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Coding & Billing 38 CMS's Lowest vs. Highest-Paid Physicians: 5 Key Points By Laura Dyrda T he highest-paid surgeons by CMS bill five times higher than the lowest paid surgeons, according to a study published in Surgery. The study authors investigated pro- vider and regional payment varia- tion to surgeons from CMS with data released for 2012. The data included Medicare B participants in the fee-for-service program. The researchers found: 1. The services-per-beneficiary ratios were: • 20th percentile: 1.6 • 40th percentile: 2.2 • 60th percentile: 3.1 • 80th percentile: 5.0 2. The surgeons who earned more offered more services per beneficiary. There is a precipitous increase from the lowest docile to the highest docile. 3. The charges between the physi- cians were consistently greater than payments by a factor of three. 4. The female providers had lower ratios on a multivariate analysis of services per beneficiary ratio. 5. There was a regional variation in the ratio of services per benefi- ciary. n 2. New payment models, such as bundled payments and per-member, per-month payments, can help improve care and reduce waste. 3. e bundled payment model is one in which a pro- vider is given a lump sum payment to cover the cost of services provided during the defined episode. 4. e bundled payment model can support improved care for a discrete procedure, such as a colonoscopy. 5. In the per-member, per-month payment model, a provider or group of providers receive a set amount per attributed life. However, the delivery model dif- fers based on the complexity of the condition 6. e per-member, per-month payment model can support improved management of chronic condi- tions, such as IBD or hepatitis C. n Considering Alternative Payment Models in GI: 6 Takeaways (continued from cover) At t n: H e a lt hc a re Princ ipa ls 2 % Fina nc ing - Ava ila ble H a ve de bt or ne e d fina nc ing? I f ye s, t he n w e ne e d t o t a lk …… When it comes to financing did you know that most hospitals do not borrow money from Commercial Banks? No, they obtain their financing institutionally from the Capital Markets where they are able to structure financing at wholesale rates. For example, most hospital debt is in the 2.25-2.75% range or lower. If you have current practice and facility (including ASCs) related debt or new a project planned totaling $3 million or more (with no maximums) and want similar interest rates as the hospitals then you should contact our firm. Our financing structure can help with the following: Current Practice and Facility Related Debt ASC Debt - New Project Financing (construction and permanent) Partner Buy Out - New Partner Buy In - Debt Consolidation - Practice Expansion - Practice Acquisition Our rates are always at wholesale (up to "40% below" current WSJ Prime) pricing. Want to know more about capital market financing, our business and the services we offer? Please contact us. a division of MMC Capital Markets National Headquarters - PO Box 533304 – Orlando, Fl 32853 - Ph 321.231.8747