Leverage over psychiatry (government, employment model, medicare, etc)

[Frazier]

Hi guys,

First I am typing this from my phone, so please excuse any typos, etc.

This recent development of Medicare reimbursements released to the public (and the suspicions that it is more strategy on the government's part than mere "transparency") had me thinking about leverage that outside entities yield over psychiatry compared to other specialties.

For example, I know the overall trend and projection for medicine as a whole (at least according to SDN) is elimination of PP with transition to a hospital-based employment model.

I can see with new regulations and comparatively outrageous startup costs/overhead it might be tempting for surgical specialties to sell the boat and float into the hospital's port for all their procedures...

I have a somewhat harder time fitting psychiatrists into the grand plan of things. It seems that it is rather straightforward to set up shop with (comparatively) low initial startup costs/risk. It seems that psych is well positioned to (comparatively) overcome medicare reimbursement manipulation by simply going cash (say in opposition to ortho).

With all the private practice psychiatrists in my region, I also find it hard to picture a scenario where the local hospital systems would be eager to buyout and absorb all these practices. Both due to psych's (comparatively) lower profit margin, etc.

Plus the issue of other providers that bill insurance for therapy/etc... np's... therapists... lcsw's... psychologists.... do all these people get regulated and absorbed too? It is hard to imagine.

Overall I am trying to get your opinion on how the future could play out. Obviously no one knows for certain, but conjecture from those with experience in the field is better than conjecture of med students.

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[vistaril]

I think you are overthinking this- leverage, if there isn't a lot of money in the pot, is overrated. A cardiologist who generates 10x but id pushed into a hospital system vs a psychiatrist who generates x but is in true pp......the cardiologist is still going to make close to 10 times more, so who cares?

 

[Frazier]

I think you are overthinking this- leverage, if there isn't a lot of money in the pot, is overrated. A cardiologist who generates 10x but id pushed into a hospital system vs a psychiatrist who generates x but is in true pp......the cardiologist is still going to make close to 10 times more, so who cares?

Yeah, I get that cards will be paid higher than psych regardless of employment model or whatever variable we adjust in this vacuum. As you often allude to they are somewhat like apples and oranges in regards to practice set ups and revenue potential.

So that's not my question.

Question is how those trends apply specifically to psych.

 

[Leo Aquarius]

A psychiatrist is more than someone's doctor, he or she is someone's confidant whom the patient grows close ties to. The preference for those with the cash will always be "my own private psychiatrist" vs whomever I get at the local hospital / kaiser / community clinic. So if you ask me I see the future of PP staying solid in our fascinating and ever-growing needed field.

 

[nancysinatra]

There was an article in the New York Times or some other major paper recently about how a higher percentage of psychiatrists than other specialists take no insurance. I would guess this will continue.

 

[nancysinatra]

A psychiatrist is more than someone's doctor, he or she is someone's confidant whom the patient grows close ties to. The preference for those with the cash will always be "my own private psychiatrist" vs whomever I get at the local hospital / kaiser / community clinic. So if you ask me I see the future of PP staying solid in our fascinating and ever-growing needed field.

The heading at the top of the SDN home page right now says that fully 1/4 of med students are suffering from depression! If that continues, there will be a very reliable supply of high functioning patients willing and able to pay cash in the future! Knowing what I know about medical school and residency, I don't expect this trend to reverse itself. I actually think I might just open up a part time private practice in a discreet location away from a hospital right now catering specifically to depressed future physicians.

 

[Leo Aquarius]

When I interviewed at Stanford, UCLA-Harbor, UCLA-NPI, and UCSD the program directors said every year a third or so graduates go forth and start their own private practices (solo practices). They've been doing this for years.

 

[Frazier]

There was an article in the New York Times or some other major paper recently about how a higher percentage of psychiatrists than other specialists take no insurance. I would guess this will continue.

Thanks for the input -- you make a good point!

Do you have any thoughts about the future push towards hospital employment?

 

[vistaril]

There was an article in the New York Times or some other major paper recently about how a higher percentage of psychiatrists than other specialists take no insurance. I would guess this will continue.

which will continue to bring salaries down imo. Volume, with anything in billing, is where the money is.

Yeah, I get that cards will be paid higher than psych regardless of employment model or whatever variable we adjust in this vacuum. As you often allude to they are somewhat like apples and oranges in regards to practice set ups and revenue potential.

So that's not my question.

Question is how those trends apply specifically to psych.

for people who want to do cash pay (which in many aeas for some practitioners involves a pay cut), the pp option will always be available....

for people who want to see insured outpts, this is up in the air......hospital systems and insurers certainly hav the power if they want to bring us all in a employer model...simply by those two entities to require certain things(insurers requiring hospital priv and the hospital only granting such priv in loose employment model)....but again, the pie is so small in psych that it may not be a huge priority

 

[Frazier]

which will continue to bring salaries down imo. Volume, with anything in billing, is where the money is.
for people who want to do cash pay (which in many aeas for some practitioners involves a pay cut), the pp option will always be available....

for people who want to see insured outpts, this is up in the air......hospital systems and insurers certainly hav the power if they want to bring us all in a employer model...simply by those two entities to require certain things(insurers requiring hospital priv and the hospital only granting such priv in loose employment model)....but again, the pie is so small in psych that it may not be a huge priority

This makes sense.

Do you imagine that the (hypothetical) push would be directed only at physician mental health care providers...or would those other professions (as mentioned in the OP) would be pressured as well?

 

[nancysinatra]

Volume only generates high income if the pay is fair. Insurance companies are well known to lowball the pay. Obviously you can't have a thriving cash only practice just anywhere. But people in some parts of the country will pay hundreds of dollars an hour to see a private psychiatrist. If you set your rate high enough you won't need to crank through as much volume.

 

[vistaril]

This makes sense.

Do you imagine that the (hypothetical) push would be directed only at physician mental health care providers...or would those other professions (as mentioned in the OP) would be pressured as well?

probably not as affected

 

[Jester25]

Child psych + west coast/ east coast + suburbia. Charge $200/hr cash. You'll be fine. Low overhead, you should be able to take a decent amount home.

I know people have mentioned $300-500/hr on this forum. I have no idea about that.

 

[Shikima]

Child psych + west coast/ east coast + suburbia. Charge $200/hr cash. You'll be fine. Low overhead, you should be able to take a decent amount home.

I know people have mentioned $300-500/hr on this forum. I have no idea about that.

May want to look at some of the threads being written by forum members who are doing cash PP.

 

[vanfanal]

May want to look at some of the threads being written by forum members who are doing cash PP.

Are you implying that these are overestimates? Having searched the psych forum, the numbers are all over the place.

 

[Shikima]

Are you implying that these are overestimates? Having searched the psych forum, the numbers are all over the place.

No, you may want to read the real success stories and the tribulations associated with PP. And the amount you charge per hour is dependent upon what the locality can bear.