I don't know about that. I think rads and rad onc have been hit pretty rough thus far, as well as ortho and cards, not sure there is much room to go down any more. Derm still has some room sadly, and I'm sure they'll make it painful, as the always do. Derm salaries are still holding up pretty well imo, particularly given the huge shortage of dermies out there.
I have not kept up with derm cuts, but what have been the cuts you mention?
Sorry to the ortho people for going in a different direction here! Just figured it's pertinent to discuss too.
Good Dr,
First thing -- and this is an important one -- most docs do not have "salaries" as their sole (or even primary) determinant of income. It's a production thing, and only looking at the net at the end of the year tells you little about what went into it.
The two biggest revenue generators for general dermatology will take close to a 50% hit -- cut in half -- with the next cycle (next year) according to those who were involved in the discussions. Those would be biopsy and local destruction codes for those interested. Worse still, coverage and "medical necessity" criteria have been made more stringent for things such as warts, molluscum, irritated sebs, etc. Intermediate linear layered repairs have taken a hit recently and the medical necessity criteria has been increasingly applied to any reconstructions -- something that is totally arbitrary and nebulous in the CPT language.
Looking to Mohs -- we took a 35% or so (30-40% depending on the practice, case, etc) haircut in 2008 due to the loss of the multiple procedure reduction exemption. This was wholly inappropriate by definition for a variety of reasons -- the procedure occurred during separate and identifiable operative sessions, sometime separated by hours or even days on special occasions, involves two separate sessions of informed consent (tumor extirpation and reconstruction), and then there was the little issue of initial RVU determination for micrographic surgery... which did not include E&M, did not include reconstruction E&M, and took into consideration the multiple procedure reduction exemption in lowering its valuation. The multiple procedure reduction was already employed with micrographic surgery given the fact that subsequent stages were already reduced by approximately 50%...
Turning now to island pedicle reconstructions -- these were taken away from our use via the CPT committee by a language change. They arbitrarily chose to redefine it in order to save its valuation, just limit the providers performing it. It's nuts -- from its inception until the time of this arbitrary redefinition it meant one thing -- then, magically, it means something else? Okay...
All of the above are not driven by any increase in efficiency or decrease in labor and other cost inputs -- it is wholly at the behest of our CMS overlords. It's both sad and infuriating at the same time that our "independent physician leadership" in the AMA is such the lap dog ***** of the government agency.
What does all of this mean for someone like me? Well, in 2007 my average reimbursement per case was hovering around 1250-1300; it's now 850-900. Overhead has increased approximately 15% over the same time period as well. The practice was young then and not all that busy. I'm performing close to twice the volume now as the practice has matured, working 75% more hours, making about 20% more than then. If you are familiar with medical practice financing, you'll recognize quickly that this is not the way it is supposed to be -- much of our costs are relatively fixed and inelastic and it is the minority of costs that are incremental. I should be making twice what I was. Thank you CMS.
They will always target the smaller and more lucrative specialties first -- this is political, remember. Fairness and justice has jack **** to do with it.
