Private Practice is not Dead Yet...

[drusso]

http://www.forbes.com/sites/larrymyler/2015/06/16/the-private-medical-practice-is-not-dead-yet/

"My hope is that individual practitioners will be able to improve their business skills, become entrepreneurs, stay profitable and continue to serve patients at the level of their extraordinary training. Let’s preserve the wonderful tradition of the great American private medical practice."

It ain't easy: But if you had what takes to get accepted into medical school, then you can persevere despite efforts from the dominant culture.

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[rekrul]

Isn't this article painting a rather bleak picture? The only hard bits of data and analysis in this piece is the following:

According to a February, 2014 article in Modern Healthcare, the median loss for employing a physician was $176,463 in 2012. This revelation has some analysts predicting a pullback in the hiring of physicians going forward. Also, Becker’s Hospital Review recently reported on a spate of layoffs taking place this year within various health systems. Current revenue realities may not be supporting projected performance in the healthcare industry. And that is changing the metrics of doctor hiring by health groups.

The rest of the article consists of a single anecdote about a doctor who is struggling to make money in private practice and is trying new things to alleviate his financial difficulties. It doesn't even mention whether he's succeeding!

Everyone knows private practices have been struggling to make money. This article does nothing to suggest that trend is beginning to reverse. It does however imply that the other model for doctors to make money, by becoming employed members of health groups, is starting to fray as well. I hardly see this as being very reassuring.

P.S. yep I'm a premed and don't have any real world exposure to healthcare economics but I think based on just the information in that article the above is the conclusion that should be drawn.

 

[Aether2000]

I agree private practice is in serious trouble....perhaps a premed could take those warning signals and find a profession that will not leave them in $385K debt after medical school and would not be targeted by lawyers, hospital administrators, insurers, federal/state regulators, and medical boards.

 

[ampaphb]

Sure, but could you have as much fun?

 

[drusso]

Medical educators now openly discourage medical students from starting their own business/practice. My post was prompted from a telephone call from a medical student I've mentored over the last few years. Her attending told her, "Don't even consider private practice. You're better of working for a large organization." Is this the way leaders are made?

 

[jettavr6]

Medical educators now openly discourage medical students from starting their own business/practice. My post was prompted from a telephone call from a medical student I've mentored over the last few years. Her attending told her, "Don't even consider private practice. You're better of working for a large organization."

Which is exactly the reason why she should start planning to open a practice right after she finishes a residency or fellowship.

 

[emd123]

I agree private practice is in serious trouble....perhaps a premed could take those warning signals and find a profession that will not leave them in $385K debt after medical school and would not be targeted by lawyers, hospital administrators, insurers, federal/state regulators, and medical boards.

I think overstated. There are some signs hospitals are losing money on many doctor practices. The trend could reverse.

 

[Tenesma]

the only way the trend will reverse is for doctors to accept lower and lower salaries in return for the "safety" of being employees -

 

[anononononymous]

I think overstated. There are some signs hospitals are losing money on many doctor practices. The trend could reverse.

If doctors are losing money in private practice, and now are also losing money under the auspices of hospital employment, what is their other option? Isn't this just evidence that it's getting harder and harder for anyone to make money in medicine under the current financial, regulatory, and demographic situation?

I mean, sure, I'd rather make 400k through owning my own business, but if that's not possible, then making 400k working for someone else is not the end of the world,either. It's when I cannot make 400k at all, no matter what I try, that I'm going to start getting worried, and that's what this article is implying.

 

[Baritonebass]

Losses could be explained by buying primary care groups with hopes of making money once they hire specialist to bring in the facility fees from surgery and procedure... Plus I never trust hospital accounting they find new and exciting ways to loose money

 

[emd123]

If doctors are losing money in private practice, and now are also losing money under the auspices of hospital employment, what is their other option? Isn't this just evidence that it's getting harder and harder for anyone to make money in medicine under the current financial, regulatory, and demographic situation?

I mean, sure, I'd rather make 400k through owning my own business, but if that's not possible, then making 400k working for someone else is not the end of the world,either. It's when I cannot make 400k at all, no matter what I try, that I'm going to start getting worried, and that's what this article is implying.

I'm in private practice. Not losing money at all. Salary is going up.

 

[Ducttape]

Everyone has to find his or her own way.

On this forum are several physicians who take particularly keen interest in maintaining a way of practice. This form of practice is not for everyone or even most physicians, yet because of their vested interest, nothing other than that practice pattern will be considered viable or "good" for medicine...

We should all revel in the fact that options exist, unlike many other professions (like engineers, cpas, teachers, etc).

 

[emd123]

We should all revel in the fact that options exist, unlike many other professions (like engineers, cpas, teachers, etc).

I agree with this.

 

[drusso]

Everyone has to find his or her own way.

On this forum are several physicians who take particularly keen interest in maintaining a way of practice. This form of practice is not for everyone or even most physicians, yet because of their vested interest, nothing other than that practice pattern will be considered viable or "good" for medicine...

We should all revel in the fact that options exist, unlike many other professions (like engineers, cpas, teachers, etc).

I wonder if its less about interests and more about principles? In my lifetime, I haven't seen more government intrusion into *anything* result in better outcomes. Health care is no different. In fact, subsidizing large physician employers to ration care, lose money, and book large cash transfers between self-dealing entities seems misguided. I feel more comfortable having control.

 

[jettavr6]

I'm in private practice. Not losing money at all. Salary is going up.

Same here -- But you have to actively grow by offering various other services, ancillary income, etc.

 

[jettavr6]

Plus I never trust hospital accounting they find new and exciting ways to lose money

And the hospital finance department heads make good money providing this key service!

 

[lobelsteve]

Same here -- But you have to actively grow by offering various other services, ancillary income, etc.

This is where I see folks getting in trouble. Playing whack a mole with codes and services that may not be medically necessary....

 

[Aether2000]

Where I see doctors making lots of money is through performing useless tests on people and charging them for them (ala genetic testing for hepatic isozyme metabolism), having their own urine drug testing center and doing expensive drug tests on every patient every visit (or far more than they would if they did not own their own UDT equipment), telling patients they need back braces and selling $1800 back braces to these individuals, doing procedures in an out-of-network ASC they own, telling patients they need the percutaneous auricular stimulator and charging $250-500 for each one of these devices that they repetitively use, selling compounding creams at a 1000% profit, and using a injection-for-drug quid pro quo, it diminishes my estimation of the ethics of the entire profession. In pain medicine, there are scams inside of scams and eventually the house will come crashing down. I stand by my original statement. If I were advising a premed- my advice would be don't.

 

[drusso]

Most US Physicians Still Work in Small Practices

Most physicians in the United States continue to work in small practices despite the challenging healthcare working environment, according to an updated Policy Research Perspectives from the American Medical Association (AMA).

"These data show that the majority (60.7%) of physicians were in small practices of 10 or fewer physicians, and that practice size changed very little between 2012 and 2014 in the face of profound structural reforms to healthcare delivery," AMA president-elect Andrew W. Gurman, MD, says in a news release.

But the percentage is down markedly from 30 years ago, when more than three quarters of doctors worked in the small practice setting, the report notes. "It is clear that physician practice has undergone marked changes over the past 30 years," the report says.

AMA senior economist Carol K. Kane, PhD, assessed practice arrangements of physicians in 2014 and changes in work arrangements that occurred between 2012 and 2014 using data from the AMA's Physician Practice Benchmark Surveys. The surveys compose a nationally representative sample of postresidency physicians who provided at least 20 hours of patient care per week, were not employed by the federal government, and practiced in one of the 50 states or the District of Columbia.

Where possible, Dr Kane compared the current data with those from 30 years ago, which turned up some "dramatic" changes.

Owner or Employee?

According to the report, in 2014, 50.8% of physicians were owners of their practices, down slightly from 53.2% in 2012 but well below what it was in 1983, when 76.1% of physicians owned their practices.

Forty-three percent of physicians were employed by their practice in 2014, and 6.2% had a contract with their practice. Since the mid-1980s, the contractor percentage has been in the 4% to 7% range, with no discernable trend either upward or downward, the report says.

In 2012 and 2014, single specialty practice was the most common practice type, with 42% of physicians in single specialty practices in 2014, down slightly from 45.5% in 2012. "Second, and growing, was multi-specialty practice," with 25% of physicians in this practice type in 2014, up from 22.1% in 2012, the report notes.

More physicians worked directly for a hospital or in practices that had at least some hospital ownership in 2014 than in 2012 (32.8% vs 29%). The share of physicians directly employed by a hospital rose from 5.6% in 2012 to 7.2% in 2014; the share of physicians in practices with at least some hospital ownership increased from 23.4% to 25.6%.

Practice size changed very little between 2012 and 2014. In 2014, 22.3% of physicians were in practices of two to four doctors, up by slightly more than 2 percentage points from 2012. This was the biggest change, and the only one that was statistically significant across six size categories, the report notes.

In 2014, 20% of physicians were in practices of five to 10 physicians (about 2 percentage points lower than in 2012), 12.1% were in practices of 11 to 24 doctors, 6.3% in practices with 25 to 49 doctors, and 13.5% practiced with 50 or more physicians.

"Although recent changes in practice size have been minimal, there are marked differences from the mid-1980s," the report notes, with a smaller share of physicians now working in practices with 10 or fewer physicians than in 1983 (60.7% vs 79.6%).

The share of physicians in solo practice fell from 18.4% in 2012 to 17.1% in 2014 and is down from more than 40% in 1983.

The AMA is "committed to ensuring physicians in all practice sizes and types can thrive and offers innovative strategies and resources that address common practice challenges in the new health environment," Dr Gurman said in the release.

The updated Policy Research Perspectives is available on the AMA's website.

 

[Tenesma]

i think that those who are familiar w/ private practice will jump back into private practice as the house of cards starts falling down, and administrators hand lower and lower salaries to docs because of the focus on "value-based" care/"population health", etc.

however, the reality is that those private docs are a dying breed. The majority of grads are focused on 1) paying down their college/med school debts 2) life-style (no call, no holidays, no working hard. This is what makes hospital employment so beautiful for them - they don't have to "buy-in" to a practice, they don't have to take out loans to cover pay roll, there is literally no financial risk to them - and because of the shortage of docs/specialists they can dictate terms for hospital employment that would have been unheard of before (ie: my hospital is trying to hire a neurologist - to sweeten the deal, there is NO inpatient/ER call requirement/expectation, NO requirement/expectation to cover their patients after hours/weekends). These grads are going from residency/fellowship into this hospital model - so they truly never knew the taste of freedom/autonomy/decision-making/business decisions, so they don't understand what the "old-timers" are griping about. They were used to seeing 8 patients per day as a fellow, so seeing 10 patients per day is a big improvement in their mind, and 12 patients per day is just plain "unsafe".
.
My prediction though continues to be the same - we will see parallel medical systems
1) Hospital employed groups that are filled to the gills with Medicaid, Obamacare xchanges - poor customer service, poor productivity - with a revolving door of doctors and mid-levels who get disenchanted after 2-3 years. (WalMart model)
2) Private practice gorups that will primarily see private payers, better customer service, better productivity - with more consistency in the community since they have investments to safe-guard/build (Mercedes dealership)

I have been employed by a spine surgeon, I have been self-employed, I have been employed by a hospital - and can honestly say I couldn't be happier about transitioning back to private practice, and focusing on patient care/quality instead of corporatization of medicine.

 

[drusso]

i think that those who are familiar w/ private practice will jump back into private practice as the house of cards starts falling down, and administrators hand lower and lower salaries to docs because of the focus on "value-based" care/"population health", etc.

however, the reality is that those private docs are a dying breed. The majority of grads are focused on 1) paying down their college/med school debts 2) life-style (no call, no holidays, no working hard. This is what makes hospital employment so beautiful for them - they don't have to "buy-in" to a practice, they don't have to take out loans to cover pay roll, there is literally no financial risk to them - and because of the shortage of docs/specialists they can dictate terms for hospital employment that would have been unheard of before (ie: my hospital is trying to hire a neurologist - to sweeten the deal, there is NO inpatient/ER call requirement/expectation, NO requirement/expectation to cover their patients after hours/weekends). These grads are going from residency/fellowship into this hospital model - so they truly never knew the taste of freedom/autonomy/decision-making/business decisions, so they don't understand what the "old-timers" are griping about. They were used to seeing 8 patients per day as a fellow, so seeing 10 patients per day is a big improvement in their mind, and 12 patients per day is just plain "unsafe".
.
My prediction though continues to be the same - we will see parallel medical systems
1) Hospital employed groups that are filled to the gills with Medicaid, Obamacare xchanges - poor customer service, poor productivity - with a revolving door of doctors and mid-levels who get disenchanted after 2-3 years. (WalMart model)
2) Private practice gorups that will primarily see private payers, better customer service, better productivity - with more consistency in the community since they have investments to safe-guard/build (Mercedes dealership)

I have been employed by a spine surgeon, I have been self-employed, I have been employed by a hospital - and can honestly say I couldn't be happier about transitioning back to private practice, and focusing on patient care/quality instead of corporatization of medicine.

I wonder why Generation X and Generation Y doctors seem so attracted to the "employment" narrative offered by the hospital recruiters?

http://www.huffingtonpost.com/brian-secemsky/the-generation-y-physicia_b_6006616.html

I wonder why the "self-employed/ownership" counter-narrative like the one you've discussed above hasn't taken wider hold in residency training programs? Many physicians in hospital employed relationships tell me that "the dew falls off the lily" pretty much before the ink dries, but that story doesn't get widely disseminated. In other words, after the deal closes, suddenly, the hospital admins who were wining and dining you aren't returning telephone calls...

 

[Baritonebass]

Maybe it depend on where they train I went to med school in Alabama where they exclaimed with pride that private practice physicians were the larges small business demographic to NYC where no believes in private practice only large group employment or academic centers... It seems in Boston there is so much dissatisfaction with the partners system that PP is actually growing... I was born in 1985

 

[Tenesma]

I think the counter narrative Doesn't work. I have seen this in the last 8 years of interviewing docs.... I am shocked each time by their focus on salary, vacation, no call, no weekends. I don't think it is laziness, but rather the new generation of thinking.

One of the questions I used to ask was: you are on a romantic dinner w ur wife for anniversary, u are not on call, the hospital switchboard accidentally called u, but one of your patients is in the ER w a pain issue. How do u deal with it? Just the silence/pause tells me everything I need to know. I stopped asking that question because when the candidates tell me they just want job security and that seeing more than 12 patients a day is unsafe, I already know any further conversation is pointless.

It is also what u are exposed to during training... large academic centers or large Hospital systems will breed the employee mentality for the.most part. Out of my fellowship year only 2 out of 7 are in private practice.

 

[Disciple]

I think the counter narrative Doesn't work. I have seen this in the last 8 years of interviewing docs.... I am shocked each time by their focus on salary, vacation, no call, no weekends. I don't think it is laziness, but rather the new generation of thinking.

I think the turnaround starts to occur when the hospital can no longer offer this, i.e. as the transition to value based payments takes hold. At that point, there are few advantages to the physician.

Low pay, see all comers, keep satisfaction scores high, etc.

I would say that most physicians, once they come to acceptance of a ceiling on their earnings, will choose freedom over the constraints of large health systems.

 

[VA Hopeful Dr]

I think the counter narrative Doesn't work. I have seen this in the last 8 years of interviewing docs.... I am shocked each time by their focus on salary, vacation, no call, no weekends. I don't think it is laziness, but rather the new generation of thinking.

One of the questions I used to ask was: you are on a romantic dinner w ur wife for anniversary, u are not on call, the hospital switchboard accidentally called u, but one of your patients is in the ER w a pain issue. How do u deal with it? Just the silence/pause tells me everything I need to know. I stopped asking that question because when the candidates tell me they just want job security and that seeing more than 12 patients a day is unsafe, I already know any further conversation is pointless.

It is also what u are exposed to during training... large academic centers or large Hospital systems will breed the employee mentality for the.most part. Out of my fellowship year only 2 out of 7 are in private practice.

I can't speak to pain specifically, but to my generation of doctors generally (I finished med school in 2010) the emphasis is on lifestyle. Most of us want to work hard at work but then be off when we're off. For the time being, most are willing to trade autonomy for this. Disciple, in the post above mine, nails exactly when we usually stop being willing to make that trade.

 

[Tenesma]

VA hopeful just confirmed it

Regarding patient satisfaction.... part of.my salary is based on 90% "satisfaction with this providers office". Not my care mind you... so that means that if I had a cranky secretary, or a dirty floor or whatever I can be dinged for that. Thank you to press ganey.

 

[Disciple]

Health System job of the future:

Low base salary, with meager bonus dependent on meeting certain metrics and overall savings of the hospital for that year.

Must see x number of patients per day (penalty for not meeting quota), see all payers, do as little as possible-but somehow keep satisfaction scores high, keep staff satisfaction scores high (or penalty), rotating home call for crisis intervention to prevent costly ER visits and potential hospital admission.

Several layers of managers/admin. Remember that movie office space?

Health insurance benefits-within health system only, and subject to same rules. Pension plan available, until default down the line.


Awesome.

 

[Gauss]

Health System job of the future:

Low base salary, with meager bonus dependent on meeting certain metrics and overall savings of the hospital for that year.

Must see x number of patients per day (penalty for not meeting quota), see all payers, do as little as possible-but somehow keep satisfaction scores high, keep staff satisfaction scores high (or penalty), rotating home call for crisis intervention to prevent costly ER visits and potential hospital admission.

Several layers of managers/admin. Remember that movie office space?

Health insurance benefits-within health system only, and subject to same rules. Pension plan available, until default down the line.

your future is today...
except pensions are extinct

 

[Ducttape]

Disagree, respectfully.

The common physician practice in the future imo will be a hospital employed position for sure, but as ACOs take hold, there will be good competition between systems such that physician salaries will be "average", "sustainable", and not low. This will be especially true of the vast majority of doctors - Primary Care.

We have a glut of specialists, compared to primary care. These changes clearly benefit PCPs in ways that we can't imagine.

Doctors instead of changing or advertising hormone adjustment, anti-aging, weight loss treatment, PRP (gasp), Botox, etc to improve reimbursements will instead bounce between hospital systems and group practices as they leverage themselves.



Perhaps we are the ones in the wrong... Having a life not dedicated entirely on medicine may be right and better for us.

Lifestyle>>$$?

 

[lobelsteve]

your future is today...
except pensions are extinct

In addition to my 401k and 403b I also have a pension. How long that lasts I have no idea.

 

[Disciple]

Disagree, respectfully.

The common physician practice in the future imo will be a hospital employed position for sure, but as ACOs take hold, there will be good competition between systems such that physician salaries will be "average", "sustainable", and not low.

Perhaps we are the ones in the wrong... Having a life not dedicated entirely on medicine may be right and better for us.

Lifestyle>>$$?

Depends on your perspective I guess. Most specialists would consider primary care level salary to be low. They are going to expect major lifestyle perks in exchange.

As for lifestyle, ask some of the health system PCPs how they like going home for the day and spending a few hours each night answering a couple hundred patient e-mails.

 

[Ducttape]

there is a reason hospital docs dont see as many patients during a typical workday.

they spend their time in the office answering those questions, not taking them home.

 

[Disciple]

Not how it goes at Kaiser. From what I hear.

 

[hyperalgesia]

From my perspective there's not that much difference between being employed by a hospital and being employed by the various payers that insure patients. There is only the illusion of autonomy in a subsidized practice. We are either fed by our masters in the employer scenario, or we are zapped with electricity if we don't eat what they tell us in the self-employed scenario. Sure we don't HAVE to eat what they tell us to eat, or fill out all the boxes, or run on the hamster wheel, as long as we don't mind getting f-ing zapped.

I'm not feeling optimistic these days. Healthcare is a tainted industry, like a miniature North Korea, right here in the US.

 

[VA Hopeful Dr]

Disagree, respectfully.

The common physician practice in the future imo will be a hospital employed position for sure, but as ACOs take hold, there will be good competition between systems such that physician salaries will be "average", "sustainable", and not low. This will be especially true of the vast majority of doctors - Primary Care.

We have a glut of specialists, compared to primary care. These changes clearly benefit PCPs in ways that we can't imagine.

Doctors instead of changing or advertising hormone adjustment, anti-aging, weight loss treatment, PRP (gasp), Botox, etc to improve reimbursements will instead bounce between hospital systems and group practices as they leverage themselves.

Perhaps we are the ones in the wrong... Having a life not dedicated entirely on medicine may be right and better for us.

Lifestyle>>$$?

See, I'm not sure that the future of us all being hospital employed is actually true. Eventually, insurers are going to stop paying hospitals so much more for things that ASC's, free standing imaging centers, or just regular offices can do for much less money. The day that outpatient facility fees go away, hospital employed physicians will either be fired in mass or have their paychecks cut significantly. On that day, private practice will look much much more appealing.

 

[Aether2000]

insurance, including Medicare, has stupidly been paying a huge premium for the same services offered in hospitals compared with asc or offices for several decades. I don't see anything changing in the near future. Hospitals have more power than you can possibly imagine at this point in time. this is a trend that started two decades ago but has accelerated enormously under Obama's regime due to rules and regulations adopted under the PPACA

 

[Tenesma]

I agree that some of it is illusory.

However w hospital employed level u have multiple levels of learned helplessness and incompetence. And their strategy for cost containment is doctor pay cuts and administrative bonuses. .. that is something a private practice doesn't need to deal with.

 

[Tenesma]

And regarding hospitals having more power, I respectfully disagree....

The private insurers are pushing very hard for all imaging to be done at free standing MRI centers which is killing the hospital revenue. They are also pushing for elective surgeries to be done at in network ascs. ... also killing hospitals. And the Medicare observation and 2 midnight rule is killing hospitals.

 

[Aether2000]

considering many of the imaging center and surgery centers are now being bought by hospitals that are flush with excess funding, it really doesn't make any difference. Many of the hospital owned practices that are located even far away from hospitals are now charging facility fees in addition to the doctor fee for patients in their practices. This has caused the price the patient paid to the hospital to double or triple over the last couple of years. In my area the reimbursement to surgery centers has dropped so low that they are no longer in network. Patient now being seen in these surgery centers will pay two to three times what the hospital we see. Therefore ensures are not so keen on referring their patients to surgery centers that will charge them even more than the hospitals. It is quite a conundrum

 

[Ducttape]

Hospitals also seem to be almost coordinating with insurers to keep patients in network at hopd rather than out of network at free standing facilities. And many of the free standing facilities are being bought by hospitals...

 

[Tenesma]

i guess this is a regional issue regarding free-standing centers - in my area, any time i order an MRI or CT the insurance no longer requires pre-auth if i send to a non-hospital affiliated free standing imaging center, getting an MRI/CT done at a hospital or hospital owned entity is like pulling teeth - and even once i get auth for a hospital based study, the insurer still calls the patient and advises them if they go to a free-standing center they will have a lower co-pay.

in new england, hospitals are losing money left right and center - and that is one of the other reasons they no longer can subsidize their money losing physician subsidiaries...

 

[lonelobo]

Hospitals also seem to be almost coordinating with insurers to keep patients in network at hopd rather than out of network at free standing facilities. And many of the free standing facilities are being bought by hospitals...

Where?
In my area that would be ridiculous as HOPD are at least 50 to 75% more expensive

 

[VA Hopeful Dr]

insurance, including Medicare, has stupidly been paying a huge premium for the same services offered in hospitals compared with asc or offices for several decades. I don't see anything changing in the near future. Hospitals have more power than you can possibly imagine at this point in time. this is a trend that started two decades ago but has accelerated enormously under Obama's regime due to rules and regulations adopted under the PPACA

Admittedly it may be because I'm fairly young, but from looking around I think this may change sooner than you think.

With high deductible plans, patients are now become more cost conscious and expect us to be the same when we send them somewhere for imaging, a procedure, or whatever. A local ENT was telling me just last week that outpatient procedures at their surgery center aren't even hitting many patient's deductibles. Meanwhile the hospitals are billing over 10 grand more for the same thing. Obviously the patient doesn't pay all of that, but paying 3 grand at the ASC versus 6 to hit your deductible is very noticeable.

Patients just seem to be getting more and more angry about how things are, its a great set up for private practice to step in and do better.

 

[Ducttape]

Here is the big conundrum for patients - they want to save costs and physicians want to make money. For most physicians that means doing procedures at an ASC.

For many patients, it is actually cheaper to get procedures at HOPD than ASC. Impossible! You say...

Well actually no. A patient pays for office visit copay for a HOPD procedure. $50.

They are billed for surgical copay at an ASC, even for an injection - which runs anywhere from $150-250+

End cost to insurance -$600 vs $300+ (depending on the ASC - obviously out of network is much more, which you don't get with HOPD).

End cost to patient, however, is $50 vs $200+.

Guess what patients want???

 

[drusso]

Here is the big conundrum for patients - they want to save costs and physicians want to make money. For most physicians that means doing procedures at an ASC.

For many patients, it is actually cheaper to get procedures at HOPD than ASC. Impossible! You say...

Well actually no. A patient pays for office visit copay for a HOPD procedure. $50.

They are billed for surgical copay at an ASC, even for an injection - which runs anywhere from $150-250+

End cost to insurance -$600 vs $300+ (depending on the ASC - obviously out of network is much more, which you don't get with HOPD).

End cost to patient, however, is $50 vs $200+.

Guess what patients want???

Level the playing field so the decision is cost-neutral to the patient. Or, compete on service.

 

[Tenesma]

Ducttape... Really?

When I do procedures at hospital it is considered outpatient surgery and pts copay for that for most private payers is in 250 range. Similar to ascs.

 

[VA Hopeful Dr]

Here is the big conundrum for patients - they want to save costs and physicians want to make money. For most physicians that means doing procedures at an ASC.

For many patients, it is actually cheaper to get procedures at HOPD than ASC. Impossible! You say...

Well actually no. A patient pays for office visit copay for a HOPD procedure. $50.

They are billed for surgical copay at an ASC, even for an injection - which runs anywhere from $150-250+

End cost to insurance -$600 vs $300+ (depending on the ASC - obviously out of network is much more, which you don't get with HOPD).

End cost to patient, however, is $50 vs $200+.

Guess what patients want???

Man, the insurance plans in your area must be great. Down here, it's all the same towards the deductible. The only plans that give significant advantages to the hospital are the plans for hospital employees.

 

[Ducttape]

Ducttape... Really?

When I do procedures at hospital it is considered outpatient surgery and pts copay for that for most private payers is in 250 range. Similar to ascs.

thats possibly because you are doing them in the OR, instead of office based HOPD?

 

[Aether2000]

The way to tell if a hospital is lying about losing money: have they built any major additions, expansions, new hospitals, or acquired any new medical practices, surgery centers, or imaging centers in the past 3 years. If they have, they are definitely not losing money.

 

[Baritonebass]

Hence the accounting gymnastics acquiring practice investing in equipment hiring physician are all expenses that may not realize a profit within a 12 month period... Also bonus for the board is an expense