Physician Friendly States

[SoonerPainDoc]

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Could someone point me to a comparison list of medicare/aid reimbursement rates by state? I know that there is a reimbursement index out there, but I can't seem to find it. I'd like to find out which states pay the most for these patients.

 

[Tenesma]

medicare/medicaid reimbusremsents don't really change that much between states - especially if you consider that usually those states with higher reimbursement also generally have a higher cost of living...

and you have to figure that pretty much anywhere you go you will have a certain percentage of medicare and a certain percentage of private payers...

what really makes the difference are the private payers and the amount of HMO penetration... and that data will be very hard to come by - because technically according to most contracts the fee schedules can't be disclosed.

but if you want to do some online snooping type in each states medical carrier and go to the provider section and check out fee schedules and use 2 or 3 of your most common codes...

 

[Ephesus]

I believe TX has the best reimbursements and NY has the worst - shouldn't it be the other way around?

 

[deleted50478]

I believe TX has the best reimbursements and NY has the worst - shouldn't it be the other way around?

No. Why should the rest of the country subsidize NY by paying you more to correct for your self-inflicted high cost of living?

If you think New York is expensive because it is desirable, then you should get paid the same and the 'desirablilty' should be reward enough for you without your getting paid more.

I don't think New York costs more because it's so desirable though. Everything cost a fortune largely due to high rents caused by zoning laws, rent-controlled housing, construction regulations, etc. The high cost of doing business in NY leads to high taxes which leads to higher costs and on and on. Rather than having the rest of the country pay for the mistakes of NY government, NY should fix its government and bring the cost of living down.

 

[Tenesma]

actually medicare reimbursements are higher in states with higher costs of living (geographical differential)

the reason private payers pay more in states with lower cost of living is because usually those states are more rural, and are therefore a less desirable place to live and have less doctors... less doctors means managed care doesn't have a chance of stepping foot by having doctors compete over the pie... for example, in NYC if blue cross wanted to drop reimbursements by 20% I bet you doctors would continue seeing those patients because of how competitive it is over there ---- if Blue cross tried to pull that in northwest Texas, the doctors would just pull out of blue cross and still have plenty of patients coming in....

we are our own worst enemy.

 

[Mister Mxyzptlk]

There are some states (I think Missouri and Arkansas) where Medicaid pays better than Medicare.

 

[deleted50478]

actually medicare reimbursements are higher in states with higher costs of living (geographical differential)

the reason private payers pay more in states with lower cost of living is because usually those states are more rural, and are therefore a less desirable place to live and have less doctors... less doctors means managed care doesn't have a chance of stepping foot by having doctors compete over the pie... for example, in NYC if blue cross wanted to drop reimbursements by 20% I bet you doctors would continue seeing those patients because of how competitive it is over there ---- if Blue cross tried to pull that in northwest Texas, the doctors would just pull out of blue cross and still have plenty of patients coming in....

we are our own worst enemy.

New York has 16.6 million urban and 2.4 million rural population
Texas has 17.2 million urban and 3.6 million rural population

Texas does have a somewhat higher percent rural population 17% vs 12%, but I doubt the difference is great enough to explain reimbursement differences.

I know you put NYC not NY and NW TX not all TX, but anyway I thought those figures were worth pointing out.


For Medicaid, I read that states with higher rates have stricter qualification and benefits packages while states with lower rates let more people qualify and give more benefits. Basically politicians in low payment states have found that giving your services away at a loss-producing payment rate to a large number of people is good for them politically. Or something like that...

 

[Mister Mxyzptlk]

Texas has higher reimbursement because the doctors are better.

 

[Tenesma]

i meant rural in a broad sense - everything is spread out over a larger distance -

most texas reimbursements are higher because there is less HMO penetration (overall) - HMO penetration is getting worse though in Austin, San Antonio, dallas and even Houston - so you really have to be about 1 hour drive from those markets before you start seeing REALLY higher reimbursements -

i know, i know - 1 hour drive in houston - you are still in houston - but i mean 1 hour OUTSIDE of the cities.

 

[Mister Mxyzptlk]

"even Houston"? Houston is thoroughly saturated with managed care and has been for years, as are all the major metropolitan areas.

 

[Tenesma]

gorback - i KNEW that would catch your eye 🙂

 

[Ephesus]

No. Why should the rest of the country subsidize NY by paying you more to correct for your self-inflicted high cost of living?

If you think New York is expensive because it is desirable, then you should get paid the same and the 'desirablilty' should be reward enough for you without your getting paid more.

I don't think New York costs more because it's so desirable though. Everything cost a fortune largely due to high rents caused by zoning laws, rent-controlled housing, construction regulations, etc. The high cost of doing business in NY leads to high taxes which leads to higher costs and on and on. Rather than having the rest of the country pay for the mistakes of NY government, NY should fix its government and bring the cost of living down.

There's more to NY than NYC.

 

[Mister Mxyzptlk]

Such as northern New Jersey and west Connecticut..

 

[Ephesus]

Yes, that was almost funny, but I forgot you live in Texas.

 

[Pain Newbie]

I'm new to this website and I love it. Thank you everyone for your time and expertise. I hope I can contribute as well.

Regarding the originall comment (bottom of page):
I presume your trying to decide the best city/state to go, to start a pain practice. That's my situation anyway.

I think others might have additional suggestions about how to make this decision about the best location to open a practice. I would also love to hear them.

Could someone point me to a comparison list of medicare/aid reimbursement rates by state? I know that there is a reimbursement index out there, but I can't seem to find it. I'd like to find out which states pay the most for these patients.

 

[Tenesma]

choose the area based on where you and your family (ie: wife) want to live - then choose the location that is the least competitive or where you can bring a new product....

the area i came to was saturated with narcotic pain clinics and a few guys who do bind ESI x3 and that is it - so it wasn't hard to convince PCPs that i have a lot more tricks up my sleeve...

now if your wife wants you to move to LA then you are screwed - unless you join a group

 

[clubdeac]

I'm new to this website and I love it. Thank you everyone for your time and expertise. I hope I can contribute as well.

Regarding the originall comment (bottom of page):
I presume your trying to decide the best city/state to go, to start a pain practice. That's my situation anyway.

I think others might have additional suggestions about how to make this decision about the best location to open a practice. I would also love to hear them.

I too would be very curious to find out where everyone thought was the friendliest spot to set up shop. I was doing some reading on the internet and came across an article in "Physician'sPractice" (not sure if it's reputable). But they apparently did a survey taking reimbursement, cost of living, saturation and tort reform into account and came up with these five states as the top states to practice medicine: Texas, Kansas, Oklahoma, South Dakota and Indiana. The only problem is getting people to move to those places. I'd be interested to hear other's advice/suggestions.

 

[tchoupdoc]

Physician's Practice is good. It started showing up in my mail when I got my TN license (which is not where I work, by the way). Seems to be written half by practice managers/ coding and billing experts.

I am with the poster above who suggested going to a state's medicare site and looking at the most commonly done procedures. I also felt ashamed when I first opened my doors and all I had was medicare and medicaid, because all the established docs in the community turned up their noses at it. But you know what you are getting paid and they pay it quickly.

Funny how those established docs turn 65, get their red-white-and-blue cards, and then expect to be seen and treated everywhere.

 

[Tenesma]

what gets me even more are the ridiculously wealthy patients who are using medicare for their healthcare when they could drop 10K on a visit and not even bat an eyelid --- i have quite a few of those patients - and it kind of disgusts me.... then again if they were paying 3% of their income in medicare tax, then maybe they "REALLY" deserve it?

 

[Pain Newbie]

If anyone can tell me how I can find the website which lists the reimbursements for any pain procedures/blocks, in a state, I will greatly appreciate that info.

I have spent some time looking but havent found it yet, if it is public!

 

[Kwijibo]

Ok, I guess it is my responsibility to stand up for New York here.
I practice in New York city and I think it is a great place to practice. All major medical in network rates are above 100% medicare most between 110 and 130% medicare. Worker's compensation is on a fee schedule of 150-200% of medicare, and the no-fault/auto runs on the WC fee schedule. You do not need precert on procedures under 1000.00 and no precert needed for auto.
Many of the reputable physicians in the city are out of network/cash providers. The top of the top does not accept medicare.
There are no surgical centers, which can be viewed as bad or good. The negative aspect is that you do not collect a facility fee. The positive is that every group does not have their own pain doc that they have a vested interest in.
The catch population of the tri state area is 25 million people.
New Jersey is also an excellent state for pain physicians but is saturated beyond belief.