Oh the ER person!
Which was worth $40.
They got billed $900 that had nothing to do with treatment.
âComplete bullshitâ as you said.
And you still donât understand English apparently.
Sigh. I was mostly agreeing with you. Anyway, pvn is technically correct that you do have âa financial interest in being able to collect fees from patients he doesnât interact withâ. If that happened a lot, it would likely benefit you. Do I think the typical ER doc acts with that incentive in mind? No.
Hey man, if you want to say that your equivalent is an NP, go right ahead. Iâm not going to argue with you.
Sure pvn but again, the facility fee that youâre complaining about has nothing to do with the ER doctor. The vast majority of us are employed by hospitals, and only get the professional fee (which is the 40 bucks).
And fuck dude I think itâs fair to complain about the facility fee. My issue with the article is that they make it sound like they never got seen when they did and the ridiculous demand that they see a burn specialist within an hour when they arenât a truly emergent case.
My issue with you is your ignorant insult that I have a financial interest in this.
Lol sure dude
So your argument is that youâre sad that it makes you look bad when people see what the bill is.
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Uh, but you do
I donât. Itâs been explained to you why, and if you canât figure it out you can either ask questions or let it go.
I hate to break it to you buddy, but Iâm afraid youâre the one who has no idea what youâre talking about.
Imagine that professional fees at Emergency rooms remained constant, but facility fees increased ten fold. What do you think would happen to the average ER docâs compensation:
A. It would go up
B. It would go down
C. It would remain completely unchanged.
The answer to that is obviously A, and if you need the reasons explained to you, then youâre more out of it than I thought. Now it wouldnât go up anywhere near proportionally to that increase, because the people who manage hospitals donât want to pay any more than they have to for labor (i.e., you), but market forces (even in this imperfect market) would cause compensation to rise at least somewhat.
I do need the reasons explained to me. Please tell me. You seem to think that ER physicians are hospital employees. Itâs quite rare for that to be true.
No problem. It would help me provide a better explanation if you could tell me what you think the answer is: A, B, or C.
Let me know and Iâll explain it.
I donât think this. I get that you happen to be and that your employment situation is really quite atypical for an ER physician in a few ways. It doesnât change the answer to the hypothetical question I asked.
C is most likely, then B, then A.
Iâm also not a hospital employee
whether you are technically employed by the hospital is really just an accounting curiosity. youâre not going to get ambulances bringing patients to you if you just decide to practice emergency medicine in your garage.
ERs are largely staffed by third party companies outside of any hospital. The ER provider doesnât see a penny of that facility fee. That difference isnât technical, it dictates how everyone gets paid.
In this example, the providerâs third party company got 40 dollars. The hospital, not the provider, was the rest of the bill. The provider doesnât get that money.
And again, unlike what you said before the ER doctor doesnât get paid when you donât see the patient.
I didnât say that they did, I said they would benefit if they did. I literally quoted the article that showed that only the nurse was line-itemed!
Cool and youâre wrong about that. The hospital benefits from that. The doctors and providers donât. The NP may be a hospital employee here which is why it all comes from the hospital as one bill, but the doctor does not get the facility fee. They get the professional fee only. That would be a very atypical setup if the np is a hospital employee in the ER.
Youâre free to use that to indict âthe systemâ. I agree! My disagreement comes from you ignorantly insulting me. This story is asinine. It should be about the facility fee, instead the author canât differentiate between a np and a nurse, then ludicrously states that the doctor didnât show up when it was a specialist coming down for a non emergent call.
Wow! I donât know if I can help you with B being more likely than A. But here goes:
If professional fees stayed constant but facility fees in the ER went up ten-fold, then ER docs would be a money printing machine. Every time they see a patient the facility would get a massive amount of money.
In order to take advantage of this hospitals will want to hire more ER docs so that can cash in on that sweet, new, ten-fold increased facility fee. When the demand for ER docs goes up, the compensation for said doctors will go up.
I guess I could stop there but we can get into some details.
â Imagine the scenario where the hospital doesnât employ the ER doc, but contracts him (or his group) to provide services at their facility. Now imagine a contractual situation where the facility keeps the facility fee and the doc keeps the professional fees.
At some point, the facility fee increases 10 fold. At this point, unless overhead has also increased 10 fold (which we can assume didnât happen or I would have stated it in the scenario), the ER group can very easily negotiate with the hospital and say âHey I just noticed that you guys happen to be getting more money as a result of the work that I do, I think we would like some of that. Or maybe we may not be able to staff your ER any longerâ.
Now if you are in the hospitalâs position, you are making a ton of money off of these guys, if you kickback a bit of them a bit of your windfall, you come out way ahead. So, you go ahead and everyone gets richer.
Now, at this point, youâre probably thinking âDumbass Melk, kickbacks are illegal, you donât know what youâre talking about.â Because that is what you do.
I know that. There are plenty of creative ways to structure compensation contracts so that more money ends up in the docs pocket that meet the letter of the laws concerning kickbacks. I guess I could give some examples of these, but there is only so much I want to type.
â Now letâs imagine an employed doc scenario. Remember the employed doc is working in the same ecosystem as these other docs. If those other ER groups offer better compensation, then the employer needs to do this to in order to be able to attract desirable candidates. Furthermore, in the case of the employed doc, the employer doesnât really care about facility fee or professional fee. The money is fungible. All they know is they suddenly have way more money coming. It is very easy for them to pay you a few extra bucks and keep the money printer running than it is to try to lowball you.
As I alluded to previously, the hospitals and employers have way more power in these negotiations than the docs or the groups (unless they are massive), so the doc is not going to get a âfairâ raise (whatever that may be) relative to the massive increase. But there will definitely be some, because ER docs will be a hot commodity. Everyone will be building/expanding ERs and trying to attract more of them so that they can cash in on that sweet facility-fee windfall.
Also, I realize this is hypothetical. In the real world there is not going to be any ten-fold increase in facility fee. But any upward rise in the collection of facility fees will exert (perhaps only a tiny) upward pressure in the compensation of ER docs. In the real world, this effect is so attenuated that I donât think the typical ER doc is incentivized by it. But it exists in some minuscule form.
P.S. I think youâre semantikesing me on the âhospital employeeâ part. Based on how you have described your work situation, Iâm pretty sure you are an employee of some sort. I will let this go out of fear of accidentally doxxing you. Iâm a dick, but not that much of a dick.
The limiting factor isnât the ER doctor. Patient volume isnât determined by the number of ER docs in the back.
Iâm not reading the rest of this drivel. I find it cute you are playing at Dr Melk again but you have no idea what youâre talking about.
Of course, you donât need them. There are plenty of ways to try to take advantage of the windfall. Building/expanding ER facilities, and subsequently staffing them is one way to do this.
No. Just no. You can pretend knowing this stuff all you want but itâs wrong. ER compensation has dropped since the pandemic despite facility fees rising, and thatâs because the two are for completely different things.