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Money issues: hospital versus office procedure fees

Discussion in 'Pain Medicine' started by Ligament, Mar 28, 2007.

  1. Ligament

    Ligament Interventional Pain Management Physician Lifetime Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Hi All,

    I understand how it is financially sound to do pain procedures in an office setting. But for those of you who do pain procedures in a hospital setting, how do you make your money? With professional fees in the hospital setting roughly 1/3 less, it seems very difficult to achieve financial parity with the pain docs that own a C-arm in the office. Perhaps one upside do doing procedures in hospital is less overhead costs...?

    I'd really like to hear the pros/cons of both.

    Thanks!
     
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  3. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    In the majority of situations the only way to make better money doing procedures at a facility is if you own shares in the facility or get some other form of compensation (e.g., medical director or board of directors stipend).

    The best mix is to have an office procedure room and facility shares. You take your cases where the carrier gives you the incentive. The non-differential payers are telling you they want you to use facilities. Oblige them but use the facility you own.
     
  4. mille125

    mille125 7+ Year Member

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    i agree with gorback. i would like to add the following:

    In the short-term doing procedures in a surgery center may make sense for the following reasons:

    1) Not needing to buy expensive radiology equipment (ie a c-arm). Costs can exceed 100K for some models.

    2) Not needing to pay salaries for highly trained personnel. Of course salary varies from region to region. In my region an xray tech commands 16-22 dollars per hour plus benefits. An RN (who you would need if you are doing procedures in your office) commands 46-54K per year plus benefits. You would also need other office staff who would be 11-15/hr each. Compare this to an facility based practice. You could likely get away with a medical assistant and a receptionist for 12/hr each. This is a big difference.

    3) Not being able to buy into a surgery center or be recruited by a hospital. Many times you can negotiate very good terms with a hospital if you are willing to do procedures in their facilities. You are also be more likely to get referrals from other doctors (ie orthopedics, neurosurgery, etc) who are invested in your center.


    As you can see most of these points are more beneficial to someone starting their own practice or some who is cash poor. Most practices can break even fairly quickly. I hope that this helps.
     
  5. algosdoc

    algosdoc algosdoc 10+ Year Member

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    Indeed it is important to strike a balance. It depends on whether you insist on outfitting your office with the latest greatest everything for procedures or can get by with less. Our first C-arm for the office (9400) cost around $27,000. We bought no service contract, have had no maintenance, and the machine is continuing to work today, 4 years later. We do not use rad techs but do have a nurse administrator in the office that puts on her sedation/monitoring/recovery hat for procedures. We have 2 MAs that double as assistants to take patient input data and to assist during procedures.
    So far, it makes sense to continue in an office setting.....for now....
     
  6. Doctodd

    Doctodd 10+ Year Member

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    I dont think you need an RN to do office based procedures...might depend on your state. An MA makes the most sense.

    T
     
  7. mille125

    mille125 7+ Year Member

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    wow, you must really trust your MA's...if something goes wrong, I dont feel that they are prepared to deal with it in general, but that is just me...I am interested in hearing other opinions....MA's have very little training when compared to an RN....
     
  8. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    Having done it both ways I would say that RNs are worth the extra money. The discipline and training make a world of difference. There's no comparison.
     
  9. Doctodd

    Doctodd 10+ Year Member

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    sorry.....maybe i wasnt clear in my reply....i dont need an RN for anything really. I have MA's do MA work....im obviously not saying an MA should do procedures or recovery from sedation cuz i dont do sedation in my current office.

    T
     
  10. PainDr

    PainDr 7+ Year Member

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    You could also consider working for the hospital. This type of arrangement requires a very committed and fair hospital administration but with the right group of people it can be a win/win situation. I'm a hospital employee and do all my procedures in our endo suite. My clinic is off site, about three blocks away. The hospital is in a small community and the administration was very committed to having a comprehensive pain program. They aggressively marketed the practice and even hired billing/coding consultants. They're a real class act. Gave me everything I asked for...generous salary with full benefits, great equipment, got to hand pick my staff, etc. They even gave me a fat budget for clinic and office furnishings. Most importantly, they've kept every promise they made and are very hands off, ie., it's my practice and I run it the way I want. So far everyone is quite happy. We just crossed the 6 month point and are now in the black. Plus they really like the increased revenue from radiology, PT, lab, etc.:D
     
  11. knoxdoc

    knoxdoc New Member 10+ Year Member

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    Does anyone have any recommendations for where to shop for a c-arm? Algos- you got a great deal on that 9400 - where did you buy it? I've seen it selling for twice that much.
     
  12. mille125

    mille125 7+ Year Member

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    the key is a good administration..it sounds like you have a good relationship so far...i would be interested in what you say about it at the 2-3yr mark...this is where a lot of these relationship unravel.
     
  13. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    Exactly. Update us after the honeymoon.
     
  14. algosdoc

    algosdoc algosdoc 10+ Year Member

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    http://algosresearch.org/PracticeTools/ManufacturerWebsites/C_arm.html and scroll down to refurb, reconditioned C-arms. Other locations include ebay, dotmed.com, and labx.com
    At this point there are no new 9800 or 9900 C-arms due to OEC/GE being completely shut down for an indefinite period. Philips and Ziehm are offering some specials as market share rapidly shifts to these manufacturers.
     
  15. PainDr

    PainDr 7+ Year Member

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    Of course we're still in the honeymoon period, but hopefully things will continue to go well. I just wanted to point out that there are other options. I wasn't in any position to start my own practice right out of fellowship and my only other local option was an "eat what you kill" opportunity with a group of orthopods. Like everyone else, I was tired of being poor and wanted to be near family and friends. This hospital offered me a chance to be on my own, but with alot of support and a built in referral base. I was very grateful for the opportunity.
     
  16. knoxdoc

    knoxdoc New Member 10+ Year Member

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    Thanks for the info, algos. What is the situation with OEC/GE? I hadn't heard all that.
     
  17. algosdoc

    algosdoc algosdoc 10+ Year Member

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    To let you know the severity of the situation, it was relayed to me that a pain course not long ago had to be supplied solely with non-OEC machines due to fears of running afoul of regulatory authorities. I personally believe it is non-sensical to force OEC to not use their machines on cadavers. Clearly this whole ordeal represents a major blow to the OEC US market. It is my hope they will be permitted to return soon in some fashion since competition drives innovation and will perhaps keep prices within reason. Most of us that have been involved in interventional pain medicine throughout the years will have used an OEC machine at one time or another and most find them to be reliable with excellent images. On the other hand, when considering a used or refurb model (available from third party vendors), I would caution against purchasing anything made before the OEC 9600 due to the higher radiation output from single phase generators.
     
  18. Disciple

    Disciple Senior Member 10+ Year Member

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    FDA News
    FOR IMMEDIATE RELEASE
    P07-06
    January 12, 2007
    Media Inquiries:
    Karen Riley, 301-827-6242
    Consumer Inquiries:
    888-INFO-FDA



    GE OEC Medical Systems Signs Consent Decree with FDA;
    Agrees to Correct Manufacturing Deficiencies

    The U.S. Food and Drug Administration (FDA) today announced that GE OEC Medical Systems, Inc., its parent company, the General Electric Company doing business as GE Healthcare, and two of their top executives have signed a consent decree of permanent injunction related to X-ray surgical imaging systems manufactured by GE OEC Medical Systems. The consent decree prohibits the manufacturing and distribution of specified GE OEC Medical Systems X-ray surgical imaging systems at facilities in Salt Lake City, Utah, and Lawrence, Massachusetts, until the devices and facilities have been shown to be in compliance with FDA's current good manufacturing practice (CGMP) requirements as set forth in the Quality System (QS) regulation for devices.

    The decree was filed today in the U.S. District Court for the District of Utah and is subject to court approval.

    The X-ray surgical imaging systems subject to the decree are manufactured and designed at GE OEC Medical Systems' facilities in Salt Lake City, Utah, and Lawrence, Massachusetts, and include the 9900 Elite C-Arm System, 9900 Elite NAV C-Arm System, 9800 C-Arm System, 2800 UroView System, 6800 MiniView System, Insta-Trak 3500 NAV System, and ENTrak 2500 NAV System, as well as their components and accessories. These are radiological image processing and image-intensified fluoroscopic X-ray systems that are used during diagnostic, surgical, and interventional procedures, such as orthopedic, cardiac, critical-care, emergency room procedures, and other imaging applications.

    "These devices are used on thousands of patients, and their dependability and accuracy are critical for the successful outcomes of important medical procedures," said Daniel Schultz, M.D., director of FDA's Center for Devices and Radiological Health. "When FDA's August 2006 inspection found ongoing CGMP deficiencies at the Utah facility, GE voluntarily stopped distributing devices from that facility and is working with FDA to ensure that necessary corrective actions are fully implemented."

    FDA's most recent inspection of the Utah facility, conducted between July 31 and August 29, 2006, revealed CGMP deficiencies, including failure to establish and maintain adequate procedures for validating the device design and failure to establish and maintain adequate procedures for implementing corrective and preventive actions. FDA previously inspected the Utah facility between November 15 and December 1, 2004. Following that inspection, FDA issued a Warning Letter on March 31, 2005, citing violations of the CGMP requirements. The government brought this enforcement action when FDA's 2006 inspections showed inadequate responses to FDA's requests for corrections in the 2005 Warning Letter.

    Under the terms of the consent decree, signed by Joseph M. Hogan, Senior Vice President, GE Company and President and Chief Executive Officer, GE Healthcare, and Peter McCabe, President and Chief Executive Officer of GE OEC Medical Systems and GE Healthcare Surgery, the companies have agreed to take necessary measures to ensure that the X-ray surgical imaging systems manufactured and designed at the Utah and Massachusetts facilities comply with CGMP requirements, as well as FDA regulations for reporting adverse events and malfunctions and device corrections and removals.

    The decree also requires that the companies hire an independent expert to conduct inspections of GE OEC Medical Systems facilities in Utah and Massachusetts and certify to FDA that corrections have been made. Manufacturing and distribution can resume at the Utah and Massachusetts facilities once FDA is satisfied that those facilities are in compliance with the law. An outside expert also will conduct yearly audit inspections for four years to assure that the facilities remain in compliance and will submit his/her findings to FDA. FDA may order the companies to stop manufacturing and distributing the X-ray imaging systems if they fail to comply with any provision of the consent decree, the Federal Food, Drug, and Cosmetic Act or FDA regulations.

    Under the consent decree, the companies are also required to submit to FDA a corrective action plan for bringing into compliance with the Act the 9900 Elite C-Arm Systems, the 9900 Elite NAV C-Arm Systems, and the 9800 C-Arm Systems that are currently in use in the U.S. by physicians, hospitals, and other facilities. GE OEC Medical Systems also has voluntarily initiated product recalls on several models of its X-ray surgical imaging systems. Copies of the recall notices are available on the company's website at http://www.gehealthcare.com/usen/xr/surgery/oec_info.html.

    The consent decree allows the companies to continue to provide routine service maintenance, replacement parts, and accessories for the GE OEC X-ray surgical imaging systems that are already employed in U.S. hospitals and other health care facilities.





    Anyone care to comment on the reliability/best service contracts of different brands?

    Our OEC 9800 broke down yesterday (battery had to be replaced) and we had to cancel an entire day of procedures.
     

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