I'm semi retired and work every Wednesday in a local Occupational Clinic. I signed a contract 3 years ago for $65.00 an hour. Been very satisfied until a new service manager came in last January. My first encounter with her was anything but cordial. She said that I needed to get DOT Medical Certification qualified. I said will the clinic pay for it. She said no, and then said I was not going to become certified. Then she asked about my contract and I said I was hourly. She asked if I would consider RVU pay base. I said no and explained that it wasn't my job to get patients into the clinic, it was her job. The subject was dropped until April when she approached me again and said that all the clinics she managed were going to a RVU reimbursement for their providers. I asked if this included non provider management such as she. Well of course not. She is salaried. I said nope I have a contract. She said you will never get another raise. I then said fine, I don't need this job and all this drama. I was hired to see patients. If 10 or 35 come in the door on any given day I will see them. She said I don't understand and I told her that this is some bean counters way to screw the providers. I quit effective today.
And here's the rub with RVU's working in ER's, OH and Urgent Care Clinic. You are at the mercy of what comes in the door. You don't have the luxury of building a patient base that are reoccurring. My daughter in law is a PA in Tacoma, WA. She worked a 12 hour shift last Thanksgiving Day. Saw 4 patients.
This system is set up for fraud and over billing. As a example I cut my finger last winter. I needed a Tetnaus shot. I went to my local Urgent Care after hours. I didn't need sutures, I needed a Tetnaus shot which I got. I was floored when I got a bill for over $800.00. I asked for a comprehensive breakdown of the cost. The provider billed me at new patient comprehensive. I asked for my records and was stunned by the crap he had documented to get to that level. I protested the exorbitant charge and told the billing office
1. There was no way the provider spent 1 hour with me to charge at that level. He walked in looked at my finger and walked out. My check in time was 610 and discharge was 655. I told her I don't recognize the patient he documented seeing that day. I have no idea how he gleamed that much information in a 30 second encounter.
2. I was charged a afterhour premium charge. I said your clinic advertises its open hours as 7 am - 1000 pm. That is not after hours. I'm not paying that.
3. I was charged a surcharge for records review. I said what records were reviewed. This was the first time I had ever been i there system.
4. She then said one of the most incredible things. She said why are you making a big deal of this. Your insurance, "TriCare" is going to pay 100%. I told her we will see about that after I get done calling TriCare fraud hot line and tell them to contest these charges. I told her that I was a Physician Assistant and I knew a scam of over billing when I saw one.
5. About a week later I received a revised bill for $180.00.
In summary how many of these clinics operate that way? How many patients just shrug their shoulders and pay the bill. Some of these providers are just driven by quantity to get paid.
Sorry for the rant.