Physician Reimbursement - Excellent Site

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Some (possibly eye-opening) excerpts from "AustinTxMD":

For over twenty years I have loved being a doctor. I used to drive to work every day with a joyful heart, looking forward to seeing and helping all my patients who have also become my friends over the years.

Nowadays I drive to work each morning with a heavy heart and a knot in my stomach, dreading the day, filled with resentment about what's being done to my profession by the medical insurance industry and wondering what the next bad news will be. I always assumed I would continue to love practicing medicine until I was too old to continue. Now I find myself considering, more and more seriously every day, whether I should retire and do something else with the rest of my life.

One voice inside me shouts ever more loudly, "If I'm not going to be paid fairly, what's the point in working all the long hours and having all this responsibility."

The other voice says softly, "But I love this work, and I love these people!"



HOW BAD IS IT?

I recently calculated my projected income if I were to work a full schedule seeing only patients from one of several managed care plans for an entire year. The facts and figures presented on this website are rock-solid and easily verified. They lead inescapably to conclusions that should scare the socks off any Primary Care doctor who reads them (it sure scared the heck out of me once I started to look seriously at the numbers!) I hope that by presenting this information in clear, understandable form I can help the readers (doctors and their patients alike) realize just how deadly serious the looming crisis is becoming.

Because every insurance plan varies from every other plan in what it pays for each different physician service, trying to sort out which companies pay doctors better can become confusing. However, Office Visit fees are by far the most important income source in a medical office; so if we simply structure the comparison so that we're evaluating potential income as if it all came only from that one source, it then becomes very simple to rank the different insurance plans.

If ALL My Patients Were Covered By:
My Net Annual Income from Office Visit Fees (only) Would Be:

Humana
$19,030


Anthem
$13,896


Blue Cross/Blue Shield
-$12,020


MEDICARE
US Gov't

-$13,973


Prucare/Prudential
-$30,174


NYLCare
-$34,072


Yes, you read correctly. Those are negative income figures! This means that all Office Visit payments from certain companies for an entire year wouldn't even cover the overhead in a typical medical office. This means that in my practice, the Office Visits of patients on the lower-paying plans are actually being subsidized by what I earn from the better-paying plans. Unfortunately, all the plans are cutting their reimbursements; and there will soon be little left to subsidize anyone.

If you find this difficult to believe, please read on. You will find all the information necessary to support these conclusions at this web site.
 
Hello everyone,
Dr. Sampson here. I'd like to make a few points with regards to that website. My office manager and I combed through that website and found it interesting. However, there are a few point to be made here.

1-The AGE of the data. All I see is fugures and data from 1997-1998. THAT WAS 6 YEARS AGO. A WHOLE LOT has changed in 6 years. How come nothing CURRENT is posted???

2-Medicine is REGIONAL !!! Whatever goes on TEXAS, does NOT necessarily go on in other states. For example the insurance reimbursement. Here in my state, Medicare is the BEST payer, the only higher payers are PHCS and Canadian insurance plans (Des Jardins, Trent, SSQ, etc) ,all others pay a PERCENTAGE of the medicare rate (between 70-90%). Blue Cross for example, pays 80% of the medicare rate. On the FLIP side, insurance on the Beech Street network is one of the WORST payers around. Beech Street is somewhere between 50-60% of the Medicare rate, which is why my group does not take anything in the beech street network. I found it interesting that on his site, ,Medicare was the worst reimburser, but the stuff on Beech Street were one of the best payers.

3-NOWHERE on his site do I see anything about hospitalizations. In the private practice world where I am at, Doing inpatient hospital admissions is a GOOD source of income. Most months, I make more from my hostpializations then I do my outpatients, especially during the winter season. Now the KEY is to do hospitalizations and do "unassigned on call" in private hosptials that have a high yield of insured patients. If you do the same at "county" hosptials, your income yield won't be good, because you will admit a higher percentage of uninsured patients.

4-How come the Physician who runs his site doesn't post his NET/TAKE HOME PAY?? I see the expenses, and what the insurance reimburses, maybe I am not looking thoroughly enough, but I don't see a gross and a net income. Even better would be some 2003 figures and not some 1998 figures.

**and finally**
5-Simple equation...MD =/= MBA (MD DOES NOT EQUAL MBA)
I will reiterate a point made by a previoius poster. Just because you had the scientific acumen to finish medical school and residency, DOES NOT MEAN, you have the buisiness and financial acumen to RUN A PROFITABLE BUSINESS. Too many people falsely assume that since they are of a certain specialty, that the money should just be rolling in. Nothing could be farther from the truth. If you don't make the proper "buisinessman" decisions after your training, you can find youself in a financial situation that is NOT rewarding. In my same town, ther are FP's that are doing GREAT financially, and on the flip side, I know of one that was losing his shirt. These ppl are both in the same region, but one is doing well, and the other wasn't. The LAUNDRY LIST of factors that determine how much $$$ you will make is TOO long and extensive to list here completely (maybe I will list them one day, but even then it wouldn;t be complete). Enough of my rambling. PEACE!!!

-Derek
 
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