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

Other messages in this thread:

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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