Dr. Reece’s Pieces, 24/7, Friday, April 30

Key words - on-call payment, on-call payment rates, physician opt-out rates for Medicare and Medicaid, concierge practices, cash-only, open-access scheduling, house calls, virtual medicine, bundled hospital-physician payments

Daily summary – Almost half of doctors do not receive pay for being on call; more doctors are not accepting Medicare and Medicaid patients; small practices are going into concierge practices with specialized services; hospitals and medical staffs are experimented with bundled payments.

FOR ALMOST HALF OF DOCTORS, IT DOESN”T PAY TO BE ON-CALL -MGMA, Health Leadersmedia.com -Nearly Half of Primary Care Docs Get No Additional Compensation for On-call “- Nearly half—44%—of primary care physicians received no additional compensation for on-call coverage, according to the Medical Group Management Association’s Medical Directorship and On-Call Compensation Survey: 2010 Report Based on 2009 Data. In addition, 49% of nonsurgical specialists who answered Englewood, CO-based MGMA’s survey reported no additional compensation for on-call coverage, while 72% of surgery specialists received additional on-call compensation. Most survey respondents said the compensation was in the form of a daily or annual stipend.The daily rate of on-call physician compensation varied greatly among specialties. Family practitioners with and without OB/GYN earned $110 and $100, respectively, per day. Neurosurgeons earned $1,671 daily. Ophthalmologists earned $500 in additional compensation per day while general surgeons earned $905 and urologists earned $283. The holiday rate for general surgeons was $3,000, and family practitioners received $588 per day.

WHY WOULD YOU ACCEPT MEDICARE OR MEDICAID PATIENTS IF YOU LOST MONEY ON EACH TRANSACTION? – Wall Street Journal, New York Times, ABC, CNN, FOX News - The story of doctors opting out of Medicare and Medicaid is all over the news these days, but the Obama administration doesn’t seem to notice. There is little in their health plans to encourage doctors to accept patients on government rolls or to create more doctors. Instead, the government is cutting reimbursements for specialists and for Medicare, and giving token increases for Medicaid beneficiaries. This at a time when the government is promising to add 16 to 18 million Medicaid patients, and 13,000 baby boomers each day will be joining Medicare ranks in 2011. In New York City, only 37 of 93 internists affiliated with NT-Presbyterian accept new Medicare patients. In Texas, only 38% of doctors take new Medicare patients. Nationwide, less than 50% of doctors accept Medicaid patients. It does not seem to have occurred to government that doctors must pay staff and business expenses, that getting paid and harassed by government agencies is a horrific harassment, and that doctors, like other ordinary mortals, have creditors who listen with a deaf ear to doctors who complain of poor reimbursement. Like other businesses, you don’t make up for payments below your cost of doing business by seeing more patients.

YOU CAN MAKE YOUR SMALL PRACTICE SUCCEED – ModernMedicine.com, “Physician's Focus: Make Your Small Practice Successful,” Whether you see it as small practice revolution or evolution, Modern Medicine thinks you'll be interested in the stories of physicians who have found innovative ways to make a small practice successful, starting with the experiences of several cash-only practitioners to help explain the concept and then the accounts of two others, one who has thrived and one who failed in cash-only practices. Next, discussion and perspective on concierge medicine, the open-access office and micropractices are presented, wrapping up with Modern Medicine blog posts and a CME opportunity for professional development.

• Cash-only medical practices skip the middleman - It's possible to walk away from third-party payers and still create a satisfying practice. In cash-only medicine, practices collect .

• from patients at the time of service (cash, check, or credit card), and don't accept private insurance. If a patient has coverage, it's the individual’s responsibility to get reimbursed.

• How to run a cash-only practice and thrive - This family physician runs a cash-only practice, sees 16 patients a day, goes home at 5, and takes home more than $250,000 a year.


• Why my cash-only practice failed -The author and her partner bet that patients would pay out of pocket for extra service. They were wrong.

• Making the switch to concierge medicine- If you want to spend more time with your patients, consider a retainer practice. However, unraveling your current practice to become a concierge doctor isn't for the faint of heart. This article explores the benefits (and drawbacks) of this type of practice and may help you decide if you're a candidate and tell you what steps to take to make the switch.

• The open-access medical office -By giving same-day or next-day appointments to people who desire them, an open-access practice can become a patient magnet. Seeing patients when they want to be seen helps you respond to their needs and stay competitive.

• Does an open access medical practice reduce risk? -By shifting responsibility to patients, true open access can also shift liability. The key is to be sure patients realize that it's up to them to comply with your guidance and recommendations.


• The medical micropractice -Using technology, doing without staff, and spending more time with fewer patients characterize the micropractice model. A micropractitioner typically works alone in a space that's drastically smaller than used by the average soloist. Such austerity reduces the customary overhead by 40% to 50%, thereby lowering the break-even point and enabling a physician to spend more time with fewer patients.

SURVIVING IN SMALL PRACTICES MAY DEPEND ON CREATING CONCIERGE NICHES – Healthleadersmedia.com – The newly redesigned practice of pediatrician, Natalie Hodge, is thriving. She has developed a concierge practice, renamed it Personal Medicine, avoiding 3rd parties, and specializing in house calls and “virtual medicine.”

LUMP AND BUNDLE IT. ANOTHER WAY TO GET PAID. Los Angeles Times and Dallas Morning News. Hospitals and medical staffs in California, Texas, New Mexico, and Oklahoma are experimenting with bundled payments for big ticket hospital procedures, like joint replacements. Hospitals and doctors negotiate on how to split a single payment for the procedure. As someone who has been there and done that as a PHO chairman I can attest that bundling is doable, not only for big but for common procedures and episodes of care as well. Its success depends on hospital-physician trust, physician leadership, and whether the bundled payments gain market share and health plans go along with the arrangement. Medicare has bundled payments on its innovation list, and Massachusetts is exploring this as a cost-cutting option.