Regional variation in reimbursement

[agolden1]

Working up in the Northeast. A frequent complaint I've heard about the area, particularly the state I am in, is that insurance reimbursement for all medical services (not just pain) is significantly lower here than in other adjacent states, or even other parts of the country. If this is true, is there any resource or way to determine which regions may offer the best rates for service, or is this just a matter of contacting insurance companies directly.

While I have a job I can tolerate for now, I'm trying to figure out potential next moves and am mulling the idea of opening up my own shop as there aren't many job opportunities which align with the way I want to practice in the area where I am.

Thanks!

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[Dr. Ice]

Northeast:

Bigger = better (rates that is)

Southeast, Midwest = better rates because of less competition

In New Jersey the closer you are to NYC the better rates you get..it’s just plain fact

 

[agolden1]

Northeast:

Bigger = better (rates that is)

Southeast, Midwest = better rates because of less competition

In New Jersey the closer you are to NYC the better rates you get..it’s just plain fact

Fair enough.

But any resource that more or less codifies this? I live at the junction of several states and if I move forward with a practice opportunity, I'm trying to decide where exactly to open up shop.

If it doesn't and is just by anecdote, then I understand too.

Thanks!

 

[Dr. Ice]

Fair enough.

But any resource that more or less codifies this? I live at the junction of several states and if I move forward with a practice opportunity, I'm trying to decide where exactly to open up shop.

If it doesn't and is just by anecdote, then I understand too.

Thanks!

I can only speak for my state. The northern part of NJ, which let’s call it north of edison (assuming you have any idea what I’m talking about) is packed with out of network docs. They are making a ridiculous amount of money working 25 hours a week. Then there are those working at big hospitals getting rvu based payment, also doing well. Everyone else is trying to figure out whether or not it’s worth it to continue to live in the state. South of Edison, by many considered “south jersey” but isn’t, it’s either massive ortho group with good contracts or hospital employment or trying to join a multi-specialty group with good in network contracts, or joining an existing single speciality group which was fortunate to negotiate really great rates because they started in the “north” part of the state and already had the rates. And yes many who aren’t intertwined in anything are thinking of also leaving the state.

To ask me for hard evidence of this is not really possible. Your question is based on anecdotes. It’s not like someone did a case controlled study on what people are doing and so there are hard facts on it. These are stories based on hearsay but not false because it’s based on the experiences I have gathered from having colleagues in every part of my state.

What part of the northeast are you in?

 

[sevo00]

They are making a ridiculous amount of money working 25 hours a week.

How much we talking

 

[agolden1]

I can only speak for my state. The northern part of NJ, which let’s call it north of edison (assuming you have any idea what I’m talking about) is packed with out of network docs. They are making a ridiculous amount of money working 25 hours a week. Then there are those working at big hospitals getting rvu based payment, also doing well. Everyone else is trying to figure out whether or not it’s worth it to continue to live in the state. South of Edison, by many considered “south jersey” but isn’t, it’s either massive ortho group with good contracts or hospital employment or trying to join a multi-specialty group with good in network contracts, or joining an existing single speciality group which was fortunate to negotiate really great rates because they started in the “north” part of the state and already had the rates. And yes many who aren’t intertwined in anything are thinking of also leaving the state.

To ask me for hard evidence of this is not really possible. Your question is based on anecdotes. It’s not like someone did a case controlled study on what people are doing and so there are hard facts on it. These are stories based on hearsay but not false because it’s based on the experiences I have gathered from having colleagues in every part of my state.

What part of the northeast are you in?

Appreciate the insight, and it sounds like this isn't the kind of thing you can call insurance companies for, or that there's an online listing or resource for similar to how medicare will list the reimbursement amount for each procedure.

I live close enough to the junction of Eastern NY, MA, CT, VT and RI and have a bit of flexibility in that I could probably live in any of them while meeting some of my wife's criteria as far as where we need to be. I was just trying to see if there was an easy way if there was an optimal location based on reimbursement trends.

Thanks though!

 

[Dr. Ice]

A

How much we talking

5-600 working 25 hrs/week

 

[sevo00]

A

5-600 working 25 hrs/week

is that part of NJ getting pretty saturated? i always thought comps were lower closer to NYC as there was more competition between pain docs?

 

[GlowInTheDark]

Appreciate the insight, and it sounds like this isn't the kind of thing you can call insurance companies for, or that there's an online listing or resource for similar to how medicare will list the reimbursement amount for each procedure.

I live close enough to the junction of Eastern NY, MA, CT, VT and RI and have a bit of flexibility in that I could probably live in any of them while meeting some of my wife's criteria as far as where we need to be. I was just trying to see if there was an easy way if there was an optimal location based on reimbursement trends.

Thanks though!

That region is not only saturated, it has a heavily established opioid prescribing culture that is nauseating.

 

[Status Sciaticus]

A

5-600 working 25 hrs/week

Out of curiosity, why would a patient go to see an out-of-network pain doc vs in-network?

 

[agolden1]

That region is not only saturated, it has a heavily established opioid prescribing culture that is nauseating.

It's a weird area to be sure. There are some older practitioners who started practicing pain medicine in the late 90's early 00's who don't have the best prescribing habits to be sure. Unfortunately they've formed some super groups where they try to do as little med mgt as possible and pawn it all off to young NP/PA/MDs who don't know better. A few people doing a good job of cleaning this up, but some of these practices definitely need to fold and sooner rather than later...

As far as saturated, there's still plenty of work to go around, but there aren't many jobs per se. Most docs are booking weeks to months out locally. It's just there aren't many vacancies unlike the midwest and southeast.

 

[Dr. Ice]

Out of curiosity, why would a patient go to see an out-of-network pain doc vs in-network?

Marketing, shorter wait times, they don’t know the doc is out of network, their cousin Mary told them the doc spend 1.5 hours with them and it was a wonderful experience…cause she didn’t get the bill yet..