Concerning [aapce] group reimbursement for comp survey-
I wonder if we could get some simple survey done via AAPCE to help groups determine how to reimburse FP's doing endoscopy.
I know many of us have some RVU/production base but they are so different than an office visit.
for example in the past we have had a benchmark for an FP endoscopist which was 2xRVU and 3X the charges based on what GI's produce and make.
They also increase our baseline pay for that time.
We are trying to rework our primary care to focus on population base care, i.e, patient panel and quality etc, so we also will be looking at endoscopy.
Clearly payers differ but I wonder what others have for a plan for just their endoscopy services?
Derek Hubbard, M.D.
I've always refused contracts that said "RVU" because nobody could ever explain to me what that meant. Until I can buy a car with RVUs my contract will always be a percentage of net collections in actual dollars. I think RVUs is another conspiracy against primary care, an accounting shell game.
Brian W. Meeker D.O. FAAFP
RVU’s are well defined. Most of the employed docs I know like it because as noted in other emails, when they receive “credit”/bonuses/portions of their salary based on RVU’s, it doesn’t matter what insurance the patient has or any insurance at all. The “reimbursement” is the same in RVU’s. Surgeons with high cost procedures especially like it because in general the “rates” end up being much better than ‘caid, etc.
I’ve compiled the National Procedures Institute Reimbursement Manual for the last 15 or so years (annual update). We include work and total RVU’s as well as the 50th percentile fees charged in the country, ‘care rates, ‘caid rates, and BCBS rates for the majority of common procedures. www.npinstitute.com.
I think the secret to negotiating (no matter who the “payer” is) is to obtain agreement on a high monetary value for the RVU initially. If you can do that, you’ll end up ahead in the long run….even the short!!
Jack Pfenninger
I have been in a couple RVU contracts the past five years. The first paid me RVU + 90% collections in endoscopy. The second is near MGMA median for RVU for everything, which essentially underpays endoscopy (but I don't do a ton). Regardless of what contract you're in, you need to demand accurate accounting and if your clinic is turning a profit, then you aren't getting enough for your work. Clinics shouldn't be profit centers for hospitals. When negotiating an RVU contract, you need to know the MGMA data regionally.
Kevin S.
My evidence is purely anecdotal, but when I worked for an "integrated health system" under an "RVU" system the production bonuses never materialized under calculations Einstein wouldn't be able to follow. So I "disintegrated". My adjusted gross income doubled in the first year without relocation. If your integrated system (soon to be an ACO) treats you fairly - consider yourself lucky.
Brian Meeker, D.O.
WMR Writes:
During my 25 years as Chair/residency director,accounting bias within the university/hospital consistently short changed family medicine. This is one of the major factors in the decline of procedural teaching within our residency programs. We were constantly being told that these procedures(and deliveries) "did not make money".
The first of our published papers on this topic was in J Med Ed 1984. More recently:
Rodney WM, Hahn RG. The impact of the limited generalist (no procedures, no hospital) on the viability of Family Medicine Training. J Am Board Fam Pract, May-June 2002;15:191-200.
These data suggested benchmarking income data against hypothetical promises from usual, customary, and reasonable" fee schedules. After controlling for a variety of fixed and variable expenses, these data predicted systematic underbilling and failed collections for all things related to surgical family medicine obstetrics(ie procedures). We projected this loss as $50,000-$100,000 per year per procedural FP depending on case mix and productivity.
These predictions were supported by studies that followed.
Rodney WM, Hardison RD, McKenzie LM, Rodney-Arnold K. The Impact of Deliveries on Office Hours and Physician Sleep. J National Med Association October 2006; 98: 1685-90. [Medicaid payments for deliveries average $1350 each but fails to count nursery, office ultrasound, miscarriages, subsequent well child visits and more.] Hidden value of each delivery probably equals $1200 per medicaid delivery if you can provide the family medicine service model amortized over the year following the delivery.]
Rodney WM, Martinez CM, Chiu KW, Garcia RL, Carson G. Prenatal patients not delivered: Unplanned events, uncounted services , and risks.[Delivery volumes at one office in Memphis]. Am J Clin Medicine Spring 2009; 6[2]: 31-36.
Rodney WM, et al. Medicos para la Familia: A Successful Model for Service Through Procedurally Enriched Family Medicine Obstetrics. University of Illinois, Rockford. Department of Family Medicine. May 5, 2010. Also presented at the World Organization of Family Doctors in Cancun, Mexico May 25, 2010.
In the example of GI endoscopy, the principles remain the same. Corporations promise professional freedom while creating a culture in which staff and financial staff have no direct connection with the doers of deeds. These disconnections lead to a variety of hidden "costs" which seem to defy any logical explanation.
The tragedy is that these hidden "costs" extinguish the affordability and access to health care services. I urge the AAPCE membership to use the compensation survey idea, and then conduct a formal study.
When deception is universal, to tell the truth is a HIPAA violation-paraphrased from George Orwell.
Or as my sainted grandmother, Dr. Mary MacMillan, used to say, "When the lamb lays down with the lion, that lamb should be very nervous."
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