Money, Medicine & Meeting Demand

Totting up the tab

Checking into a hospital for surgery is a detail-oriented enterprise. There’s the pre-surgery medication and food requirements to think about, the decision on whether to donate blood for possible transfusions after surgery, admission paperwork to complete and transportation arrangements to be made, to name just a few of the particulars.

And that’s before the business side of surgery comes into play. Surgical procedures themselves may involve an apparently complex array of arrangements and physicians, with their varied responsibilities, schedules and bills. Take knee joint replacements, an increasingly common surgery performed hundreds of thousands of times each year in the United States. Each knee replacement patient is treated at a minimum by an orthopaedic surgeon and an anesthesiologist, and spends days recovering in the hospital following surgery. Other procedures might call for a radiologist or a pathologist as well. All in all, the potential for a billing headache may seem high.

At University of Missouri Health Care hospitals, a physicians group—University Physicians—helps organize the process. University Physicians is a multi-specialty practice group that includes more than 500 physicians employed by the MU School of Medicine who offer care at the university’s hospitals and outpatient clinics. The group handles what’s called the “professional billing” that charges for physician effort, training and skills used during a procedure, University Physicians Executive Director Scott Hofferber says. Those bills are based not on a particular physician’s personal pay rate, but on the procedures performed.

“So the doctor’s going to bill for the services he or she renders,” Hofferber says. “And the payment is the same regardless of who renders it.”

Every surgical procedure and service has a so-called Current Procedural Terminology (CPT) code assigned to it under a system developed and maintained by the American Medical Association. Physicians involved in a procedure inform University Physicians of the tasks or services they provided, and the group applies the appropriate code to each, Hofferber explains. University Physicians acts as a sort of physician fee clearinghouse, collecting all the CPT codes from a procedure and issuing a bill.

MU surgical patients can expect to receive a second bill, considered a “technical fee,” he says. Mailed separately by any of MU’s hospitals, that bill covers such costs as charges for hospital rooms, equipment and laboratory tests.

Meeting demand for physicians

TimeLine Recruiting, a national physician and health care staffing firm based in Columbia, highlights a number of community characteristics to attract physicians to the area. Recruiters point to Columbia’s vibrant downtown, its wide range of amenities and its schools, says Lora Utley, TimeLine’s director of recruiting.

“It’s a college town with a medical school,” Utley notes. “We have good education here for physicians and their kids—and that appeals to any family, and certainly to a physician’s family.”

TimeLine recruiters are working in a field feeling the pinch of a physician shortage driven by America’s aging population and the needs of those newly insured by the Affordable Care Act. Throughout the country, physicians are in short supply. By 2015, the physician shortfall will number 62,000, and by 2025, that shortfall will have grown to 130,600, according to Association of American Medical Colleges predictions.

Columbia can bear witness to that shortage, says Drew Lanham, the national director of TimeLine Recruiting. TimeLine Recruiting, a division of health care staffing firm Maxim Healthcare Services, focuses on recruiting physician faculty within academic medicine. Lanham notes that it has become generally more difficult to recruit physicians in every specialty over the last three to five years. The physician shortage “is everywhere,” he says.

“The shortage is here. The competition is here,” Utley agrees. “It’s in every community across the nation.”

TimeLine Recruiting works to offset that shortage with both tactics and incentives. The firm’s recruiters start by widening the pool of candidates, talking to as many physicians as possible throughout the Midwest, for example, as they seek to fill a position in Columbia, Lanham says. TimeLine administrators also urge facilities recruiting physicians to recognize the national nature of the job market. The facilities should take a look at the median salaries as benchmarked by the Medical Group Management Association, billed as the premier association for professional administrators and leaders of medical group practices, Utley says.

Along with salaries, recruiting facilities can attract physicians by offering benefits that are proving popular. For example, Lanham says, student loan reimbursement appeals strongly to physicians who often have to repay between $300,000 and $400,000 in education debt. Any facility that can help shoulder that loan burden is offering a major bonus, Lanham says.

Another popular benefit is the option of a bonus structure, offering physicians the ability to make more money. Such bonuses may be based on such things as quality measures or a physician’s number of patient visits, Lanham says. Quality of life concerns, such as the ability to have a definite end to the work day, are also a significant factor in attracting physicians, he says.

With all its amenities, TimeLine has found that Columbia—which Utley considers mid-sized, neither a small town nor a metropolitan area—has a lot of recruiting appeal. “It’s a community that’s fun to talk about, to get physicians interested in,” Utley says.