Ross434

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Hey, I've noticed that neurosurgeons, cardiac surgeons, and ortho spine are all paid a LOT higher (with 500-700k averages in private practice) than pretty much anyone else. Since its insurance companies controlling the reimbursement, what is keeping these salaries so high? Does insurance just pay more because the doctor has trained longer? Is it equipment and or time? Or is it because the cases are more delicate and have higher risk? All three? Do you foresee reimbursement cuts?
 

hans19

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Ross434 said:
Hey, I've noticed that neurosurgeons, cardiac surgeons, and ortho spine are all paid a LOT higher (with 500-700k averages in private practice) than pretty much anyone else. Since its insurance companies controlling the reimbursement, what is keeping these salaries so high? Does insurance just pay more because the doctor has trained longer? Is it equipment and or time? Or is it because the cases are more delicate and have higher risk? All three? Do you foresee reimbursement cuts?
In the case of spine surgery, the surgeon can bill each level of spine as a separate procedure. Sure reimbursement will come down at some point in time.

Insurance companies don't give a rats ass how long you have trained, they want any excuse to not reimburse or to reimburse less. I think reimbursements for procedure in all specialties will decline.
 

Celiac Plexus

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Ross434 said:
Hey, I've noticed that neurosurgeons, cardiac surgeons, and ortho spine are all paid a LOT higher (with 500-700k averages in private practice) than pretty much anyone else. Since its insurance companies controlling the reimbursement, what is keeping these salaries so high? Does insurance just pay more because the doctor has trained longer? Is it equipment and or time? Or is it because the cases are more delicate and have higher risk? All three? Do you foresee reimbursement cuts?
Reimbursement is subject to a number of forces... in no particular order here are some that i can think of:

supply v. demand - in smaller fields that are procedure-driven, there is typically more demand than supply. so in order to offer the opertaive services of hard to get physicians, reimbusement rates will have to be as high as necessary to attract these professionals.

innovative procedures - newer procedures tend to pay more for a number of reasons. a couple of examples: radiofrequency ablation, lvad... some earlier examples where reimbursement is declining: cabg, coronary stenting, ct scanning....

malpractice rates - higher rates mean lower income

medicare rates - medicare is essentially the state sponsored insurance program. the rates are not set solely according to supply v. demand, or any other typical economic dynamic. rather these rates are limited by the budget of the federal government. insurance companies tend to use medicare rates as benchmarks for their own reimbursement rates. medicare typically is a stabilizing, and potentially deflationary force on reimbursement. medicare once paid thousands of dollars for a cabg, now it's around a thousand dollars.

i'm sure others will have additional insight.

the fields that do not depend heavily on medicare or insurance companies are likely to have much higher reimbursement though... there is a small, but growing number of surgeons whom do not accept medicare or insurance reimbursement... only fee-for-service. this group has the potential to be a stabilizing/inflationary force in reimbursement trends...

these things are important to consider, and reimbursement forces are critical for physicians to understand. good question.