Why do hospitals pay neurologists so much if neurology doesn't make the hospital money?

[deleted1139416]

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[Spinothalamic]

Neurologists treat stroke and order a lot of MRIs which both make the hospital a lot of money

 

[mrbreakfast]

I forget the exact number, but I think a neurohospitalist only needs to treat 2-3 acute strokes/week, and nothing else, to pay for their salary.

Many, many patients have neurological complications or present with neurological complaints, and there isn't anyone else to address those. You can't discharge an encephalopathic patient or someone who can't walk

And ignoring the above, neurosurgeons make the hospital a lot of money, and someone has to keep those post-op patients alive.

 

[DrSatan]

Neurologists make hospital systems **** tons of money.

 

[BoneWizard]

https://www.aupn.org/files/2022/Leadership%20Minutes/Leadership_Minute_PPT_ep_24.pdf

"In 2012, using methodology identical to that of the Merritt Hawkins analyses, the combined revenue for technical and professional services per 1 cFTE provider neurologist in the Department of Neurology at the University of Kentucky was $1,915,149."

 

[Postictal Raiden]

Neurologists treat stroke and order a lot of MRIs which both make the hospital a lot of money

I was under the impression that ordering tests actually costs the hospital money since hospitals get a flat rate from insurance companies based on the complexity of admission.

Not sure if i produce enough (in RVUs) to justify my pay and benefits, but I can tell you that I am a necessary cost. I help hospitalists and ED physicians discharging patients safely. I also cut down on unnecessary costs tremendously by canceling redundant tests (IM often orders MRAs on patients who already got CTAs, or dopplar on those already got other vascular imaging modality, or MRI brain on every encephalopathy).

 

[Freeinfinity]

I was under the impression that ordering tests actually costs the hospital money since hospitals get a flat rate from insurance companies based on the complexity of admission.

Not sure if i produce enough (in RVUs) to justify my pay and benefits, but I can tell you that I am a necessary cost. I help hospitalists and ED physicians discharging patients safely. I also cut down on unnecessary costs tremendously by canceling redundant tests (IM often orders MRAs on patients who already got CTAs, or dopplar on those already got other vascular imaging modality, or MRI brain on every encephalopathy).

or MRIs and EEGs on known epilepsy patients who are just noncompliant with their seizure meds and/or with other identifiable reasons for breakthrough seizures.

 

[Telamir]

You gotta pay to have someone this good looking on staff.

 

[deathmerchant]

Title

Not everyone in the hospital needs to make money directly. How do you put into numbers what a nurse or janitor or an admin makes for the hospital. Hospital is a like a complex machine and every part essential in their own way. Our job is essential to most medium sized hospitals that take sick patients like strokes, seizures or other surgical/cardiac/neurosurgery patients. This is one of the reasons we get paid. Thats also why you will hear stories about locums getting paid 5k for seeing 3-4 patients/day!

And as @Ibn Alnafis MD mentioned, hospitals can actually lose money by ordering more tests as inpatient due to Diagnosis based bundled payments these days. Outpatient is a different story.

 

[FutureInternist]

You gotta pay to have someone this good looking on staff.

So your CVA is presenting with major visual changes 😏

 

[FutureInternist]

or MRIs and EEGs on known epilepsy patients who are just noncompliant with their seizure meds and/or with other identifiable reasons for breakthrough seizures.

Dude/dudette….

The # of tests is just ridiculous

Medication OD, but slurred speech… that’s a CVA
Hepatic encephalopathy due to no lactulose, so AMS… that’s a CVA
GSW to head leading to L facial droop… that’s a CVA 😏

MRI hasn’t even been done to confirm but CTA, echo, have ALL been ordered already 🤦‍♂️

 

[mrbreakfast]

Dude/dudette….

The # of tests is just ridiculous

Medication OD, but slurred speech… that’s a CVA
Hepatic encephalopathy due to no lactulose, so AMS… that’s a CVA
GSW to head leading to L facial droop… that’s a CVA 😏

MRI hasn’t even been done to confirm but CTA, echo, have ALL been ordered already 🤦‍♂️

You forgot the #1 sign of stroke, which is being woken up at 4 am for "mental status check" and not knowing the exact date.

 

[Spinothalamic]

Dude/dudette….

The # of tests is just ridiculous

Medication OD, but slurred speech… that’s a CVA
Hepatic encephalopathy due to no lactulose, so AMS… that’s a CVA
GSW to head leading to L facial droop… that’s a CVA 😏

I’m getting PTSD from residency. Those incessant consults prompted by a general lack of doctoring and lack of thought drove me to outpatient.

Then again, we may still get referrals for history of a single “possible TIA” twenty years prior

or chronic teeth grinding?

or hallucinations prior to falling asleep in a patient with known narcolepsy

so there is no winning.

Poor psychiatry literally gets referrals just because a patient happens to cry during an office visit (even when totally justified)

 

[Postictal Raiden]

Dude/dudette….

The # of tests is just ridiculous

Medication OD, but slurred speech… that’s a CVA
Hepatic encephalopathy due to no lactulose, so AMS… that’s a CVA
GSW to head leading to L facial droop… that’s a CVA 😏

MRI hasn’t even been done to confirm but CTA, echo, have ALL been ordered already 🤦‍♂️

Just today, I saw a patient who presented for headache. ED had already spent 1 million dollars of Medicare money on him. Start with a CTH because that’s what everyone with a brain gets every time they step a foot in the ED, CTA H/N because what if this was a dissection, CTP because the CTA showed incidental asymptomatic severe carotid stenosis, MRI brain wwo because the stenosis may have caused a stroke that can only cause a headache without neuro deficits and the contrast just in case he has a tumor causing headache (again without neuro deficits), and CTV to rule out CVST.
All this was on a patient who presented with a BP of 210/140 because of antihypertensives noncompliance.

I’m not bashing the ED provider (can’t remember they were MD/DO or NP/PA). This is simply a product of a litigious healthcare system we practice in. CYA.

 

[sloh]

Not everyone in the hospital needs to make money directly. How do you put into numbers what a nurse or janitor or an admin makes for the hospital. Hospital is a like a complex machine and every part essential in their own way. Our job is essential to most medium sized hospitals that take sick patients like strokes, seizures or other surgical/cardiac/neurosurgery patients. This is one of the reasons we get paid. Thats also why you will hear stories about locums getting paid 5k for seeing 3-4 patients/day!

And as @Ibn Alnafis MD mentioned, hospitals can actually lose money by ordering more tests as inpatient due to Diagnosis based bundled payments these days. Outpatient is a different story.

This is a great post. And it’s misunderstood by a lot of physicians, even seasoned physicians—across all specialties

 

[sloh]

Just today, I saw a patient who presented for headache. ED had already spent 1 million dollars of Medicare money on him. Start with a CTH because that’s what everyone with a brain gets every time they step a foot in the ED, CTA H/N because what if this was a dissection, CTP because the CTA showed incidental asymptomatic severe carotid stenosis, MRI brain wwo because the stenosis may have caused a stroke that can only cause a headache without neuro deficits and the contrast just in case he has a tumor causing headache (again without neuro deficits), and CTV to rule out CVST.
All this was on a patient who presented with a BP of 210/140 because of antihypertensives noncompliance.

I’m not bashing the ED provider (can’t remember they were MD/DO or NP/PA). This is simply a product of a litigious healthcare system we practice in. CYA.

And it probably wasn’t even the high BP causing the headache

 

[BlueBleck]

You forgot the #1 sign of stroke, which is being woken up at 4 am for "mental status check" and not knowing the exact date.

One of my favorite stroke alerts: patient's husband wakes up literally every day at 0200 to hug her, tell her that he loves her, and she does the same. But today, she was less responsive (because she recently started to take trazadone on top of a bunch of psych meds, which he forgot to tell me). Thanks everybody for this interesting consult at 0230.

 

[Freeinfinity]

Lol.
Chief complaint: Less hugs than usual.

 

[vanfanal]

Lol.
Chief complaint: Less hugs than usual.

Sounds like a psych consult. lol.

 

[Postictal Raiden]

Sounds like a marriage counselor consult. lol.

Fixed it for you

 

[vanfanal]

Fixed it for you

What’s this? A colleague who actually understands an appropriate vs inappropriate psych consult! Who are you sir? 😅

 

[AlbinoHawk DO]

As an IM doctor, i can tell you neurology is essential so i don't have to do the physical exam

 

[Splenda88]

They should make more. The hospital CEO does not bring any revenue and he/she is making millions for a job that he/she should get paid 200-250k