Insurance won’t pay for anesthesia care if procedure goes beyond time limit

[Izzyman]

Wtf.


In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York, and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes

https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical

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[NicholasPavona]

Dead link.

 

[aneftp]

Found the link

Anthem Blue Cross Blue Shield Won’t Pay for the Complete Duration of Anesthesia for Patients’ Surgical Procedures

In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes...

www.asahq.org

 

[crna2006]

Well higher subsidies

 

[Dr. Rude]

Well higher subsidies

Which leverages the system's ability to force employment.

 

[crna2006]

Which leverages the system's ability to force employment.

You will be assimilated resistance is futile.

 

[aneftp]

Which leverages the system's ability to force employment.

That’s why everyone should grab as much as they can these days

Market conditions can change quickly

 

[caligas]

That’s why everyone should grab as much as they can these days

Market conditions can change quickly

This.

And at your next contract negotiation get a revenue guarantee from your hospital…it’s like a warm blanket for all this type of bull****.

 

[BlueRug]

"Check this box if you want to limit your duration of anesthesia to your insurer's limit. You will woken up regardless of what's going on surgically, but will incur no extra expense. Check this other box if you would like supplemental anesthesia coverage: billed at the prevailing market rate on a 15 minute interval. Alternatively, we do offer supplemental anesthesia insurance....."

 

[PainInTheAnes]

Just remember, this was guaranteed by the ACA. They want us employed and for billing to become irrelevant. If you voted for this, this is the outcome, and if you don’t embrace it and go hourly and disconnected from billing, you’re leaving money on the table.

 

[aneftp]

Just remember, this was guaranteed by the ACA. They want us employed and for billing to become irrelevant. If you voted for this, this is the outcome, and if you don’t embrace it and go hourly and disconnected from billing, you’re leaving money on the table.

The ACA weeded out weak hospitals. Encouraged mergers so hospitals could get more negotiating power vs insurer

And this is where I actually defend a usap practice strategy. What is usap doing any different than what a big hospital corp cough cough 501c entity that owns 40-50% of the market share of inpatient services in a local community. What’s the difference?

None

Both have negotiating power over insurers. But insurers would rather pick on little usap vs the big bad AHA

 

[crna2006]

Lets tell the truth. The ACA did not cover healthcare..it covered INSURANCE. As long as profit making entities stand between the patient and payment we are going to see a huge disconnect between desired outcomes (services, costs), for one side and and outcomes (reimbursement making a living) on the other. And the middlemen will pit the 2 against each other and take the money

 

[Howard888]

The ACA weeded out weak hospitals. Encouraged mergers so hospitals could get more negotiating power vs insurer

And this is where I actually defend a usap practice strategy. What is usap doing any different than what a big hospital corp cough cough 501c entity that owns 40-50% of the market share of inpatient services in a local community. What’s the difference?

None

Both have negotiating power over insurers. But insurers would rather pick on little usap vs the big bad AHA

Usap did have negotiating power…before no surprises act. No longer. They see it too. They’ve pivoted to a managed services type model for that exact reason. Napa too.

Even to fight the insurance companies in arbitration isn’t worth it cost wise….for PE at least

It’s game over now

 

[aneftp]

Usap did have negotiating power…before no surprises act. No longer. They see it too. They’ve pivoted to a managed services type model for that exact reason. Napa too.

Even to fight the insurance companies in arbitration isn’t worth it cost wise….for PE at least

It’s game over now

And the hospital facilities fees continue to go up

That’s why I tell especially the private practice guys to stop hanging on to the past with their private models. The end is near for most private groups. Yes it’s lost of autonomy. But your private anesthesia practice will sink in most major urban metro areas.

Alarm bells sound when previously profitable surgery centers can’t staff anesthesia anymore

I literally price gouged this private surgery center (with anesthesia contract run by big amc) to the tune of $800/hr yesterday and I didn’t even want the money. $9600 for 12 hrs. So they both got $4800 each for 6 hrs. I let these other two docs split. They are hungrier and need the money more. We all know each other in this circle. It’s a game now to me. Everyone needs to tag team to manipulate coverage and cover each other.

Just sit back and see things collapse. Because the amc isn’t paying. It’s the facility fees paying for anesthesia.
So grab the money like I said in the other post

Eventually these guys will figure it out. Hint the first step is to get rid of the 1099 crnas and pay the docs $300-350-hr directly daytime in metro areas. It’s less headache than dealing with a 1099 crnas who is more demanding. But docs have gotten lazy as well. I’m a straight shooter. Some docs refuse to sit their own rooms. It’s far easier to sit own cases than run around 1:4 daytime.

The other step is to do compressed schedules for docs. Who knows maybe hospitals corporate will read these forums and understand the anesthesia market. But ride it out the next couple of years

 

[pgg]

This.

And at your next contract negotiation get a revenue guarantee from your hospital…it’s like a warm blanket for all this type of bull****.

Our new hospital contract relinquishes all anesthesia billing to them, in exchange for a guaranteed payment to us, for which we will cover N lines each day. Annual % increases baked in. And yeah - now when I read the latest story about how billing is taking another hit, I can shake my head and not really worry about it.

(Except to the extent that, as time goes by and the reality of their collections doesn't live up to their naive expectations, I know they will be motivated to alter the deal, Darth Vader style.)

We remain a private group, managing ourselves, scheduling ourselves, dividing up the hospital payment as we see fit, based on how we value day shifts vs call vs weekend, allowing for much more vacation time than an employer would permit. It essentially removes all of the billing risk from our group and shifts it to the hospital system. It was an odd sort of compromise. They were unwilling to incrementally increase the stipend to our group, so they came up with this idea of ... massively increasing the stipend to our group but claiming the "win" of taking over billing.

Is the hospital system being dumb? Professional fee billing is in a continuous decline, and they're absorbing significant risk here. It seems fabulously unlikely that they're going to be better at collecting than our billing dept has been. Maybe they will? Maybe they have better contracts negotiated with insurance companies? It's possible it's a calculated loss on their part, part of a nefarious long term plan to control us, to get get one step closer to a true employed physician arrangement with the dissolution of our group.

The paranoid voice in my head assumes it's a nefarious plan, but given how I can't say "administration has a long term plan" with a straight face, and given how often we see administrators shoot their own feet, most of me thinks they're just reloading the gun and we should just keep on keepin' on, and cash the checks for as long as we can.

Maybe we'll be employees in 5 years. I hope not.

Which leverages the system's ability to force employment.

Yes, this is my fear, but so far, so good(ish): more money, more predictability, annual increases, long term contract (albeit with the 180-day no-fault out clause for both sides) ...

Ultimately we didn't have much choice. We aren't viable as a private group with just billing receipts. We need a hospital stipend to pay enough to recruit and retain people. That bargain is made and baked into today's reality. So I think we've done the right thing in maximizing the stipend and minimizing the billing risk.

 

[Status Sciaticus]

"Check this box if you want to limit your duration of anesthesia to your insurer's limit. You will woken up regardless of what's going on surgically, but will incur no extra expense. Check this other box if you would like supplemental anesthesia coverage: billed at the prevailing market rate on a 15 minute interval. Alternatively, we do offer supplemental anesthesia insurance....."

Lots more awake spinal surgeries coming your way.

Just remember, this was guaranteed by the ACA. They want us employed and for billing to become irrelevant. If you voted for this, this is the outcome, and if you don’t embrace it and go hourly and disconnected from billing, you’re leaving money on the table.

No it wasnt. Not everything is Democrats this, ACA that.
Its as simple as a greedy for-profit insurance company looking to increase margin for their shareholders. Its actually free-market capitalism that is allowing this to happen. You dont have a problem with capitalism, do you, comrade?

 

[jthedestroyr]

And the hospital facilities fees continue to go up

That’s why I tell especially the private practice guys to stop hanging on to the past with their private models. The end is near for most private groups. Yes it’s lost of autonomy. But your private anesthesia practice will sink in most major urban metro areas.

Alarm bells sound when previously profitable surgery centers can’t staff anesthesia anymore

I literally price gouged this private surgery center (with anesthesia contract run by big amc) to the tune of $800/hr yesterday and I didn’t even want the money. $9600 for 12 hrs. So they both got $4800 each for 6 hrs. I let these other two docs split. They are hungrier and need the money more. We all know each other in this circle. It’s a game now to me. Everyone needs to tag team to manipulate coverage and cover each other.

Just sit back and see things collapse. Because the amc isn’t paying. It’s the facility fees paying for anesthesia.
So grab the money like I said in the other post

Eventually these guys will figure it out. Hint the first step is to get rid of the 1099 crnas and pay the docs $300-350-hr directly daytime in metro areas. It’s less headache than dealing with a 1099 crnas who is more demanding. But docs have gotten lazy as well. I’m a straight shooter. Some docs refuse to sit their own rooms. It’s far easier to sit own cases than run around 1:4 daytime.

The other step is to do compressed schedules for docs. Who knows maybe hospitals corporate will read these forums and understand the anesthesia market. But ride it out the next couple of years

Bro where are you finding these gigs ? I thought I scored with 450/h sitting my own for a bigger hospital system.

1H drive from my house, but yesterday I legit gave breaks in the AM to CRNAs, than sat a few cases.

 

[pgg]

Bro where are you finding these gigs ? I thought I scored with 450/h sitting my own for a bigger hospital system.

You scored.

Don't let the internet skew your perspective. 450/hr solo work, without the hassle of locums & travel, is killing it.

I think I'll average around 350/hr for 2024 once the books are squared at the end of the year. I'm pretty happy with that, given the big picture here.

1H drive from my house, but yesterday I legit gave breaks in the AM to CRNAs, than sat a few cases.

We give lunch breaks. Hopefully less of them starting in January. So it goes.

 

[PainInTheAnes]

Lots more awake spinal surgeries coming your way.


No it wasnt. Not everything is Democrats this, ACA that.
Its as simple as a greedy for-profit insurance company looking to increase margin for their shareholders. Its actually free-market capitalism that is allowing this to happen. You dont have a problem with capitalism, do you, comrade?

Are you under the impression that facility fees increase with inflation and physician fees don’t due to an administrative oversight?

The ACA is meant to drive private practice doctors of all kinds out of business. That’s its purpose. Streamlines government payments to hospitals that divvy them up to docs as they see fit.

 

[aneftp]

Bro where are you finding these gigs ? I thought I scored with 450/h sitting my own for a bigger hospital system.

1H drive from my house, but yesterday I legit gave breaks in the AM to CRNAs, than sat a few cases.

Just get credentials at multiple places. The more places you get credentials. The bigger the opportunity. Someone is always out sick or has a family emergency. Something comes up always. Even docs leaving the practice without notice.

Honestly. I only average $375/hr most of the time. I just negotiate bigger guarantees especially on beeper calls.

I’ve also taken $300/hr simply because it’s down the street from me.

And the most important thing is work load to me.

$450/hr is an excellent rate. Keep doing it. You are doing it right.

I’ve just gotten lucky the last 18 months. It can end anytime and I’m prepared for it to end. That’s why I’m working on 2 more hospitals. I will be at 7 hospitals. Plus another one in Georgia soon as a backup (20k 1099 for 3-4 days of work). I didn’t want to pickup that job till they paid my malpractice.

Anywhere between 17-20k a week without calls is great. Just the calls run up the hourly billing quickly. There is so much competition for the calls.

 

[Status Sciaticus]

Are you under the impression that facility fees increase with inflation and physician fees don’t due to an administrative oversight?

The ACA is meant to drive private practice doctors of all kinds out of business. That’s its purpose. Streamlines government payments to hospitals that divvy them up to docs as they see fit.

I'm under the impression that facility fees keep going up and physician fees keep coming down due to budget neutrality among other things.

The ACA was designed to increase the number of people who could get medical coverage, protect patients, and to have increased accountability on employers.

 

[aneftp]

I'm under the impression that facility fees keep going up and physician fees keep coming down due to budget neutrality among other things.

The ACA was designed to increase the number of people who could get medical coverage, protect patients, and to have increased accountability on employers.

The 800 pound gorilla did to kill physicians once and for all was ban new physican own hospitals. They was written by the AHA into law to prevent completion. Eliminate the only ones (physicians) who could remotely compete with the AHA

Imagine a national legal law saying lawyers can’t build their own massive law firms. No way the lawyers would ever agree to this.

There were so few doctor owned hospitals to begin with. But to completely eliminate the expansion of doctor owned hospitals and write it into law was ingenious of the the AHA.

 

[PainInTheAnes]

I'm under the impression that facility fees keep going up and physician fees keep coming down due to budget neutrality among other things.

The ACA was designed to increase the number of people who could get medical coverage, protect patients, and to have increased accountability on employers.

Ah yes, budget neutrality. With the nice side effect of making it impossible for physicians to keep the lights on while hospitals can build multi billion dollar towers in downtown LA.

Every system is perfectly designed to get the outcomes it gets. In this case physician owned practices have collapsed in a way we have never seen, while hospital admins and buildings get billions shoved into their pockets.

 

[Volatile]

Maybe we'll be employees in 5 years. I hope not.

I think you know this, but you’re already an employee. And yes they absolutely will come back with a lower contract if they don’t think you’re worth it, lucky for you there’s ample opportunity out there and you can talk with your feet.

I do see most private practices going to a similar setup

 

[Dr. Rude]

The ACA was designed to increase the number of people who could get medical coverage, protect patients…

There were so few doctor owned hospitals to begin with. But to completely eliminate the expansion of doctor owned hospitals and write it into law was ingenious of the the AHA.

Both right. The ACA had multiple goals. The first one is laudable. Not so much the second IMO.

 

[pgg]

I think you know this, but you’re already an employee. And yes they absolutely will come back with a lower contract if they don’t think you’re worth it, lucky for you there’s ample opportunity out there and you can talk with your feet.

I do see most private practices going to a similar setup

No, we're not employees.

We still manage
- hiring and recruitment (and firing if it came to that)
- benefits, especially including choosing what benefits or options are offered
- far superior retirement planning (e.g. choice to max 401k via profit sharing; CBP; etc)
- decisions regarding division of group income amongst partners, e.g. how to value, allocate, and trade call
- vacation quantity and scheduling
- daily assignments
- call assignments
- not directly beholden to hospital admin or hospital HR or that foul ward RN with an axe to grind

Beyond that, there is the very important aspect of group culture. Employees don't really give a **** about each other - partners* have a vested interest in the success of other partners. It's the difference between working in the same building with some colleagues, and being part of an actual team. Yeah this is sort of touchy feely, but I've worked at a lot of places, from toxic to great.

We're a private group with a contract to a hospital system. Instead of collecting a stipend from the hospital plus billing 17 insurance companies and the government, we'll bill the hospital.

There's a world of difference between that and punching a clock for a hospital W2 paycheck. We're more akin to a gang of transactional mercenary locums dealing with a hospital client, than a bunch of loner employees with different pay scales and benefits and no idea who's making what, or who'll get hours cut or who's first to be laid off (not that anyone's getting laid off these days).

Yes, now that all money comes from the hospital there are implications concerning future contract negotiations. The leverage that they have vs what we have is different. But, possibly better for us. Honestly, we have more leverage against the hospital than we ever did against insurance companies or (ha!) the government.

In the meantime - more money for us, more predictability, no billing risk.

Of course, it could all blow up tomorrow. But that's true everywhere for everyone.


* At least, partners in a truly egalitarian group give a **** about each other; the existence of superpartner dinosaurs is toxic well beyond what a direct hospital employee would ever endure. Not ALL private groups are awesome, but mine is.

 

[Dr. Rude]

Historically, What you have was never common, but it was around. It is super rare today.

 

[pgg]

Historically, What you have was never common, but it was around. It is super rare today.

Yeah, I feel lucky to have the option to be part of a private group, and will ride it as long as I can.

 

[Dr. Rude]

And then it becomes poker. Everybody doing the math on everybody else. How unified is the group? Is the group’s non-compete with its employees enforceable? How much does the hospital value the group’s skill level, service level? How will that change if they become employees. How many $$ are there to be saved? At what risk? Administrators and docs sometimes play stupid hands that cost them big.

 

[Ashers]

We're going to have to follow what The Gomer Blog predicted in 2016.

Anesthesiologist, Tired of Inaccurate Surgical Time Estimates, Tells Surgeon How Much Anesthesia Time is Left | GomerBlog

Anesthesiologists are now informing Surgeons how much time they have left to operate before the patient will start waking up

gomerblog.com

 

[aneftp]

No, we're not employees.

We still manage
- hiring and recruitment (and firing if it came to that)
- benefits, especially including choosing what benefits or options are offered
- far superior retirement planning (e.g. choice to max 401k via profit sharing; CBP; etc)
- decisions regarding division of group income amongst partners, e.g. how to value, allocate, and trade call
- vacation quantity and scheduling
- daily assignments
- call assignments
- not directly beholden to hospital admin or hospital HR or that foul ward RN with an axe to grind

Beyond that, there is the very important aspect of group culture. Employees don't really give a **** about each other - partners* have a vested interest in the success of other partners. It's the difference between working in the same building with some colleagues, and being part of an actual team. Yeah this is sort of touchy feely, but I've worked at a lot of places, from toxic to great.

We're a private group with a contract to a hospital system. Instead of collecting a stipend from the hospital plus billing 17 insurance companies and the government, we'll bill the hospital.

There's a world of difference between that and punching a clock for a hospital W2 paycheck. We're more akin to a gang of transactional mercenary locums dealing with a hospital client, than a bunch of loner employees with different pay scales and benefits and no idea who's making what, or who'll get hours cut or who's first to be laid off (not that anyone's getting laid off these days).

Yes, now that all money comes from the hospital there are implications concerning future contract negotiations. The leverage that they have vs what we have is different. But, possibly better for us. Honestly, we have more leverage against the hospital than we ever did against insurance companies or (ha!) the government.

In the meantime - more money for us, more predictability, no billing risk.

Of course, it could all blow up tomorrow. But that's true everywhere for everyone.


* At least, partners in a truly egalitarian group give a **** about each other; the existence of superpartner dinosaurs is toxic well beyond what a direct hospital employee would ever endure. Not ALL private groups are awesome, but mine is.

My brothers “private” place out west. The group gave up its own billing 2 years ago and stipend.

Let the hospital handle all the billing. But with an even bigger twist. Because the hospital let each individuals choose what they want to do w2 per hour or do individuals do their own negotiations with units and what the they can bill individually and the hospitals pays it directly to each individual member.

My brother stil manages the schedule, the number of rooms to run per contract , vacation. It’s weirdest I’ve ever heard of his arrangement.

Hospital originally wanted to take everyone in w2 and most of the partners said no. Due to tax advantages as stated above. Traded etc.

 

[Status Sciaticus]

The 800 pound gorilla did to kill physicians once and for all was ban new physican own hospitals. They was written by the AHA into law to prevent completion. Eliminate the only ones (physicians) who could remotely compete with the AHA

Imagine a national legal law saying lawyers can’t build their own massive law firms. No way the lawyers would ever agree to this.

There were so few doctor owned hospitals to begin with. But to completely eliminate the expansion of doctor owned hospitals and write it into law was ingenious of the the AHA.

I agree that is one of the things that was pork barreled in, that I also did not like.
Hopefully the new bill that will overturn that should help.

Ah yes, budget neutrality. With the nice side effect of making it impossible for physicians to keep the lights on while hospitals can build multi billion dollar towers in downtown LA.

Every system is perfectly designed to get the outcomes it gets. In this case physician owned practices have collapsed in a way we have never seen, while hospital admins and buildings get billions shoved into their pockets.

Youre using faulty logic. The physician reimbursement cuts also applies to the physicians employed by the hospitals. The hospitals in downtown LA can afford it because of their larger, more affluent donor list and their endowments. When was the last time you ever heard of private practices and ASCs having donors LMAO?


I guess you could rally all the independent physicians to pool their money to get a billion dollar wealth fund to index and manage the same way the hospital systems do and reap the benefits.

 

[PainInTheAnes]

I agree that is one of the things that was pork barreled in, that I also did not like.
Hopefully the new bill that will overturn that should help.



Youre using faulty logic. The physician reimbursement cuts also applies to the physicians employed by the hospitals. The hospitals in downtown LA can afford it because of their larger, more affluent donor list and their endowments. When was the last time you ever heard of private practices and ASCs having donors LMAO?


I guess you could rally all the independent physicians to pool their money to get a billion dollar wealth fund to index and manage the same way the hospital systems do and reap the benefits.

You think that TAVR centers get built because of donors? They’re cash machines, why do you think they’re always the nicest most well groomed area of every hospital while every other ward and operating room rots out? Gotta impress the hospital CEO by showing him the prized calf that pays his bonus.

 

[Status Sciaticus]

You think that TAVR centers get built because of donors? They’re cash machines, why do you think they’re always the nicest most well groomed area of every hospital while every other ward and operating room rots out? Gotta impress the hospital CEO by showing him the prized calf that pays his bonus.

the margin on a TAVR is similar to that of a SCS implant. I've seen my hospital charge sheets, but that is only one example.
The margin pays for the multiple nurses, techs, anesthesiology, supplies, etc..
You can look at most hospital 991s and their balance sheets. Margins are about 2-5% for most hospitals.

 

[pgg]

You think that TAVR centers get built because of donors? They’re cash machines, why do you think they’re always the nicest most well groomed area of every hospital while every other ward and operating room rots out? Gotta impress the hospital CEO by showing him the prized calf that pays his bonus.

I don't believe our TAVR program is especially profitable.

The EP cardiologists, on the other hand, make it rain ...

 

[PainInTheAnes]

the margin on a TAVR is similar to that of a SCS implant. I've seen my hospital charge sheets, but that is only one example.
The margin pays for the multiple nurses, techs, anesthesiology, supplies, etc..
You can look at most hospital 991s and their balance sheets. Margins are about 2-5% for most hospitals.

They’re so money neutral that I can make 3.5k per 8 hour day doing them and the staff run around like their heads are cut off trying to fit in one more case, and the structuralist is the highest paid physician in the hospital, and literally every hospital is trying to start a program.

Maybe these hospitals are just trying to best serve their communities, we should give more credit to their admins I guess.

 

[BlueRug]

They’re so money neutral that I can make 3.5k per 8 hour day doing them and the staff run around like their heads are cut off trying to fit in one more case, and the structuralist is the highest paid physician in the hospital, and literally every hospital is trying to start a program.

Maybe these hospitals are just trying to best serve their communities, we should give more credit to their admins I guess.

3.5k per 8 hours? Where is this magical place?

 

[Status Sciaticus]

They’re so money neutral that I can make 3.5k per 8 hour day doing them and the staff run around like their heads are cut off trying to fit in one more case, and the structuralist is the highest paid physician in the hospital, and literally every hospital is trying to start a program.

Maybe these hospitals are just trying to best serve their communities, we should give more credit to their admins I guess.

Right, but the cardiology department doesnt file its taxes and profits separately, now does it? The hospital also takes into account the losses to balance its ledger. You think all those dialysis and surgeries to undocumented people, underinsured, uninsured, poorly insured, medicaid, etc... patients generate a profit?

I never said the hospital is trying to serve its community. Its trying to put more positive net income to balance out its losses.
How much is your structuralist guy making vs generating?
Now how much is your ID or Pathologist making vs generating?

One is also subsidizing the other.

 

[nimbus]

3.5k per 8 hours? Where is this magical place?

4-5 Tavrs is a 80-100unit day.

 

[PainInTheAnes]

Right, but the cardiology department doesnt file its taxes and profits separately, now does it? The hospital also takes into account the losses to balance its ledger. You think all those dialysis and surgeries to undocumented people, underinsured, uninsured, poorly insured, medicaid, etc... patients generate a profit?

I never said the hospital is trying to serve its community. Its trying to put more positive net income to balance out its losses.
How much is your structuralist guy making vs generating?
Now how much is your ID or Pathologist making vs generating?

One is also subsidizing the other.

The point I’m making is that hospitals clearly are profitable or get extremely large government subsidies to stay open. There is no such subsidy given to individual practitioners or practices. The ACA and Medicare made it that way intentionally, to drive us all out of private practice and onto a hospital ledger.

 

[Status Sciaticus]

The point I’m making is that hospitals clearly are profitable or get extremely large government subsidies to stay open. There is no such subsidy given to individual practitioners or practices. The ACA and Medicare made it that way intentionally, to drive us all out of private practice and onto a hospital ledger.

Right, but those subsidies are tied to various metrics. Are you seeing medicaid patients and doing medicaid work? No? Well the hospital has to see them and cant turn them away. they get paid to hedge the loss and to be available 24/7. If you have an emergency, do you open up your surgery center at 3AM to deal with an epidural hematoma? Or do you send to the big hospital that has the ER open and the surgeon on call?

I do see the point you are making in that larger corporations have an advantage over the small businesses. However, thats been true as long as the US has existed and isnt specific to medicine either.

 

[PainInTheAnes]

Right, but those subsidies are tied to various metrics. Are you seeing medicaid patients and doing medicaid work? No? Well the hospital has to see them and cant turn them away. they get paid to hedge the loss and to be available 24/7. If you have an emergency, do you open up your surgery center at 3AM to deal with an epidural hematoma? Or do you send to the big hospital that has the ER open and the surgeon on call?

I do see the point you are making in that larger corporations have an advantage over the small businesses. However, thats been true as long as the US has existed and isnt specific to medicine either.

What? Ask anyone who’s still doing their own billing whether they see Medicare/caid and whether those people make up a larger part of the patient population than before.

Seeing poor patients hurts physicians pocketbooks. Seeing poor patients makes hospitals rich beyond measure.

I’m not even going to bother linking the multi billion dollar builds that every broke academic center can somehow afford to build and then cry poor constantly. This speaks for itself. It used to be that private practice was the way to go as a doctor. Now it’s a joke in almost every specialty. The government wanted this.

 

[amyl]

you can look up your hospitals 990 form if they’re non for profit-
my old hospital cried poverty often…. With a reported profit over 600 million. That was a much higher margin than 2-5%.

 

[UscGhost]

What? Ask anyone who’s still doing their own billing whether they see Medicare/caid and whether those people make up a larger part of the patient population than before.

Seeing poor patients hurts physicians pocketbooks. Seeing poor patients makes hospitals rich beyond measure.

I’m not even going to bother linking the multi billion dollar builds that every broke academic center can somehow afford to build and then cry poor constantly. This speaks for itself. It used to be that private practice was the way to go as a doctor. Now it’s a joke in almost every specialty. The government wanted this.

Well it's an issue of negotiating leverage.

Hospitals have much more leverage than we do as physicians.

 

[nimbus]

What? Ask anyone who’s still doing their own billing whether they see Medicare/caid and whether those people make up a larger part of the patient population than before.

Seeing poor patients hurts physicians pocketbooks. Seeing poor patients makes hospitals rich beyond measure.

I’m not even going to bother linking the multi billion dollar builds that every broke academic center can somehow afford to build and then cry poor constantly. This speaks for itself. It used to be that private practice was the way to go as a doctor. Now it’s a joke in almost every specialty. The government wanted this.

I think most big name academic centers are not broke. They’re doing better than most of their competitors.

 

[pgg]

I think most big name academic centers are not broke. They’re doing better than most of their competitors.

It's easy to stay afloat and ahead when you've got $billion+ endowments. And they can still claim poverty by pointing to operating costs and revenue, conveniently ignoring the stacks of cash in the basement that are holding the building up.

 

[centdoc]

Our new hospital contract relinquishes all anesthesia billing to them, in exchange for a guaranteed payment to us, for which we will cover N lines each day. Annual % increases baked in. And yeah - now when I read the latest story about how billing is taking another hit, I can shake my head and not really worry about it.

(Except to the extent that, as time goes by and the reality of their collections doesn't live up to their naive expectations, I know they will be motivated to alter the deal, Darth Vader style.)

We remain a private group, managing ourselves, scheduling ourselves, dividing up the hospital payment as we see fit, based on how we value day shifts vs call vs weekend, allowing for much more vacation time than an employer would permit. It essentially removes all of the billing risk from our group and shifts it to the hospital system. It was an odd sort of compromise. They were unwilling to incrementally increase the stipend to our group, so they came up with this idea of ... massively increasing the stipend to our group but claiming the "win" of taking over billing.

Is the hospital system being dumb? Professional fee billing is in a continuous decline, and they're absorbing significant risk here. It seems fabulously unlikely that they're going to be better at collecting than our billing dept has been. Maybe they will? Maybe they have better contracts negotiated with insurance companies? It's possible it's a calculated loss on their part, part of a nefarious long term plan to control us, to get get one step closer to a true employed physician arrangement with the dissolution of our group.

The paranoid voice in my head assumes it's a nefarious plan, but given how I can't say "administration has a long term plan" with a straight face, and given how often we see administrators shoot their own feet, most of me thinks they're just reloading the gun and we should just keep on keepin' on, and cash the checks for as long as we can.

Maybe we'll be employees in 5 years. I hope not.



Yes, this is my fear, but so far, so good(ish): more money, more predictability, annual increases, long term contract (albeit with the 180-day no-fault out clause for both sides) ...

Ultimately we didn't have much choice. We aren't viable as a private group with just billing receipts. We need a hospital stipend to pay enough to recruit and retain people. That bargain is made and baked into today's reality. So I think we've done the right thing in maximizing the stipend and minimizing the billing risk.

This is great on the surface, but it seems like you are already “employees” in this scenario. The hospital owns you now. You are no longer an independent group. Regardless of contracted N lines per day, ability to split the money how you like, etc, the bottom line is that a surgeon will want to post a case at 430pm that you can’t staff (remember N lines), that surgeon will complain to hospital, and hospital behind your back will look for another group. He who has the gold has the control.

 

[aneftp]

PGG’s practice almost seems like a scopes North Carolina type of practice practice gig where legally they are private practice but with the financial backing of the hospital system

 

[caligas]

This is great on the surface, but it seems like you are already “employees” in this scenario. The hospital owns you now. You are no longer an independent group. Regardless of contracted N lines per day, ability to split the money how you like, etc, the bottom line is that a surgeon will want to post a case at 430pm that you can’t staff (remember N lines), that surgeon will complain to hospital, and hospital behind your back will look for another group. He who has the gold has the control.

not sure how that is really different than any other private group, refuse to staff the case and surgery will be pissed regardless of stipend. PGG has a contract so he is good for x years. And if his contract is really good they get extra money for staffing those late cases beyond a certain allocation of late rooms

 

[jthedestroyr]

PGG’s practice almost seems like a scopes North Carolina type of practice practice gig where legally they are private practice but with the financial backing of the hospital system

That’s how my new group is, will see how it turns out.

I will tell you, sitting your own cases may be boring, but its 10000x better knowing my decisions done by me, and not having to offend some nurses ego.