Understanding facility reimbursement
Started by SpineandWine
facility should be getting 1 set fee. the equipment doesnt really change (ie fluoroscopy, use of procedure suite, etc).
i dont do 64636, as it is generally not covered by Medicare and those that follow Medicare guidelines. i suspect there is no additional reimbursement.
i dont do 64636, as it is generally not covered by Medicare and those that follow Medicare guidelines. i suspect there is no additional reimbursement.
RFA is low margin then
Pain facility fee is not as high as I thought
Pain facility fee is not as high as I thought
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Depends on payer/contract but we get 1.5x pro and facility. Facility only gets paid on 1st level though.
1.8k is good, way higher than ASC or office. Needles don't cost that much, I'd consider good margin.
1.8k is good, way higher than ASC or office. Needles don't cost that much, I'd consider good margin.
Assuming half hour for bilateral RFa
Similar to two slots of 15 minute epidurals bilateral TFESi
What's your facility fee for ESI?
Medicare procedure price look up for TFESi- is 800 buckaroos.
1.5x is 1200
X2 15 minute slot= 2400
1.8k x1.5 is 2700
1.5x is 1200
X2 15 minute slot= 2400
1.8k x1.5 is 2700
Pretty similar. Bilateral TF are the minority for me.
Agree.
Just not as high as I thought.
Total knee facility is much higher margin per time
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I would recheck those numbers. Nothing cranks like a busy pain doc.
TKA CPT 27447 facility is 12k. Assuming 6k for implant cost
6 k margin for 1.5 hours
RFA comes close
Better than joints is 2 level ACDF, hard to beat/time
The hospital got 25k from Aetna for my wife’s tkr. Outpatient less than 3 hours in the facility total. SOS
How do you get HOPD facility rates?
working in hospital
But do you have ownership? How are you benefiting from facility fee?
He’s trying to understand his salary and trying to figure out the rvu pellets relative to it
Just my guess
Just trying to understand theoretically
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Is there another site for facility fee for Medicaid?
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Is there another site for facility fee for Medicaid?
No one asks about Medicare and Medicaid facility reimbursements out of “theoretics”
The vail of anonymity on a social media forum should be good enough for you…
“Show yourself” what gives?
Does office work same way?
So let’s say pricing for facet one level for office ablation let’s say at 1k
When people do bilateral L5-S1 ablation, do office people get 1.5k?
So let’s say pricing for facet one level for office ablation let’s say at 1k
When people do bilateral L5-S1 ablation, do office people get 1.5k?
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real world medicare reimbursement in the office is more like 500 for bilateral L345 RFA. just checked some of my 1/2024 #'s. when I do the same procedure at an ASC that I do not own, its down to ~300 for the same procedure. ugh. this stone has nearly bled out
I think we are getting closer to $800 Medicare for a two level lumbar bilateral rfa in the office. Traditional with humana/uhc med advantage a little lower.
Anyone finding in ortho group find this to be true? Are pain docs top producer or above median?
I’ve been in two ortho groups. I work hard but do well. 14,000 wRVU
In my first job in a 5 man group I made more than half of the surgeons and less than the other half.
In my current 8 man group I bring in more $ than 5 of the orthopods and but less $ than 2 of the orthopods.
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@bedrock
Are you looking at just pro fees or also including ASC fees -minus case costs?
Are you looking at just pro fees or also including ASC fees -minus case costs?
There are several surgeons in my group that I cannot hope to compete with under any circumstance.
We have a few outliers that do insane numbers of totals, and two hand guys who do ridiculous numbers as well. Overall, we are 22 or 23 guys and I’m in the upper half.
Our practice is basically set up for the guys doing totals.
We have a few outliers that do insane numbers of totals, and two hand guys who do ridiculous numbers as well. Overall, we are 22 or 23 guys and I’m in the upper half.
Our practice is basically set up for the guys doing totals.
Unlikely to top busy total joint and spine docs…. All else is fair game and doable.
Are you talking top half professional or facility?
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I’m looking at just pro fees.
All the ancillary profits from ASC and MRI are collected and distributed evenly to the partners
A general orthopedist can not hang with a moderately busy pain doctor who is mostly doing clinic procedures, with some ASC.
Not all orthopedists do well BTW, especially trauma (they eat **** on collections, but make up for it with call pay). Too many cases in the hospital IMO, and the payor selection often sucks when they do cases in our surgical centers. Sports is not great either, but many sports guys supplement sports with general ortho cases and that helps.
In my group, if you separate out facility fees and compare me against everyone else, I am very competitive and the only thing that makes it close with a lot of my colleagues are the DME they Rx day in/out. Braces all day, and post op PT.
I do virtually zero DME, so their ancillary collections added into their nonfacility clinic collections adds a huge boost to what they collect.
If I am doing 200-240 spine injections per month, and I am doing roughly 37% of those in an ASC (I own 4% of that 100% physician-owned ASC and do not have a clinic procedure space at that location). I do around 500-600 patient encounters per month (6300 last year), and those numbers put me in the top half of my group before you add in facilities.
End of Feb this year, I was set to end the year around 7000 total patient encounters and have a huge year, but we went live with Athena in March, and this has literally sabotaged my practice. I am F'd right now, but I'll figure out how to fix it.
I'm doing 37% of my procedures in an ASC, but even with just that number of procedures/cases in the ASC I'm competitive. If all of my procedures were ASC I'd be extremely competitive in the facility numbers because of the fact some people seem to forget that collections are just that - collections. That does not include the cost for a case. Ortho cases are expensive.
It's when you add in the outrageously efficient total joint and hand guys that I fall way behind, and I cannot imagine how a pain guy could keep up with them. Bob and GDub sound like they're outliers capable of cranking huge amounts of volume, but I do NOT believe my practice would be able to keep up with that.
Every time I bring a new "thing" to our practice it has a been nightmare. I'm rolling out Intracept now, and this has been quite smooth this time around. Our old ASC director was an ignorant *****, but she's gone.
So I find myself doing tons of procedures (mostly LESI, TFESI, SI joint) ~70%
15-20% mbb/RF
1 kypho on average/week
Very little stim and advanced procedures
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Hard to build when most of my referral is spine asking for injections to then surgerize
- they don’t like SCS so I don’t do on their patients
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1 kypho a week in office will bring it at least $255k/yr on it's own. At medicare rates.
10 last year Jan 1-dec 31
How many ppl do that though? I know office kyphos are routinely performed, but how often does someone do that many in the clinic?
Same. I rarely do stim. Chronic opioid population is the best way to get stims
I did 28 last year, all in office. My partner definitely did more than that.
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I could do 2-3 per week if I wanted. I see failed back daily.
Failed back or revision candidate?
My group has an ASC but it’s 51% owned by a national chain (apparently due to payor contracts the partners actually made a lot more after selling out). Buy-in is individual though, and I do almost all my procedures in office including a lot of RF. Trying to decide whether it would be worth it for me to move enough of my RFs to the ASC to qualify for shares. If I’m reading the safe harbor rules correctly it’s possible if I moved about 1/3 of my RFs and SCS cases there I could qualify. Anyone think that would actually pencil out?
Exactly the reason I am the way I am. I could get authorization for tons of stimulators but I don’t bc I think it’s a very limited therapy that only works for a small number of diagnoses.
Not sure what you mean but I see pts post spine surgery all day every day
Me too but I don’t see that many great SCS candidates. Lots of adjacent segment disease, degenerative foraminal stenosis, etc, but not so much of the “hurts all the time” back and leg nerve damage type of pain. Maybe it’s a function of the local surgeons? They’re all pretty conservative, very reasonable guys.
I always end up seeing some adjacent level disease, then fusion extension if failed TFESI
rf adjacent levels
I do if facet arthropathy
SI if SI as adjacent pain generator
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