OMFS Facial Trauma Pay

[54807]

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I've asked a similar question in the past regarding OMFS facial trauma call and compensation but I have a new take on it now.

I found the medicare compensation chart, which is ridiculously complicated and took me about 2 hours to figure out.

It has the following as compensation:
Closed Reduction/Fixation Mandible - $1300
Open Red/Fixation Mandible - $1800
Le Fort I Reduction/Fixation - $3200
Plus a few bucks per laceration, paid by the length (simple vs complex)

I understand this is chump change relative to good ol' wisdom teeth and implants but are these numbers typical? Is the surgeon expected to supply plating or is that billed to the OR/patient? Add in the small stipend for some hospitals and it's still money coming in. Why such the negativity towards trauma call? Isn't that part of the deal with getting paid HUGE sums for taking out wisdom teeth, placing implants, and sedations? And I do think the fee for wisdom teeth is very high compared to other medical procedures. The only way I understand it is because it is elective, dental related, and sedation adds to it.

Also, for facial trauma where the OMFS or PRS or ENT is essentially a contractor, who manages the patient all day? They aren't being brought into the 'OMFS Department' like a residency program, are they? Does the 'trauma' service keep them in house on their service? I understand the treating surgeon is ultimatly responsible for care and will likely do morning and evening rounds on their trauma patients but who is the moment to moment care managed by?

I only ask this because I genuinely want to include trauma call as part of my future private practice and I just need to get to the bottom of this! Am I going to get stuck near a OMFS program only? Fill me in.

 

[crazy_sherm]

Before starting dental school, I used to work in pharmaceutical reimbursements, primarily with Medicare payments. Medicare billing and reimbursement is quite complicated. Reimbursement to the hospital is separate from reimbursement to the physician. Part A deals with inpatient services to the hospital. Part B deals with outpatient services and reimbursement to the physician whether the procedure was done on an inpatient or outpatient basis.

If the patient is admitted and treated as an inpatient, the hospital only receives reimbursement for the most highest ranked Diagnosis-related group (DRG), which are driven by ICD-9 diagnosis codes. So say a patient gets in a car accident, you plate his mandible, but he also suffers a heart attack and needs a bypass. Medicare will look at their DRG ranking chart and only pay the hospital based on whatever is higher. The physicians involved bill separately for whatever procedures they performed for their payment.

If the patient was treated on an outpatient basis, the case is assigned to a particular Ambulatory Payment Classification (APC) which is driven by CPT procedure codes, which hospital reimbursement is derived. Just like with the inpatient, however, the physician can also bill separately for services rendered.

I'm not sure if your numbers are just the physician's payment or also the payment to the hospital, but in general, Medicare reimbursement is not very high for procedures. They do overpay for pharmaceuticals and durable medical equipment because of the antiquated formulas used for payment calculation. The pharm lobby is also very strong and money carries a lot of influence.

 

[54807]

Before starting dental school, I used to work in pharmaceutical reimbursements, primarily with Medicare payments. Medicare billing and reimbursement is quite complicated. Reimbursement to the hospital is separate from reimbursement to the physician. Part A deals with inpatient services to the hospital. Part B deals with outpatient services and reimbursement to the physician whether the procedure was done on an inpatient or outpatient basis.

If the patient is admitted and treated as an inpatient, the hospital only receives reimbursement for the most highest ranked Diagnosis-related group (DRG), which are driven by ICD-9 diagnosis codes. So say a patient gets in a car accident, you plate his mandible, but he also suffers a heart attack and needs a bypass. Medicare will look at their DRG ranking chart and only pay the hospital based on whatever is higher. The physicians involved bill separately for whatever procedures they performed for their payment.

If the patient was treated on an outpatient basis, the case is assigned to a particular Ambulatory Payment Classification (APC) which is driven by CPT procedure codes, which hospital reimbursement is derived. Just like with the inpatient, however, the physician can also bill separately for services rendered.

I'm not sure if your numbers are just the physician's payment or also the payment to the hospital, but in general, Medicare reimbursement is not very high for procedures. They do overpay for pharmaceuticals and durable medical equipment because of the antiquated formulas used for payment calculation. The pharm lobby is also very strong and money carries a lot of influence.

Excellent post! I reviewed the chart I have based upon your info and I don't know enough to further my own understanding. No big deal, I just took low compensation rates for each procedure.

No OMFS residents know the deal with trauma pay? Are there any ways to get hired 'full time/salary' at the hospital providing various OMFS procedures? Can you operate a teeth and titanium practice within the hospital if the hospital procedures and trauma really pay so little? And I am not referring to OMFS residency programs, my home state doesn't have any and that's where I will likely return to. Just a couple dental schools.

 

[IcedOMFS]

I found the medicare compensation chart, which is ridiculously complicated and took me about 2 hours to figure out.

It has the following as compensation:
Closed Reduction/Fixation Mandible - $1300
Open Red/Fixation Mandible - $1800
Le Fort I Reduction/Fixation - $3200
Plus a few bucks per laceration, paid by the length (simple vs complex)

.

For a single case, it kind of sucks.

If you can arrange it such that you have a steady volume of cases at a hospital with great turnaround time, you could conceivably do 5- 6 cases a day, when you get your day.

$1800 x 6 = 10,800, with no overhead.

Not that bad of a day, actually.

 

[OMSDoc]

Actually, the dollar numbers that you list strike me as being high. However, the numbers of Medicare fracture patients that we see are low...most of the trauma patients tend not to be in the Medicare age group. Conversely, they are younger, and they either (1) have no money, (2) have Medicaid, (3) are covered by auto insurance in the case of an accident, or (4) have a private health plan, such as Blue Cross Blue Shield. The majority having no money. If they do have Medicare or Medicaid, these typically pay only about 25 percent of our UCR fees, and we do not have the highest fees in our area.

The private plans are no better in our area, as we have to sign up to be a "provider", and the reimursement rates tend to be not much different than Medicare. I used to practice in the Twin Cities, and I remember spending five hours on a Saturday admitting and operating on a fracture patient, only to receive $600 for everything.

One friend of mine in the Twin Cities, who used to take call at one of the Level-I trauma centers there, made a deal with that hospital that all trauma patients would become patients of the hospital, and the hospital would have to pay his group 50% of their fees, no matter what. Then it was up to the hospital to get the reimbursement (and they had the infrastructure to maximize that effort). Sometimes the hospital got nothing, but other times they did well. This ended up being a pretty good deal for the surgeons, compared to what they usually received.

The objective of Medicare and these plans (and eventually "Universal Health Care") is to have a European model, where patients with trauma must go to a tertiary center to receive treatment.