Comments on: Minute Clinics Part II… http://www.letstalkhealthcare.org/health-care-costs/minute-clinics-part-ii/ Sat, 22 Nov 2008 06:04:38 +0000 http://wordpress.org/?v=2.5.1 By: Ian McCarty (formerly Ian M) http://www.letstalkhealthcare.org/health-care-costs/minute-clinics-part-ii/#comment-752 Ian McCarty (formerly Ian M) Thu, 05 Jul 2007 17:06:28 +0000 http://www.letstalkhealthcare.org/?p=110#comment-752 Charlie, what is the standard model for reimbursing NPs and PAs who practice in PCP offices and ASCs? It seems to me, through experiences both professional and personal, that many patients are cared for by these providers when seeking minor care in a "traditional" setting. Are the facilities usually reimbursed as a whole to pay their providers as they see fit? If that be the case, I don't think it would be a stretch to firmly conclude that the main gripe of the AMA is the "easy money" that will be leaving their practices, and seeking care at these clinics. Charlie, what is the standard model for reimbursing NPs and PAs who practice in PCP offices and ASCs? It seems to me, through experiences both professional and personal, that many patients are cared for by these providers when seeking minor care in a “traditional” setting. Are the facilities usually reimbursed as a whole to pay their providers as they see fit? If that be the case, I don’t think it would be a stretch to firmly conclude that the main gripe of the AMA is the “easy money” that will be leaving their practices, and seeking care at these clinics.

]]> By: Barry Carol http://www.letstalkhealthcare.org/health-care-costs/minute-clinics-part-ii/#comment-731 Barry Carol Tue, 03 Jul 2007 22:33:55 +0000 http://www.letstalkhealthcare.org/?p=110#comment-731 As you say, the Minute Clinics can handle the simple cases for a lower cost than PCP's can and provide more timely access as well. The ASC's are more of a focused factory concept doing a few things well at, probably, 25%-30% lower cost than a full service hospital can do them. The question, I think, is: how should the PCP's and full service hospitals respond? For PCP's, I think the real issue is what is the appropriate value of an hour of their time assuming every patient they see needs to see a doctor instead of an NP or PA? I think there is a general consensus that PCP's are underpaid by Medicare, Medicaid, and private insurers as compared to specialists who perform procedures. To the extent that such spots exist, PCP's and pediatricians might be better off working for a salary instead of on a fee for service basis. There are two issues for hospitals if they lose a considerable amount of profitable business to ASC's. One is whether or not they need to reduce capacity either individually or regionally. The other is (assuming capacity utilization is satisfactory) are they being paid adequately for the cases that they handle and is uncompensated care unduly burdensome? If I were a payer, I would want the really simple primary care cases handled by an NP or PA. For hospitalizations, if an ASC can properly handle a case for 25%-30% less than a full service hospital would charge, that's a good thing. If the patient's issue can be competently handled by a community hospital instead of an AMC (at considerably lower cost), it should be. At the same time, we need to make sure that PCP's are compensated fairly for the work that they do and that payers (including taxpayers) aren't stuck paying billions of dollars annually for unneeded, excess hospital capacity. As you say, the Minute Clinics can handle the simple cases for a lower cost than PCP’s can and provide more timely access as well. The ASC’s are more of a focused factory concept doing a few things well at, probably, 25%-30% lower cost than a full service hospital can do them. The question, I think, is: how should the PCP’s and full service hospitals respond?

For PCP’s, I think the real issue is what is the appropriate value of an hour of their time assuming every patient they see needs to see a doctor instead of an NP or PA? I think there is a general consensus that PCP’s are underpaid by Medicare, Medicaid, and private insurers as compared to specialists who perform procedures. To the extent that such spots exist, PCP’s and pediatricians might be better off working for a salary instead of on a fee for service basis.

There are two issues for hospitals if they lose a considerable amount of profitable business to ASC’s. One is whether or not they need to reduce capacity either individually or regionally. The other is (assuming capacity utilization is satisfactory) are they being paid adequately for the cases that they handle and is uncompensated care unduly burdensome?

If I were a payer, I would want the really simple primary care cases handled by an NP or PA. For hospitalizations, if an ASC can properly handle a case for 25%-30% less than a full service hospital would charge, that’s a good thing. If the patient’s issue can be competently handled by a community hospital instead of an AMC (at considerably lower cost), it should be. At the same time, we need to make sure that PCP’s are compensated fairly for the work that they do and that payers (including taxpayers) aren’t stuck paying billions of dollars annually for unneeded, excess hospital capacity.

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