Private practice family medicine still possible?

[dpmd]

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Medicare may only pay $50, but there is a 20% co-payment the pt is required to pay on the full amount of the visit. So if the Doc has a $150 visit fee (and medicare only reimburses $50 from that), he/she will also collect $30 in co-payment from the full $150, making that visit really be worth $80.

Medicaid does not pay $75. Probably more like $45 per visit.

You can't collect the copay on the amount you charge for the visit. It is based on 20% of the medicare approved amount. Also, I am pretty sure the OP got his medicare and medicaid amounts mixed up.

 

[MrSunny1]

You can't collect the copay on the amount you charge for the visit. It is based on 20% of the medicare approved amount. Also, I am pretty sure the OP got his medicare and medicaid amounts mixed up.

So essentially there is good money to be made as long as you are seeing at least probably 30 patients per day. 20 is needed to breakeven. On average with a standard practice that accepts a mix of payers. I guess also I would wonder how many hours per week you would work seeing 30 patients per day including charting and all of the paper work that goes in. Also that is 15 min patient visits assuming that is feasible in the long run or is it likely to result in burnout.

 

[MrSunny1]

I did look over several different surveys combining a total of 20,000 physicians and the average FM in the US sees between 11-20 patients per day (40% of pcp in that range) with 20 percent seeing less than 11 pt per day and 26% seeing more than 20 patients. only 8% of physicians are seeing 30+ patients per day so it may not be a smart to setup a business with the expectation of seeing 30+ patients per day. There actually seems to be some sort of catastrophe in pcp visits per physician. In 2008 41% of physicians were seeing 20+ patients and that number has dropped substantially to just 26%.

 

[tymont12]

There are medical consulting firms that can help assess these sorts of details for you. It's difficult to say whether or not you'll be able to do a solo practice because it all depends on where you are, how available you are and how many cash-only services you provide versus medicaid patients you take on. I know PP family med groups doing well, and I know of at least one solo FP doc who takes capitated Medicaid patients at $12/mo. He can barely pay his mortgage. It all depends on your business acumen.

 

[Slack3r]

So essentially there is good money to be made as long as you are seeing at least probably 30 patients per day. 20 is needed to breakeven. On average with a standard practice that accepts a mix of payers. I guess also I would wonder how many hours per week you would work seeing 30 patients per day including charting and all of the paper work that goes in. Also that is 15 min patient visits assuming that is feasible in the long run or is it likely to result in burnout.

Ya, believe it or not you actually have to WORK to make money.

 

[yunsenb]

Another great procedure that I saw a lot of in outpatient was steroid joint injections- they take all of a few minutes and reimburse $119. Do one of those a day and you just earned an extra $31,000.

Any type of joint injection nets $119 or only specific types? I was reading the coding and some of the rvus are different for different injection sites. Where did you get this number if you don't mind me asking

 

[Mad Jack]

Any type of joint injection nets $119 or only specific types? I was reading the coding and some of the rvus are different for different injection sites. Where did you get this number if you don't mind me asking

Can't remember which CPT code it was

 

[VA Hopeful Dr]

Can't remember which CPT code it was

Probably large joint. The CPT codes are broken down into large medium and small joints and or bursa.

The vast majority of the injections that us family doctors do are large joints for the obvious reasons.

 

[MedicineZ0Z]

I worked with a physician who transitioned to this model from her rather successful insurance based family medicine practice during my rotation there. It was pretty interesting to see. She lost a lot of her patients from her old practice but was much happier not having to deal with the insurance BS and to being able to offer her patients reduced costs on labs, meds, etc.. There was a definite lean period during the transition, but from all accounts the practice is starting to gain steam again and pick up new patients and some that she had initially lost.

Why did she lose patient exactly?

 

[VA Hopeful Dr]

Why did she lose patient exactly?

Most likely because people are resistant to not using their insurance for care.

 

[kubyx]

Why did she lose patient exactly?

I work with a lot of doctors that have moved into cash practices because insurance does not work in the area of medicine they practice in. It sounds like most of them took anywhere from 5-30% of their patients with them. The majority of patients are not eager to give up their insurance coverage for a doctor unless they find them irreplaceable.

I am currently working with one doctor that moved from a hospital to PP this year. He charges $350/hour and was able to immediately get about 10% of his patients to move with him. I'm guessing he had over a 1000 patients within his pool previously, so that's not a bad start. He's very unique in what he does so I think he'll continue to gain back patients as they realize they cannot replace him with a conventional insurance practice.

But, if you're just doing the same stuff as the doctor down the road does, good luck differentiating yourself and justifying the additional financial burden your patients will face.

 

[MedicineZ0Z]

I work with a lot of doctors that have moved into cash practices because insurance does not work in the area of medicine they practice in. It sounds like most of them took anywhere from 5-30% of their patients with them. The majority of patients are not eager to give up their insurance coverage for a doctor unless they find them irreplaceable.

I am currently working with one doctor that moved from a hospital to PP this year. He charges $350/hour and was able to immediately get about 10% of his patients to move with him. I'm guessing he had over a 1000 patients within his pool previously, so that's not a bad start. He's very unique in what he does so I think he'll continue to gain back patients as they realize they cannot replace him with a conventional insurance practice.

But, if you're just doing the same stuff as the doctor down the road does, good luck differentiating yourself and justifying the additional financial burden your patients will face.

Makes sense. I'm curious what the Dr was doing exactly though besides conventional medicine?