Physician reviewer for hospital

[cyanide12345678]

Has anyone been a physician reviewer for a hospital? Essentially the person who fights for the hospital to get things approved by insurance.

One day i was really bored and disliking the ER more than usual so i decided to apply to a bunch of remote stay at home non clinical positions.

Got 1 rejection, ghosted by 3, but my own hospital system happened to be hiring as well and now I’m finding myself with a third interview in my internal hospital system. Obviously it’s going to be a pay cut, 250k for full time.

I honestly only applied to things to see what else is out there, just to get offers to see if anything would come remotely close to my clinical medicine salary. I don’t think i was ever fully willing to jump ship from clinical medicine

Whose done this kind of work? Is it terribly frustrating work dealing with insurance? Is a regular schedule worth working so many more days in a month? Is there job security in this kind of work?

If the money is right, i might consider doing M-W remote work at home. Thursday 24 hour ER shift in my critical access hospital. But a huge part of me just prefers a 10 x 12 hour shifts per month schedule that I’ll have this October onwards.

Thoughts from the group?

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[bravotwozero]

The only thing that might want to make me jump ship is the prospect of saying goodbye to nights weekends and holidays forever. Otherwise, not worth it.

 

[Pigg-O-Stat]

Sounds like a nightmare. But I still enjoy the ER.

 

[RustedFox]

So, insurers won't pay what they say they will, so we need someone to make them pay what they said they would.

And we wonder why healthcare is so bloody expensive in America.

 

[cyanide12345678]

Sounds like a nightmare. But I still enjoy the ER.

Yeah no idea what the job is like. Never done anything like this. I honestly just applied for giggles to see what else i can do as a physician and what sort of money ill get offered.

I actually don’t mind my current job at all except the circadian rhythm disruptions. Those are really tough for me now with kids.

 

[cyanide12345678]

So, insurers won't pay what they say they will, so we need someone to make them pay what they said they would.

And we wonder why healthcare is so bloody expensive in America.

A surprising amount of companies do just that. There are a dozen or so open positions for this kind of work.

The highest paying one was corrohealth with a 300k. I got rejected by them 🤣

 

[em1234]

I've been doing it part time (16-20h/mo) for my hospital system for a year now. They are now asking some of us to do it full time. About the same money. fully remote.

The work isn't bad, it's pretty easy, the p2p insurance calls are sometimes annoying but a lot of the time they give in and agree that xyz admission should be paid for. A lot of the time, I tell them some piece of info that they didn't have that changes my "peers" opinion of the case and click, 10 minutes later I've made the hospital 20k and scored a win for the good guys. Sometimes you run in to a recalcitrant douche who just says NO NO NO, but meh, world is full of aholes, on to the next one.

I would NEVER work for an insurance side of this work. I don't think I could handle spending my days trying to screw people out of benefits they paid for and should clearly be covered. I'd spend all day trying to be Robert Parr in the Incredibles, covertly trying to get people to say enough trigger words to get their stuff paid for. I can't imagine a worse way to spend my time.

We also help hospitalists with making sure patients are in the right bed status, obs v inpt. which is again, light work.

It's not overly stimulating or gratifying work, but for a pgy13 who worked his tail off during the golden years of EM and saved like a beast, I am considering making the switch to the full time gig. I'm starting to feel old, (mid40s) sick of nights, sick of missing holidays, sick of missing the time I have left with my children (teenagers). I have already cut back to 10 shifts per mo but my wife and kids are at school/work all day. As fun as it is to putter around the house and watch TV, take a nap and work out, I'm still missing the time with the people I want to be with. As they get home, 5 days a month I am heading out to a night shift and then the inevitable internal clock flip that is taking longer and longer to overcome as I have gotten older, so I am also considering making the switch to full time. 4 day a week-regular hours, no weekend, no nights, no holidays might be worth a 100k pay cut to me. I'm still grappling with the it.

FWIW, I don't mind the work. i wake up at about 7:50, 10 minutes before my shift starts, login and hop on my treadmill, work at my treadmill desk, walking 1.5 mph, knocking out a 6 mile walk every 4h work day. I'd consider it a pretty secure longtime outlook. Bureaucracy only ever seems to get worse and become more complicated. I doubt the state and federal government's ineptitude will do anything but embolden insurance companies to get more brazen in their desire to not pay for care so we'll always be needed to argue with the soulless chumps.

-1234

 

[JacobMcCandles]

A lot of the time, I tell them some piece of info that they didn't have that changes my "peers" opinion of the case and click, 10 minutes later I've made the hospital 20k and scored a win for the good guys.

In no world is the hospital the good guy. You’re just negotiating between two bad faith actors.

 

[em1234]

I knew as soon as I wrote that someone would say that, before posting I meant to change it to good-ish guy.

Maybe score one for the "better" guy is most accurate. good guy is too generous.

 

[cyanide12345678]

I've been doing it part time (16-20h/mo) for my hospital system for a year now. They are now asking some of us to do it full time. About the same money. fully remote.

The work isn't bad, it's pretty easy, the p2p insurance calls are sometimes annoying but a lot of the time they give in and agree that xyz admission should be paid for. A lot of the time, I tell them some piece of info that they didn't have that changes my "peers" opinion of the case and click, 10 minutes later I've made the hospital 20k and scored a win for the good guys. Sometimes you run in to a recalcitrant douche who just says NO NO NO, but meh, world is full of aholes, on to the next one.

I would NEVER work for an insurance side of this work. I don't think I could handle spending my days trying to screw people out of benefits they paid for and should clearly be covered. I'd spend all day trying to be Robert Parr in the Incredibles, covertly trying to get people to say enough trigger words to get their stuff paid for. I can't imagine a worse way to spend my time.

We also help hospitalists with making sure patients are in the right bed status, obs v inpt. which is again, light work.

It's not overly stimulating or gratifying work, but for a pgy13 who worked his tail off during the golden years of EM and saved like a beast, I am considering making the switch to the full time gig. I'm starting to feel old, (mid40s) sick of nights, sick of missing holidays, sick of missing the time I have left with my children (teenagers). I have already cut back to 10 shifts per mo but my wife and kids are at school/work all day. As fun as it is to putter around the house and watch TV, take a nap and work out, I'm still missing the time with the people I want to be with. As they get home, 5 days a month I am heading out to a night shift and then the inevitable internal clock flip that is taking longer and longer to overcome as I have gotten older, so I am also considering making the switch to full time. 4 day a week-regular hours, no weekend, no nights, no holidays might be worth a 100k pay cut to me. I'm still grappling with the it.

FWIW, I don't mind the work. i wake up at about 7:50, 10 minutes before my shift starts, login and hop on my treadmill, work at my treadmill desk, walking 1.5 mph, knocking out a 6 mile walk every 4h work day. I'd consider it a pretty secure longtime outlook. Bureaucracy only ever seems to get worse and become more complicated. I doubt the state and federal government's ineptitude will do anything but embolden insurance companies to get more brazen in their desire to not pay for care so we'll always be needed to argue with the soulless chumps.

-1234

How much are you paid to do this work?

Is the work and quality of life hands down better than being in an emergency room?

How did you learn this stuff? Or did someone train you when you started?

The only downside to doing it full time is that once you’ve committed and been out of clinical medicine, there’s no way to go back i feel.

What’s work flow like? Is there a list of rejected insurance claims where you pick a case, do a chart review, then email the insurance company about it and set up a time for a peer to peer?

Are you expected to get a certain number of approvals per month and go through a quota of certain number of cases per day?

 

[Pigg-O-Stat]

Yeah no idea what the job is like. Never done anything like this. I honestly just applied for giggles to see what else i can do as a physician and what sort of money ill get offered.

I actually don’t mind my current job at all except the circadian rhythm disruptions. Those are really tough for me now with kids.

I only work days now. Years of nights and circadian rhythm disruptions were taking a toll. It wasn't easy, but I found a way to do days only and I feel way better.

 

[thegenius]

Has anyone been a physician reviewer for a hospital? Essentially the person who fights for the hospital to get things approved by insurance.

One day i was really bored and disliking the ER more than usual so i decided to apply to a bunch of remote stay at home non clinical positions.

Got 1 rejection, ghosted by 3, but my own hospital system happened to be hiring as well and now I’m finding myself with a third interview in my internal hospital system. Obviously it’s going to be a pay cut, 250k for full time.

I honestly only applied to things to see what else is out there, just to get offers to see if anything would come remotely close to my clinical medicine salary. I don’t think i was ever fully willing to jump ship from clinical medicine

Whose done this kind of work? Is it terribly frustrating work dealing with insurance? Is a regular schedule worth working so many more days in a month? Is there job security in this kind of work?

If the money is right, i might consider doing M-W remote work at home. Thursday 24 hour ER shift in my critical access hospital. But a huge part of me just prefers a 10 x 12 hour shifts per month schedule that I’ll have this October onwards.

Thoughts from the group?

Overall seems like a pretty thankless job.
Really sad that there are probably 10s billions of dollars spent every year to fight to get 100s billions of dollars in revenue.

Personally I wouldn't be proud to do this job. That may not be a priority for some though.

I still like being an ER doc, it's just harder and harder to find situations where you genuinely help someone get over their illness or injury.

 

[Apollyon]

I knew as soon as I wrote that someone would say that, before posting I meant to change it to good-ish guy.

Maybe score one for the "better" guy is most accurate. good guy is too generous.

I've never seen that guy post something positive. Maybe he has, but, I missed it. All I know is, what I see from him is a negative, or tearing someone down.

 

[cyanide12345678]

Overall seems like a pretty thankless job.
Really sad that there are probably 10s billions of dollars spent every year to fight to get 100s billions of dollars in revenue.

Personally I wouldn't be proud to do this job. That may not be a priority for some though.

I still like being an ER doc, it's just harder and harder to find situations where you genuinely help someone get over their illness or injury.

A job is a job. It’s not a calling. If someone paid me 350k to work from home, regular schedule, paid time off, federal holidays off, with great job security, then id take it.

 

[thegenius]

A job is a job. It’s not a calling. If someone paid me 350k to work from home, regular schedule, paid time off, federal holidays off, with great job security, then id take it.

Duh
I never said it's a calling. I said it's nice to have a job where you can have some pride doing it.

 

[Groove]

Sounds miserable. Get a Twitch account and get paid to play Starfield all day long. Then you could do an options course and sell it on EMDocs. That'd be way more fun. Throw in a bonus section at the end going over a few weird rashes and they'd all be hooked.

 

[cyanide12345678]

Sounds miserable. Get a Twitch account and get paid to play Starfield all day long. Then you could do an options course and sell it on EMDocs. That'd be way more fun. Throw in a bonus section at the end going over a few weird rashes and they'd all be hooked.

Hahah i did buy the domain putselling.com 4 months ago in case i ever decide to pursue a business out of financial education. And i got all social media handles for that name as well.

Haven’t even built a website yet. I have 1 tiktok follower 😂

 

[JacobMcCandles]

I've never seen that guy post something positive. Maybe he has, but, I missed it. All I know is, what I see from him is a negative, or tearing someone down.

That guy as in me? Most of the threads here are negative in nature. I still have a positive outlook on the specialty as a whole, as I’ve mentioned previously, but EM isn’t for everyone. Hospitals (especially “non-profits”) are generally just as shady as insurance companies when it comes to finances and not doing what’s best for the patient. Other things that are frequent topics are ACEP, CMGs, stock trading, etc., all things I don’t support. Where are the threads about SDGs, sports, personal finances (in general), puppies, etc.?

 

[em1234]

How much are you paid to do this work?

Is the work and quality of life hands down better than being in an emergency room?

How did you learn this stuff? Or did someone train you when you started?

The only downside to doing it full time is that once you’ve committed and been out of clinical medicine, there’s no way to go back i feel.

What’s work flow like? Is there a list of rejected insurance claims where you pick a case, do a chart review, then email the insurance company about it and set up a time for a peer to peer?

Are you expected to get a certain number of approvals per month and go through a quota of certain number of cases per day?

1. The pay is basically what you quoted above. 250-275. W2

2. The work is infinitely easier. Normal hours. No med mal risk. There is a TON of grey area in this business which is why actual physicians have to do it and AI is not much of a concern at the moment. It is not the most riveting thing you’ll do but it is certainly mentally engaging. It’s like detective work. Looking for critical pieces of the case to support your argument for or against.

3. Our hospital system trained us by way of watching a million modules and sort of apprenticing other docs who have been doing it for a lot longer helping coach you along.

4. The set up is 4 10h days so I could still work in the ED if I wanted so less of a concern. If you get a hankering for an old fashioned professional beat down, there is always a Saturday overnight someone wants to get rid of, I’m sure. 🙂

5. There are two primary arms to the job.
A-obs vs inpt assignment
-a seemingly never ending list of admissions that are thought to be in the wrong status are created by all the case managers in our hospital system. We comb through the chart to see if we agree with the status the hospitalist chose and if not let them know to make a switch. That’s about half of the day. We shoot for about 60 charts in 4h.

B-peer to peer conferences.
Yes, someone somewhere makes a list of denied claims. A few get assigned to you. We comb through the chart. Make sure we agree there is merit to our argument. The system sets up the p2p and give you a time my peer will call me. Make a case for why we should get paid and move on. Some of the stuff they initially deny is WILD. STEMI with stents-denied. Overturned on p2p. Full blown sepsis on pressors -denied then overturned. Part of the insurance scam is that they hope to win a battle of attrition. They hope hospitals won’t invest the time to argue and they get to keep the money.

There might be bad actors everywhere, but it is pretty easy to sleep at night knowing that I’m on the right side of these phone calls.

I wouldn’t consider it thankless. The hospital is happy with what we do. Small rural hospitals are closing and that trend will accelerate because insurance companies are maliciously not holding up their end of the bargain. This job helps our hospital system keep door open, keep services offered and taking care of people. There is a measure of satisfaction hearing the p2p person slap their forehead and say “oh yeah, that should be paid”

It’s not for everyone, I’m not even sure it’s for me. I still only do it part time. Hell, I’m writing this from the department right now. but I’m older, I’m tired, I’ve made my money and am debt free, I don’t need the excitement, I’ve saved plenty of lives in my career. I can proudly say there are dozens of people walking the earth because of me and if I decide to make the switch I am content with what I have achieved. Unfortunately, I’ve kind of lost my love for the game. For those of you who haven’t, good on you. We need you there. I need you there for when my family or I get sick. For people entertaining the switch or just wondering what we do, that’s what our system has us doing.

-1234

 

[bravotwozero]

Well at the very least, here’s one more side gig option/exit strategy to consider. Good to know.

 

[Brigade4Radiant]

Also you can still do a couple of ED shifts on the side with these insurance jobs if you need the extra cash

 

[namethatsmell]

1. The pay is basically what you quoted above. 250-275. W2

2. The work is infinitely easier. Normal hours. No med mal risk. There is a TON of grey area in this business which is why actual physicians have to do it and AI is not much of a concern at the moment. It is not the most riveting thing you’ll do but it is certainly mentally engaging. It’s like detective work. Looking for critical pieces of the case to support your argument for or against.

3. Our hospital system trained us by way of watching a million modules and sort of apprenticing other docs who have been doing it for a lot longer helping coach you along.

4. The set up is 4 10h days so I could still work in the ED if I wanted so less of a concern. If you get a hankering for an old fashioned professional beat down, there is always a Saturday overnight someone wants to get rid of, I’m sure. 🙂

5. There are two primary arms to the job.
A-obs vs inpt assignment
-a seemingly never ending list of admissions that are thought to be in the wrong status are created by all the case managers in our hospital system. We comb through the chart to see if we agree with the status the hospitalist chose and if not let them know to make a switch. That’s about half of the day. We shoot for about 60 charts in 4h.

B-peer to peer conferences.
Yes, someone somewhere makes a list of denied claims. A few get assigned to you. We comb through the chart. Make sure we agree there is merit to our argument. The system sets up the p2p and give you a time my peer will call me. Make a case for why we should get paid and move on. Some of the stuff they initially deny is WILD. STEMI with stents-denied. Overturned on p2p. Full blown sepsis on pressors -denied then overturned. Part of the insurance scam is that they hope to win a battle of attrition. They hope hospitals won’t invest the time to argue and they get to keep the money.

There might be bad actors everywhere, but it is pretty easy to sleep at night knowing that I’m on the right side of these phone calls.

I wouldn’t consider it thankless. The hospital is happy with what we do. Small rural hospitals are closing and that trend will accelerate because insurance companies are maliciously not holding up their end of the bargain. This job helps our hospital system keep door open, keep services offered and taking care of people. There is a measure of satisfaction hearing the p2p person slap their forehead and say “oh yeah, that should be paid”

It’s not for everyone, I’m not even sure it’s for me. I still only do it part time. Hell, I’m writing this from the department right now. but I’m older, I’m tired, I’ve made my money and am debt free, I don’t need the excitement, I’ve saved plenty of lives in my career. I can proudly say there are dozens of people walking the earth because of me and if I decide to make the switch I am content with what I have achieved. Unfortunately, I’ve kind of lost my love for the game. For those of you who haven’t, good on you. We need you there. I need you there for when my family or I get sick. For people entertaining the switch or just wondering what we do, that’s what our system has us doing.

-1234

Good on ya for finding something sustainable that works for you.

When I started considering pain fellowship I can’t tell you the amount of shade I received from some of my EM colleagues and former mentors. That was 6 years ago.. fast-forward and surprise surprise several of THEM no longer do EM.

Very few people outside of immediate family really truly give a damn about your (royally speaking) career choices. If you can sleep well at night with the work you do and the job otherwise works for your life situation that’s great.

 

[namethatsmell]

And for what it’s worth, in the dumpster fire that is our health care “system”…the majority of hospitals are not anywhere close to the biggest problem—that would be the insurers. At least hospitals provide something of value to patients.

 

[namethatsmell]

The only thing that might want to make me jump ship is the prospect of saying goodbye to nights weekends and holidays forever. Otherwise, not worth it.

I haven’t worked an overnight in years and haven’t worked a weekend or holiday in ~3 years. Once you get used to it…it’s incredibly difficult to go back. I’m not sure I ever will.

 

[bravotwozero]

I haven’t worked an overnight in years and haven’t worked a weekend or holiday in ~3 years. Once you get used to it…it’s incredibly difficult to go back. I’m not sure I ever will.

You work at the VA, if I’m not mistaken?

 

[namethatsmell]

You work at the VA, if I’m not mistaken?

I used to do prn work at a VA ED. The way VA EDs are staffed (and run) varies massively. Some are great places to work and some are pretty lame. At the shop I worked, only contractors worked the overnights. And if stayed late on a shift they asked me to amend my timecard so they could pay me accordingly. It was pretty swell.

 

[bky3c]

I have a friend (former EP who retired around the same time I did) who's been doing this for about a year and likes it. Flexible schedule, 6-hour shifts, easy to switch shifts with coworkers, not very demanding work. She only works part time, but she's been very happy with it.

 

[NITRAS]

Dude, I’ve done plenty of P2P for insurance companies. Make you postal.
I’ve been able to make like 3 reversals. Either they make a denial without any information and it is no issue, or it is a flat denial.

I had a LOL who was altered, UTI, afib rvr, subacute stroke on MRI, had her like 5 days. The guy ultimately agreed with inpt, but it took a 10 minute phone call .. . “Each of these things is obs, but given everything together I guess we can agree with inpt.”

 

[SeekerOfTheTree]

Has anyone been a physician reviewer for a hospital? Essentially the person who fights for the hospital to get things approved by insurance.

One day i was really bored and disliking the ER more than usual so i decided to apply to a bunch of remote stay at home non clinical positions.

Got 1 rejection, ghosted by 3, but my own hospital system happened to be hiring as well and now I’m finding myself with a third interview in my internal hospital system. Obviously it’s going to be a pay cut, 250k for full time.

I honestly only applied to things to see what else is out there, just to get offers to see if anything would come remotely close to my clinical medicine salary. I don’t think i was ever fully willing to jump ship from clinical medicine

Whose done this kind of work? Is it terribly frustrating work dealing with insurance? Is a regular schedule worth working so many more days in a month? Is there job security in this kind of work?

If the money is right, i might consider doing M-W remote work at home. Thursday 24 hour ER shift in my critical access hospital. But a huge part of me just prefers a 10 x 12 hour shifts per month schedule that I’ll have this October onwards.

Thoughts from the group?

I did this and am happy to say I quit a while ago. Just my two cents. Initially it seemed fun but you get tired of always dealing with insurance companies. Admin breathes down your neck hoping you can make magic money appear. The other physicians start seeing you in a not so nice light. I have a feeling I know where you are and just will say make sure you are 100% remote. Some of these places can bait and switch. They are low balling you just a little for 40 hours a week. Make sure you get some CME and vacation time. I feel this would be a gig I might consider in my late 50s. I've done it long enough where for the next decade I would stay away. Based on hospitals changing direction from their CEOs the role can be rocky so be careful of that.

 

[SeekerOfTheTree]

In no world is the hospital the good guy. You’re just negotiating between two bad faith actors.

This is the truth, there are no good guys. I saw the hospital try to screw the docs and also go down the slippery slope of wanting to overbill. I didn't want to get caught in that mess.

 

[SeekerOfTheTree]

How much are you paid to do this work? Should be 300k for fulltime

Is the work and quality of life hands down better than being in an emergency room? The same to me. Deal with one frustrating insurance call and your day feels wrecked. The regular schedule is nice but more days are not.

How did you learn this stuff? Or did someone train you when you started? Trained. You used MCG and Interqual. You learn about coding, appeals, and other things.

The only downside to doing it full time is that once you’ve committed and been out of clinical medicine, there’s no way to go back i feel. Keep doing 3 shifts a month to stay relevant

What’s work flow like? Is there a list of rejected insurance claims where you pick a case, do a chart review, then email the insurance company about it and set up a time for a peer to peer? You set a time range for the P2P, you write appeal letters, nurses send you cases to review. The day and flow varies. Some days are more overwhelming

Are you expected to get a certain number of approvals per month and go through a quota of certain number of cases per day? No

 

[SeekerOfTheTree]

Dude, I’ve done plenty of P2P for insurance companies. Make you postal.
I’ve been able to make like 3 reversals. Either they make a denial without any information and it is no issue, or it is a flat denial.

I had a LOL who was altered, UTI, afib rvr, subacute stroke on MRI, had her like 5 days. The guy ultimately agreed with inpt, but it took a 10 minute phone call .. . “Each of these things is obs, but given everything together I guess we can agree with inpt.”

I agree, this is what gets you. 90% of your calls are trying to convince the insurance company that we kept the 50 year old with back pain for 5 days to give IV dilaudid to every 2 hours as INP because it was justified.

Here's the kicker to all this OBS and INP stuff...the hospital signed the contracts and read the details of what will be allowed and what criteria will be used. The CEOs of these hospitals and all the freaking C-suite got 100% raises. Look at their tax returns, they are public knowledge. They are all complaining now that the money is gone. The hospitals have convinced us docs that everyone else is the problem and they are just trying to do the right thing.

Please always remember the good guy hospitals lobbied (American Hospital Association) to get rid of physician owned hospitals. These are the good guys that lobbied to get travel nurses pay capped because they were making too much and the C-suite wasn't making enough. My friends have lost their Urgent cares because the big non-profit hospital decided to open an urgent care across theirs because they wanted the business; not because it was the right thing to do. The C-suite gives contracts to those that benefit on the board. I have seen all this first hand.

Nobody is better in this game of healthcare.

 

[Tiger26]

I do this for our hospital as 0.2 of my FTE. It's somewhat mundane but pretty easy. Definitely shows you a little more about how the sausage is made with regard to healthcare.

 

[NYEMMED]

This sounds like a physician advisor job

 

[Birdstrike]

I know a guy that left EM to work for an insurance company to deny patients care. He's a reat guy. It surprised me that he took such a job. But I know he wanted, and needed, to get out of EM, so...it is what it is.

I wasn't aware hospital employ docs to be on the other side, but it makes sense that they would, as much money as is involved.

If you can do this work and prevent patients getting denied care or stuck with outrageous bills, it seems like a job worth doing, to me. If it's allowing a hospital to get paid a 5 times overcharge for something, or allows an insurance company to screw a patient out of healthcare they paid premiums for, then it's not something I would want to be a part of.

 

[Dr Mantis Toboggan]

I know a guy that left EM to work for an insurance company to deny patients care. He's a reat guy. It surprised me that he took such a job. But I know he wanted, and needed, to get out of EM, so...it is what it is.

I wasn't aware hospital employ docs to be on the other side, but it makes sense that they would, as much money as is involved.

If you can do this work and prevent patients getting denied care or stuck with outrageous bills, it seems like a job worth doing, to me. If it's allowing a hospital to get paid a 5 times overcharge for something, or allows an insurance company to screw a patient out of healthcare they paid premiums for, then it's not something I would want to be a part of.

It’s primarily trying to get insurance versus obs $ from what I understand. Obs I think pays 1/3 as much as inpatient.

 

[Tiger26]

To expand a little more, insurance companies have their medical directors to deny coverage and hospitals have physician advisors to try to dispute those decisions. A lot of it is fighting over obs vs inpatient statuses.

 

[cyanide12345678]

To expand a little more, insurance companies have their medical directors to deny coverage and hospitals have physician advisors to try to dispute those decisions. A lot of it is fighting over obs vs inpatient statuses.

Yes exactly. That’s my understanding as well.

Physician advisor position fighting inpatient vs obs to get hospital extra reimbursement

 

[cyanide12345678]

I wasn't aware hospital employ docs to be on the other side, but it makes sense that they would, as much money as is involved.

So instead of having their clinical staff spend time and energy making phone calls to insurance and doing peer to peer, they have separate physicians doing it.

 

[gutonc]

This conversation has me thinking about another potential position that pretty much any group of outpatient physicians could implement. Somebody to take point on all the appeal/P2Ps that need to be done for drugs, labs, imaging and procedures. My hospital employed group has 30-35 physicians in it. If I were to extrapolate my own experience to the group as a whole, that's something on the order of 30-50 P2Ps a week, since I do 1-2 a week on average.

Each of those takes me 20-30 minutes total including reviewing the chart, reviewing guidelines/recommendations/studies that support whatever I want approved and talking to the reviewer, who almost universally approves what I've requested. That time doesn't take into account needing to block my schedule or do this on my off time. So on the low end (30 P2Ps a week at 20 minutes a pop), you're looking at 10 hours for a group of our size. Add in a 10% fudge factor for the overall lack of efficiency in the system and you're looking at .25-.3 FTE (on the low end) to .65-.7 FTE (on the high end) "wasted" on P2Ps and appeals. It honestly probably comes closer to a 1.0 physician FTE if you factor in the real inefficiencies, but I'm trying to be conservative here.

It would make a ton of sense for my group (or any group of any specialty of reasonable size) to assign that FTE to a single physician who could set aside half a day once or 3 times a week (depending on the need), to allow the other physicians to continue to see patients and generate revenue.

 

[cyanide12345678]

This conversation has me thinking about another potential position that pretty much any group of outpatient physicians could implement. Somebody to take point on all the appeal/P2Ps that need to be done for drugs, labs, imaging and procedures. My hospital employed group has 30-35 physicians in it. If I were to extrapolate my own experience to the group as a whole, that's something on the order of 30-50 P2Ps a week, since I do 1-2 a week on average.

Each of those takes me 20-30 minutes total including reviewing the chart, reviewing guidelines/recommendations/studies that support whatever I want approved and talking to the reviewer, who almost universally approves what I've requested. That time doesn't take into account needing to block my schedule or do this on my off time. So on the low end (30 P2Ps a week at 20 minutes a pop), you're looking at 10 hours for a group of our size. Add in a 10% fudge factor for the overall lack of efficiency in the system and you're looking at .25-.3 FTE (on the low end) to .65-.7 FTE (on the high end) "wasted" on P2Ps and appeals. It honestly probably comes closer to a 1.0 physician FTE if you factor in the real inefficiencies, but I'm trying to be conservative here.

It would make a ton of sense for my group (or any group of any specialty of reasonable size) to assign that FTE to a single physician who could set aside half a day once or 3 times a week (depending on the need), to allow the other physicians to continue to see patients and generate revenue.

While technically it will make your group more productive where you guys will be and to see more patients and deal with less administrative headache, but I’m not sure if the activity of outpatient p2p generates any direct revenue. Mostly you guys have p2p conversations to get things approved for patients correct?

It will basically only be a convenience factor for you guys, will save you guys time and energy and only an indirect financial benefit if you guys choose to see more patients during that time. So it would be harder to justify that cost i feel.

On the other hand, for a hospital, this directly generates revenue. Most likely 3 or 4 obs to inpatient conversions in a month probably pays the physician salary.

 

[cyanide12345678]

I agree, this is what gets you. 90% of your calls are trying to convince the insurance company that we kept the 50 year old with back pain for 5 days to give IV dilaudid to every 2 hours as INP because it was justified.

Here's the kicker to all this OBS and INP stuff...the hospital signed the contracts and read the details of what will be allowed and what criteria will be used. The CEOs of these hospitals and all the freaking C-suite got 100% raises. Look at their tax returns, they are public knowledge. They are all complaining now that the money is gone. The hospitals have convinced us docs that everyone else is the problem and they are just trying to do the right thing.

Please always remember the good guy hospitals lobbied (American Hospital Association) to get rid of physician owned hospitals. These are the good guys that lobbied to get travel nurses pay capped because they were making too much and the C-suite wasn't making enough. My friends have lost their Urgent cares because the big non-profit hospital decided to open an urgent care across theirs because they wanted the business; not because it was the right thing to do. The C-suite gives contracts to those that benefit on the board. I have seen all this first hand.

Nobody is better in this game of healthcare.

Hey thank you so much for the education and sharing your experience. Greatly appreciated.

I initially got quoted $140/hr starting salary. Haven’t seen the full benefits package because i don’t have an official offer yet.

 

[end stage fibro]

I have been doing this for roughly 2ish years full time now. I wrote a post about it in the IM forum.

It is maddening dealing with payors all the time. As you and your program mature, you become a victim of your success. All the easy cases are already streamlined (XSOLIS is well utilized, there is a good denials team with templates that you wrote, strong front and back end team). What makes its way to you are more difficult cases and you can have a low success rate at that point. The average physician has no idea what the payors (including CMS) are up to but to me it essentially looks like pay cuts in perpetuity. This is the main threat to the longevity of the job for me; these payors are scum. Job security otherwise good. I easily make my salary (and then some) in terms of reclaiming money for the hospital. This doesn’t even account for derisking compliance and audit issues.

250k is below market rate unless you are dealing with an extremely light load.

I do think it is a thankless job. Other docs were happy I was going into the job because they thought I would somehow magically cut all red tape in the hospital. Now they see me as complicit, even though behind the scenes I put in a lot of work to shield physicians and make our processes less intrusive for them.

I do agree that in a perfect world, my position shouldn’t exist...bureaucracy begets bureaucracy. Some docs moan endlessly about going into medicine to see patients and medicine shouldn’t be like this. yeah no ****. Your principles ain’t gonna pay the bills, though. I know the AHA/corporatization of medicine sucks. They are by no means the good guys, but they are the lesser of 2 evils. Playing the game is what allows our hospital system to have staffing well into the 1st quartile, good physician lounges, and a bunch of new toys that the big box hospital down the street does not provide. Hell, we even have IR on the weekend.

Most importantly, I can work from home and have monitors dedicated to trading platforms. I am a firm believer in “What’s the fastest way to make a million? Start with 2 million.”

A tangent: some haters at my previous job were wondering aloud if I was worried about losing my skills. One, they don’t know how many side gigs I have. Two, I can still order “pan CT and consult cardiology,renal,ID” as well as they can. Three, I see way more charts and read them (and guidelines) way more thoroughly than I did as a hospitalist (and definitely more than an EP 😁). I could see in EM that losing procedural skills might be an issue.