Medicare to stop audit on third and fourth level?

[drusso]

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The bloat is paid for by the SOS differential. Without the SOS differential there would be much less bloat.

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[Dr. Ice]

Ofcourse - only reason I care is that my pro fees are not high

I don’t mind facility being high (is what I’m getting at- other people are arguing facility should be lowered). I’m arguing facility remains as is or higher

Pro fees go much higher

The point is that your pro fees are never gonna go up as long as you provide servitude to the machine. The machine continues to get fed and fatter and you need to continue to provide a “leaner” service

 

[drusso]

Whoever doesn’t believe, want to believe, is in denial about believing or is actually part of the SOS machine…is actually the problem

Hospitals need to stop hiding behind emtala as reason to “squeeze everyone’s juice dry”

Im fairly certain Harris and her boy toy are just going to continue to drive docs into more “controllable” massive systems which are themselves out of control from a cost perspective.

It’s funny how she wants to talk about grocery stores price gauging but can’t comprehend how much hospitals price gauge bandaids…

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[SpineandWine]

The point is that your pro fees are never gonna go up as long as you provide servitude to the machine. The machine continues to get fed and fatter and you need to continue to provide a “leaner” service

They’re never going up, no matter what happens but I can see how getting rid of SOS altogether evens said paying field between hospitals and PP (or more like PE based) docs

 

[CleanUp]

The point is that your pro fees are never gonna go up as long as you provide servitude to the machine. The machine continues to get fed and fatter and you need to continue to provide a “leaner” service

Ice I think we haven’t seen eye to eye in the past but you’re spot on here.

 

[clubdeac]

The largest healthcare expenditures are administrative costs, primarily administrative salaries and payroll, not this SOS vig juicing BS.
Yep, I've had MRIs done. I specifically go to freestanding centers that charge minimal to my deductible. If I am maxed on my OOP, then IDGAF where I go as long as its most convenient and quickest.

If you have such an issue, juice the vig, send out that SOS, whatever you call it, and then drop the patient portion. Patients dont pay much, insurers pay like they are supposed to, and you get paid appropriately.

you're right, admin costs are a massive waste and bloated expenditure. But these things are connected. Can't have the one w/o the other

Bob summed it up

"The bloat is paid for by the SOS differential. Without the SOS differential there would be much less bloat"

 

[sloh]

But you’re back handed paid if wRVU (depending on negotiated price, you make out more than collections) or own shares in ASC

So its good for physicians as well

So it appears bloat is not bad
But what you’re getting at is feeling of unfairness in pro fee cut, which I agree is bad

It’s not good for most employed physicians bc they get paid pennies on the dollar from the facility fees. Their employers keep a way larger chunk of these facility fees. They are feeding most employed docs scraps. Want to keep pro fees flat or keep cutting them? Sure, then pay docs their fair share of the facility fees.

 

[Status Sciaticus]

The bloat is paid for by the SOS differential. Without the SOS differential there would be much less bloat.

I disagree. See below

That’s exactly why nothing will ever change and just continue to worsen. The facility will never take a pay cut..but we will continuously

Facility also has to pay for the infrastructure, equipment, salaries, rent, taxes, etc...
Easy way to fix the problem is be the owner if it bothers you that much.

You don’t find something wrong with your payment being mostly (and if it continues, solely) based on under what roof you place the needle and not that fact that YOU acquired the skill to place it?

Nope I dont. Its not simply the roof that its being done under. Its also the cost of roof and the higher operating cost.
Its also not MY skill that is getting paid, but the service being provided to the patient, the post procedure observation, and immediate access for post procedure complications. You are also providing customer service if patient is requesting sedation or MAC. Lastly, there are some procedures that cannot be done in the office such as mild or PNS.

Why should I waste my money buying a C-arm for my office and a second C-arm for my ASC? I'm going to centralize where I do all my procedures because it optimizes workflow.

you're right, admin costs are a massive waste and bloated expenditure. But these things are connected. Can't have the one w/o the other

Bob summed it up

"The bloat is paid for by the SOS differential. Without the SOS differential there would be much less bloat"

In my opinion, its the other way around.
The significant increase in administrative costs is due to increasing billing complexity and insurance interactions. More documentation is needed, more denials, appeals, preauthorization things to do. Hiring people to do that costs money. Without the SOS differential, the profit margin wouldve dwindled further.

 

[drusso]

I disagree. See below

Facility also has to pay for the infrastructure, equipment, salaries, rent, taxes, etc...
Easy way to fix the problem is be the owner if it bothers you that much.

Nope I dont. Its not simply the roof that its being done under. Its also the cost of roof and the higher operating cost.
Its also not MY skill that is getting paid, but the service being provided to the patient, the post procedure observation, and immediate access for post procedure complications. You are also providing customer service if patient is requesting sedation or MAC. Lastly, there are some procedures that cannot be done in the office such as mild or PNS.

Why should I waste my money buying a C-arm for my office and a second C-arm for my ASC? I'm going to centralize where I do all my procedures because it optimizes workflow.


In my opinion, its the other way around.
The significant increase in administrative costs is due to increasing billing complexity and insurance interactions. More documentation is needed, more denials, appeals, preauthorization things to do. Hiring people to do that costs money. Without the SOS differential, the profit margin wouldve dwindled further.

Most HOPD physician employers don't pay taxes because they're nominally "non-profit." Another example of Juicing the Vig...

 

[SpineandWine]

Most HOPD physician employers don't pay taxes because they're nominally "non-profit." Another example of Juicing the Vig...

Who is allowed to own hospitals?
How is it fair it’s a random group of people.

Should they make it that dentists can’t own dental practices….

 

[drusso]

Who is allowed to own hospitals?
How is it fair it’s a random group of people.

Should they make it that dentists can’t own dental practices….

It was built into the un-Affordable Care Act. Including the prohibition against physician owned hospitals which hopefully will be overturned by Congress soon.

Opinion: Striking A New Bargain for Oregon Hospital Community Benefit Programs | The Lund Report

www.thelundreport.org

Bill permitting new physician-owned hospitals gains steam

"New bipartisan bill introduced in House to expand healthcare options for patients and allow physicians to open hospitals in rural areas, supported by medical s

www.beckershospitalreview.com

 

[Status Sciaticus]

Most HOPD physician employers don't pay taxes because they're nominally "non-profit." Another example of Juicing the Vig...

Sigh... I cant believe people dont have a grasp on these things....
Do you think a state just voids all property taxes for all non-profits?
Lets do a simple calculation:
a typical 2 OR/1 procedure room ASC would be about 4-5M to build (1.4M/OR plus the actual building shell itself)
Lets take TX and OR property taxes
OR 1.02 * 4.5M = 45K
TX 1.81% * 4.5M = 81K

Of course this doesnt include the payroll taxes that needs to be paid for the staff.

So yeah, the ASC owners have to pay that out of their top line.

Who is allowed to own hospitals?
How is it fair it’s a random group of people.

Should they make it that dentists can’t own dental practices….

Dentists cant own hospitals either.
No one is stopping you from owning your own practice.
Also, hospitals are not highly profitable. Most of their money comes from HOPDs.

 

[SpineandWine]

Sigh... I cant believe people dont have a grasp on these things....
Do you think a state just voids all property taxes for all non-profits?
Lets do a simple calculation:
a typical 2 OR/1 procedure room ASC would be about 4-5M to build (1.4M/OR plus the actual building shell itself)
Lets take TX and OR property taxes
OR 1.02 * 4.5M = 45K
TX 1.81% * 4.5M = 81K

Of course this doesnt include the payroll taxes that needs to be paid for the staff.

So yeah, the ASC owners have to pay that out of their top line.

Dentists cant own hospitals either.
No one is stopping you from owning your own practice.
Also, hospitals are not highly profitable. Most of their money comes from HOPDs.

Who can own HOPD then? Makes no sense for it to be not physicians
ASC can be profitable if run well- lot are depending on specialty (ortho, pain, GI, IR, cardiology)

You don’t pay federal taxes in non profit

 

[Status Sciaticus]

Who can own HOPD then? Makes no sense for it to be not physicians
ASC can be profitable if run well- lot are depending on specialty (ortho, pain, GI, IR, cardiology)

You don’t pay federal taxes in non profit

Only hospitals can own HOPDs.
Single specialty ASCs, especially pain ASCs should be the most profitable due to the low cost of consumables and quick turnovers. I dont think there is a single other specialty that can do procedures as quickly as we can, though optho is a close second.

For the purposes of this discussion, nearly every physician's ASC is for-profit. Even with the new FTC ruling, non-profit status of many institutions will come under scrutiny, and rightfully so.

 

[Ducttape]

I’m confused, do you not think the SOS differential is a thing or not a significant cost to patients or the system as a whole?

Have you yourself ever had to get an MRI or colonoscopy and looked at the out of pocket difference bw HOPD and an outpatient stand alone facility? I’ve done both. Got royally screwed with the colonoscopy when I thought I was doing the right thing. Found out I could’ve had it done at a fraction of the cost at the facility down the street not associated with the hospital, same practice.

OOP difference for MRI was $150 instead of $1250. I fortunately chose correctly on that one despite two different people from the insurance company telling me otherwise on the phone. It’s truly a corrupt system and that corruption, I would argue, dwarfs the few bad apple physicians duct sanctimoniously bemoans

Most patients have no idea the 10x difference in cost for the same service/procedure. It’s a complete racket

you are conflating 2 separate issues.

SOS is clearly out there and affects healthcare, driving up costs to pay for the excessive administrative costs.

that is not what is directly causing us from having lower reimbursements or having limitations put on the procedures we hope are helpful. that is because CMS believes - and probably rightly so - that (more than a) "few bad apples" are vigging the system to increase reimbursements without medical justification.



you need to keep them separate otherwise your arguments fall apart.

 

[nvrsumr]

It is difficult to get a man to understand something, when his salary depends on his not understanding it.

 

[pmrmd]

I disagree. See below

Facility also has to pay for the infrastructure, equipment, salaries, rent, taxes, etc...
Easy way to fix the problem is be the owner if it bothers you that much.

Nope I dont. Its not simply the roof that its being done under. Its also the cost of roof and the higher operating cost.
Its also not MY skill that is getting paid, but the service being provided to the patient, the post procedure observation, and immediate access for post procedure complications. You are also providing customer service if patient is requesting sedation or MAC. Lastly, there are some procedures that cannot be done in the office such as mild or PNS.

Why should I waste my money buying a C-arm for my office and a second C-arm for my ASC? I'm going to centralize where I do all my procedures because it optimizes workflow.


In my opinion, its the other way around.
The significant increase in administrative costs is due to increasing billing complexity and insurance interactions. More documentation is needed, more denials, appeals, preauthorization things to do. Hiring people to do that costs money. Without the SOS differential, the profit margin wouldve dwindled further.

You want an in-office c-arm because you don’t want to stick your patients with a facility fee x 2 for MBBs that don’t require that level of service. Same for an ESI. Your office is at least twice as efficient at minimum than an ASC.

Otherwise spot on.

 

[drusso]

you are conflating 2 separate issues.

SOS is clearly out there and affects healthcare, driving up costs to pay for the excessive administrative costs.

that is not what is directly causing us from having lower reimbursements or having limitations put on the procedures we hope are helpful. that is because CMS believes - and probably rightly so - that (more than a) "few bad apples" are vigging the system to increase reimbursements without medical justification.



you need to keep them separate otherwise your arguments fall apart.

I remember when you were a SOS denier. Many others were too.

 

[Status Sciaticus]

You want an in-office c-arm because you don’t want to stick your patients with a facility fee x 2 for MBBs that don’t require that level of service. Same for an ESI. Your office is at least twice as efficient at minimum than an ASC.

Otherwise spot on.

You should be able to check your patients eligibility and when they hit the OOP maximum. Can do office based before then, and ASC after.

 

[pmrmd]

Yes you could. I’ve just never made decisions based on my payment.