Pain Guys

[acidbase1]

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I’m building my new pain practice and now that reimbursements have started rolling in, I’ve noticed how poorly Medicare and Medicaid pay. I’m talking 75-80 bucks for an cervical epidural. Clearly this isn’t shocking but my question is, is it worth the liability to perform these procedures on these patients? My payer mix is about 50/50. I’m guess this is why most practices don’t see Medicare/Medicaid.

 

[dhb]

You're one step away from an empire

 

[acidbase1]

Pretty snarky

 

[lord_jeebus]

I don't take Medicaid but I wouldn't be able to sustain my pain practice without Medicare. I also imagine that my referral sources would refer elsewhere if I stopped performing bread-and-butter pain procedures like CESI. Of course, I offer them to patients when it's the right thing to do, as a medical decision, not a business decision.

 

[acidbase1]

Yeah my thoughts exactly. It’s in the patients best interest to take care of them, but it was a little shocking to see how poorly they’re reimbursed. Just seems like a lot of risk to barely break even. Our overhead was around $175. So it’s basically being done for free (when accounting for the facility fee)

 

[dmk5n]

What if you refused to accept Medicare but continued to see those patients for a flat $15-20 cash.
Probably what you net anyway.
Maybe eliminate a lot of headaches.

 

[acidbase1]

I’ll pay my student loans off in around 50 years... not a bad play

 

[Aether2000]

Medicare employs a "site of service differential" in an attempt to penalize physicians who do these cases in a surgery center or hospital. They pay roughly 2.5 times as much in an office setting. Also, it is not possible to not accept Medicare insurance and charge them cash unless you have formally "opted out" of Medicare, a paperwork process meaning you cannot bill Medicare for any service in any practice for any medical or surgical services including anesthesiology.