NYT article on EmCare

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The Company Behind Many Surprise Emergency Room Bills

Interesting, but I wish it had done a better job clarifying than EmCare docs are employees who in no way decide the amounts billed.

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I haven't read the whole thing yet but this line makes it out like the docs are huge crooks when it's likely that the previous docs were not billing correctly:

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

I am willing to bet that prior to EmCare they had less board certified EM docs than they do now.
 
Ahh, someone beat me to it.

Bottom line: EMCare is run by a bunch of douchebags who not only pay you much less than you generate so they can skim some profits off your work, but also stick it to your patients.

Your hippocratic oath to your patients demands you don't work for a CMG.

Juanito- 6% critical care seems reasonable, 28% does not. That's just fraudulent. The line you should have been focused on was this one:

For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

Not sure if they're referring to Level 5s or critical care charges here, but I think $500 is plenty reasonable for either.
 
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Nationwide, more than one in five visits to an in-network emergency room results in an out-of-network doctor’s bill, previous studies found. But the new Yale research, released by the National Bureau of Economic Research, found those bills aren’t randomly sprinkled throughout the nation’s hospitals. They come mostly from a select group of E.R. doctors at particular hospitals. At about 15 percent of the hospitals, out-of-network rates were over 80 percent, the study found. Many of the emergency rooms in that fraction of hospitals were run by EmCare.

Bottom line, EmCare is making the rest of us look bad, and the docs working there aren't even getting the money. That goes to the shareholders of Envision. Now you know why the corporate practice of medicine is supposed to be illegal.
 
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I wish it had done a better job clarifying than EmCare docs are employees who in no way decide the amounts billed.

When you agree to work for EmCare, you are playing on their team and your name is sullied right along with theirs when the C-suite makes decisions like these.

CMGs go away when docs stop working for CMGs.
 
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Yeah this isn't a good look for anyone. You're just screwing over patients who came to a hospital in good faith thinking their insurance plan covers their care because they go there for other stuff and then get screwed over. And its not like the physicians are making bank working for EmCare compared to other places. You're just taking money from the patient and sending it pretty much directly to the shareholder. And especially if what they mention in article is true - about firing docs who refuse to order extra tests.
 
I'm not sure how they could fire physicians for not testing more. I have always had the consistently lowest RVU/pt of any group I work for (about 3.93/pt) and I've never had threats made in this regard.
 
Ahh, someone beat me to it.

Bottom line: EMCare is run by a bunch of douchebags who not only pay you much less than you generate so they can skim some profits off your work, but also stick it to your patients.

Your hippocratic oath to your patients demands you don't work for a CMG.

Juanito- 6% critical care seems reasonable, 28% does not. That's just fraudulent. The line you should have been focused on was this one:

For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

Not sure if they're referring to Level 5s or critical care charges here, but I think $500 is plenty reasonable for either.

Like I said, I didnt read the whole article but if there is some massive fraud going on wouldn't a simple audit uncover it? The beginning of the article mentions how the hospital had a hard time staffing the emergency department so I assume it was mainly staffed by family docs who likely don't know how to bill correctly. The jump does seem staggering though.
 
It's never actual fraud its just the maximum possible to bill under the law.
 
I'm not sure how they could fire physicians for not testing more. I have always had the consistently lowest RVU/pt of any group I work for (about 3.93/pt) and I've never had threats made in this regard.

Does ordering more tests really equal more rvu generation?


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I'm not sure how they could fire physicians for not testing more. I have always had the consistently lowest RVU/pt of any group I work for (about 3.93/pt) and I've never had threats made in this regard.


Hmmm, I did not know this. I've been incentivized by my hospital to generate more RVU's/patient and yet I continue to struggle with this, despite improving on my other numbers.
 
Does ordering more tests really equal more rvu generation?


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Yes. Anything that increases the "complexity" of a patient will increase how much they can bill for that chart. If you give a medication, order a lab test, and do a radiology test, and admit the patient it's worth more RVUs.
 
Read the NYT Picks Comments. The majority apparently only see the "greedy doctor" narrative and don't realize it's the C-Suite in EMCare who are at fault. Then again, as posters have alluded to above, we are complicit in their corruption each time one of us signs a contract with them.
 
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Yes. Anything that increases the "complexity" of a patient will increase how much they can bill for that chart. If you give a medication, order a lab test, and do a radiology test, and admit the patient it's worth more RVUs.

This doesn't work for already complex patients. Obtaining an X-ray and labs on the asthma/COPD exacerbation on CPAP won't boost what is already a level 5 due to the CPAP indicating a high risk patient. However, for the simple asthma with a URI, obtaining the same X-ray, labs, and Z-Pak could move you from a 3 to a 4 (more thorough H+P) or even a 5 in the right circumstances (documenting risk, reason for the labs/imaging). The only difference between a 3 and 4 is the level of detail in the history and physical exam. The difference between a 4 and 5 is the Medical Decision Making (MDM) and this is where ordering those extra labs, medications, and imaging will come into play the most.
 
Yeah, we as a profession have to realize that we are definitely complicit in a lot of things. You don't necessarily think about billing issues and patients' ability to pay for what you order based on their insurance status and whether they are in network or not, but the administrators due, and the patients sure as hell do. Physicians and nurses are the faces of medicine and with that, it's who patients think about and see the most when they're in the ED or the hospital. So with that, you get all the good - and all the bad. If we decide not to care about billing stuff and how much a patient gets screwed over because of ridiculous out of network costs even though they came in good faith to a particular hospital thinking they'd be covered under their plan, we are undermining our ourselves and our profession. I mean, think about it from their perspective - if they somehow find out which ED has in network providers (and I don't even know how to do that very easily) - then the inpatient hospital services may not be covered if its with a different institution. And vice versa. They're just stuck and have to pay thousands (if not more) for a visit through really no fault of their own. We can't just be oblivious to that or we deserve the scorn.
 
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As much as I am not a fan of any CMG (worked for one previously), I would be hesistant to draw too many conclusions because of the vague data. What is the source? Who ran it? Is there another more reasonable control or standard than the anecdote they provide?

Although I do wish there was no corporate practice of medicine, and although I acknowledge that some in our field (like EMcare + HMA out west, certain FSEDs such as First Choice) have pushed the boundaries of ethics so far that they have drawn untoward attention and tarnished the reputations of many ethical players in our space (something that we will all have to pay the bill for), much of the issue today has to do with health insurers and their war with providers over profits. There is a pervasive desire on the part of payers to avoid paying for things that they should pay for, to stay out of network, to pass the cost on to patients and to pass the task of collections on to providers in the form of higher deductibles, coinsurance, and staying out of network.
 
This doesn't work for already complex patients. Obtaining an X-ray and labs on the asthma/COPD exacerbation on CPAP won't boost what is already a level 5 due to the CPAP indicating a high risk patient. However, for the simple asthma with a URI, obtaining the same X-ray, labs, and Z-Pak could move you from a 3 to a 4 (more thorough H+P) or even a 5 in the right circumstances (documenting risk, reason for the labs/imaging). The only difference between a 3 and 4 is the level of detail in the history and physical exam. The difference between a 4 and 5 is the Medical Decision Making (MDM) and this is where ordering those extra labs, medications, and imaging will come into play the most.

I agree with this walking into the ED can easily net you a 3, 4 for a complete history and a prescription/study and 5 for some saline and iv narcotics.
 
There are complaints that you can move up to a level 5 if you order more testing.


Chest pain in young adult < 30, add a troponin. The same with palpitations.

Head CT on people with headaches

Children with abominal pain and order labs versus exam and no labs

Chest pain workup on people with URI and chest pain.

There are just many complaints that can get away with less and if you do more you could likely increase your RVU by about 0.5.

The only difference between docs I work with and me is that I typically order less work ups and my average RVU/patient over the last 3 years runs about 0.50 below the group. So this is my only theory as why the difference is there.
 
In my city Emcare runs the show. They are in an illegal profit sharing scam with HCA. They contract with essentially no one. HCA doesnt care as they collect a part of the profit by screwing patients over.

http://www.aaem.org/UserFiles/MayJun14PresidentsMessage.pdf

Even with raising our charges we are over 40% cheaper. One of the very interesting things here locally is that Emcare bills very low for critical care though their charges for a level 5 are very much in line with the article.. Actually a little higher.

While a big stink (rightfully so) was made over the merger state attorney generals did nothing. This shows the power of influence of these companies. It is also why I will be finally dropping my acep membership. If you believe in SDGs you can not continue to support ACEP. AAEM while smaller needs to support of EM docs to stand up for us and not the CMGs.
 
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We all have to be realistic in that with our large student debt we have to work. That being said why work for these clowns for under $300/hr. They need us, we are a requirement for them. If they want to rape the patients we need to rape them back and have their business fall apart.
 
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In my city Emcare runs the show. They are in an illegal profit sharing scam with HCA. They contract with essentially no one. HCA doesnt care as they collect a part of the profit by screwing patients over.

http://www.aaem.org/UserFiles/MayJun14PresidentsMessage.pdf

Even with raising our charges we are over 40% cheaper. One of the very interesting things here locally is that Emcare bills very low for critical care though their charges for a level 5 are very much in line with the article.. Actually a little higher.

While a big stink (rightfully so) was made over the merger state attorney generals did nothing. This shows the power of influence of these companies. It is also why I will be finally dropping my acep membership. If you believe in SDGs you can not continue to support ACEP. AAEM while smaller needs to support of EM docs to stand up for us and not the CMGs.

We all have to be realistic in that with our large student debt we have to work. That being said why work for these clowns for under $300/hr. They need us, we are a requirement for them. If they want to rape the patients we need to rape them back and have their business fall apart.

Theres two things wrong with this argument. You cant rape them back by holding out for higher hourly rates because 1. someone will try to undercut you and 2. the increase in costs to them will get pushed in an even larger bill to the patient. This in effect leads to you "raping" the patient with CMGs being the middle man.

Secondly, if you dont like how things are run in ACEP or other organizations, the answer is to fix it, not quit and let things fall apart. It is more costly to build it back up from scratch and the optics look terrible to the average American. Regarding the power that EmCare and HCA wields, you are right. Which is why more physicians need to get involved in political discourse, donate to your PACs, and even run for public office. Unfortunately, most wont do any of the above.
 
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Yeah, we as a profession have to realize that we are definitely complicit in a lot of things. You don't necessarily think about billing issues and patients' ability to pay for what you order based on their insurance status and whether they are in network or not, but the administrators due, and the patients sure as hell do. Physicians and nurses are the faces of medicine and with that, it's who patients think about and see the most when they're in the ED or the hospital. So with that, you get all the good - and all the bad. If we decide not to care about billing stuff and how much a patient gets screwed over because of ridiculous out of network costs even though they came in good faith to a particular hospital thinking they'd be covered under their plan, we are undermining our ourselves and our profession. I mean, think about it from their perspective - if they somehow find out which ED has in network providers (and I don't even know how to do that very easily) - then the inpatient hospital services may not be covered if its with a different institution. And vice versa. They're just stuck and have to pay thousands (if not more) for a visit through really no fault of their own. We can't just be oblivious to that or we deserve the scorn.


At my hospital, the hospitalist group a patient goes to is based on insurance. However I'm not about to commit malpractice because I didn't check to see if the radiologist group is in network before ordering a CTA chest on a patient with a high Well's criteria. I'm not going to ask about whether they can afford a vent stay before intubating them. I'm not going to hold off the fentanyl drip because they're uninsured yet intubated. Nor am I going to put off putting a central line in on a patient needing levophed because of insurance.
 
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This is one of those issues I chalk up to "not my problem". With all the other things I need to worry about while on-shift, patient insurance, co-pays, networks isn't going to take up one bit of grey matter. Does it suck? Yeah. Let the hospitals and CMGs take the heat for it.
 
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Wait, so I shouldn't feel bad about being low on RVUs per patient ?? I always thought I was doing something wrong but couldn't figure it out. So, more tests = more RVUs? And my bonus is based on RVUs/ patient ... so I should order more tests????

I always thought maybe I was missing out on bs note taking like "p-IV insertion" or whatever. (As if I want to let nurses know they can ask me to do a p-IV with ultrasound! You know what that does to their success rate?!!)
 
We all have to be realistic in that with our large student debt we have to work. That being said why work for these clowns for under $300/hr. They need us, we are a requirement for them. If they want to rape the patients we need to rape them back and have their business fall apart.

I agree with this but I just don't think we have the unity to do it. I also think a lot of us don't realize how huge these profit margins are that the CMGs and predatory SDG's (worse than the CMG imo) are taking off the top of our work. Grinds my gears to see them throwing these huge recruiting parties and dinners while some unsuspecting doc is working an overnight for $175/hour.


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This is one of those issues I chalk up to "not my problem". With all the other things I need to worry about while on-shift, patient insurance, co-pays, networks isn't going to take up one bit of grey matter. Does it suck? Yeah. Let the hospitals and CMGs take the heat for it.

But they won't. You will. Not caring about it is going to come back to bite us as a profession.
 
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At my hospital, the hospitalist group a patient goes to is based on insurance. However I'm not about to commit malpractice because I didn't check to see if the radiologist group is in network before ordering a CTA chest on a patient with a high Well's criteria. I'm not going to ask about whether they can afford a vent stay before intubating them. I'm not going to hold off the fentanyl drip because they're uninsured yet intubated. Nor am I going to put off putting a central line in on a patient needing levophed because of insurance.

I didn't say nor imply that you should treat anyone differently based on insurance status or what their co-pay might be. All this has to be worked out before either you or the patient steps foot in the hospital.
 
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I didn't say nor imply that you should treat anyone differently based on insurance status or what their co-pay might be. All this has to be worked out before either you or the patient steps foot in the hospital.


I have no way of knowing what patients are going to be admitted to the hospital prior to stepping into the hospital. Most hospitalized patients didn't plan on going to the hospital when they woke up in the morning (or if the inciting event happened overnight, prior to going to bed).

Just curious, what year are you? When you reach an inpatient service, by all means, please feel free to discuss costs with the patient and keep track of which specialists take which insurance... assuming of course that you have the ability to choose from multiple specialty groups instead of using the one on call or being in the situation where only one group covers the hospital.
 
I have no way of knowing what patients are going to be admitted to the hospital prior to stepping into the hospital. Most hospitalized patients didn't plan on going to the hospital when they woke up in the morning (or if the inciting event happened overnight, prior to going to bed).

Just curious, what year are you? When you reach an inpatient service, by all means, please feel free to discuss costs with the patient and keep track of which specialists take which insurance... assuming of course that you have the ability to choose from multiple specialty groups instead of using the one on call or being in the situation where only one group covers the hospital.

That's my point though, right? You're making it. It's impossible for me to do with the way these things are set up. If most of the hospital groups and the hospital coverage is "in network" but ED (and ED is just an example, you could substitute other things like Radiology, or Anesthesia, or the local GI group for example) isn't, that's not fair to the patient at all. Stuff like that is what drives people into bankruptcy even though they did the right thing by picking a plan that they believed would cover them. So what's the alternative for the patient? Just expect to go bankrupt when they go to the hospital? Because even if they're paying for insurance and think the hospital they are going to for their problem is "in network", there's no way for anyone to make sure all the services they would be getting are going to be covered under their in network plan. My point when I said you have to decide before stepping foot in the hospital is just that - the hospital system (and physicians have a large voice in that, whether they choose to exercise it or not) has (or rather, should) has some responsibility in terms of making sure that they only contract with groups where the insurance plans match up reasonably well. Because no one is going to blame the 'suits' - they're going to blame the people they think are fleecing them.

Since you asked, I'm a PGY-3 (but not a EM resident).
 
That's my point though, right? You're making it. It's impossible for me to do with the way these things are set up. If most of the hospital groups and the hospital coverage is "in network" but ED (and ED is just an example, you could substitute other things like Radiology, or Anesthesia, or the local GI group for example) isn't, that's not fair to the patient at all. Stuff like that is what drives people into bankruptcy even though they did the right thing by picking a plan that they believed would cover them. So what's the alternative for the patient? Just expect to go bankrupt when they go to the hospital? Because even if they're paying for insurance and think the hospital they are going to for their problem is "in network", there's no way for anyone to make sure all the services they would be getting are going to be covered under their in network plan. My point when I said you have to decide before stepping foot in the hospital is just that - the hospital system (and physicians have a large voice in that, whether they choose to exercise it or not) has (or rather, should) has some responsibility in terms of making sure that they only contract with groups where the insurance plans match up reasonably well. Because no one is going to blame the 'suits' - they're going to blame the people they think are fleecing them.

Since you asked, I'm a PGY-3 (but not a EM resident).
You're missing the problem from our end.

Let's say I'm an EM doctor working at hospital A. Hospital A is large and so has a very favorable contract from Aetna. Aetna then offers my EM group a very bad contract. They do this because Aetna patients will go to Hospital A since it is in network. If the EM group accepts the bad contract, Aetna wins by not having to pay them very much. If the EM group does not accept the contract, Aetna still wins because now they don't have to pay the EM docs AND they can blame the high bills on the EM group. Aetna never has to say "Yeah they're not in our network because we offered them a ****ty deal and they refused to take it".

If we change things so that every sole-provider group in a hospital has to be in the same network then the insurance companies can low-ball the hell out of EM, radiology, and pathology knowing that they must take the deal. Does that seem wise or fair to you?
 
You're missing the problem from our end.

Let's say I'm an EM doctor working at hospital A. Hospital A is large and so has a very favorable contract from Aetna. Aetna then offers my EM group a very bad contract. They do this because Aetna patients will go to Hospital A since it is in network. If the EM group accepts the bad contract, Aetna wins by not having to pay them very much. If the EM group does not accept the contract, Aetna still wins because now they don't have to pay the EM docs AND they can blame the high bills on the EM group. Aetna never has to say "Yeah they're not in our network because we offered them a ****ty deal and they refused to take it".

If we change things so that every sole-provider group in a hospital has to be in the same network then the insurance companies can low-ball the hell out of EM, radiology, and pathology knowing that they must take the deal. Does that seem wise or fair to you?

You don't have to work for that hospital. Your skills are in demand - if you vote with your feet, you can get a fair contract. They can't run a hospital without an ED...
 
You don't have to work for that hospital. Your skills are in demand - if you vote with your feet, you can get a fair contract. They can't run a hospital without an ED...
This makes no sense in the context of VA Hopeful Dr's post. You leaving the hospital doesn't change the fact that the insurance company isn't offering you a fair contract. How does your threat to leave change what the insurance company is willing to pay you?

The alternative is to have the hospital use it's size and leverage to get your group built into their existing favorable contract with Aetna, except now, you're a hospital employee instead of an independent group. That's a trade that most SDGs wouldn't be willing to make, nor should they have to.
 
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This makes no sense in the context of VA Hopeful Dr's post. You leaving the hospital doesn't change the fact that the insurance company isn't offering you a fair contract. How does your threat to leave change what the insurance company is willing to pay you?

The alternative is to have the hospital use it's size and leverage to get your group built into their existing favorable contract with Aetna, except now, you're a hospital employee instead of an independent group. That's a trade that most SDGs wouldn't be willing to make, nor should they have to.

Yes, very unfair and completely unreasonable for doctors and patients- both of which have little influence. The solution is national legislation so that insurance has to negotiate prices with huge entities on behalf of all groups (like maybe whole specialty associations?). It's either that or everything becomes like kaiser where insurance, doctors and facilities are all integrated so nothing is "out of network."

It's insane that drug and device companies dont have to negotiate much and have lots of leverage whereas small doc groups get the shaft.




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You don't have to work for that hospital. Your skills are in demand - if you vote with your feet, you can get a fair contract. They can't run a hospital without an ED...
Ideally yes. In real life many people are tied down geographically for a multitude of reasons. You would also have to have a large enough number of doctors all leaving places like this to affect change and there aren't enough good jobs to support that large of a number. This won't happen as a) doctors don't organize well and b) most docs don't have enough of a rainy day fund to survive not working for more than a month or two.
 
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That's my point though, right? You're making it. It's impossible for me to do with the way these things are set up. If most of the hospital groups and the hospital coverage is "in network" but ED (and ED is just an example, you could substitute other things like Radiology, or Anesthesia, or the local GI group for example) isn't, that's not fair to the patient at all. Stuff like that is what drives people into bankruptcy even though they did the right thing by picking a plan that they believed would cover them. So what's the alternative for the patient? Just expect to go bankrupt when they go to the hospital? Because even if they're paying for insurance and think the hospital they are going to for their problem is "in network", there's no way for anyone to make sure all the services they would be getting are going to be covered under their in network plan. My point when I said you have to decide before stepping foot in the hospital is just that - the hospital system (and physicians have a large voice in that, whether they choose to exercise it or not) has (or rather, should) has some responsibility in terms of making sure that they only contract with groups where the insurance plans match up reasonably well. Because no one is going to blame the 'suits' - they're going to blame the people they think are fleecing them.

Since you asked, I'm a PGY-3 (but not a EM resident).


By the way, you're still tagged as a med student.

So what's the option? Force GI to sign with Aetna? Not consult GI? Transfer the patient to another hospital? As a 3rd year IM resident applying to crit care. I have no clue what insurances the specialists at my hospital take... not that it matters, it's not like I have a choice in groups most of the time anyways.
 
This makes no sense in the context of VA Hopeful Dr's post. You leaving the hospital doesn't change the fact that the insurance company isn't offering you a fair contract. How does your threat to leave change what the insurance company is willing to pay you?

The alternative is to have the hospital use it's size and leverage to get your group built into their existing favorable contract with Aetna, except now, you're a hospital employee instead of an independent group. That's a trade that most SDGs wouldn't be willing to make, nor should they have to.
BCBS feels that ER visits are worth $12.
Patients pay THOUSANDS of dollars in premiums, and thousands more in deductibles. That's so BCBS will give us $12. But their CEO gets 8 figures, so it's ok.
Hell, we should just work for free anyway. What is this, Pre-Allo?
 
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Theres two things wrong with this argument. You cant rape them back by holding out for higher hourly rates because 1. someone will try to undercut you and 2. the increase in costs to them will get pushed in an even larger bill to the patient. This in effect leads to you "raping" the patient with CMGs being the middle man.

Secondly, if you dont like how things are run in ACEP or other organizations, the answer is to fix it, not quit and let things fall apart. It is more costly to build it back up from scratch and the optics look terrible to the average American. Regarding the power that EmCare and HCA wields, you are right. Which is why more physicians need to get involved in political discourse, donate to your PACs, and even run for public office. Unfortunately, most wont do any of the above.
The best thing you can do with ACEP is to quit them and you dont have to build anything new. AAEM is already out there.

I have a buddy who works for 5-700/hr for Emcare. I know the facilities and they lose money every shift he works. They cant pass the costs to their Medicare/Medicaid population. Instead if they are on a cost plus model the hospital will dump them.

If someone undercuts you then so be it. Dont be the loser working for crap pay.
 
If docs cant go out of network the insurers will screw us even more than they do now. One of the biggest downsides to docs with the ACA (obamacare) was the rush to grow. This was seen with the rapid consolidation in hospitals and insurers and providers.

If BCBS is the monster insurer in your area there is no way the hospital will allow you to go out of network with them. In some states like AL and NC they are really the only insurer. So what leverage do you have? They will pay you whatever they want simply because they can. Most SDGs either have great legacy contracts or have to threaten to go non par or go non par to get a fair rate.

Remember in EM ~12% (post obamacare) of our patients are self pay/no pay. On top of this we get crappy rates (in most states) from medicaid. This combo is likely 40% of our population. Throw in medicare and thats probably 70% of our volume.

So to earn a medicare rates for all patients the 30% of commercial patients have to have contracts at 200% of medicare. BCBS isnt paying that in any state I have looked at for EM.
 
The best thing you can do with ACEP is to quit them and you dont have to build anything new. AAEM is already out there.

I have a buddy who works for 5-700/hr for Emcare. I know the facilities and they lose money every shift he works. They cant pass the costs to their Medicare/Medicaid population. Instead if they are on a cost plus model the hospital will dump them.

If someone undercuts you then so be it. Dont be the loser working for crap pay.

You have a buddy that does that. However, this anecdotal data point cant be applied to the EM world in general. They most definitely can pass their costs to M/M by increasing the level at which they bill their cases, as evidenced by the article. I agree that I am not going to be the loser working for crap pay, but there are always uninformed EM docs who will, and thus it destroys the idea that we can basically walk away from CMGs in this manner.

AAEM is a very small organization with 8,000 members compared to ACEPs 45,000. Let's entertain the idea that quitting ACEP is the solution. What then? You dont think the same will happen with AAEM?
To your argument about payor mix, I wholeheartedly agree. The goal should be to increase reimbursement from M/M rather than go out of network and pass the buck onto the patient.
 
You have a buddy that does that. However, this anecdotal data point cant be applied to the EM world in general. They most definitely can pass their costs to M/M by increasing the level at which they bill their cases, as evidenced by the article. I agree that I am not going to be the loser working for crap pay, but there are always uninformed EM docs who will, and thus it destroys the idea that we can basically walk away from CMGs in this manner.

AAEM is a very small organization with 8,000 members compared to ACEPs 45,000. Let's entertain the idea that quitting ACEP is the solution. What then? You dont think the same will happen with AAEM?
To your argument about payor mix, I wholeheartedly agree. The goal should be to increase reimbursement from M/M rather than go out of network and pass the buck onto the patient.

I won't be so naive as to claim that every person or organization keeps its promises, but AAEM has a pretty good track record of doing so. Look at their mission statement, and you'll find the (ostensible) answer to your question: "The Academy supports fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care. Such an environment includes provisions for due process and the absence of restrictive covenants."
 
I completely understand your points but then what is the solution for people who pay for insurance either independently or through work and still get charged ridiculous out of network fees for their services (as in if the hospital is in network but EM isn't, or surgeon is in network but anesthesiologist isn't, etc)?
 
I completely understand your points but then what is the solution for people who pay for insurance either independently or through work and still get charged ridiculous out of network fees for their services (as in if the hospital is in network but EM isn't, or surgeon is in network but anesthesiologist isn't, etc)?

The solution is that patients quit their insurers and join integrated systems like kaiser where this isn't an issue. Enough patients do this and insurers/hospitals will take notice and change the laws. Sucks for independent groups but thats sort of the trend if this continues.


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Most people get insurance through work - that's really not an option at this point.
 
You really think that's the solution? How likely do you think that is to get a critical mass of people to complain to the insurance company on behalf of increased physician reimbursement? Or is it more likely that they will blame the 'greedy doctor' who 'saw me for a minute' and [as far as they are concerned] charging exorbitant prices?


I think that if the status quo continues and physicians continue on their current path as well, whatever solution that people come up with - physicians will NOT be coming out of it well in 10-15 years.
 
Ok. None of our solutions work.
What's yours?
Forcing us to be in network for whatever rate they pick?
 
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Gee, if only there was a set rate that all the hospitals charged for each service they provided and that everyone's insurance was accepted everywhere cough*singlepayer*cough.
 
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