In Maryland - fee schedules for all private carriers are the same as Medicare.

[wscott]

Hello,

I just got back from an interview in Maryland.

I was told that reimbursement for all private carriers is equal to that of Medicare and that this was the only state in the union as such.

Does anyone have any experience with pain practice in Maryland or know more about this payment issue? Can you confirm this fact?

If you really liked the position and the location in Maryland, but were flexible with your options of geographic location and had equal opportunities in other states, how would this influence your decision?

The position is basically a start-up position with a hospital affiliation. How would this fact influence your desired contract structure and affiliation with the hospital? Would you ask for anything different?

What is a good source to discover the pluses/minuses of practicing medicine in different states?

Thanks for your feedback,

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[Aether2000]

If the private carriers all have site of service fee differential payments as does medicare, if you did your procedures in a hospital or ASC, then you would get slaughtered. That would be my first question....do all the carriers follow medicare's site of service differential. If so, then you must either perform your procedures in an office or skip Maryland altogether.

 

[Mister Mxyzptlk]

I don't know about the fee schedules in MD, but I do know that a doctor can add a small ASC to his or her office without a certificate of need from the state. I think you can have two O.R.'s, or maybe an O.R. and a procedure room.

I will check with a friend in MD regarding the uniform rates. If that's the case I'd open the Maryland Center for Spinal Stenosis and just see Medicare. Who needs the overhead of precert and educating peer reviewers on the phone during clinic hours when you can just do straight Medicare without the hassles?

wscott, can you PM me please so we chat off the list? Click on the name to the left and select "send a private message". You don't have your PM turned on.

 

[wscott]

Algos:
Could you please explain the term "site of service differential" as it applies to my question? Thanks for your input

Gorback:
Drop me an email [email protected].

Does anyone have a good source to compare pros/cons of working in different states? Which states are the most attractive/unattractive and why? How does Maryland compare to Suffolk county New York?

Thanks

 

[Aether2000]

Effectively, it means for Medicare and Anthem, the professional fee collected is 2.5-3 times as great when the procedure is performed in an office rather than an ASC.

 

[Mister Mxyzptlk]

I don't know of any general differences between MD and NY in terms of practice of medicine. How referrals are done, the best place to do procedures, etc, are very sensitive to local factors. Every locale has its own medical microclimate that is largely driven by economics. For example, if there is a busy ortho group that owns a surgery center they will want their referrals taken there for procedures. You'll lose the fee differential in the office in exchange for volume. Those sorts of things are hard to predict before you move there unless you're joining a group that can fill you in. Even then, you'll still get surprised because everyone's perceptions vary.

When people are recruiting they tend to hide the crazy uncle in the attic. They don't want you to meet disgruntled docs or employees who will tell you the dirt. You won't meet the accountant who was fired because he refused to cook the books. Watch out for who you are being steered away from during your visit. Ask everyone you talk to "Who is it important that I meet while I'm here?". If they mention people that you haven't been told about that's something to check out. Many years ago when I was interviewing for a chairman job several people named the chief of OB, but he wasn't on my list of interviews. That seemed strange - OB is an important facet of an anesthesia practice. Well guess what? It turned out that (how shall I say this in a public forum?) if I wanted to give the medical staff an enema, the nozzle would have gone into this guy.

Also try to find out as much as you can about the last guy. What is his name? Why did he leave? Where did he go? Call him up. Or her.

The only comparison data you will find are the web sites that compare cost and quality of living. There should be info regarding unemployment rate, age distribution, average salary, maybe even what % have health insurance. That might give a comparative idea of what to expect for a payer mix.

It will also tell you how far those collection dollars will go. For instance, if you make $300K in Houston you'd have to make $500K in Washington, DC.

Both MD and NY will eat you alive with taxes. NH, FL, and TX have no state income tax. There may be others but those are the ones I know of.

 

[Mister Mxyzptlk]

Here's what I got back from someone in Maryland. Sounds grim.

"Actually, the insurance companies are trying to pay less than medicare rates. One of the major reasons is that Maryland is an all payor state and the insurance companies will pay the same amount for a facility fee, regardless of the type of insurance (commercial, HMO, MA and Medicare). The professional fees are where the insurance companies try to make up for the amount they are paying the facilities by low balling the MD's. I just received a contract offer from an insurance company that wants me to agree to 95% of medicare for our new pain mgmt llc.

In this state, it is very important to create your own facility (surgery center) or procedure room in your office to get that reimbursement. Surgery Centers are left to dealing with the facility groupers for reimbursement. Additionally, this is a medicare limitation (most insurances follow) for the procedures that can be performed in a Surgery Center. The good news, is that the limitation on the procedures that can be performed in a surgery center will be lifted in 2008 or 2009."

 

[FullTimePain]

Interesting discussion! I did a gaswork search and came up with 8 listings for pain management in Maryland, all starting around 200k with a maximum income of 400+ k , I even recall a posting 2 months back that listed a maximum income of 600k. Salaries don't seem thatbad in Maryland, not sure how the difference is made up - I guess volume? Or does every pain group
have a single suite surgery center and collect facility fees (unlikely?)

-FTP

 

[Mister Mxyzptlk]

Salary estimates in job listings are like the kids in Lake Wobegon - they are all above average.

 

[FullTimePain]

So do you think those maximum salaries are not realistic? I too have
interviewed in Maryland with a practice and they were quoting salaries
in the 400-500 range with partnership - is this realistic or just smoke and
mirrors?

Thanks!
FTP.

 

[Mister Mxyzptlk]

Could be. I know of one practice in MD that nets about $1M if you count the ASC (which contributes half). From what I posted earlier it sounds like if you don't go the ASC route you are going to get hammered.

Maryland is an expensive place to live so fees may be proportionately higher. $500K in the MD-DC-VA area is like $325K in Indianapolis.