Cash Practice John Cianca, MD
Disclosures• Owner: Musculoskeletal Ultrasound Consultants, LLC• Medical Director: Houston Marathon Committee• Instructor: Advanced Health Education Center• AAPM&R
– Medical Education Committee– Ultrasound Task Force– Early Career Task force– QPPR-MEC work group– Annual Assembly: Practice Tract Director
Background
• Fellowship trained in MSK• Board credentials
– Sports Medicine– Acupuncture– Ultrasound
• Began practice in 1993– Faculty: BCM
• Solo practice since 2004
Philosophy
• I value sincerity• I am angered by injustice• I care about what I do and how I do it• I try to remain true to my ideals• Clinically, I need to know why• Education is my primary objective• Medicine as a ministry
RVUs
– Relative Value Units (RVU)• Payment = [(RVU work x GPCI work) + (RVU PE
x GPCI PE) + (RVU malpractice X GPCI malpractice)] x conversion factor (region determination)
– GPCI = geographic practice cost indices– PE = Practice expense
RVUs = Satan’s Pitchfork
CARE
• Merriam Webster– Care: to be interested in or concerned about
something– Synonyms: conscientiousness, heedfulness,
meticulousness, scrupulousness
• Health is precious and we are entrusted as its guardians
• Care before Cash
Questions of Time
• Care requires thoughtfulness• We must take time to listen• We must afford ourselves time to consider, to
think, to be compassionate• Can we do this in 10-15 minute visits• Can we do this seeing 20-30 patients / day• Can you be happy this way• Who benefits in this format
Physician Errors
• “ Most process breakdowns were related to the clinical encounter, wherein practitioners are always pressed for time to make decisions”
Singh H, Giardina TD, et al. Types and Origins of Diagnostic Errors in Primary Care Settings. JAMA Intern Med Mar 25 2013:173(6)418-425
Cash Practice: Can You Do It
• Area of expertise• What is it that you do clinically• Established reputation• Collegial support• Patient referrals
Cash Practice: Infrastructure
• Keep it simple• Don’t over build• Be efficient
– One employee• phones / scheduling / check in and check out / rooms• In office accounting with CPA oversight
Setting Fees
• Fairness vs greed• Time • Complexity• No insurance > less constraints • Adjust fee if it seems fair
Fees
• 99201- $175• 99202 - $225• 99203 - $325• 99204 - $350• 99205 - $400
• 99211 - $80• 99212 - $100• 99213 - $130• 99214 - $200• 99215 - $250
Fees
• 20600 – 20610 - $85• 20552 - $100• 20553 - $155• 97810 - $90• 97813 - $120
• 0232T - $850 • J7325 - $500
• 76881 - $150• 76882 - $50• 76970 - $75• 76942 - $100
Day to Day Schedule
• 6-10 patients per day typical• 8-12 is ideal• 45-60 minute new evals• 20-30 minute follow ups• Leaves time for add on patients or procedures
Patient Filing
• Super bill with CPT coding and ICD-9/10 codes and charges
• Walk them through the process• Be available for questions