Negotiating with an academic pain group- all advice welcome!

[SSdoc33]

The 5X higher SOS differential payment for providing the same service produces perverse economic incentives that only help the MBAs.

I dont see all the amazing medical services others purport that large hospital chains are providing the indigent population with this extra money. In fact I get at least 5 medicaid patient referrals a week from the big box stores as they limit their number of Medicaid patients.

and do you take them all? if i remember correctly, medicaid pays roughly medicare rates in your neck of the woods.

its not that hospitals offer "amazing medical services" to the indigent/medicaid/refugees/etc. its that they offer treatment at all.

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[nvrsumr]

Yes. I take medicaid patients. There is a disconnect between the perception of what this SOS differential is providing and what is really happening. One of the big box shops is the local University hospital and the other a Catholic charity hospital chain. My taxes pay for Peyton Manning to advertise against me for one and the other just got bought out by Intermountain health, so much for their charity mission.

Unlike other posters I dont take medicaid patients out of the goodness of my heart. I do it because my small nimble practice is a better mousetrap and I make a profit

 

[Ducttape]

i dont purport to be better than private practices. if anything, i provide fewer of the expensive services that lead to high SOS. you dont get SOS for talking about CBT, EAET, mindfulness or home exercise or weight loss (this system does not charge facility fee for office visits.)


yes, private practices seeing medicaid is probably location dependent. overall, i would be pretty confident in thinking that majority do not see a large volume.

in my location, the private practices are very low on Medicaid.

at one point, 2 of these practices tried to open their own ASC. they claimed they needed the ASC because of their high volume of Medicare and Medicaid patients. the state shot them down because the numbers the state reviewed revealed that Medicaid made up 1% of their patient population and Medicare 7%.

a separate private practice also sees medicaid patients - at the rate of 1 a week. this was touted when i interviewed there, 12 years ago. i was told by the owner that i would never survive in the hospital practice i took over because of the medicaid volume

 

[buddababa]

and do you take them all? if i remember correctly, medicaid pays roughly medicare rates in your neck of the woods.

its not that hospitals offer "amazing medical services" to the indigent/medicaid/refugees/etc. its that they offer treatment at all.

im hospital based and i would say about 9-11 percent of my patients are some form of medicaid

 

[vit8bsm]

A big reason for the SOS differential is because hospital execs and owners have buddies with buddies up in congress lobbying to keep their facility fees juicy

 

[drusso]

i dont purport to be better than private practices. if anything, i provide fewer of the expensive services that lead to high SOS. you dont get SOS for talking about CBT, EAET, mindfulness or home exercise or weight loss (this system does not charge facility fee for office visits.)


yes, private practices seeing medicaid is probably location dependent. overall, i would be pretty confident in thinking that majority do not see a large volume.

in my location, the private practices are very low on Medicaid.

at one point, 2 of these practices tried to open their own ASC. they claimed they needed the ASC because of their high volume of Medicare and Medicaid patients. the state shot them down because the numbers the state reviewed revealed that Medicaid made up 1% of their patient population and Medicare 7%.

a separate private practice also sees medicaid patients - at the rate of 1 a week. this was touted when i interviewed there, 12 years ago. i was told by the owner that i would never survive in the hospital practice i took over because of the medicaid volume

SOS arbitrage is a scam and working as an HOPD doc just to juice the vig on SOS for your employer has got to be the most unethical thing I can think of...especially when your bonus depends on it.

No one can depend on HOPD docs to fix this problem. They have competing commitments. Only the private sector can step up.

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01006?journalCode=hlthaff

HEALTH AFFAIRSVOL. 40, NO. 5: CONSOLIDATION, PRIVATE EQUITY & MORE
CONSIDERING HEALTH SPENDING

Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration

Christopher M. Whaley, Xiaoxi Zhao, Michael Richards, and Cheryl L. Damberg
AFFILIATIONS
PUBLISHED:MAY 2021No Accesshttps://doi.org/10.1377/hlthaff.2020.01006

Abstract
In recent years direct ownership of physician practices by hospitals and health systems (that is, vertical integration) has become a prominent feature of the US health care system. One unexplored impact of vertical integration is the impact on referral patterns for common diagnostic tests and procedures and the associated spending. Using a 100 percent sample of 2013–16 Medicare fee-for-service claims data, we examined whether hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2 million and $32.9 million increases in Medicare spending, respectively, for the entire study period. This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.

 

[deleted131481]

Ever since our clinic converted from office based procedures to HOPD down the hall a couple of years ago, we are doing fewer procedures (copay too expensive), paying more people, using more sedation, using more supplies, and documenting more useless stuff.

 

[drusso]

Ever since our clinic converted from office based procedures to HOPD down the hall a couple of years ago, we are doing fewer procedures (copay too expensive), paying more people, using more sedation, using more supplies, and documenting more useless stuff.

This is happening everywhere.