NAPA in trouble in NJ

[aneftp]

Medicare cataract. 4 base units+2 time units at $21-22/unit ends up being about $120/case. Maybe you have commercial insurance cases mixed in. We pool our units so Medicare cataract work is subsidized by other cases. But Medicare cataracts are bad for the bottom line and a drag on our unit value. We recently left an eye surgery center because of that.

Mix in medi-cal. It’s bad. I’ve seen my family member individual billing and collections for cases ranging from cataracts to open heart cases.

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[GravelRider]

No. Entitled means not understanding market conditions. Location, practice etc. all these complaints about amc’s. They are not one glove fits all. I’m not defending them. Some are really bad. But some are more locally run and better.

And yes. I’ve had tons of discussions with newer gen docs ranging in age from 31-38. So some fresh out and some 5-7 years out. It’s just a different generation. All work in various practices from academics to private track partnership to amcs.

Entitled means believing you deserve special treatment. If there were a bunch of young anesthesiologists out of work and refusing to work for anything less than say $400/hr or for some low workload arrangement, you could say they are entitled. But shouldn’t people push the market as far as it goes to be compensated the most they can for their time and energy? Is that entitlement or is that just the free market at work? Sure, those conditions that are increasing the demand of anesthesiologists might not last forever, but should people not take advantage of it when it exists? Or is putting other priorities ahead of your career entitlement? I’m just confused by the use of the word here.

 

[nimbus]

Mix in medi-cal. It’s bad. I’ve seen my family member individual billing and collections for cases ranging from cataracts to open heart cases.

Medi-cal is a mixed bag nowadays. Some medi-cal HMOs now pay significantly better than Medicare. Still not good but not horrendous.

 

[Mman]

Funny how people forget about those hospitals that always have locums.

I am unaware of any hospital anywhere near me (hundreds of miles) that has ever permanently had locums. Most never use any locums except for odd vacation coverage here or there.

Is there an example of any hospital that has never had full time staff and only used locums for the last 5+ years?

 

[Mman]

i dont know where this 75 dollars per cataract comes in

in my group we get 300 (start up units and time units), with a largely medicare population (~50%), this is legit data from our actual billing company in the real world.

do you seriously have 50% commercially insured patients for cataracts? Our cataract population is more than 90% medicare.

 

[maxxor]

A

Entitled means believing you deserve special treatment. If there were a bunch of young anesthesiologists out of work and refusing to work for anything less than say $400/hr or for some low workload arrangement, you could say they are entitled. But shouldn’t people push the market as far as it goes to be compensated the most they can for their time and energy? Is that entitlement or is that just the free market at work? Sure, those conditions that are increasing the demand of anesthesiologists might not last forever, but should people not take advantage of it when it exists? Or is putting other priorities ahead of your career entitlement? I’m just confused by the use of the word here.

sounds like “I don’t want to pay what these people are asking for” to me.

 

[Dr. Rude]

I am unaware of any hospital anywhere near me (hundreds of miles) that has ever permanently had locums. Most never use any locums except for odd vacation coverage here or there.

Is there an example of any hospital that has never had full time staff and only used locums for the last 5+ years?

Until I retired last year, We had locum
CRNAs for over 20 years. No locum docs.

 

[GravelRider]

I am unaware of any hospital anywhere near me (hundreds of miles) that has ever permanently had locums. Most never use any locums except for odd vacation coverage here or there.

Is there an example of any hospital that has never had full time staff and only used locums for the last 5+ years?

I know plenty of places that have used per diem CRNAS and docs for as long as I’ve been practicing…more than 5, but less than 10 years. Maybe that was myopic in hoping that keeping per diems on staff would allow flexibility if there were volume decreases. However, nearly every private practice, AMC, and hospital uses a few local agencies for per diem CRNAs (mainly) and some docs.

 

[<(^_^)>]

I think one thing sometimes neglected in these discussions is inflation. We went through such a long period of low inflation many haven’t adjusted mentally yet. Inflation over last 2 years is 15%. That’s more than 2015 to 2020 (~10%). So 300 in 2015 is 375 in 2022.

When locums rates go from 250 to 300 that sounds like a significant increase, but adjusted for inflation 250 in 2020 is same as 287.5 in 2022.

In 2016-2017 EM boards were saying 300-325 an hour is the new floor for regular jobs. That would be ~375 in 2022 $. Locums people were saying 400 is their floor with many getting 500. That’s 500 and 625 an hour today respectively. Truly a different animal, in part because of shorter residency path and shorter path for mid-levels, as well as the pay in absolute terms being much higher. Plus I feel like anesthesia locums can be more dangerous to your license than EM locums. 4:1 CRNAs that are fresh out of school etc.

If anesthesiology got the “usual” rates EM was talking about that would be 55 hours a week * 44 weeks a year * 375 an hour= 907.5k a year. For a pretty normal job.

The market isn’t nearly as overheated as EM was.

 

[Mman]

Until I retired last year, We had locum
CRNAs for over 20 years. No locum docs.

only locum CRNAs? nobody full time?

 

[Mman]

I know plenty of places that have used per diem CRNAS and docs for as long as I’ve been practicing…more than 5, but less than 10 years. Maybe that was myopic in hoping that keeping per diems on staff would allow flexibility if there were volume decreases. However, nearly every private practice, AMC, and hospital uses a few local agencies for per diem CRNAs (mainly) and some docs.

per diem is 1099, not locums

 

[Dr. Rude]

only locum CRNAs? nobody full time?

We had plenty of full time CRNAs just never enough. I wasn’t clear. No need for locum docs though.

 

[GravelRider]

per diem is 1099, not locums

Rates are about the same, though. Hospitals may not always have locums per se, but they are still feeling the effects of the market forces driving up those rates. CRNAs have been chasing those rates for years now. Obviously supply and demand can be a regional thing, but the high per diem rates have been partially responsible for employers raising salaries.