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Your Top Questions Answered
Insurance Verification; Dropping Payers; Going Solo
VERIFICATION SPEED
QUESTION: What should I expect in terms of productivity from the person who verifies insurance in my office?
ANSWER: Expect an insurance verification clerk to complete 75 verifications per day, although technology (or the lack thereof) can affect this productivity significantly. Such technology includes online and automated-call systems for checking verification. The availability of this technology depends upon a payer's willingness and ability to allow practices to access information regarding their subscribers.
Measure your success by tracking the number of denials you receive because the subscriber was not eligible on the date of service or some similar reason that could have been prevented by verification. Your goal shouldn't be speeding up the process, but rather eliminating or reducing your denials.
DROPPING A PAYER
QUESTION: We're soon going to part ways with a specific managed-care payer. I will be sending a letter to my patients covered by that payer to inform them of our decision, explaining to them that we will not be renewing our contract because the insurer has ignored our complaints, been grossly substandard in its partnership with us, and has exasperated our staff. Will giving our patients the above reasons for the non-renewal open us up to any sort of litigation?
ANSWER: At the risk of seeming evasive, allow me to ignore the legal issue. It seems to me what you really have on your hands is a communications and business problem.
What do you hope to accomplish with the letter? I think the letter you propose will not do much to help you retain any of these patients, may alienate a payer you might want back in your corner someday, and really only serves to let you blow off some steam. Your patients don't care that your staff is exasperated, and they may not understand what all this has to do with them except that they probably need to find a new physician.
Instead, accomplish something positive.
Write a letter that briefly states that you are dropping the payer, and then go on into some detail explaining that you want to keep these individuals as patients and that money shouldn't have anything to do with it. Outline exactly how they can go about continuing to see you out of network.
If you want to push back on the payer, push where you might have some effect.
Determine whether a large percentage of this payer's patients work for the same company. Arrange a meeting with the human resources director of that company, and explain your situation. Encourage the company to drop this payer as a provider of benefits to its employees. Tell them that they are paying for administrata, not healthcare. The point of your communication should be to keep your patients' business if at all possible, not to change the country's entire healthcare system or achieve some personal release. Besides, success is the sweetest revenge.
SHOULD I STAY OR SHOULD I GO?
QUESTION: For my geographical area (Northern California), what should I expect to earn on an hourly basis as a well-respected family-practice physician? When I recently requested a raise where I currently practice, the practice's owner said she could not afford it because of overhead costs. I am considering leaving to start my own "cash-only" practice.
ANSWER: According to data from the Medical Group Management Association (MGMA), family physicians nationwide earn an annual median compensation of $152,000 without OB and $154,000 with OB. This is slightly lower in the West: $148,000.
It's difficult to translate that directly into an hourly wage because hours worked vary so much, but take a look at your income tax statement from last year to see how you compare.
Many practices are straining under increasing overhead costs. You might want to ask whether you can get involved in the management and financial review of your current practice - or at least have access to the practice's data and offer what suggestions you can. Explain that you aren't expecting to be a partner but that since this is your livelihood too, you'd like to help. If you can find ways to drop any overhead expenses or boost productivity, you may well earn yourself a raise. Doing this would also be useful if you do decide to head out and open your own practice. At the very least, you'll know if your boss is being honest with you.
I'd also start playing with the math on the cash-only practice question. How many patients would you need to see, at what rate, and how would you charge for your services (monthly? fee for service?) to earn what you make now? Remember to account for your own newly acquired overhead costs as a business owner (marketing, staff, equipment, software, etc.).
The grass may appear greener on the other side of the fence, but you need to take a closer look to know for sure.
NEUROLOGY PAY
QUESTION: What is the salary range for a neurologist with 25 years experience specializing in headaches?
ANSWER: Whatever it takes to get them to stay.
More seriously, here are some data to compare. All are the most recent salary data for neurologists, gathered from various sources by Merritt Hawkins, a physician recruitment company. I'm not aware of breakdowns by area of specialization.
MGMA: $239,511
AMGA: $213,300
Merritt: $209,000
Sullivan: $195,614
Hay: $189,100
According to a recent Merritt Hawkins survey, 63 percent of hospitals consider neurologists "very difficult" to recruit. Demand drives salaries up.
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