Obamacare reimbursement rates

[bigeyedfish]

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So jan 1 Obamacare will be upon us in full. Part of that means the Medicaid roles will be expanded. How much depends on the state. From our point of view that could be bad, because obviously Medicaid reimbursement is dismal. On the other hand, if you work at a state, academic institution for example, you might be taking care of a lot of these patients anyway, and a fraction of normal reimbursement is better than none. Although I think that's a terrible rationalization.

I'm more wondering about the reimbursement rates of the plans purchased through the exchanges, specifically for anesthesia. Will the be the 40-70 per unit or the 18-20 per unit of government pay?

Or does no one know the answer to this?

 

[BLADEMDA]

Unit rates for anesthesia depends on the Payer/Health care plan. If it is a governmental payer the rate will be as usual (16-20) vs. a private payer (60-80). The Obamacare exchange does NOTHING to alter your reimbursement rate but it may alter/affect your income as patients assume a greater share of their deductible costs via Obamacare (usual deductible is very, very high).

 

[Impromptu]

One of my biggest complaints in healthcare is that the bill is significantly different for the same case on 2 similar people with different insurance plans. Also, you cannot know what the bill will be before getting the service, even giving some allowance for time variance. I wanted some semi-elective blood work done. Neither the insurance company nor the different lab companies could tell me what the price would be cash or with insurance. I was on the line with the insurance company for over an hour and the representative tried hard to figure it out, but couldn't. True capitalism cannot occur without being able to compare my options to make an informed choice. The current system does not allow for capitalism in providing medical services. The Affordable Care Act is not really a step in the right direction, except that when patients are forced to pay higher deductibles and co-pays they may start to demand more transparency.

 

[jwk]

One of my biggest complaints in healthcare is that the bill is significantly different for the same case on 2 similar people with different insurance plans. Also, you cannot know what the bill will be before getting the service, even giving some allowance for time variance. I wanted some semi-elective blood work done. Neither the insurance company nor the different lab companies could tell me what the price would be cash or with insurance. I was on the line with the insurance company for over an hour and the representative tried hard to figure it out, but couldn't. True capitalism cannot occur without being able to compare my options to make an informed choice. The current system does not allow for capitalism in providing medical services. The Affordable Care Act is not really a step in the right direction, except that when patients are forced to pay higher deductibles and co-pays they may start to demand more transparency.

If you're paying cash, you have the ability to shop around. Surely there are labs out there more than happy to give you a cash price.

Asking the insurance company is pointless. Why would you think they would have any idea what some private company would charge for their services on a cash basis? You ask the provider, and if they don't have an answer, find another one.

Would you ask an insurance company what you should charge as a cash option for your services? Of course not. If you have no idea what the actual cost of providing your services are, you have homework to do.

 

[KGflyboy]

Unit rates for anesthesia depends on the Payer/Health care plan. If it is a governmental payer the rate will be as usual (16-20) vs. a private payer (60-80). The Obamacare exchange does NOTHING to alter your reimbursement rate but it may alter/affect your income as patients assume a greater share of their deductible costs via Obamacare (usual deductible is very, very high).

I've seen some articles from reputable news sources (maybe that's an oxymoron) that suggest the opposite.

In some areas, doctors have already been shown the reimbursement rates under the exchange plans and report them to be closer to government reimbursement levels that the policies offered outside the exchange. In order to keep exchange policy prices low for customers, they have lower reimbursement rates.

This was a general observation by docs and not specific to any specialty. What do you think? Could it be true?

 

[Mman]

Unit rates for anesthesia depends on the Payer/Health care plan. If it is a governmental payer the rate will be as usual (16-20) vs. a private payer (60-80). The Obamacare exchange does NOTHING to alter your reimbursement rate but it may alter/affect your income as patients assume a greater share of their deductible costs via Obamacare (usual deductible is very, very high).

I'd file private payer rates as ranging up to 120+ per unit. 60-80 is pretty low ball if you ask me.

 

[aneftp]

I'd file private payer rates as ranging up to 120+ per unit. 60-80 is pretty low ball if you ask me.

Seriously?

Most blues pay in the $50-70/unit range. Maybe in Wyoming they are paying $100-110/unit. Texas was paying $80-90/unit.

But $120/unit is extremely high for private insurance for anesthesia.

 

[Southpaw]

I'd file private payer rates as ranging up to 120+ per unit. 60-80 is pretty low ball if you ask me.

Say what? In my neck of the woods no one is paying > $80 per unit.

 

[Mman]

Say what? In my neck of the woods no one is paying > $80 per unit.

Our worst contract is higher than that and every group near us is in triple digits with at least 1 payer.

 

[aneftp]

Our worst contract is higher than that and every group near us is in triple digits with at least 1 payer.

What state are you in? Obviously not Cali or Florida or even Northeast states.

 

[deleted87051]

What state are you in? Obviously not Cali or Florida or even Northeast states.

Seriously.....I need to move. Our payor mix is so bad we may actually be helped by obamacare.

 

[Mman]

What state are you in? Obviously not Cali or Florida or even Northeast states.

southeast

 

[aneftp]

southeast

Well than. I am 100% Southeast doesn't include Florida cause I know the reimbursement rates for most of the state of Florida outside of the panhandle area.

 

[BLADEMDA]

$120 per Unit? I am aware that Long island and NYC approach that level but in the Southeast? Maybe Atlanta? My Billing company informs me $100 per unit is very rare in the Southeast.

 

[BLADEMDA]

southeast

After some research the ASA reports the highest contracts in the southeast are 160 per unit. Hence, You are likely telling the truth. Still, the median contract is more like the high 70s than over 100.

 

[Mman]

After some research the ASA reports the highest contracts in the southeast are 160 per unit. Hence, You are likely telling the truth. Still, the median contract is more like the high 70s than over 100.

I can almost assure you that American Anesthesia is getting $120+ per unit with all their groups they've been gobbling up since many of those groups were well above $100 before being acquired and they are gradually getting more and more leverage with negotiations with each group they acquire.

 

[BLADEMDA]

I can almost assure you that American Anesthesia is getting $120+ per unit with all their groups they've been gobbling up since many of those groups were well above $100 before being acquired and they are gradually getting more and more leverage with negotiations with each group they acquire.

So you can see by your own posts that AMCs buying groups will turn a profit on this purchase more quickly than the buyout/lockout period. One of the ways the AMC can turn that profit in 3 years instead of 5 (the duration of the buyout clause for those who sold the company) is to raise the reimbursement per unit by 20%. When you combine the fact that the AMC has lower billing costs, slashes CRNA salaries by 15% and probably squeezes a few dollars out of the administrators along with the 20% increase per unit reimbursement the acquiring AMC doesn't need 5 years to break even.

 

[IkeBoy18]

So you can see by your own posts that AMCs buying groups will turn a profit on this purchase more quickly than the buyout/lockout period. One of the ways the AMC can turn that profit in 3 years instead of 5 (the duration of the buyout clause for those who sold the company) is to raise the reimbursement per unit by 20%. When you combine the fact that the AMC has lower billing costs, slashes CRNA salaries by 15% and probably squeezes a few dollars out of the administrators along with the 20% increase per unit reimbursement the acquiring AMC doesn't need 5 years to break even.

Does this mean they will be keeping physician salaries stable or will they slash those as well

 

[aneftp]

After some research the ASA reports the highest contracts in the southeast are 160 per unit. Hence, You are likely telling the truth. Still, the median contract is more like the high 70s than over 100.

Gotta be reason groups in Atlanta are selling out to Mednax.

Maybe they anticipate decrease reimbursement rates with the ACA in the

So you can see by your own posts that AMCs buying groups will turn a profit on this purchase more quickly than the buyout/lockout period. One of the ways the AMC can turn that profit in 3 years instead of 5 (the duration of the buyout clause for those who sold the company) is to raise the reimbursement per unit by 20%. When you combine the fact that the AMC has lower billing costs, slashes CRNA salaries by 15% and probably squeezes a few dollars out of the administrators along with the 20% increase per unit reimbursement the acquiring AMC doesn't need 5 years to break even.

And this is why I don't understand why its illegal for physician owner groups to gobble up an entire local market and dictate rates (there have been hospitals and or insurance companies that have successfully challenged certain physician groups ( ortho and anesthesia) from becoming a monopoly in a local area. So as not to dictate rates and staffing.

But AMCs can (along with super hospital system mergers) can dictate to insurance companies rates along with physician salaries. And the larger they get the more power they can leverage.

It's at these times I support single payer and getting the middle guys out of the business.

 

[Mman]

And this is why I don't understand why its illegal for physician owner groups to gobble up an entire local market and dictate rates (there have been hospitals and or insurance companies that have successfully challenged certain physician groups ( ortho and anesthesia) from becoming a monopoly in a local area. So as not to dictate rates and staffing.

[/quote]

It's not illegal. In fact in anesthesia, in most cities there is only 1 group. It's also why we've explored merging with other groups in surrounding areas to increase our own footprint and increase everybody's contract rate.

Crappy reimbursement contracts are a drag on a group and act like leaving free money on the table and groups with bad contracts need to strongly consider ways to improve them.

 

[aneftp]

And this is why I don't understand why its illegal for physician owner groups to gobble up an entire local market and dictate rates (there have been hospitals and or insurance companies that have successfully challenged certain physician groups ( ortho and anesthesia) from becoming a monopoly in a local area. So as not to dictate rates and staffing.

It's not illegal. In fact in anesthesia, in most cities there is only 1 group. It's also why we've explored merging with other groups in surrounding areas to increase our own footprint and increase everybody's contract rate.

Crappy reimbursement contracts are a drag on a group and act like leaving free money on the table and groups with bad contracts need to strongly consider ways to improve them.[/quote]

State of Maryland has very restrictive physician practices. They have laws going back to 1993 regarding ortho groups merging and gobbling up contracts along with owning all their equipment for medical imaging.

 

[bigeyedfish]

Well this has generated some interesting discussion. Two things.

It seems no one knows the reimbursement rates for Obamacare plans. But I'm not optimistic.

The disparity in reimbursement per unit is so wide. Prior to this thread the highest I'd heard of was 100 per unit from a buddy in Phoenix. But that was just one payer, the others were lower but still good. I'm a hospital employee but our billers tell me they have negotiated around 70 per unit.

The number I was always told for an anesthesiologist doing his own cases 50 hours a week 48 weeks a year was around 10,000 units. At 120 a unit the math on that is pretty rediculous.

 

[BLADEMDA]

Well this has generated some interesting discussion. Two things.

It seems no one knows the reimbursement rates for Obamacare plans. But I'm not optimistic.

The disparity in reimbursement per unit is so wide. Prior to this thread the highest I'd heard of was 100 per unit from a buddy in Phoenix. But that was just one payer, the others were lower but still good. I'm a hospital employee but our billers tell me they have negotiated around 70 per unit.

The number I was always told for an anesthesiologist doing his own cases 50 hours a week 48 weeks a year was around 10,000 units. At 120 a unit the math on that is pretty rediculous.

Typically the average reimbursement rate is more like $50 per unit for many private practice groups (solo MD) not getting a subsidy. This is because governmental payers ($20 per unit) and no pay (Zero per unit) may comprise 1/2 your cases. If you are fortunate the average unit could be $60 per unit (Fewer CMS cases).

 

[aneftp]

Judging from ACA sign up rates. 80% of people signing up are getting the free stuff (medicaid) vs 20% private insurance (of that probably 60-70% are getting subsides).

And an estimated 20-30 million who will still be uninsured.

Oh by the way the 50 million uninsured is really a bogus number cause

Typically the average reimbursement rate is more like $50 per unit for many private practice groups (solo MD) not getting a subsidy. This is because governmental payers ($20 per unit) and no pay (Zero per unit) may comprise 1/2 your cases. If you are fortunate the average unit could be $60 per unit (Fewer CMS cases).

And that's why single payer may make sense if the rates are reasonable. At least it will be equal work equal pay.

It's truly unfair for someone like my brother who's fee for service out in Los Angeles (the actual city limits) where he'll be lucky to get $15/unit from Medicare and gets around $50-60/unit from private and zero pay for a "self pay" cabg.

You have guys who simply luck out in terms of payer mix.

There are a few guys in cali who pull over 7 figures simply doing Ob cause payer mix is so good (over 70% private) and they each take 15-16 weeks of vacation vs in Florida say Orlando where 40% plus of the OB population in most hospitals is medicaid or no pay.