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Semi-OT: Medical Schools in Texas
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greyowl72 Offline
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Post: #21
RE: Semi-OT: Medical Schools in Texas
(11-18-2020 07:05 PM)georgewebb Wrote:  
(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided.

Honest question: if the residents work is being billed, and their salaries are low, it seems like they should be net money makers for the hospital. Does a lot of their work not billable at all? Or is it billable but (for some reason) doesn't actually get billed? Or is there something I else I don't know (perhaps a great deal!)?

Good question. And it goes to the heart of the Byzantine character of graduate medical education. As ruowls said, the residents can’t bill while they are in a training program. The work that they do is billed under the physician faculty member who is supervising them. Often times the program that is sponsoring the residency provides care for indigent and/or under-funded patients. So, it’s not uncommon for the collections from resident supervised care to be in the 10-30% range, or less. And in many programs, those collections go to support the supervising faculty salaries, as well as adiministrative costs (lots), insurance..medical and malpractice, didactic educational expenses, travel to other educational activities, etc. If the residency program is federally funded, that federal money goes a fair way to support resident salaries, but that’s about it. Collections from patient care will not make up the rest of the cost of running the programs. Not by a long shot.
11-18-2020 07:48 PM
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grOWLer Offline
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Post: #22
RE: Semi-OT: Medical Schools in Texas
(11-18-2020 07:05 PM)georgewebb Wrote:  
(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided.

Honest question: if the residents work is being billed, and their salaries are low, it seems like they should be net money makers for the hospital. Does a lot of their work not billable at all? Or is it billable but (for some reason) doesn't actually get billed? Or is there something I else I don't know (perhaps a great deal!)?

I wish I it remember who was talking, but it was a Georgia politico who said that they had found that a happy resident tended to put down his roots where he/she was doing their residency, and they were trying to supplement the pay of residents to attract them to Georgia.
11-18-2020 07:52 PM
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ruowls Offline
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Post: #23
RE: Semi-OT: Medical Schools in Texas
(11-18-2020 07:48 PM)greyowl72 Wrote:  
(11-18-2020 07:05 PM)georgewebb Wrote:  
(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided.

Honest question: if the residents work is being billed, and their salaries are low, it seems like they should be net money makers for the hospital. Does a lot of their work not billable at all? Or is it billable but (for some reason) doesn't actually get billed? Or is there something I else I don't know (perhaps a great deal!)?

Good question. And it goes to the heart of the Byzantine character of graduate medical education. As ruowls said, the residents can’t bill while they are in a training program. The work that they do is billed under the physician faculty member who is supervising them. Often times the program that is sponsoring the residency provides care for indigent and/or under-funded patients. So, it’s not uncommon for the collections from resident supervised care to be in the 10-30% range, or less. And in many programs, those collections go to support the supervising faculty salaries, as well as adiministrative costs (lots), insurance..medical and malpractice, didactic educational expenses, travel to other educational activities, etc. If the residency program is federally funded, that federal money goes a fair way to support resident salaries, but that’s about it. Collections from patient care will not make up the rest of the cost of running the programs. Not by a long shot.

Couldn't have said it better.

Medical charges are based on procedure codes*. Only 1 physician may bill for a specific code per day and 1 physician may only bill for 1 code per patient per day. Also, some surgeries are bundled so the charges get capped during this global period (usually 2-4 weeks).

* CPT codes if you want to look them up.
11-18-2020 09:04 PM
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georgewebb Offline
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Post: #24
RE: Semi-OT: Medical Schools in Texas
(11-18-2020 09:04 PM)ruowls Wrote:  
(11-18-2020 07:48 PM)greyowl72 Wrote:  
(11-18-2020 07:05 PM)georgewebb Wrote:  
(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided.

Honest question: if the residents work is being billed, and their salaries are low, it seems like they should be net money makers for the hospital. Does a lot of their work not billable at all? Or is it billable but (for some reason) doesn't actually get billed? Or is there something I else I don't know (perhaps a great deal!)?

Good question. And it goes to the heart of the Byzantine character of graduate medical education. As ruowls said, the residents can’t bill while they are in a training program. The work that they do is billed under the physician faculty member who is supervising them. Often times the program that is sponsoring the residency provides care for indigent and/or under-funded patients. So, it’s not uncommon for the collections from resident supervised care to be in the 10-30% range, or less. And in many programs, those collections go to support the supervising faculty salaries, as well as adiministrative costs (lots), insurance..medical and malpractice, didactic educational expenses, travel to other educational activities, etc. If the residency program is federally funded, that federal money goes a fair way to support resident salaries, but that’s about it. Collections from patient care will not make up the rest of the cost of running the programs. Not by a long shot.

Couldn't have said it better.

Medical charges are based on procedure codes*. Only 1 physician may bill for a specific code per day and 1 physician may only bill for 1 code per patient per day. Also, some surgeries are bundled so the charges get capped during this global period (usually 2-4 weeks).

* CPT codes if you want to look them up.

Thanks, guys -- nice clear explanation. I'm glad I asked, and glad you answered!
11-18-2020 10:21 PM
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