Reimbursement: What does the future hold?

[tmvguy03]

Any thoughts on what reimbursement will be like in the next 5-10 years for:
1. SCS Trials
2. RFA
3. ESI
(just some examples of the most common things most of us do...)
I've been in practice for 1.5 years now, and don't really have a concept of where things were in the past or how to think about the future in terms of changes in reimbursement.

---

Members don't see this ad.

 

[clubdeac]

They’ll continue to slowly decrease

 

[BobBarker]

They’ll continue to slowly decrease

Pretty sure that most things have slowly increased, actually.

 

[nvrsumr]

Relative to inflation has decreased.

The slice of the pie the doc receives will slowly decrease. The mbas will continue to rent seek and skim the tiny increased reimbursement.

 

[drusso]

The future is to get outside the thumb of traditional payer arrangements.

 

[emd123]

Can't tell you what it'll do the next five to ten, but here's what reimbursement is doing in 1 year:

http://files.constantcontact.com/be15115b001/a3355a8d-7658-4248-b7b5-046be703f640.pdf

 

[clubdeac]

Pretty sure that most things have slowly increased, actually.

Yes you are correct. The cost of college tuition has doubled (100% increase) in 20 years. Home prices and overall cost of living have increased by approximately 50%. Physician salaries not so much

 

[Ferrismonk]

Someone I know who helps set Medicare rates gave me an idea how this works. Let me put it this way, the people who recommend Medicare rate adjustments own ASCs and do procedures in them...

I would expect ESI, RFA, Stim, etc will increase, especially the ASC facility fee, and SI, misc joints, periph nerves, etc will continue to flatline.

 

[drusso]

Someone I know who helps set Medicare rates gave me an idea how this works. Let me put it this way, the people who recommend Medicare rate adjustments own ASCs and do procedures in them...

I would expect ESI, RFA, Stim, etc will increase, especially the ASC facility fee, and SI, misc joints, periph nerves, etc will continue to flatline.

But wait until Medicare sees the SOS for office-based venues...

 

[painfree23]

But wait until Medicare sees the SOS for office-based venues...

sos?

 

[Disciple]

But wait until Medicare sees the SOS for office-based venues...

Think it will get that far? Countdown to 2020 election starts in about 6 months.

 

[drusso]

sos?

site of service differential.

 

[Ferrismonk]

But wait until Medicare sees the SOS for office-based venues...

Right. Once things go to ASCs, next step will be moving to in-office I'm sure. My guess is that will take years though.

 

[Ducttape]

Right. Once things go to ASCs, next step will be moving to in-office I'm sure. My guess is that will take years though.

why? give me one group that has clout (ie plenty of cash on hand) to convince CMS to approve SOS for inoffice procedures.

just one group....


fwiw, its not AMA. its not the hospital contingency. its not Big Pharma or Device Co.

 

[drusso]

why? give me one group that has clout (ie plenty of cash on hand) to convince CMS to approve SOS for inoffice procedures.

just one group....


fwiw, its not AMA. its not the hospital contingency. its not Big Pharma or Device Co.

Absolutely disgusting. This SOS difference is adding **NO** value for patients & just padding Big Hospital's Pocketbook...

Procedure Price Lookup

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
Code: 64483

Patient pays (average)

$70

Ambulatory surgical centers
Average Medicare pays
$280
Average total cost
$350
Patient pays (average)

$134

Hospital outpatient departments
Average Medicare pays
$538
Average total cost
$672

 

[Disciple]

Absolutely disgusting. This SOS difference is adding **NO** value for patients & just padding Big Hospital's Pocketbook...

Procedure Price Lookup

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
Code: 64483

Patient pays (average)

$70

Ambulatory surgical centers
Average Medicare pays
$280
Average total cost
$350
Patient pays (average)

$134

Hospital outpatient departments
Average Medicare pays
$538
Average total cost
$672

I thought that extra money was needed to cover Medicaid and uninsured patients?

What? Are you saying that’s total BS?

 

[painfree23]

Absolutely disgusting. This SOS difference is adding **NO** value for patients & just padding Big Hospital's Pocketbook...

Procedure Price Lookup

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
Code: 64483

Patient pays (average)

$70

Ambulatory surgical centers
Average Medicare pays
$280
Average total cost
$350
Patient pays (average)

$134

Hospital outpatient departments
Average Medicare pays
$538
Average total cost
$672

What exactly is a “HOPD” - is that a Hospital based procedure?? Or a clinic associated with a hospital?

 

[emd123]

What exactly is a “HOPD” - is that a Hospital based procedure?? Or a clinic associated with a hospital?

Hospital based procedure.

 

[DOctorJay]

Hospital outpatient department is what the acronym stands for I believe. I have one of these suites attached to my office through a door. Once I cross the threshold I’m in the “hospital”. They no longer allow these types of suites to be built unless you’re within like 250 yards from the actual hospital.

Our group built a new office and had planned to include another HOPD suite there but it was scrapped at the last minute because of these new rules. That guy now has to go to the hospital OR for his procedures which is a huge waste of time but is the only option (of course it’s not the only option, they could have built an “office” suite but then no gigantic facility fees).


Sent from my iPhone using SDN

 

[clubdeac]

Someone I know who helps set Medicare rates gave me an idea how this works. Let me put it this way, the people who recommend Medicare rate adjustments own ASCs and do procedures in them...

I would expect ESI, RFA, Stim, etc will increase, especially the ASC facility fee, and SI, misc joints, periph nerves, etc will continue to flatline.

This kind of crap needs to be exposed for what it is.... it's a total racket. These individuals are no different than the pain docs we read about every week who get thrown in jail for 20+ years for breaking anti-kickback rules and over prescribing. The NYT, Washington Post etc. need to run an article about this stuff. What a scam

 

[SSdoc33]

This kind of crap needs to be exposed for what it is.... it's a total racket. These individuals are no different than the pain docs we read about every week who get thrown in jail for 20+ years for breaking anti-kickback rules and over prescribing. The NYT, Washington Post etc. need to run an article about this stuff. What a scam

wait a minute: money buys political influence? the hell you say.......

your naivete' is inspiring.

 

[olafa]

just curious...
Where did these numbers come from?

QUOTE="drusso, post: 20497061, member: 200"]Absolutely disgusting. This SOS difference is adding **NO** value for patients & just padding Big Hospital's Pocketbook...

Procedure Price Lookup

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
Code: 64483

Patient pays (average)

$70

Ambulatory surgical centers
Average Medicare pays
$280
Average total cost
$350
Patient pays (average)

$134

Hospital outpatient departments
Average Medicare pays
$538
Average total cost
$672[/QUOTE]

 

[drusso]

just curious...
Where did these numbers come from?

QUOTE="drusso, post: 20497061, member: 200"]Absolutely disgusting. This SOS difference is adding **NO** value for patients & just padding Big Hospital's Pocketbook...

Procedure Price Lookup

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
Code: 64483

Patient pays (average)

$70

Ambulatory surgical centers
Average Medicare pays
$280
Average total cost
$350
Patient pays (average)

$134

Hospital outpatient departments
Average Medicare pays
$538
Average total cost
$672

[/QUOTE]

The Federal Government...if you believe them...