OB anesthesia

[pmichaelmd]

Anyone have experience and/or interest in OB anesthesia? Just got back from SOAP and am pretty pumped. Seems to be quite a market for it if one is so inclined.

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[UTSouthwestern]

Anyone have experience and/or interest in OB anesthesia? Just got back from SOAP and am pretty pumped. Seems to be quite a market for it if one is so inclined.

OB anesthesia remains quite lucrative even if your practice has a high amount of medicare/medicaid patients. I think that a lot of anesthesiologists out of residency pass up that opportunity because of a variety of factors ranging from the in-house overnight call that many dedicated OB groups have to the feeling that you are narrowing your focus too much too early.

Considering the numbers involved, however, some would say that you shouldn't look a gift horse in the mouth (Private insurance labor epidural: $1,500 - $2,500 for placement and management; if you put in 10 epidurals a day . . . you do the math).

Even the Parkland OB anesthesia department, otherwise known as a whole other country, makes money on 20,000+ deliveries a year, of which 70+% is uninsured.

I enjoy OB anesthesia and making pregnant patients' fears and worries disappear, but I'm not sure I could do OB anesthesia exclusively or for the majority of my time.

 

[gaslady]

OB is awesome, but it doesn't have the predicitability of the regular OR. You can be bored out of your mind or running around doing epidurals and C secs. Often you have more than one patient at a time. The nice thing is that most of the patients are healthy in contrast to what I'm used to. Once you get them comfortable they are so grateful. There is more call though.
It's not clear to me if most groups take call separately from the regular OR or if they cover both at the same time.

 

[gaspimp]

UTSW where did you get those numbers for ob anesthesia epidural reimbursement? i'm having a hard time figuring out how anesthesiologist reimbursement works. I understand the drg system, but it seems that anesthesiologists are on some sort of time value system. is there a website that better explains reimbursement and has concrete numbers too? thanks

 

[jetproppilot]

Anyone have experience and/or interest in OB anesthesia? Just got back from SOAP and am pretty pumped. Seems to be quite a market for it if one is so inclined.

Most groups handle both the OR and OB- at my current gig we have two doctors here during the day- one guy is the call guy; he gets to do the big cases (CABGs, etc), and is at work until the night dude comes on at 5pm (I'm the night guy this week). The number 2 doc during the day helps in the OR with cases, and handles OB when an epidural is needed or a C section comes up. We've got a designated OB CRNA who facilitates this process by pre-opping the epidural lady, so when we go to OB the lady is already sitting up- take a look at the pre-op, pop in the combined spinal-epidural, tape it up, and our CRNA hooks up the infusion.
The number 2 doc during the day is here until the call doc can handle the OR, which is typically between 1-3pm.
The night dude comes on at 5pm; sometimes the OR schedule is done, sometimes it isnt. Tonite everything was done, so I didnt have to come in at 5, but came in at 8pm for a C section. Now I'm back at midnight-something for a lap appy (currently waiting for the OR team to be ready).
After midnight cases here are rare, so its mostly OB work for the night doc.
Exclusive OB groups are rare but they do exist; I know when I was considering Vegas in 1996 there was an OB group out there.
Yeah, OB anesthesia is cool and gratifying, but after a eight years, I'd be just as happy without it. The problem is the night work, which I've never really cared for. OB is a big player in keeping you up all night.
As UT said, if you have alot of insurance paying epidurals, it can be lucrative. At my previous job where I was until a year ago our OB collections paid the equivalent of one partner's salary. 1500 bucks for an epidural is pretty steep- maybe thats what the dudes in Dallas/Houston are getting- if I remember correctly we got about $700.00 for an epidural from insurance. Medicaid was $270.00 or thereabouts.

 

[UTSouthwestern]

The going rate for private insurance ED's is high here in Dallas. That would probably explain why there are at least 4 dedicated OB groups that I know of in town, two of which reportedly pull in >$600K a year and haven't hired in 4+ years.

One of my OR nurses complained that for her delivery she was charged $2,800 for her epidural of which insurance covered $2,100, all to the anesthesia group. Ancillary charges for the ED kit, drugs, etc., added up to another $400.

One of the big Dallas hospital's medical director who is an OB-Gyn commented after receiving a bill for an epidural that was inadvertently sent to him instead of his patient that he charges the same amount for a year's worth of clinic visits and availability as the anesthesiologist who spent 10 minutes putting in an epidural and monitored it for 2 hours until delivery.

gaspimp, reimbursement is a bit too lengthy of a topic to discuss today, but I have a previous post in my profile that addresses it. You can do a search for it there. It varies widely by group.

 

[jetproppilot]

The going rate for private insurance ED's is high here in Dallas. That would probably explain why there are at least 4 dedicated OB groups that I know of in town, two of which reportedly pull in >$600K a year and haven't hired in 4+ years.

One of my OR nurses complained that for her delivery she was charged $2,800 for her epidural of which insurance covered $2,100, all to the anesthesia group. Ancillary charges for the ED kit, drugs, etc., added up to another $400.

One of the big Dallas hospital's medical director who is an OB-Gyn commented after receiving a bill for an epidural that was inadvertently sent to him instead of his patient that he charges the same amount for a year's worth of clinic visits and availability as the anesthesiologist who spent 10 minutes putting in an epidural and monitored it for 2 hours until delivery.

gaspimp, reimbursement is a bit too lengthy of a topic to discuss today, but I have a previous post in my profile that addresses it. You can do a search for it there. It varies widely by group.

Thats really wild, UT. Are the groups out of network or something with all the insurance companies or something?

And yeah, reimbursement is beyond a lengthy topic. To be very honest, I still don't understand it all. We had a fantastic office manager in my previous group that handled everything and she would report to us what was billed, what was collected, etc. Every once in a while we would talk about unit price, etc.
One thing that alot of residents/med students don't know yet is that YOU USUALLY DONT GET WHAT YOU BILL FOR. 😱
This isnt just in anesthesia, this is all doctors.
Lets say your hospital has a contract with Blue Cross Blue Shield. That means you'll be the provider in the surrounding area for Blue Cross pts. Whats bad is the insurance company will offer your group a certain percentage of your fees, not the whole amount.
Lets say your group is not a Blue Cross provider. Then the patient has to pay "out of network" fees, which is essentially what you are charging per unit. Of course this doesnt happen much- most people (you and me included) will go to the designated "in network" hospital/doctors because of the lower prices. Thats why I asked UT above if those OB groups were out of network.

Reimbursement is a game in its own. An anesthesia group (or an ortho group, ENT group, etc) has to have highly skilled people in their billing office because insurance companies are deft at figuring out ways not to pay you. If patients knew how hard doctors (actually doctor's business employees) have to work to get paid for work they've already done, they would flip out. Its ridiculous, anger producing bullsh*t. They will kick back the claim for ANYTHING- any little miniscule detail (times not totaled, signature missing, etc). And even when the claims are perfect they sometimes take their sweet time paying. More than once we had to hire a lawyer to add a little muscle, trying to get paid on an insurance companies backlog of over $100,000.

Know who paid us the best? THe prison system, our states organ procurement program, and workmans comp.

Maybe military MD can chime in- sounds like he's well versed in reimbursement.

 

[UTSouthwestern]

The groups are actually in network and in control of one large hospital each (Baylor Dallas, Presby Dallas, etc.). They do get a fair portion of out of network patients which pads their pay significantly as these hospitals are desirable locations to give birth.

 

[militarymd]

Maybe military MD can chime in- sounds like he's well versed in reimbursement.

I WISH I was well versed in reimbursements. It is such a headache. Exactly as Jetprop guy says....quite a pain in the butt...negotiating, direction vs supervision of CRNAs, coding....just make sure you have a good coder/billing company.

The reimbursement rates you guys are talking about are really high. My Blue Cross patients pays us about $300 per epidural...I'm not sure what we bill.

And that is for the whole thing....if the patient labors for 8 to 10 hours....we still get paid the same. If you volume is high enough, then it is OK, but our volume sucks, so it is just an annoying part of my practice.

There was a nice article out of Duke a few years back looking at the economics of OB services....conclusion...it does not pay.

 

[MountaineerDoc]

FYI, the epidural charge for my wife in Charleston, WV as follows...
Charge = $1615, with the provider discount (Acordia National) $1065.75

 

[militarymd]

FYI, the epidural charge for my wife in Charleston, WV as follows...
Charge = $1615, with the provider discount (Acordia National) $1065.75

I the charge was $1615, but how much was paid? Was it 1065.75? If that is how much was paid, then maybe I should move.

 

[militarymd]

Take a look at this abstract. I know it is an academic model and does not necessarily apply to private practice, but you get the gist of it.

OB cost

 

[MountaineerDoc]

the charge was $1615, but how much was paid?

You were too quick on me MilMD! After I hit submit, I said to myself I better edit that 🙄
What was paid to the Anesthesiology Group was $549.25. 👎

If that is how much was paid, then maybe I should move.

Guess we won't be neighbors soon

 

[jetproppilot]

You were too quick on me MilMD! After I hit submit, I said to myself I better edit that 🙄
What was paid to the Anesthesiology Group was $549.25. 👎

Guess we won't be neighbors soon

I don't know Dudes, I'd have to give that a thumbs up. I, like you, can put in a combined spinal-epidural in literally five minutes. This technique utilizing ropivicaine/sufentanil intrathecally and subsequent infusion is near maintenance free. Give your little spinal dose with the included 26" spinal needle through the Tuohy, pull out the spinal needle, thread the catheter, pull out the Tuohy, pop on the little cap thing, put on the little yellow sponge catheter holding thing, tape it up, hook up the infusion. You're done. No dosing the catheter. Last time I gave ephedrine was about eight months ago since hemodynamic sequelae is rare, as are high levels. And the best part?? Redoses are just as rare. You'll get called 9 hours later to change the bottle if the lady is still in labor.
There are very few anesthesia trends that I think are practice changing things, since just about anything in anesthesia can be done 25 different ways. But I really don't know why a clinician would NOT wanna do CSEs, especially if you are handling initial dosing and redoses yourself. Literally saves you tons of work.
Skeptics say, "Well you're giving two anesthetics when she really only needs one. And what about headaches?" Well, yes, you're giving 2 anesthetics, but the intrathecal dose is enough for analgesia, but small enough to be devoid of the stuff you see sometimes with a 10-15 mL epidural bolus of whatever your cocktail is. And we havent seen an increase in incidence of post dural puncture headaches.
Anyway, even 500 bucks collected isnt bad- figure 80 deliveries a month for your average community hospital, times $500.00 each, times 12 months..not bad for the work invested. 👍

 

[militarymd]

You'll get called 9 hours later to change the bottle if the lady is still in labor.
, times $500.00 each, times 12 months..not bad for the work invested. 👍

My malpractice insurance requires me to stay in house after the epidural is placed....major bummer if it is the weekend and there is nothing else going on....especially if the patient is "self-pay".

Bottom line, it is economics...if the deliveries are high enough with enough insured patients, it is worth it.

If the deliveries are low (30 to 50 per month for me), and reimbursement sucks, then the weekends outside of the hospital is worth giving up the 300 to 500 hundred bucks for that day.

I want to know where they pay you 1500 bucks for an epidural because I want to move there and become an OB anesthesiologist.

 

[jetproppilot]

My malpractice insurance requires me to stay in house after the epidural is placed....major bummer if it is the weekend and there is nothing else going on....especially if the patient is "self-pay".

Bottom line, it is economics...if the deliveries are high enough with enough insured patients, it is worth it.

If the deliveries are low (30 to 50 per month for me), and reimbursement sucks, then the weekends outside of the hospital is worth giving up the 300 to 500 hundred bucks for that day.

I want to know where they pay you 1500 bucks for an epidural because I want to move there and become an OB anesthesiologist.

Sounds like if you give your first born child and probably a few hundred K buy in, they might glance at your CV. UT said they havent hired in 4+ years. Nope folks, you won't find those high caliper jobs on gas net.

 

[UTSouthwestern]

My malpractice insurance requires me to stay in house after the epidural is placed....major bummer if it is the weekend and there is nothing else going on....especially if the patient is "self-pay".

Bottom line, it is economics...if the deliveries are high enough with enough insured patients, it is worth it.

If the deliveries are low (30 to 50 per month for me), and reimbursement sucks, then the weekends outside of the hospital is worth giving up the 300 to 500 hundred bucks for that day.

I want to know where they pay you 1500 bucks for an epidural because I want to move there and become an OB anesthesiologist.

Baylor Dallas, Presbyterian Dallas, Presbyterian Plano. Have at it. Again, though, those groups haven't hired in a while and I doubt they will unless someone retires, and they aren't rushing toward the social security line at this time.

 

[militarymd]

Baylor Dallas, Presbyterian Dallas, Presbyterian Plano. Have at it. Again, though, those groups haven't hired in a while and I doubt they will unless someone retires, and they aren't rushing toward the social security line at this time.

Just consulted a partner of mine....MBA/MD....established 15+ practices throughout the country....has 2 practices right now along with an active consulting business for anesthesia practices...practiced from San Franciso to Charlotte, NC...

The above practices are rarities....Don't go into OB anesthesia thinking this is common.

 

[UTSouthwestern]

Just consulted a partner of mine....MBA/MD....established 15+ practices throughout the country....has 2 practices right now along with an active consulting business for anesthesia practices...practiced from San Franciso to Charlotte, NC...

The above practices are rarities....Don't go into OB anesthesia thinking this is common.

Not common, but out there. Still doesn't interest me at this time, but maybe way, way, WAY in the future.