TeslaCoil

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Just wanted to learn more about how anesthesia is billed within the various practice settings and where there is more or less potential for making money.
 
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TeslaCoil

TeslaCoil

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Can't make money in Anesthesia anymore. Consider derm.
Right, I get it. No money here, blah blah blah. Can somebody try to take an honest stab at the question?
 
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dr doze

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Getting harder. Geographic flexibility still very important...be willing live in a less than desirable location and be willing to relocate to an even less desirable location if things go south.
 

GassmanMD

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Getting harder. Geographic flexibility still very important...be willing live in a less than desirable location and be willing to relocate to an even less desirable location if things go south.

Since pay is based on billing units, does moving to less desirable areas just give you a better opportunity to not get screwed over by the man? Because the way I see it, less desirable areas equals poorer populations, meaning poorer payer population, thus lower revenues. Is it just that all the best areas are being taken over by the AMCs?
 

dr doze

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BFE hospitals have to pay a subsidy to attract quality people. If purely private, you can stick it to the insurers if you are the only game in town.
 

ZzzPlz

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Own your own practice. Find a way to make sure crnas sit around doing nothing as little as possible.

We supervise/direct crnas and make some money doing it, but the good money comes from what we do with our own hands--nerve blocks, chronic pain injections, labor epidurals.

Work in a surgery center and be an owner

Get a stipend from the hospital.
 

anbuitachi

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Own your own practice. Find a way to make sure crnas sit around doing nothing as little as possible.

We supervise/direct crnas and make some money doing it, but the good money comes from what we do with our own hands--nerve blocks, chronic pain injections, labor epidurals.

Work in a surgery center and be an owner

Get a stipend from the hospital.
Now what if we put in epidurals for post op pain control, or nerve blocks for post op pain? Do those get billed well? Ie tap block for lap chole. it may reduce the # of percocets patient takes on pod0/1
 

Man o War

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Drive a van around Las Vegas hooking people up to IVs, curing their hangovers so they can do it all again the next day.
Dude is brilliant- I would've laughed my butt off if he had told me this idea before he did it.
Joke is on me as I rot in cardiac cases while he's living the dream.....
 

bigeyedfish

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Money in anesthesia formula:
Have no layers between you and the billing + Fast surgeons + Very little cms or self pay = a lot of income no matter if you're supervising or sitting.

Unfortunately this is easier said than done.
 
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Consigliere

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Now what if we put in epidurals for post op pain control, or nerve blocks for post op pain? Do those get billed well? Ie tap block for lap chole. it may reduce the # of percocets patient takes on pod0/1
You can but you really don't make that much on those unless you have a well insured pt. population. Think about who most of us are doing nerve blocks and epidurals for: elderly, low reimbursing Medicare pts.
 

leaverus

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Just wanted to learn more about how anesthesia is billed within the various practice settings and where there is more or less potential for making money.
let's be more specific with your question too. what do you mean by making money? if you mean enough to let you buy some toys, then I don't think making mid 6-figure (half mil give or take) range should be that difficult most parts of the country; but you will need to put in the work. if you mean retire by age 40, then I concur with the robbing banks idea.
 
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TeslaCoil

TeslaCoil

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Great info! But when people say own your own practice, what does that mean? What kind of practice specifically?
 

Arch Guillotti

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Great info! But when people say own your own practice, what does that mean? What kind of practice specifically?
Think of it this way about a small group of anesthesiologists:

Assume 10 members of the group have been there a long time and they are all partners and all work equally. All 10 partners own 10% each of a corporation that they formed which is contracted with a hospital. Patients or their insurance company receive a bill from the corporation and the corporation is paid after a while. Money flows into the corporation from billing. Money flows out of the corporation for bills (insurance, billing expenses, salaries, rent, paper clips, whatever). Leftover money is divided amongst the partners. If you work hard and are efficient and have a decent payer mix then you do pretty good. If you have a lot of expenses, crappy payer mix, low volume, etc - then you don't do so good and may "require" a stipend to stay afloat. This is a simplified explanation and there are many variations. The key is being an owner and not an employee. Owners share in the profits (and losses) while employees typically get a salary, no matter how the business does.
 
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GassmanMD

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Think of it this way about a small group of anesthesiologists:

Assume 10 members of the group have been there a long time and they are all partners and all work equally. All 10 partners own 10% each of a corporation that they formed which is contracted with a hospital. Patients or their insurance company receive a bill from the corporation and the corporation is paid after a while. Money flows into the corporation from billing. Money flows out of the corporation for bills (insurance, billing expenses, salaries, rent, paper clips, whatever). Leftover money is divided amongst the partners. If you work hard and are efficient and have a decent payer mix then you do pretty good. If you have a lot of expenses, crappy payer mix, low volume, etc - then you don't do so good and may "require" a stipend to stay afloat. This is a simplified explanation and there are many variations. The key is being an owner and not an employee. Owners share in the profits (and losses) while employees typically get a salary, no matter how the business does.

Is having a stipend not a good thing for a group? Is this the same as a call stipend?
 

ZzzPlz

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I don't see the stipend as a bad thing per se. We provide crna coverage 24/7 and they're our employees. We pay them, not the hospital.

It's only fair for the hospital to give a stipend for this coverage. We certainly aren't making money off them during the nights and weekends when they're not doing cases.

I just wish they'd pay us like they pay the orthos for taking a night of call...
 
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GassmanMD

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I don't see the stipend as a bad thing per se. We provide crna coverage 24/7 and they're our employees. We pay them, not the hospital.

It's only fair for the hospital to give a stipend for this coverage. We certainly aren't making money off them during the nights and weekends when they're not doing cases.

I just wish they'd pay us like they pay the orthos for taking a night of call...
Yeah I figured the call stipends were for the hospitals to pay the physician for their non billable time being on call. That non billable time is valuable and should be compensated. Why are groups with stipends looked down upon? Even AMCs I have spoken to offer call stipends.
 

ZzzPlz

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The reason that stipends can often be undesirable is they can be too high. If the suits think a private group is asking for too much, they might start looking into replacing the group
 

ZzzPlz

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Yeah I figured the call stipends were for the hospitals to pay the physician for their non billable time being on call. That non billable time is valuable and should be compensated. Why are groups with stipends looked down upon? Even AMCs I have spoken to offer call stipends.
i think we're referring to two different things. The stipend I'm referring to is a set amount of money the hospital pays to the contracted anesthesia group. They pay X amount of money per month for example. This amount is usually negotiated yearly
 

GA8314

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Getting harder. Geographic flexibility still very important...be willing live in a less than desirable location and be willing to relocate to an even less desirable location if things go south.
The bolded is very true. Things are much harder in the major metro areas. Generally more competitive, more fellowship driven (not a bad thing), and perhaps less partnerships available.

If you want ownership, then have a strong conversation with your family. Sometimes you don't need to be too far off the beaten path. Just a bit. But, benefit differences alone (barring W2 differences) can be very large over 10 years time. Articulate that to your wife who may feel absolutely that she needs to be 15 minutes from her sister (not minimizing the importance of family). Most grads are financially undereducated on this and other issues. SDN is a great resource for knowledge in this area.
 

GA8314

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Now what if we put in epidurals for post op pain control, or nerve blocks for post op pain? Do those get billed well? Ie tap block for lap chole. it may reduce the # of percocets patient takes on pod0/1
Post op nerve blocks, including catheters, aren't paid all that well with our major payers. But, they aren't that time consuming, and the hospital can make legit $ on billing for US use. I view our blocks as mitigating the money we pay (we employ the NAs) our CRNA's in between ortho flip rooms for some of the less fast orthopods...... But, they do add up beyond that.
 

GA8314

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I don't see the stipend as a bad thing per se. We provide crna coverage 24/7 and they're our employees. We pay them, not the hospital.

It's only fair for the hospital to give a stipend for this coverage. We certainly aren't making money off them during the nights and weekends when they're not doing cases.

I just wish they'd pay us like they pay the orthos for taking a night of call...
Same.
 
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