employee insurance costs for PP docs

[bedrock]

The ortho practice in which I will become a full partner in January, is self insured and the CEO assures me that this is cheaper than paying the typical employer portion of insurance premiums. I'm not convinced of this when I see how much I've paid out for that portion of the overhead over the past year.

It is a large ortho practice, but I"m still not convinced of this as the practice paid well over a million dollars in medical expenses for the employees this year while being "self insured" They do have an extra rider protecting them if someone gets cancer etc, but this only kicks in at around 37K of annual medical expense for a particular employee.

My questions are these for those of you running your own practice-

1- What is the typical amount and percentage you pay as the employer of your employees health insurance premiums?
2- Are any of you self insured? How did it work out? Pros , Cons , Pitfalls?

Thanks

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[oreosandsake]

Congrats on making partner

 

[pastafan]

How large is large? Generally if you have greater than 100 covered lives the rates drop precipitously.

 

[drusso]

The ortho practice in which I will become a full partner in January, is self insured and the CEO assures me that this is cheaper than paying the typical employer portion of insurance premiums. I'm not convinced of this when I see how much I've paid out for that portion of the overhead over the past year.

It is a large ortho practice, but I"m still not convinced of this as the practice paid well over a million dollars in medical expenses for the employees this year while being "self insured" They do have an extra rider protecting them if someone gets cancer etc, but this only kicks in at around 37K of annual medical expense for a particular employee.

My questions are these for those of you running your own practice-

1- What is the typical amount and percentage you pay as the employer of your employees health insurance premiums?
2- Are any of you self insured? How did it work out? Pros , Cons , Pitfalls?

Thanks

It depends on how rich the benefits are. You could save a lot of money with a high deductible plan and HSA for employees. You could offer a health reimbursement arrangement.

I love that your group is self-insured. It gives you much control over what you offer and pay for.

 

[BobBarker]

It depends on the risk pool. Obesity, age, smoking. A bunch of young employees and few old docs, then your CEO is probably correct.

You could lookat the employees 65+ that are still working and their compensation packages. Then come up with a package that incentivizes them to drop their employer health insurance and go Medicare for primary. That is probably the softest spot to hit without rocking the boat. There is likely a compromise where it would be mutually beneficial for your group and the employee.

Additionally, what percentage of the money out for health was paid by your group to your group? Non operative fracture care on an employee would show as over $1000 out for instance but the actual cost for your group was a $30 wrist brace, $10 plain films, and some time.

The next step is to hire multiple family docs and one pediatrician and keep everything in house.

 

[Dr. Ice]

The ortho practice in which I will become a full partner in January, is self insured and the CEO assures me that this is cheaper than paying the typical employer portion of insurance premiums. I'm not convinced of this when I see how much I've paid out for that portion of the overhead over the past year.

It is a large ortho practice, but I"m still not convinced of this as the practice paid well over a million dollars in medical expenses for the employees this year while being "self insured" They do have an extra rider protecting them if someone gets cancer etc, but this only kicks in at around 37K of annual medical expense for a particular employee.

My questions are these for those of you running your own practice-

1- What is the typical amount and percentage you pay as the employer of your employees health insurance premiums?
2- Are any of you self insured? How did it work out? Pros , Cons , Pitfalls?

Thanks

Are you gonna be paying full ortho overhead?

 

[Agast]

We have a guy who acts as our insurance broker and evaluates the different plans each year. Right now we have an Aetna Managed Choice open access plan, which is basically a PPO, for a little under 100 employees. The deductible is $6,000 so it’s not great but doesn’t seem that different from what my patients have through their employers.

 

[bedrock]

How large is large? Generally if you have greater than 100 covered lives the rates drop precipitously.

large. over 200 covered lives

 

[bedrock]

It depends on how rich the benefits are. You could save a lot of money with a high deductible plan and HSA for employees. You could offer a health reimbursement arrangement.

I love that your group is self-insured. It gives you much control over what you offer and pay for.

plan still has fairly high deductible, 4K. and they do offer a HSA.

It depends on the risk pool. Obesity, age, smoking. A bunch of young employees and few old docs, then your CEO is probably correct.

You could lookat the employees 65+ that are still working and their compensation packages. Then come up with a package that incentivizes them to drop their employer health insurance and go Medicare for primary. That is probably the softest spot to hit without rocking the boat. There is likely a compromise where it would be mutually beneficial for your group and the employee.

Additionally, what percentage of the money out for health was paid by your group to your group? Non operative fracture care on an employee would show as over $1000 out for instance but the actual cost for your group was a $30 wrist brace, $10 plain films, and some time.

The next step is to hire multiple family docs and one pediatrician and keep everything in house.

We have a lot of young people, but also also a lot of 50 something year olds, besides the physicians. 3 people diagnosed cancer in the past 12 months. Not a low risk pool.

I do like the idea that incentivizes people to go medicare for primary at 65.

Not sure on the percentage that was kept in house. Clearly we save money on ortho/spine care.

One of the surgeons is married to a family physician and she is working part time doing FP for the practice. The employees are incentivized to see her and most do use her as their PCP.

 

[bedrock]

Are you gonna be paying full ortho overhead?

Yes. But our practice expenses are fairly individualized. We all share expenses for front desk/scheduling, billing, janitorial, CEO, clinic manager, etc. but they split things out for the assistants to the docs etc, so if you want an , extra assistant or MA, or some piece of office equipment that only you will use, then you pay for it yourself.

I'm bringing in more collection $$$ than every surgeon in our group, and they aren't slackers. I don't think I could get away with asking to pay less overhead than the surgeons.

 

[bedrock]

I’d also appreciate if some of you could please answer my original question and reason for starting this thread which is….,

How much Money do each of you private practice owners spend on health insurance premiums per month per employee?

 

[Agast]

One of the surgeons is married to a family physician and she is working part time doing FP for the practice. The employees are incentivized to see her and most do use her as their PCP.

Is that…legal? What’s the incentive?

 

[bedrock]

Is that…legal? What’s the incentive?

Their office visits are free with her. All usual costs still exist for diagnostic testing, prescriptions, etc, but there are no office visit charges if they see her instead of going outside the practice.

I would think free primary care would be legal

 

[NITRAS]

Is that…legal? What’s the incentive?

Most large healthcare institutions that have their own health plan will only offer their plans to their employees. The deductibles are much higher for other institutions than from going to the primary institution. Shoot, two of the four plans at my job ONLY cover care of in plan institutions. Some of these were ridiculously cheap for people who didn’t make much hourly.

 

[pmrmd]

I start by covering 50% of my employees premium after 90 days. It’s a BC/BS plan and it’s what I have for my family also. I cover the entire amount for some of my employees if they are key members of my practice. It’s a nice thing to offer and I do that in lieu of a raise initially as it’s a pure expense and not taxable. Employee amount is just under $500 monthly. That “self-insured” thing sounds crazy to me with the amount your practice spent last year.

 

[Agast]

Their office visits are free with her. All usual costs still exist for diagnostic testing, prescriptions, etc, but there are no office visit charges if they see her instead of going outside the practice.

I would think free primary care would be legal

Is she billing their insurance for the visit? If so, I’m not sure you can have a blanket policy waiving copays. If insurance isn’t being billed, carry on.

Copays: Can you waive them? ‐ Bravado Health

Routinely waiving the patient’s insurance responsibility is a violation of the contract between your office and private insurance company plans.

www.bravadohealth.com

 

[bedrock]

Is she billing their insurance for the visit? If so, I’m not sure you can have a blanket policy waiving copays. If insurance isn’t being billed, carry on.

Copays: Can you waive them? ‐ Bravado Health

Routinely waiving the patient’s insurance responsibility is a violation of the contract between your office and private insurance company plans.

www.bravadohealth.com

Insurance isn’t being billed at all. There is literally no charge of any kind for the office visit itself.

 

[drusso]

Insurance isn’t being billed at all. There is literally no charge of any kind for the office visit itself.

That’s great. Mayo Clinic and other group practices do the same thing. Kudos on cracking that nut.

 

[Agast]

Ok, based on the data I have available, we will probably spend $516,000 this year on practice insurance costs. Since your group is twice the size of mine, about a million does not seem far-fetched.