Paying for hospital privileges is a freakin ripoff

[Socrates25]

So I'm finishing residency and have gotten some job offers from local private practice groups. Each of them has hospital privileges at 3-4 places around the city. I started looking at the credentialing process for some of the hospitals and the fees you have to pay are absolutely absurd -- anywhere from $300 up to $900 for the "privilege" of admitting patients to their hospital. Its bad enough paying just one of those fees, but if I were to join those groups I'd have to pay for 3-4 hospitals, running me upwards of $1200-$2000.

I'm not planning on doing this for a career, so I'll have to bend over and pay the money, but if this was longer than just a year assignment, I'd seriously consider saying thanks but no thanks to the hospitals and sending every patient that needs to be admitted to an ER instead and have them make the decision on whether they get admitted or not.

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[Dirt]

So I'm finishing residency and have gotten some job offers from local private practice groups. Each of them has hospital privileges at 3-4 places around the city. I started looking at the credentialing process for some of the hospitals and the fees you have to pay are absolutely absurd -- anywhere from $300 up to $900 for the "privilege" of admitting patients to their hospital. Its bad enough paying just one of those fees, but if I were to join those groups I'd have to pay for 3-4 hospitals, running me upwards of $1200-$2000.

I'm not planning on doing this for a career, so I'll have to bend over and pay the money, but if this was longer than just a year assignment, I'd seriously consider saying thanks but no thanks to the hospitals and sending every patient that needs to be admitted to an ER instead and have them make the decision on whether they get admitted or not.

I have to say that doesn't seem like all that much money considering all the other things we get squeezed on.

Also, I would think it would be more annoying to have to pay for 1 year of privileges than to pay for a lifetime.

 

[gutonc]

I'm not planning on doing this for a career, so I'll have to bend over and pay the money, but if this was longer than just a year assignment, I'd seriously consider saying thanks but no thanks to the hospitals and sending every patient that needs to be admitted to an ER instead and have them make the decision on whether they get admitted or not.

And then you'd lose out on the billing available for the inpatient admission. I feel like you don't really understand the purpose of hospital privileges.

Patients you see in the outpatient setting can go anywhere you want them to (or that they want to) for admission and evaluation. But if you don't have privileges there you (or the group you work for) won't capture the inpatient billing which will instead go to the group covering that hospital for your specialty. And you also stand to lose that particular patient on the flip side as well, since, on discharge, if another group took care of your patient in the inpatient setting, they may just arrange outpatient follow-up with themselves instead of your group.

You're being penny-wise and pound foolish. You're unwilling to give up 1-2 days of salary in order to get hospital privileges but do seem willing to give up dozens or hundreds of patient billings which would likely be 1-2 orders of magnitude higher than what you paid for privileges.

 

[Socrates25]

And then you'd lose out on the billing available for the inpatient admission. I feel like you don't really understand the purpose of hospital privileges.

Patients you see in the outpatient setting can go anywhere you want them to (or that they want to) for admission and evaluation. But if you don't have privileges there you (or the group you work for) won't capture the inpatient billing which will instead go to the group covering that hospital for your specialty. And you also stand to lose that particular patient on the flip side as well, since, on discharge, if another group took care of your patient in the inpatient setting, they may just arrange outpatient follow-up with themselves instead of your group.

You're being penny-wise and pound foolish. You're unwilling to give up 1-2 days of salary in order to get hospital privileges but do seem willing to give up dozens or hundreds of patient billings which would likely be 1-2 orders of magnitude higher than what you paid for privileges.

They are offering flat salaries and I wont see any of the inpatient money.

At any rate, I dont think the inpatient billings are as valuable as you are implying. Its already a well established trend that many PCPs would rather have a hospitalist handle that stuff so they can see more patients in clinic. They wouldnt be doing that if they were losing a ton of potential dollars by seeing inpatients over clinic patients.

 

[reno911]

They are offering flat salaries and I wont see any of the inpatient money.

At any rate, I dont think the inpatient billings are as valuable as you are implying. Its already a well established trend that many PCPs would rather have a hospitalist handle that stuff so they can see more patients in clinic. They wouldnt be doing that if they were losing a ton of potential dollars by seeing inpatients over clinic patients.

1. Offering a flat salary to start is a pretty standard deal. Most in your situation would still pay for the privileges to help establish themselves for the future when they will no longer be on a salary. If you know there's no long term for you, then not paying would make sense.

But the way you're thinking about is backwards, because if you were planning to stay there for an entire career (or even just several years) it would make sense to pay these fairly nominal fees. You seem to be able to justify paying the fees for a year, but you wouldn't pay them if you were going to be in the same position for many years. That is almost exactly the opposite of what makes the most sense (from a financial standpoint)

2. There may not be a "ton of potential dollars" in inpatient care relative to outpatient care. I really can't say for you as this is very specialty dependent. However, what I'm pretty sure of is that even if outpatient work is better compensated than inpatient work on a $/hr basis, the amount of money one would receive from the inpatient work (and the resulting benefits like retaining your outpatients) is still far more than the cost of the fees.

3. The fact that outpatient work may be better compensated on a $/hr basis only becomes relevant if you have enough outpatient work that the inpatient work is cutting into it. Most physicians, when they are starting out, are just not that busy. So your decision is not going to be doing inpatient work versus doing more lucrative outpatient work. It's actually going to be doing inpatient work versus sitting idle (because you just don't have enough demand for outpatient services to fill all of your time). Of course how busy you expect to be is only something you will know for sure. If you're going to an underserved area and you know you're going to be super busy from day 1, then this issue may not apply.

Basically, what gutonc said.

 

[michaelrack]

OP, I am confused. Why isn't the group that is hiring you paying for the hospital privilege fees?

 

[Arcan57]

1. If you're being paid a flat salary by the group, the group may not be too keen on you not getting hospital privileges since you won't be able to perform part of your job's function.

2. While it seems expensive (but really, really isn't), credentialing actually requires a fair amount of work for the hospital and opens the hospital up to liability if they are not diligent about verifying your credentials.

3. As the above poster (who also raises a solid point about the group paying these fees) can tell you, practicing as a doctor requires paying all sorts of fees that seem ridiculously stupid. I'm specifically referencing the $400 professional license fee Tennessee levies every year, which is in addition to the fee to actually obtain or renew your medical license.

 

[Mattchiavelli]

And just think, when you admit your own patients you have access to all their outpatient records and probably know a thing or two about the patient as opposed to getting a fresh full history and having to call a PCP office and leave a message for records

 

[michaelrack]

As the above poster (who also raises a solid point about the group paying these fees) can tell you, practicing as a doctor requires paying all sorts of fees that seem ridiculously stupid. I'm specifically referencing the $400 professional license fee Tennessee levies every year, which is in addition to the fee to actually obtain or renew your medical license.

I wasn't aware of the $400 fee, I practice in northern MS and am licensed in Mississipppi and Alabama. I was thinking about applying for a TN license, but now maybe I won't.

 

[Arcan57]

Yeah, the license itself is reasonable but forking over $400 to the state every year just because you have useful skills you are bringing to the state is galling. Although the whole driving to Jackson to obtain a MS license wasn't exactly fun or useful either.

 

[docB]

OP, I am confused. Why isn't the group that is hiring you paying for the hospital privilege fees?

Remember that even if the group is paying the credential fees it's still coming out of your pocket. Just like med mal, stipends, lab coats, etc. anything the group buys could have been paid to you instead.

Now it makes sense for the groups to pay for many things. The credential fees are a good example. My group pays ours. The two main reasons are that they don't want us to forget or do it late and cause a scheduling problems so they just take care of it. The other is that it's tax free if they pay it. If they paid me I'd have to pay 35% and then pay med staff.

If you think the fees are annoying wait 'til you see the packets you have to fill out.