Oh there is a need. I just recently switched to fulltime with Ortho, leaving my hospital gig. My hospital told me if I didn't come back to do outreach there they would hire someone just for their 8k people county. 8k people. I was making them enough money...crazy. I guess 1200 RVUs generated a year is enough...
But I love Private practice now. I am employed by Ortho, not a partner now. But I get 100 percent of collections less 3 percent supplies and 6 percent billing. And set overhead. Don't miss working for a gigantic corporation like before. I love my freedom. But I have a good setup that is not common. These Ortho dudes have killer contracts. Got paid like 8k on a BCBS retro/Achilles repair. Maybe there were a few more codes on there.....
Jeez. Either the reimbursement per procedure is enormous or you all aren't subject to the 50% off on second procedure.
The things that's funny to me about the idea of ownership and management is - its just so much more than you think it is.
Staff management - 9 employees have left since I started that I can remember. 3 did drugs on the job. One was a great employee who got run off by how she was treated. One was hired for a senior position and left at lunch on day 3 and didn't come back. One fell asleep on the job. One probably had a seamless sexual harrassment case against the practice. One was insane and didn't want to work. Another was worthless but no one seemed to realize it - everytime I walked in to talk to her she was playing a video game and minimized the screen. Another added every single patient as a new patient - post-ops, follow-ups, etc. They need to be taught. They need to understand the system. They ideally should develop clinical judgement. They need to put forward the practice and display competence. They need to make your life easier.
Reputation management - It constitutes every part of how you present yourself and your practice to patients, your local referrals and interactions, your facebook/reviews/etc. Here's a fun one. You spray for bugs. I walked through the front entrance of the practice and found literally a pile of dead roaches that patients had been walking over. I can't remember if I've told this story before, but my office had up old APMA materials that went to a now defunct website that had been take over by a hacker/someone nefarious and it redirected to an unsafe site. Fun/weird/different thing - the simple truth is a lot of blue collar folks have really nice insurance. I sometimes wonder about the sorority girls here for a nail procedure and the electricians with Charcot mingling in the waiting room. I believe I shared this one before but a very nice young woman told me she thought one of my other patients might be dying / smelled like death. She was right. He had nec fasc.
Contract management - SubMedicare rates. Regular denials of covered service (Humana). Insurance plans saying no prior authorization is required and then not paying the surgery (United). A lapidus forefoot slam being denied because you billed 99232 on 2 toes - so they pay none of it (Medicare/Novitas). 50% payment 2nd procedure, 25% payment 3rd procedure (Aetna). Insurance plans that want to reimburse you a multiplier ie. 60% of your fee schedule so you theoretically have to bump your schedule to get paid fairly, but you are trying to have straight forward fair cash pricing schedule. No one wants to pay for custom orthotics anymore - haha, jk, that's not a real problem.
The heart of contract stuff to me though is... there's still money that can be made in clinic even with cuts through the most classic form of suffering. See more patients for less $ per patient. But surgery is cruising towards being untenable for many plans. A major commercial insurer now pays $440 for an Austin. The only world where you can take $440 for an Austin is one where you bill for follow-up visits. I suppose you could try bringing the Austin into your office as a surgery suite set-up, but how much are you going to spend buying equipment. Will you buy fluoro / handsets / sterile setups.
Liability. Old man falls down in parking lot and ambulance has to come get him. Someone in your practice creeps on pretty young lady and then fires her when she declines. A tree on your property cracks a sidewalk - insurance company wants you to repair it. An old lady jumps out of a chair and gets a calcaneal fracture. Is your coding kosher? Does your partner never document dimensions of ulcer debridements...
Random stuff. Supplies. Everything is on back order, still. Medical grade equipment is overpriced. The hospital is hiring a podiatrist because the foot and ankle orthopedist is often disliked by patients. Office cleaning is becoming ridiculously expensive. So you clean it yourself and the water is -black- leading you to believe the cleaners were not actually cleaning. OTC orthotics keep disappearing. Many patients still ultimately just view podiatrists as people who trim nails and calluses. MIPS. Hackers.
