Declining reimbursements

[jmail]

Hi guys,
I have been a pharmacist for about 8 years and hate it.
Thinking of going into a med school and getting into family practice field.
What worries me, is that there is such a decline in reimbursements by Medicare that on many drugs we lose money.
You would think it would be the case with medicine in general, right?
What do you guys see in your practice? I am interested in monetary implications.
I would not want to spend all these money on med school and then earn 30K per year...
( I am exaggerating of course, but if you could give me some examples of your/your colleagues incomes before and after all the Medicare changes, I would greatly appreciate it!)

I guess, its not your income that I am trying to ask, the question is more: would you say Medicare/other insurances reimbursement for the same service increased or decreased over the last few years? For example, lets say you billed for physical an X amount of money in 2001 and you bill the same amount in 2020, do insurances pay the same percentage of the billed amount, or more, or less?
Lets say you billed 200$ in 2001 for yearly physical, insurance paid, lets say, 80% so you got 160 dollars.
How does this number look in 2020 (or 2019)?

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[deleted87716]

Our reimbursement has nothing whatsoever to do with drug prices, so your "Medicare changes" question doesn't resonate. My income has steadily increased over the years. We're getting into more ACO/P4P-type contracts these days. Know the rules, play the game.

 

[jmail]

Our reimbursement has nothing whatsoever to do with drug prices, so your "Medicare changes" question doesn't resonate. My income has steadily increased over the years. We're getting into more ACO/P4P-type contracts these days. Know the rules, play the game.

Thank you! I know Medicare reimbursements for pharmacy has nothing to do with Medicare reimbursements for medical services. I guess I just used my experience as an example, probably was not the best option to do so...

So your reimburesements for the same service billed to Medicare increased over the last few years?

 

[deleted87716]

So your reimburesements for the same service billed to Medicare increased over the last few years?

I was referring to overall reimbursements (including commercial). Medicare reimbursements haven't been declining, however.

 

[jmail]

Thank you so much!
Can I please ask you another question? What would you say you make per physical exam or per office visit? Lets say office visis is 200$, how much would insurance reimburse? Probably about 150$, right? and Medicare probably about 100$-120$ or so, right?
I understand it probably depends on insurance, but just a ball park?
You can tell in percentage form, if its easier

 

[deleted87716]

Thank you so much!
Can I please ask you another question? What would you say you make per physical exam or per office visit? Lets say office visis is 200$, how much would insurance reimburse? Probably about 150$, right? and Medicare probably about 100$-120$ or so, right?
I understand it probably depends on insurance, but just a ball park?
You can tell in percentage form, if its easier

Totally depends on your fee schedules. We're reimbursed at about 60% of charges overall. Overhead takes about 60% of that. I'm paid on revenue ("eat what you kill,") so there are no RVUs involved.

Hypothetical example: Negotiated fee for service amount = $180 (how much the payer will pay). Assuming no copay, we'd bill something like $300. The difference is written off. Of the resulting $180, I'd get around $72 after overhead. That's before taxes.

 

[bronx43]

BD, how does your group divide ancillary revenue? Does it go into a big pot to be split by various metrics?

 

[VA Hopeful Dr]

BD, how does your group divide ancillary revenue? Does it go into a big pot to be split by various metrics?

I've heard that it goes into a big pot and then they fight for it gladiator style, last doctor standing gets the whole thing.

 

[bronx43]

I've heard that it goes into a big pot and then they fight for it gladiator style, last doctor standing gets the whole thing.

Does that violate stark law?

 

[deleted87716]

BD, how does your group divide ancillary revenue? Does it go into a big pot to be split by various metrics?

Divided equally. That's how you avoid violating Stark.

 

[jmail]

Thank you so much, Blue Dog! I really appreciate your help!