure not as hard as they are now in their final year of residency. and with a 1-year partner track in a growing practice close to several major cities.
now, how do you think a job like that exists? or, maybe you're just pissed off that you don't have complete and utter dictatorial say over who goes where and in what type of practice you think should exist. nail? head?
my opinion of you continues to deteriorate the more and more you post...
Militarymd said:
Care to clarify your "extensive" prior experience? As it stands right now....the above post from another thread is all that we have on you.
My opinion of you can only go up.
GREAT for them....I guess the groups passed on you?
well, i don't now (nor will i ever) answer to you. so, why don't you answer your own question first? while you're at it, where did you do your business training? how many different practices have you worked for? how long have you been in practice? can you name at least five different types of reimbursement models? what percentage of your practice is private-payer? what is your payer mix? do you have a dedicated practice manager who is not also a practicing anesthesiologist? why or why not? who runs "the board" at your primary hospital? who assigns cases? how do you recoup non-payments? what percentage of your practice is a write off? do you offer share stake in your practice to junior partners after two years? three years? what do you initially offer to a new hire? do you actively recruit URMs? (we already know the answer to that one, don't we?) what's your call schedule for new hires? how many crnas to you expect new hires to oversee? what's your case mix? how many units do you expect an associate to bill per week? how about a junior partner? how about a senior partner? do you make them work "extra" if they don't achieve their benchmark? do you even have a benchmark?
see, i can bombard you with a littany of questions too. come on, tell us why your practice is so great and why all the gaswork jobs suck. tell us what city you practice in. hey, how about just telling us where you did your residency? are you still near iowa where you did your training? is that a "good location"?
(you're a tool, dude, with a clear over-inflated sense of self-worth.)
well, i don't now (nor will i ever) answer to you. so, why don't you answer your own question first? while you're at it, where did you do your business training? how many different practices have you worked for? how long have you been in practice? can you name at least five different types of reimbursement models? what percentage of your practice is private-payer? what is your payer mix? do you have a dedicated practice manager who is not also a practicing anesthesiologist? why or why not? who runs "the board" at your primary hospital? who assigns cases? how do you recoup non-payments? what percentage of your practice is a write off? do you offer share stake in your practice to junior partners after two years? three years? what do you initially offer to a new hire? do you actively recruit URMs? (we already know the answer to that one, don't we?) what's your call schedule for new hires? how many crnas to you expect new hires to oversee? what's your case mix? how many units do you expect an associate to bill per week? how about a junior partner? how about a senior partner? do you make them work "extra" if they don't achieve their benchmark? do you even have a benchmark?
see, i can bombard you with a littany of questions too. come on, tell us why your practice is so great and why all the gaswork jobs suck. tell us what city you practice in. hey, how about just telling us where you did your residency? are you still near iowa where you did your training? is that a "good location"?
(you're a tool, dude, with a clear over-inflated sense of self-worth.)
OK, I will play your game:
No formal business training...current mentor has MBA from Stanford and is training me...Recent new partner is working on MBA from Georgetown...also training me.
I have only owned one private practice. Passed on to me by my mentor who has owned over 15 practices across the country. I have practiced in academics, in the military, etc.
Finished training in anesthesia in 97...deployed to Guanatanamo Bay for one year as sole anesthesiologist for 1 year...followed by CCM fellowship in 1998.
There are mulitple reimbursement models, here are 5:
1) bill patient directly
2) bill insurance companies (BX/Bs, medicare, etc)
3) bill hospital..and hospital bills payors
4) hospital employee
5) blended unit model
70 to 80% of my practices collections are Blue cross blue shields depending on the month.
The remainder is a mix of tricare, medicaid, medicare.
We do not have a practice manager....we're not there yet.
On call anesthesiologist runs the board.
On call anesthesiologist assigns cases for the next day...
I and my mentor together decide who we send to the collection agency.
We collect between 60 and 80% of what we bill......the rest are "write offs" as you call it.
New hirees are offered partnership within 30 days..in general with 7 days..unless you are not BC.
The hirees are paid exactly same as partners.
We actively recruit only good anesthesiologists...we have 3 URMs out of 8
New hires share in call exactly same as everyone else.
New hires supervise the same number of CRNAs as everyone else.
We do everything except Hearts, Neuro, and high risk peds.
Everyone , new hire, non-bc, old partners...all share in the work equally. What you bill is based on what the call person the day before assigns you.
OK...so tell us about your "experience"
(you're a tool, dude, with a clear over-inflated sense of self-worth.)
One of the other differences between your posts and my posts is that I don't call you names.
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hey, how about just telling us where you did your residency? are you still near iowa where you did your training? is that a "good location"?
(you're a tool, dude, with a clear over-inflated sense of self-worth.)
I trained at Bethesday Naval Hospital....in case you didnt' know...it 's the hospital where the President of the United States goes to have surgery, members of Congress....people like that..
I've never been in Iowa.
ad hominem, how ever it's dressed up, is ad hominem.
gotta tuck the kids in. will get back to this "discussion" later.
what does that mean? better training? because the president and members of congress go there....
dude.. tool.. always have said it since reading your posts about the boards.. about race relations.. about many many other thngs.. .. i dont know why volatile is wasting his energy on a tool like you..
Odd
I was thinking the same thing about VolatileAgent.
His constant avoidance in answering a simple question put forth by Mil is telling, IMHO.
I was thinking the same thing about VolatileAgent.
His constant avoidance in answering a simple question put forth by Mil is telling, IMHO.
So what you're saying is, that in spite of the lobbying efforts of all our specialty organizations, this is a war which can't be won..
and that the best course of action is to ride it out, and then bail at first opportunity?
not to be on anybody's side....do YOU have 20 or so bodyguards standing around YOU?
That's what I suspect. The lobbying efforts will slow the progress...may even halt the progress for a while, but the destination seems inevitable.
And I'm not saying bail...I'm saying that hope that it is not too bad before you can retire.
well, it's actually your "game" (although i don't really believe this is a game. you're coming on here and insinuating that you have some superior expertise and that we should all heed your advice when, as is clear below, you have limited experience outside of your own practice.)
bully for you. you have one person's viewpoint, and you have not actually clarified that you have any formal business training, unlike myself. okay. fine. not really an expert then are you?
military doesn't count. no open billing or competition in the military. academics also doesn't count. your mentor's experience is not your experience.
confirms what i already knew: older than you. does this mean much? eh. maybe. definitely confirms that i have more real world business experience.
not really what i was talking about, but okay. would expect this type of answer from you. perhaps my question wasn't clear? i wanted to know how you run your business (accounting practices, etc.) and at least four other models (currently used by anesthesia practices, of which there are many) in directly dealing with patients and receivable accounts. for example, reimbursements are collected by practices based on basic units plus contact time, insertion through delivery, single fee for service, incremental time fees, etc. you are able to, depending how you negotiate with payers for discounts or volume service or PPO status, to structure reimbursements from the payer. are you aware of these models? you've just simplistically described the way bills are sent. and, i have no idea what "blended model" means. your practice should be negotiating directly with the providing companies (barring medicare which is pretty much set by the government) about how you will charge for your services for their covered patients. you don't have to accept simply what they will pay you, and this is an incredibly potent negotiating tool to get into a good contract at a hospital you are trying to win exclusive anesthesia rights with.
you are very lucky. this is a high mix of a premium payer. have you thought about what will happen if another group suddenly becomes the insurance provider in the area (i.e., they win the health insurance contracts with large employers that serve the area in your catchment area)? if you are not prepared for this, then you are not preemptively seeking out and setting up preferred contracts with providers who may become the dominant market in your geographic area.
let the crnas have those cases. if you are involved in them, with perhaps the exception of tricare, you are wasting your time, based on how you've described and suggested you're running your practice.
big mistake. if you are trying to grow your practice, this should be a high priority. you need someone with business training to manage the business end of your practice. you need to maximize your time (ie., the person who's currently splitting clinical duties to do that job) providing revenue, meaning that person needs to be dedicated to generating revenue. the cost of doing this by hiring someone would be more than valuable, especially if you intend to grow your practice.
fine. good. okay. this person needs to be an expert at this job in order to maximize your ability to bill and do more cases. this could already be happening, but this is a much harder job than it seems. if you have one person who can be dedicated to doing this - an expert at it - and can also manage a crna room or two, then that would be a better model for you. frankly, some people are just terrible at running the board. if that person is on call, they shouldn't be allowed to do this. you can probably do better and better maximize your time if you think about this.
ditto above.
again, practice manager.
that's probably about average. some practices do this far better. but, again, if you are spending your time doing this, then you are not generating more revenue.
that's amazing. i'd have to see that to believe it.
again, not a bad deal for new hirees. being equitable is a nice, fair way to do things. except, you've provided (at least the way you've described it here) no additional competitive incentive to grow the practice. fortunately, you are small enough now that this doesn't matter. and, i can see why you could easily get frustrated if you perceive someone is not pulling their weight. but, this is your current (suboptimal, imho) practice management model. so, you have to live with it and hope your recruiting practices will bring in the best people that are out there and that no one gets sick and no one leaves... or improve your model.
ha! that's funny. you're practice is going to get a reputation if you have high turnover. people will learn not to even bother with you. your job, again as a good manager, is to develop people, not fire them after thirty days if they aren't perceived to be good enough.
again, fair and equitable now. you are small. there will come a time when this will change, i predict.
fine. maybe you could do a better job allocating resources. i don't know. there isn't enough information provided on your case mix to make that determination.
bread and butter. this makes the world go round. i just hope that, if your hospital decides it's going to start offering these services you'll be able to meet their requirements. if not, you are poised to lose your contract(s).
again, you're lucky. this may change before you know it...
ah. guess that's how you know cmdr. greensmith.
the greensmith connection. guess you don't know hata? very nice, awesome ccm guy.
fair enough. but, i'm not going to be specific. i'm actually trying to get a job right now (and have one interview down and two more i'm going on) and i don't know who reads this forum or not. suffice it to say that the one practice i've talked to is keenly interested in my previous experience, and so far they are in the lead. this is not the most geographically desirable place for my family, but the offer (when it comes) may change my mind.
me? first off, it should be clear from my response to your response that i am not bull*****ing anyone. i have formal business training both in undergrad and graduate level. worked in the healthcare industry for years dealing with physicians and other third-party vendors and managing multi-million dollar contracts. had to negotiate and structure incentive payments and manage milestones. directly involved in negotiating contract-for-service models. had to deal regularly with pissed off folks (both internal and external to my company) who felt like they needed more money for doing work that was already negotiated for. had, at one point, 12 direct reports who i did annual evaluations, determined raises, and had to occassionally fire. got bored and sick of sitting behind a desk. finished the pre-med courses. went to med school. don't regret it looking back.
i agree that most residency programs ill-prepare graduates in knowing basic business things they should know when they finish. our's does not. teaching seniors this type of knowledge is actively part of our curriculum. we have a few private-practice faculty that like to teach and are still on staff. in addition to my own personal experience, they are a wonderful wealth of knowledge about the challenges that face our profession in the future, and are a huge benefit to our other residents.
now, what else do you want to know?
p.s. i enjoy my relative anonymity on this forum. realize that posting above, there are at least 4-5 other people in my program who post here who will now be able to easily identify me.
btw, mr. high-and-mighty, did you not also post this?
http://forums.studentdoctor.net/showthread.php?p=4020312#post4020312
referring to me as a "female" shows not only your arrogance coupled with an inability to tolerate those who don't bow down to you but perhaps some buried misogynistic tendencies. and, in the end, need i remind you that you've proven yourself to be a prejudicial bigot. don't make me drag those threads out...
so, i suggest ending the "holier than thou" parade and getting off your high horse. if you want to talk shop, let's talk shop and not make this personal. deal?
You have said nothing in your vague posts...implying superiority...while continuing to insult me...while I'm simply pointing things out to you from experience.
In the thread you linked, it was once again me....informing you why you have problems with nurses...because of your arrogance in treating them....and in return for my advice (years in practice of medicine) ....you called me names and insult me again.
If you are what's up and coming, I feel VERY secure in continuing with my ways.
Like you said before....guys like me hold all the cards....and as long as guys like you act the way you do....we will continue to hold all the cards.
why would you care if anyone can figure out who you are?
okay, you go first. go ahead and tell us where you practice and what your name is.
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hehe
Volatile, ive been reading these forums for years, I have never, in my life, met (read?) someone who was so in love with himself. Your "experience" you have quoted many times on this forum. You often have made the suggestion in posts that you were clincally apart of healthcare. Now clearly, you were either lying then or now. Truthfully, I dont care.
I appreciate the interest in anonymity, afterall many of us enjoy it. Mil may come off as brash, but he is clearly a success. I would take his advice over yours in a heartbeat. You are not a success, you are a begginer. Your buisness experience (if its real) may help you in private practice, but you have alot to learn about respect and communication if this forum is any indication. I surmise that in real life, as is often the case, you are quiet and demure else you would not have found your way through residency with this attitude toward your superiors.
You are nobody here much like myself. JPP and Mil are the proverbial "Oracles" on this forum. It is sad to see someone who pontificates about experience and age be so disrespectful and ignorant. With the future of Anesthesiology in the hands of the likes of you, we may well be doomed.
Volatile, ive been reading these forums for years, I have never, in my life, met (read?) someone who was so in love with himself. Your "experience" you have quoted many times on this forum. You often have made the suggestion in posts that you were clincally apart of healthcare. Now clearly, you were either lying then or now. Truthfully, I dont care.
I appreciate the interest in anonymity, afterall many of us enjoy it. Mil may come off as brash, but he is clearly a success. I would take his advice over yours in a heartbeat. You are not a success, you are a begginer. Your buisness experience (if its real) may help you in private practice, but you have alot to learn about respect and communication if this forum is any indication. I surmise that in real life, as is often the case, you are quiet and demure else you would not have found your way through residency with this attitude toward your superiors.
You are nobody here much like myself. JPP and Mil are the proverbial "Oracles" on this forum. It is sad to see someone who pontificates about experience and age be so disrespectful and ignorant. With the future of Anesthesiology in the hands of the likes of you, we may well be doomed.
then, i post and prove to you i know what i'm talking about and have the stuff to back it up, and i give you a lot of great advice. and, you call it "vague".
methinks you are a lost cause.
who the hell are you? seriously. 2 posts? actually prove you have anything relevant to contribute here before you expect me to give a crap about what you say.
We about done here?
I'll vouch for Mil's voice on the forum. I appreciate the honest outlook that our "attendings" provide us on this site. They are always open to counter arguement or disagreement from what I have witnessed.
Its tangibly obvious that the both of you will not be best buddies in the corporeal world as well, so how bouts we get back to the topic at hand?
I'll vouch for Mil's voice on the forum. I appreciate the honest outlook that our "attendings" provide us on this site. They are always open to counter arguement or disagreement from what I have witnessed.
Its tangibly obvious that the both of you will not be best buddies in the corporeal world as well, so how bouts we get back to the topic at hand?
i don't think mil could state in any clearer for all of you med students thinking about anesthesia or currently applying...
your salary will go down, your hours will go up. so if you're going into anesthesia because the salaries are currently high and the hours you have to work are low...you'll be ABSOLUTELY miserable. no doubt about it. if you're going into it because you actually enjoy the work, then you'll be fine.
remember though, if SO many so-called "slackers" are currently going into the field..those "slackers" are going to be your colleagues. do you think these "slackers" are going to be actively lobbying for your reimbursements to stay high? are they going to be promoting academic research that will improve the reputation of the field? think about all of those things before you commit to a field simply because it looks good on paper to you as of 2006.
your salary will go down, your hours will go up. so if you're going into anesthesia because the salaries are currently high and the hours you have to work are low...you'll be ABSOLUTELY miserable. no doubt about it. if you're going into it because you actually enjoy the work, then you'll be fine.
remember though, if SO many so-called "slackers" are currently going into the field..those "slackers" are going to be your colleagues. do you think these "slackers" are going to be actively lobbying for your reimbursements to stay high? are they going to be promoting academic research that will improve the reputation of the field? think about all of those things before you commit to a field simply because it looks good on paper to you as of 2006.
