Which physicians generate the most revenue for hospitals...

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drusso

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This is a great article and a worthy of a deep dive into the topic. A while back someone posted about an important metric called the "physician enterprise value" or PEV. This metric quantitates what a hospital MD is worth to his or her employer. It is useful information for all doctors to keep in the back of their head when they sit down with hospital leadership.

One way to make yourself more attractive to your employer is to do things that increase your PEV: Site of service differential, ancillary fees and services, and referrals to higher reimbursing service lines.

Pain physicians can position themselves well to do things to increase their PEV: Minimize revenue leak by referring in-house for radiology, PT/OT, psych, U-tox, surgical specialists, etc. Perform your own services in high intensity/venues to optimize third-party payment: Perform all routine pain management procedures with MAC & in hospital OR's.

By transparently discussing ways to improve PEV, any employed physician can take a strong position to bargain for more guaranteed income (salary), more favorable working conditions, and greater investments in resources and infrastructure to support their practice.

Which physicians generate the most revenue for hospitals?

Below are four findings from the survey.

1. On average, a primary care physician generated about $1.4 million in revenue for his or her affiliated hospital within the last year, compared to $1.6 million generated by a specialist physician.

2. Orthopedic surgeons topped the list as the physician group that generated the most revenue. A full-time orthopedic surgeon brought in an average of $2.7 million in revenue last year for his or her affiliated hospital.

3. Invasive cardiologists generated the second-most revenue, with an average of $2.4 million annually, and neurosurgeons followed close behind. General surgeons took the fourth spot on the list, generating nearly $2.2 million annually for their affiliated hospitals.


4. Primary care physicians presented the best return on investment for hospitals. In 2015, family physicians had an average starting salary of $198,000 at participating hospitals, and generated 7.5 times that amount in hospital revenue. Orthopedic surgeons averaged a starting salary of $497,000 and generated only 5.5 times that amount in revenue.

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How much does the hospital get paid for a MRI or CT by Medicare?

CDIControllingCost.jpg


Need an MRI? It pays to shop around. Big time.

"This price spread was widest in Alaska, where the median price for hospital MRIs was $3,200 more than in imaging centers. Michigan wasn’t much better with a price difference of about $2,500."
 
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good quality MRI's of the spine are $300 in Miami.....joints are less
 
How does one discuss "physician enterprise value" without running afoul of Stark laws?
 
so...patient pays $50 for spine MRI with insurance, vs $500 cash at the imaging center? which is more affordable?

The question I was answering was how much does Medicare pay for MRI. The point is SOS differential is over 5X what test should cost. Cash MRI also includes interpretation unlike hospital where radiologists charge separately.
 
Yea, $2700 is quite a bit more than I thought. I thought around $1200. Heck, I might order 15-20/week.
 
so...

patient pays $50 for spine MRI with insurance, vs $500 cash at the imaging center? which is more affordable?

Do you see the difference between the total cost and the amount "at risk" for the patient? Do you see how a lack of price transparency makes it difficult for the patient to know or feel the effects of the purchase of an MRI study?
 
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yes, but I also note that the effect on the patient is 10 fold when it comes to cash pay MRI scans.

this is the problem with insurance based healthcare, as opposed to a free market or Medicare for all plans.


if you were a patient, would you pay $50, or - apparently out of the kindness of your own moral ethical values - $500?

if you state the latter, then you are in the top 1% of the income scale or just plain nuts.
 
yes, but I also note that the effect on the patient is 10 fold when it comes to cash pay MRI scans.

this is the problem with insurance based healthcare, as opposed to a free market or Medicare for all plans.


if you were a patient, would you pay $50, or - apparently out of the kindness of your own moral ethical values - $500?

if you state the latter, then you are in the top 1% of the income scale or just plain nuts.
OK so lots of people have high deductible plans. So you can pay $500 outside of your insurance or $1500-2000 with your insurance. Not everyone has great insurance.
 
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OK so lots of people have high deductible plans. So you can pay $500 outside of your insurance or $1500-2000 with your insurance. Not everyone has great insurance.
That’s assuming that said patient only needs the MRI for the year. Some people reach their deductible from meds alone by February... in addition, the $2000 counts towards deductible and future health related costs. The $500 counts towards.... nothing.
 
That’s assuming that said patient only needs the MRI for the year. Some people reach their deductible from meds alone by February... in addition, the $2000 counts towards deductible and future health related costs. The $500 counts towards.... nothing.
Yep so it is something of a gamble. Also depends on what the deductible is. Mine has been roughly $8000 the last 5 years. The only time we hit it was when we had kids. A year of speech and occupational therapy for my girls and my vasectomy didn't hit it last year.

So if you have a very high deductible, its often worth it to pay cash since even with the 2k you might not be that close to hitting it.
 
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Get better insurance?

My point stands. It’s the insurance healthcare model that is the problem. The CEOs and admin fat cats are lining their pockets. We should not be giving them incentives towards making more money.

I also wonder whether going to a true free market economy will strengthen the insurance company complexes hold in healthcare.
 
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Get better insurance?

My point stands. It’s the insurance healthcare model that is the problem. The CEOs and admin fat cats are lining their pockets. We should not be giving them incentives towards making more money.

I also wonder whether going to a true free market economy will strengthen the insurance company complexes hold in healthcare.
Nah, this plan over the course of a year saves me almost 5k in premiums so as long as we spend less than that in a year we come out ahead.

Preaching to the choir about the rest.
 
Tell me what you're concerned about?

Drusso, I'm providing a ton of PEV with my "ancillary fees and services and referrals to higher reimbursing service lines." I'd like X for all that value.

No sir, I can't provide you X for your PEV as that makes it seem like I'm providing a quid pro quo and that might run afoul of conflict of interest laws or Stark laws with respect to the self-referrals.

Insert whatever you want for X.

Admins seem to hide behind Stark as a bogeyman, as it shouldn't apply in a bona fide employee/employer setting right?
 
more likely admin will say "but you are getting Y for salary, Z for benefits like retirement/health insurance/disability insurance/life insurance, and Q for malpractice, and S for not having to worry about marketing, billing, and all the things we do for you".
 
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Drusso, I'm providing a ton of PEV with my "ancillary fees and services and referrals to higher reimbursing service lines." I'd like X for all that value.

No sir, I can't provide you X for your PEV as that makes it seem like I'm providing a quid pro quo and that might run afoul of conflict of interest laws or Stark laws with respect to the self-referrals.

Insert whatever you want for X.

Admins seem to hide behind Stark as a bogeyman, as it shouldn't apply in a bona fide employee/employer setting right?

As long as they are not paying you on volume, then they can pay you whatever they want.

I spoke this weekend to a neurosurgeon who is getting paid $600K per year guaranteed for part-time clinical work. Why? They need a neurosurgeon for trauma certification and all kinds of quasi-administrative roles. The trick is to never actually talk about the justification for the amount out loud or in writing. Just talk about your "enterprise value." Both the surgeon and the hospital knows that the hospital will "make back" that $600K in 3 months.

She knew her PEV and knows what she's worth and that is how she negotiated.

You have to know that as a hospital employed MD that you're making your employer very rich. Just negotiate from that point of view.
 
more likely admin will say "but you are getting Y for salary, Z for benefits like retirement/health insurance/disability insurance/life insurance, and Q for malpractice, and S for not having to worry about marketing, billing, and all the things we do for you".

But, those costs are really "sunk" and fixed and they know that is pittance with respect to what the employed-MD can bring through the door...

Health systems driving prices higher with physician group purchases

"The reasoning behind such vertical integration is primarily twofold, Scheffler said. Health systems want to bolster their referral networks and send more patients to hospitals. They also benefit from charging facility fees, a higher rate that's meant to account for a hospital's overhead, he said. Hospital executives argue that more control will produce more coordinated care, while economists contend that larger health systems raise prices as they gain more leverage with insurers. Critics also claim that price hikes dwarf any purported efficiencies of scale."

Just always bring the conversation back to you what your activities (lab U-tox, psych, radiology, PT/OT, facility fees, site of service differential, referrals to other revenue generating services lines, etc) means to their bottom line...
 
so I guess you wouldn't mind the fact that my psych referrals go to private practice psychologists, my PT referrals go to the closest PT facility to the patient, and likewise with MRI scans...
 
so I guess you wouldn't mind the fact that my psych referrals go to private practice psychologists, my PT referrals go to the closest PT facility to the patient, and likewise with MRI scans...

Doesn't matter what I think, but it is bad for your Physician Enterprise Value.
 
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so I guess you wouldn't mind the fact that my psych referrals go to private practice psychologists, my PT referrals go to the closest PT facility to the patient, and likewise with MRI scans...
How hard a system works to prevent "leakage" seems highly variable and at least somewhat inversely correlated with physician satisfaction.
 
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