Hospitals getting paid for your work

[nexus73]

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I recently saw an email exchange regarding a patient admitted for a procedure. Apparently, this was a pretty standard procedure, with specified DRG payment, and average length of stay about 2 days. The patient had a complication from the procedure that was handled conservatively, and they did just fine. However, the doctor taking care of the patient didn't document the complication, a lab abnormality essentially, likely because it was relatively minor and didn't require any further intervention just monitoring. Utilization review team discovered this oversight, and when the complication was included in documentation it increased DRG and length of stay to 4 days and added approximately $4,000 to reimbursement. This became important because of delays in the doctor adding an addendum to his note to include the complication diagnosis. It became sort of a big hassle for the doctor, across several messages being exchanged over email and IT team getting involved to get the documentation completed. So what likely amounted to 30-60 minutes of time and headache for this doctor, and certainly was not compensated, the hospital is clearing an extra $4000.

This must happen hundreds of times a day across the country leading me to believe the system is completely setup to screw doctors.

 

[randomdoc1]

that's why we need to be independent. too many leechers.

 

[Sushirolls]

That's what happens when you are employed.
An independent doctor could just go about their day, but to the hospitals point, its 'money left on the table.'
If employed, you have to dance to their tune sometimes.

 

[shoomer]

Hospitals and hospital systems are never working in the physician's best interest. Never forget that these are run as businesses, and every single dollar of salary you receive is only given to you because they make a net profit off of you.

 

[mistafab]

I mean, this is more a product of our system design rather than any ill-meaning folks. This is why on medicine people heavily review cases and shoot emails regarding “additional problem list items” such as “hyperphosphatemia” that they want you to approve/include as separate from their kidney disease problem, for example. A single sentence on your document has huge implications for billing.

Thus is our system design. It costs you very little time but feeds the beast, so to speak.

Edit: this is also why every hospital pushes for nutrition assessment and ASPEN malnutrition status lol. Huge $$$

 

[randomdoc1]

I mean, this is more a product of our system design rather than any ill-meaning folks. This is why on medicine people heavily review cases and shoot emails regarding “additional problem list items” such as “hyperphosphatemia” that they want you to approve/include as separate from their kidney disease problem, for example. A single sentence on your document has huge implications for billing.

Thus is our system design. It costs you very little time but feeds the beast, so to speak.

Edit: this is also why every hospital pushes for nutrition assessment and ASPEN malnutrition status lol. Huge $$$

And...hence in our best interest to learn medical billing. Then we can take some of these billing pearls (although some you can't do outside of big hospital systems) into our independent practice. I too would rather not deal with insurance at all. However, with the way the economics shake out, insurance offers more job security and actually you can get equal or more reimbursement than a cash pay method without the psychodynamic awkwardness of customer service (like if your cash pay is $400 an hour, you can get insurances which pay say, $350-$400 an hour if you do two 30 min visits--and way more patients who can afford to see you at higher frequency). Medical billing has a learning curve, but when you crack that code, you just about literally strike gold. But we don't give ourselves enough credit. If you can get accepted into med school, go through med school, then residency, the vast majority of us can figure out medical billing. It's scary, you'll lose some money at first. But the denied payments and when you see which patients don't pay, it catalyzes that learning curve for sure.

 

[forchinet121]

And...hence in our best interest to learn medical billing. Then we can take some of these billing pearls (although some you can't do outside of big hospital systems) into our independent practice. I too would rather not deal with insurance at all. However, with the way the economics shake out, insurance offers more job security and actually you can get equal or more reimbursement than a cash pay method without the psychodynamic awkwardness of customer service (like if your cash pay is $400 an hour, you can get insurances which pay say, $350-$400 an hour if you do two 30 min visits--and way more patients who can afford to see you at higher frequency). Medical billing has a learning curve, but when you crack that code, you just about literally strike gold. But we don't give ourselves enough credit. If you can get accepted into med school, go through med school, then residency, the vast majority of us can figure out medical billing. It's scary, you'll lose some money at first. But the denied payments and when you see which patients don't pay, it catalyzes that learning curve for sure.

Let’s not be too hyperbolous regarding how lucrative insurance based psychiatry is, yes you might gross 350 an hour maybe but after overhead and the fact that you probably can’t fill that many hours, and all the uncompensated admin work, you’re not making anywhere near what the real “striking gold” specialties are. Go look in the ophthalmology forum if you want to know what striking gold is because your 400k a year certainly isn’t it. I just want to post this so med students don’t have a false perception of this field, it’s certainly not striking gold at this point in time.

 

[randomdoc1]

Let’s not be too hyperbolous regarding how lucrative insurance based psychiatry is, yes you might gross 350 an hour maybe but after overhead and the fact that you probably can’t fill that many hours, and all the uncompensated admin work, you’re not making anywhere near what the real “striking gold” specialties are. Go look in the ophthalmology forum if you want to know what striking gold is because your 400k a year certainly isn’t it. I just want to post this so med students don’t have a false perception of this field, it’s certainly not striking gold at this point in time.

I made 380k last year and see patients one day a week, maybe "comfortable" is a better term. But it sure is gold compared to the crappy employed jobs I see in the psychiatry market. Never ever going back to that again. I can make way more if I opt to do psychiatry 5 days a week, which I did once upon a time early in the career of the office. But I feel like taking a bit of a break from seeing that many patients. Had to fight people off my schedule, even people I discharged some how snuck on to the schedule. That's not bad imho. But yes, there's a lot of math, HR practice and other skill sets involved. To get the better insurance rates, it takes time to build up those rates, solid arguments on how you can save them costs, some threatening to drop them, and insurances will bend a little more with the right conditions for their network deficiency to grow and they feel the pinch as it ascends the chain of command.

 

[nexus73]

I made 380k last year and see patients one day a week, maybe "comfortable" is a better term. But it sure is gold compared to the crappy employed jobs I see in the psychiatry market. Never ever going back to that again. I can make way more if I opt to do psychiatry 5 days a week, which I did once upon a time early in the career of the office. But I feel like taking a bit of a break from seeing that many patients. Had to fight people off my schedule, even people I discharged some how snuck on to the schedule. That's not bad imho. But yes, there's a lot of math, HR practice and other skill sets involved. To get the better insurance rates, it takes time to build up those rates, solid arguments on how you can save them costs, some threatening to drop them, and insurances will bend a little more with the right conditions for their network deficiency to grow and they feel the pinch as it ascends the chain of command.

This is 380 as a practice owner with employed psychiatrists and midlevels and therapists?

 

[randomdoc1]

This is 380 as a practice owner with employed psychiatrists and midlevels and therapists?

Yes'um. I have psychologists and a psychiatrist. TMS helps a great deal. That's the 1 day a week of patient visits, follow ups on the TMS cases, working on their comorbid psych stuff.