Talk of The Villages Florida - Are Primary Care Physicians "Loss Leaders" or "Marketing Dupes"?

Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)

- The Villages, Florida, Non Villages Discussion (https://www.talkofthevillages.com/forums/villages-florida-non-villages-discussion-93/)

- - Are Primary Care Physicians "Loss Leaders" or "Marketing Dupes"? (https://www.talkofthevillages.com/forums/villages-florida-non-villages-discussion-93/primary-care-physicians-loss-leaders-marketing-dupes-360843/)

Quote:

Originally Posted by Gig1414 (Post 2456185)

Retired CFO of a hospital system here. ...

We always lost money on the PCP line of business, and when reporting these results to the Board, I began to refer to the PCP’s as our “sales force”. They got this, and understood that it was a supply/demand issue, and PCP’s were needed to feed our Cardiac, Oncology, Orthopedic etc. programs.

Hence the title of this thread. I assumed that had to be the process. The PCP gets the patient in the door and into the system .... the revenue is in the "after sell".

Selling the patients the extended warranty! :a040:

Quote:

Originally Posted by Justputt (Post 2456223)

What people haven't talked about is the overall shortage in pretty much all medical fields. Sometimes we see NP and PAs because staffing levels don't support everyone seeing an MD. Most of us remember when it wasn't hard to get into see our MD on the same day as a walk-in. Those days are gone and unlikely to return. Government run healthcare is largely to blame because the payment system (amount, complexity, and requirements) is driving people away.

For example, our 4-hospital system was just driven to convert our individual EMRs to a single EMR called EPIC for around $150M. The process was a nightmare; the company acted like we were their first client, which we were far from being, and the EPIC processes were little more than generic, e.g. Epic had their way to do things (patient flow, schedules, limited interfaces, support) and pushed us to do things their way (not what staff wanted to hear). What does the government reimburse for the required EMR? ZERO dollars! Overall, it will improve the exchange of information between hospitals when we share a patient, but for $150M and I don't know what EPIC charges for the annual licenses and support contracts. But remember, having an EMR is a government requirement that we don't get paid anything for having.

Manpower had been a problem since before COVID, but COVID drove a lot of people out of the field or into retirement. As of 1.5 years ago when I retired, my hospital was grossing more than it ever had (and we were always lean and in the black), but post-COVID, losing $2M/month largely due to the cost of travelers/LOCUMs. It took years to find my replacement, even offering top pay and living in a really nice area. Don't look for things to get any better with the government driving the payment system.

The government requires hospitals to do more and more while bundling more and more charges with the aggregate payment continually being substantially reduced. In my primary field of radiation oncology bundling charges has been very painful, but at least we're still profitable. However, our ability to cover the cost of hospital services that are routinely losses is much more limited. There are only a handful of hospital services that make the money to pay for the others. Then there are the no-pay patients we care for, which can be 35-50% or more of the patients in some areas. We do all the same work, use all the same assets, have all the same malpractice liabilities and zero income. No, the ACA doesn't cover those people as promised.... big surprise.... not! The government is driving this bus, not the hospitals or even the insurance companies.

Heh. Remember the nine scariest words in the English language?

"I'm from the government, and I'm here to help".

If there is one thing we should have learned by now (but obviously haven't) it is that if Government is doing it, private enterprise can do it better. And faster. And cheaper. Case in point: when we first moved here, I was perplexed by the office of "tax collector". Seemed sort of odd as well as sort of provincial. We were there to get our driver's licenses changed from Minnesota to Florida. Once inside the building we were directed to the end of the hall and told to wait until our names were called (maybe 10 minutes), went to a window, filled out a couple of forms, had our vision checked, etc. At the end of the process I asked the lady how long we'd have to wait for our licenses. She looked at me sort of oddly and said "you'll have them in your hand when you leave here". And we did. In Minnesota that would have been a six-week wait AFTER we got in to see the agent, and no guarantee of even that.

And then of course there is Elon and his reusable rockets.

Driver's licenses and reusable rockets are not health care, but leaving things to the bean-counters and government career turf-builders is at best a guarantee of mediocrity, if even that. Yeah, I realize that a lot of health care is government-funded so there has to be accountability, but the system we have now is way overly complicated and (if what we read is true) incredibly poorly done; and true accountability almost impossible. Dump the bureaucracy and bureaucrats and contract it out to people who KNOW how to get things done

Quote:

Originally Posted by golfing eagles (Post 2456179)

There's a lot there to respond to, so here's the highlights:

10 years ago our nurse practitioners, between salary bonus and benefits, had a compensation package of about $130,000. And no, that is not 85% of a physician's income. We made minimal "profit" on our NPs.

I don't know where that "break even" idea came from. Primary care practices generally run at about 55% overhead, we were a bit better at 47% overhead. So individually we kept about $53K out of every $100K billed and collected (another issue). But out of that we then individually paid malpractice insurance, disability insurance, overhead insurance and taxes. So on average, a primary care physician was left with 19 cents on every dollar collected.

So on average, when you see Dr. "X" billed out $1 million and are "shocked", that translates to $900K collected, $405K after overhead and about $275K after expenses---with no benefits and no pension for retirement. This comes out to less total compensation than a police sergeant married to a high school guidance counselor in a medium sized town.

if you were running at 47% overhead, you running a tight ship. I would have guessed an overhead of 55%-60%.

Doctoring seems to fit into the universal model of professional employment ...lawyers, consultant, engineers. If you only have 2-5 professionals and limit staff & overhead, you can make a fair living ... after that, you enter into "no man's land" while expanding. If you can reach critical mass and become a big operation, you're back to making money, but it's always seems like a tough go for the guys in the middle.

Thanks

One thing missing is that the Primary Physicians are seeing MORE than 1 patient per hour. As a patient, I am often in and out in 15 minutes. So, I assume that primary doctors are perhaps averaging 3 patients per hour. Note: this is just my GUESS. If anyone has real statistics on this, I would like to know them.

Quote:

Originally Posted by Michael G. (Post 2456080)

We should of sent all our kids to medical school when we had the chance.

I agree and many of our "best and brightest" high school students end up going into Business in college with the intent on ending up on Wall St.

Quote:

Originally Posted by Angelhug52 (Post 2456144)

And professional athletes get paid millions.. Seems people are OK with athletes getting big bucks.Yet a teacher or medical professional aren't valued.

A long time ago (about 50 years ago) Doctors WERE in charge of their medical profession. Somehow, insurance companies ripped away that leadership and took the lead for themselves. The Insurance Companies' CEOs now reap the rewards, "the big bucks" and the Physicians lost some salary and some STATUS. I would SPECULATE that America and Americans are the losers and we should be more like Canada, Australia, and Europe and have a Nationally controlled medical system. Most Americans COMPLAIN about our medical system, but we will probably be stuck with it for the next HUNDRED years.

I don't know this first hand but a friend who consulted small medical practices for efficiency and profitability told me that to break even a primary care physician had to see minimum 32 patients a day. At 15 minutes per appointment that works out to eight hours. Most of my appointments with the Dr are 10 minutes or less. I don't know if they get paid for referrals to specialists or hospitalizations, that would be an interesting subject.

I find these statements amazing. The USA spends more than 50% per person than the second highest country and yet doctors aren’t making that much money.

What are we doing wrong?

1. United States: $12,555
2. Switzerland: $8,049
3. Germany: $7,382
4. Netherlands: $6,753
5. Austria: $6,693

Quote:

Originally Posted by retiredguy123 (Post 2456173)

In my case, I cannot be "directed" to a PA or an NP. Unless I have an emergency, I tell the scheduler that I will only make an appointment with a medical doctor. Period.

I understand the concept of wanting to ONLY see a Doctor and not a physicians assistant or a nurse practitioner. Personally, I have never had a problem with PAs or NPs. I have known physical therapists with large amounts of medical knowledge.

Quote:

Originally Posted by Justputt (Post 2456223)

I wonder what role citizenship plays in hospital costs increasing?

Quote:

Originally Posted by Rainger99 (Post 2456286)

It is obvious what we are doing wrong by looking at that list. The US is the only non-National Health Care country. The US has too many middle-men in its system.

Quote:

Originally Posted by elle123 (Post 2456147)

It's the insurance companies pushing physcian assistants and nurse practitioners. It's also the insurance industry that's absconding with billions. Privatized Advantage Medicare allows for greater fraud. "Private Advantage Medicare plans are paid based on a "risk score" that correlates with a patient's health. To increase profits, some plans or their contractors exaggerate patients' diagnoses, making them appear sicker than they are to receive higher payments from the Centers for Medicare & Medicaid Services (CMS)."

In addition, "some health plans and brokers offer illegal incentives to gain enrollment, which violates regulations designed to protect beneficiaries.

Insurers pay brokers illegal kickbacks to steer beneficiaries toward their specific MA plans, rather than recommending the plan that best suits the beneficiary's needs." That's probably what happened in The Villages and explains why the facility rejected regular Medicare.

That is why there are so many ICD diagnosis codes on your Explanation of Benefits. It's also interesting to read your medical records- sometimes if you mention something (ex. such as occasional back pain), you might find a diagnosis that would warrant xrays with another practice you may be a patient of, when you may not need them. Interpretation by cross-sharing medical records in the cloud is another interesting occurrence. Underwriting medical exams for insurance must be much easier for denying medical or life insurance these days since everything is out there. XX Denied!

Quote:

Originally Posted by BrianL99 (Post 2456107)

The Prevailing Wage for an Electrician in Massachusetts, is $90/hour. $56 in the envelope + $13 Health Benefits + $21 Retirement.

That's not true. My son is a journeyman electrician in Boston. The numbers you're quoting are for "rated" jobs, meaning jobs on government buildings. Everyone would love that kind of work, but they're few and far between, and no one gets them all the time, no matter how politically connected they are.

Quote:

Originally Posted by BrianL99 (Post 2456107)

The Prevailing Wage for an Electrician in Massachusetts, is $90/hour. $56 in the envelope + $13 Health Benefits + $21 Retirement.

Quote:

Originally Posted by nhkim (Post 2456330)

That's not true. My son is a journeyman electrician in Boston. .

You're right, I was too low. The Electrician Prevailing Wage rate for 2025 is $102.25. The Rate I quoted was from 2023. They got a raise.

Do you understand what "Prevailing Wage" means?

Quote:

Originally Posted by Rainger99 (Post 2456286)

Curios if other countries have more or less malpractice lawsuits.