Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, July 29, 2009

Making Money in Primary Care

Imagine my excitement when I read the following headline of a post by Shadowfax: You can bet that caught my attention. What wonderful secret had the great and mighty Shadowfax unearthed about the economics of primary care? Enlighten us, oh wise one.

Turns out that the Cleveland Clinic pays primary care really well. How? Like many other large multispecialty groups, primary care is considered a loss leader. That is, primary care physicians get paid more than they generate for the practice directly, in recognition of the income produced by their referrals to the group's specialists and ancillaries.

Yawn. Old news.

So what if someone either doesn't want to work in a large group practice, or if one wishes to live in an area devoid of such an organization? How might this work?

Say specialists agree to supplement the income of referring primaries from their inflated receipts of the RBRVS, in recognition and appreciation for the work sent to them. Wait, I think there might be a name for this kind of arrangement. Oh yeah; it's called a "kickback." In fact, I'm pretty sure it's illegal (for doctors, that is. It's standard procedure for lawyers.)

How about ancillary facilities like labs and freestanding radiology centers helping to compensate primary care docs for all the lucrative business they refer? Wait; wasn't there a guy in Washington who didn't like the sound of that? Pete Somebody? Didn't they promulgate not one (I), not two (II), but THREE (Stark III) sets of regulations that basically prohibit that kind of monetary transfer?

Yes. Why yes, they did.

So with apologies to Shadowfax, it turns out that the only way to make money in primary care with the current payment structure is to cast my lot in with generous, far-sighted specialists who recognize my worth. Too bad no one else does.


At Wed Jul 29, 05:04:00 PM, Anonymous Cheryl Fuller, Ph.D. said...

I have never been a fan of big group practices. In psychotherapy, insurance also pushed to get us to be in groups where we could be more easily manipulated and controlled. As a patient I don't like them either -- the whole process of working through a whole list of options and button pushing to leave a message that seems all too often to get lost just turns me off. I enjoy that you are not in one of these medical factories with a myriad of offerings from primary care to massage.

It strikes me that the voice of the patient is strikingly absent from this entire debate.

At Wed Jul 29, 08:25:00 PM, Anonymous Anonymous said...

Just giver me enough time to save up the bucket load of cash I'll need to fork over to you when you go concierge.

Unless you want to take the Biscotta as collateral.

At Thu Jul 30, 05:12:00 PM, Anonymous SHG said...

Some of us appreciate your worth -your patients...

Don't be a Cranky Dino!!!! (my apolologies to CrankyLitProf)

At Wed Aug 19, 05:26:00 PM, Anonymous Disability Insurance for Physicians said...

It appears that primary care physicians have gone by the wayside in favor of higher paying specialist physicians. Is there any way to stop this trend? What will happen if medical students just stop electing to go into primary care?


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