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02/13/2014 Jim Shipley, DPM
Billing Equality (Alan Mauser, DPM)
In his post to PM News, Dr. Mauser asks three questions regarding billing equality.
1. Is this normal practice and reimbursement for hospitals?
You have to remember that hospitals are no different from any other big business, i.e. they are in business to make money and they'll do it in most any fashion that they can come up with legally. The numbers you gave definitely seem excessive to me, but it's still not surprising.
2. Are all physicians (orthopedists vs. podiatrists) paid the same?:
Absolutely not! Not only are orthopedists and podiatrists not paid the same, but I'd be willing to bet that most podiatrists in your state are not paid the same. I legally can't give you my numbers, but I can tell you that in our research we saw Orthopods in the state of NC getting paid around 160% of Medicare by the most prominent private health insurance company we have here.
PCPs were getting paid upwards of 150% of the codes we use here in NC, and even PAs were getting paid 135% of Medicare rates. Do you happen to know what you're getting paid from the largest private insurance payor in your state? I'd be willing to bet it's under what the PAs in your state are getting paid.
3. What can be done to ensure a reasonable fee- for-service?
Starting today, get active, find like minded individuals, and start a super group in your state. We had enough of the same stresses you're dealing with presently too. We banded together, hired an insurance negotiator (among other things), and demanded better rates from the private payors. The biggest private payors agreed and upped our rates gladly. They saw the benefit for their clientele to have a large, well functioning group take care of their needs.
Other large payors pushed back or didn't raise our rates enough to our liking. We dropped them. Goodbye! Within six weeks, they were calling us back with our agreed price. It's hard to argue with the largest podiatric practice in the state, especially when dropping us meant that all of those patients began seeing orthopods for their foot problems at 160% of Medicare rates!
I agree that it isn't as easy as I make it sound. It's not. But it is well worth it, and to be honest, I can't wait till next year because our contracted negotiated rates will go up again! Best of luck, and remember, help is just around the corner. We're here for you. :)
Jim Shipley, DPM, Mount Airy, NC, jimshipley@gmail.com
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02/13/2014 Tip Sullivan, DPM
Billing Equality (Alan Mauser, DPM)
Dr. Mauser’s comments hit a nerve with me. That is the one that runs from my brain to my heart then to my wallet. I believe his numbers; it is sick and life is unfair! And that is one of the reasons we are going down a financial toilet as healthcare providers.
Younger readers must understand that he is talking about two different payments in his comments. The “facility fee” and the “surgeons fee.” As far as equity is concerned, where I live, a podiatric surgeon gets paid at the same rate as an orthopedic surgeon regarding surgeon's fees for the same surgery. The inequity comes in the facility fee. This is the fee paid to the facility where the surgery is performed which should be a derivative of costs such as employee salary, equipment costs, durable goods costs—ad-nauseam.
Currently, there are basically three different wagons that you can be on as a “facility” : 1)hospital based 2)multispecialty outpatient based 3) single specialty outpatient based. These facilities are reimbursed at different rates for the exact same procedures regardless of who owns them-large corporations, partners in a business or individuals.
The reason that is routinely given to me as to the rational of the difference is that even though the exact same equipment and personnel might be used in a case the costs for the facilities are different. For example one could argue that it might cost a hospital more dollars per operating room hour than it does a single specialty facility.
While I am sure that there is some truth to that which can be demonstrated on some accountants books I can assure you that the difference does not account for the gross inequity in reimbursement. I can testify that my single specialty facility would be reimbursed by BXBS about $1350 for a double osteotomy and lesser metatarsal osteotomy as compared to the $30,000 reimbursement paid to the hospital-based surgery.
This disparity is an issue of greed and is maintained and promoted by the political powers which support the interests of hospitals who will argue that without this ($30,000) reimbursement for a common foot surgery they will be unable to care for the indigent and uninsured which they are mandated to care for.
I think if the public were made aware of this there could be a change but as long as we keep our heads buried in the sand it will not change. Another real question to ask is : Does the patient who’s insurance company paid $30,000 care any differently as compared to the one whose insurance company paid $1,350 as long as the $30K or the $1,350 did not come out of their pocket? Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
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