cupojava Posted April 9, 2014 Share Posted April 9, 2014 I like this fellow PAs articles but the reason I'm posting this here is because the way he is leaving his practice. It sucks that he had to be asked to basically take a pay cut or leave. Is it even worth it to work in a clinic but not be a co-owner? Is this the future of outpatient medicine with big hospitals buying out the smaller clinics? How the heck did it get to this? I understand PAFT is doing something about it but what else can we do? http://journals.lww.com/jaapa/Fulltext/2014/04000/After_20_years__Leaving_a_pediatric_practice.12.aspx# Link to comment Share on other sites More sharing options...
gbrothers98 Posted April 9, 2014 Share Posted April 9, 2014 i sympathize with this pa but i think there are several points also to consider that we dont know: if he started the practice, why is he not an owner? if he is, then he is getting something out of the sale. if he co-owned the practice then he likely was being paid much more than the median pediatric pa salary....because he was an owner. as an employee, especially if joining a 'consortium', expect there to be salary ranges to conform to. on the other hand, he is 60. if he still wants to practice, he has plenty of opportunity. maybe he opens another practice and competes with the 'consortium'. if not, i assume he saved some money, can get some health insurance somewhere and considers something else, maybe even a sabbatical or teaches or travels. i hope he looks at this change as opportunity rather than a complete loss. and while the paft may be working on this, i think the trend has moved away from independent practices. either pas will be employees or they will have to investigate the possibility of becoming partners/owners whereever they go and overcome obstacles in their way. good luck. george Link to comment Share on other sites More sharing options...
PACdan Posted April 9, 2014 Share Posted April 9, 2014 I saw the article as well and come away with only one question: Is he being forced to take the 45% pay cut just because he's a PA or would his practice partner physician have to take a percentage cut as well, if he went to practice with the new corporate owners? If it's a paycut for both, I'm not as outraged. If just for him, due to being a PA, that's unacceptable. Might have to email him to find out... Link to comment Share on other sites More sharing options...
Guest Paula Posted April 9, 2014 Share Posted April 9, 2014 I too have enjoyed his articles. He is an excellent author. I wish him well. Link to comment Share on other sites More sharing options...
whoRyou Posted April 10, 2014 Share Posted April 10, 2014 If it's a paycut for both, I'm not as outraged. If just for him, due to being a PA, that's unacceptable. Might have to email him to find out... If you do email him let me know as I am curious ... Link to comment Share on other sites More sharing options...
SocialMedicine Posted April 10, 2014 Share Posted April 10, 2014 The solo doctor or small group practice is OVER. It is impossible in this day with all the technology demands, specialty clinician involvement, reporting demands, insurance hassle, imaging follow up etc for a group to be outside of a group practice. Urgent care centers now handle the sore throats and more and more primary care/internal med is handling the complexity of general health mgmt. Unfortunately the logistical and administrative issues are just as complex as patient care. Almost everyone is going to move into a group setting or some kind of partnership, at least in urban settings, in my opinion. I also feel it is better for the patient. Currently almost 0 communication exists between hospital, specialist and primary care. It is a shame and wastes a lot of time and dollars. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted April 10, 2014 Share Posted April 10, 2014 Or if they're attempting to stay solo they're having to branch into other niche` areas such as cosmetic offerings, sleep studies, HRT, etc.. Link to comment Share on other sites More sharing options...
jmj11 Posted April 10, 2014 Share Posted April 10, 2014 I agree that the day of small practices are over. After starting and owning this practice for three years, I'm on the verge of selling out. The regulations and mostly the insurance companies bullying of small practices makes it impossible to function any longer. More than half of my energy is now spent fighting with insurance companies about contracts, reimbursement and etc. We just finished our busiest quarter ever and our collections have fallen by 50%. I've spent many, many hours on this problem. I've gone through 5 billers and my present one is excellent. It comes down to the insurance companies choosing not to pay us without explanation. They know, that a small practice, has no clout to fight back. My only options are to go cash only or sell out to a large entity who has the clout to fight back. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 10, 2014 Moderator Share Posted April 10, 2014 2 years into my own practice and a few points it is too bad that this shift away from solo practices is occuring, it does not benefit the patient in my mind insurance companies are EVIL - I only take medicare as I have no desire to have any association with insurance companies I declined to partake in Hitech funds or unmeaningful use...... it is at most a 5% hit and now I don't have to worry about box cecking there is no where near the independence in treating patients when you are an employee of a large company when are we going to have a single payer system? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted April 10, 2014 Share Posted April 10, 2014 ventana, please excuse my ignorance since I've never (yes, never) had to fill out a billing/charge sheet over 30 years for a patient encounter (gov't position, EM, and then ancillary services back in the 80's/early 90's for specialists). By declining the Hitech/meaningful usage agreement with CMS this allows you to maintain paper charting if that is your prerogative as well as not having to subscribe to any quality control screening such as how often are HbA1c values checked on diabetics, etc.; and as such, you are penalized 5% of charges for same? Link to comment Share on other sites More sharing options...
jmj11 Posted April 10, 2014 Share Posted April 10, 2014 Here is just one example of what insurance companies are doing. In our struggle to find funds, I had my biller track down five high end claims (mostly Botox) that were never paid (and over 90 days old). Each were for about $2000. It took her two weeks, sitting on hold for literally hours. Being transferred over and over again. In the end, with each case the insurer concluded that the claim was correct and should have been paid, but simply wasn't for reasons they can't explain. They say that the checks will be on the way, and we should receive them within a couple of months. So this is fine, however, I spent probably $1,000 for biller salary to get these claims paid. They will pay about 60% on the dollar, so maybe I will get 7-8K, but having to spend at least $1,000 for no reason. But play this over and over and over and it is worse. You could have 5 claims for $100 each. They do the same. I spend $1,000 in salary cost to retrieve the $380. That's when it makes no sense and the insurance company wins. They know that it is in their benefit to ignore a claim and not pay it for no good reason, and it is cost prohibitive to go after all but the very high end claims. Link to comment Share on other sites More sharing options...
jmj11 Posted April 10, 2014 Share Posted April 10, 2014 I too am opting out of Hitech, after following it for two years. Simply because the carrot, due to extremely poorly written law for PAs, does not exist for us. The stick starts with 1% and goes to 5% cut for all Medicare claims. However, our Medicare claims are small and the amount of work to follow Hitech for a sub-specialty clinic made no sense (weights, vaccines schedules and etc). It means spending 300 hours to save $200 (the 1% of medicare that my SP sees). Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 10, 2014 Moderator Share Posted April 10, 2014 ventana, please excuse my ignorance since I've never (yes, never) had to fill out a billing/charge sheet over 30 years for a patient encounter (gov't position, EM, and then ancillary services back in the 80's/early 90's for specialists). By declining the Hitech/meaningful usage agreement with CMS this allows you to maintain paper charting if that is your prerogative as well as not having to subscribe to any quality control screening such as how often are HbA1c values checked on diabetics, etc.; and as such, you are penalized 5% of charges for same? correct http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted April 10, 2014 Share Posted April 10, 2014 ventana, the more I think about it the more I'm in agreement with your decision. There is a "cost" for peace of mind. 5% for knowing that it will be assessed within a timely fashion and having to deal with only one party, aside from cash, I don't consider that an inappropriate "operational expense". What's the transaction fee for someone paying for a service with a credit card? A couple of percentage points? Getting close to being a wash at that point. Link to comment Share on other sites More sharing options...
Guest Paula Posted April 11, 2014 Share Posted April 11, 2014 I agree that the day of small practices are over. After starting and owning this practice for three years, I'm on the verge of selling out. The regulations and mostly the insurance companies bullying of small practices makes it impossible to function any longer. More than half of my energy is now spent fighting with insurance companies about contracts, reimbursement and etc. We just finished our busiest quarter ever and our collections have fallen by 50%. I've spent many, many hours on this problem. I've gone through 5 billers and my present one is excellent. It comes down to the insurance companies choosing not to pay us without explanation. They know, that a small practice, has no clout to fight back. My only options are to go cash only or sell out to a large entity who has the clout to fight back. I have followed your practice stories and admire your passion to have your own practice. (Same for Ventana). If you sell........make 'em pay. You built the practice. Link to comment Share on other sites More sharing options...
SHU-CH Posted April 11, 2014 Share Posted April 11, 2014 I heard a "friend of a friend" who worked for an unnamed government-sponsored reimbursement agency state they were advised to deny every 10th claim they processed (whether with merit or not). If it gets fought, you say oops and pay up. If not, free money. Great system we have... Link to comment Share on other sites More sharing options...
whoRyou Posted April 11, 2014 Share Posted April 11, 2014 I heard a "friend of a friend" who worked for an unnamed government-sponsored reimbursement agency state they were advised to deny every 10th claim they processed (whether with merit or not). If it gets fought, you say oops and pay up. If not, free money. Great system we have... You're kidding right? Link to comment Share on other sites More sharing options...
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