Hospital Charges

When you see a hospital charges an average of 2.5 .Medicare, did you know there are 5 pay rates?

Independent ambulatory surgery centers ASCs and PCPs only get 1/3 to 1/2 system owned clinics and remote surgery centers. But charges (retail we are billed for by system owned) can be 4x , 8x or unlimited x —even though they don’t expect to get that? “Chargemaster” rates are considered a trade secret but are how much every hospital marks up Medicare rates to bill us and our insurance.

When you read the AHA – the hospital lobby- sued POTUS to fight transparency mandates by Executive Orders, it revolves around these types of secrets.

Excerpt

CPT codeCurrent rateProposed
99201 (Level 1)$45$44
99202 (Level 2)$76$135
99203 (Level 3)$110$135
99204 (Level 4)$165$135
99205 (Level 5)$211$135

 

Value-Based Care is 3.0

Valuebasedcare is 3.0 and DirectPrimaryCare is 2.0 an expert in primary care models told me Tuesday over fish tacos.

Here’s why he’s wrong:

  • VBC relies on the kindness of BUCAH.
  • Yet they are directly competing for PCPs.
  • So can set the amount they pay below realistic economics to drive VBC ACOs to their knees.
  • Like they did with dozens of services like independent imaging or orthopids or DME.
  • They will do the same to independentACOs married to VBC in primarycare then “rescue” them. Buy em cheap. They can later pay themselves a fair rate. A fat profit, in fact, because it’s not their money. It’s ours.

DPC is more resilient to this game largely opting off the tilted game board.

Why would they do this if VBCs offer great value? Because they can.

Call me a jerk, but VBC appears a race to the bottom until BUCAH owns it all. It’s so clear.

Excerpt

“We can get typecast as anti-insurance or anti-government,” Umbehr said but likes the idea of insurance used appropriately.

“Insurance is perfect for expensive things, hospitalizations, major car wrecks, your house catches on fire, but … you don’t submit an insurance claim to wash your car, to paint a new room in your house, [or get] an oil change. … Insurance is a great tool, but not for affordable things,”

Why a Job as a Primary Care Physician?

My dermatologist sent in a 2nd-year resident yesterday. How many from her graduating class chose primary care? Most “because specialist slots don’t come easy “ for her school a lower third tier rated medical school. My son and daughter in law graduated premier medical schools and from 200 grads only 3-4 chose primary care. They are only two years ahead of my young derm resident.

Apparently, the unwilling are forced into becoming PCPs and not from the premier schools.

Here’s why…

 

Healthcare Salaries

Want to eliminate the PCP shortages

Want to eliminate the PCP shortages in a blink? Three ways:

Nurses represent the largest category of caregivers in primary care with 250,000 graduates annually but fallout rates are half after only two years. Wow and wow. Undervalued they say. And only 2% of articles mention nursing in healthcare press. So invisible, too. In most states NPs have restrictions to their scope of practice. Why ? Docs say they lack the 10,000 hours of training Malcolm Gladwell counts to become the Beatles or Steve Jobs. Residencies are 12-15,000 hours so there you go, Docs.
So why can’t nurses provide a wider scope after 10,000 hours in practice ? They are after all, a Doctor of Nurse Practitioner, today. Well it’s economic. Long as docs can bill these providers higher than they cost it’s too profitable to let them fly.
I learned last week Chief Nursing Officers are a lovely title with little budget authority and the true path to make a difference almost always involves an MBA not DNP alone. So a VP of Nursing with a budget trumps a pretty title.
Not the case for MDs. They don’t need that MBA to advance.
Here’s nursing beef I disagree with —
Training is not federally subsidized (which should be yanked from silly MD residency slotting since $60k residents we pay for are billed out at $2.4m on average )

Want to eliminate the PCP shortages in a blink?

There are three ways to eliminate the PCP shortage:
Nurses represent the largest category of caregivers in primary care with 250,000 graduates annually but fallout rates are half after only two years. Wow and wow. Undervalued they say. And only 2% of articles mention nursing in the healthcare press. So invisible, too. In most states, NPs have restrictions to their scope of practice. Why? Docs say they lack the 10,000 hours of training Malcolm Gladwell counts to become the Beatles or Steve Jobs. Residencies are 12-15,000 hours so there you go, Docs.
So why can’t nurses provide a wider scope after 10,000 hours in practice? They are after all, a Doctor of Nurse Practitioner, today. Well, it’s economic. Long as docs can bill these providers higher than they cost it’s too profitable to let them fly.
I learned last week Chief Nursing Officers are a lovely title with little budget authority and the true path to make a difference almost always involves an MBA, not DNP alone. So a VP of Nursing with a budget trumps a pretty title.
Not the case for MDs. They don’t need that MBA to advance.
Here’s nursing beef I disagree with —
Training is not federally subsidized (which should be yanked from silly MD residency slotting since $60k residents we pay for are billed out at $2.4m on average )