Re: Do We Wonder Why PTs Have Trouble Competing in a Hospital Dominated Market?

[Guest guest]

The 'take home' I get from this thread is that physician salaries are largely

driven by their ability to refer patients to the hospital.

Top line revenue is more important to the hospital than return on investment

(salary) - probably because hospitals have such a large cost base they need to

amortize.

Ortho and neuro surgery are valued relatively more highly than family practice

by hospital administrators because of top line, not return.

Right now, primary care practices selling off to hospitals for two reasons:

1 - older physicians are retiring early

2 - younger physicians don't want the 'lifestyle' associated with owning and

running a primary care private practice - the return isn't there. Many primary

care docs are looking at hospital employment favorably.

PTs can compete with physicians by screening for pathology, especially as direct

access is being considered by Medicare:

The top pathology screens, in my opinion, for physical therapists to consider

are the following:

1 - depression/anxiety

2 - falls risk (use a quantitative approach)

3 - cardio screen (BP, pulse, oximetry)

4 - neuro screen (reflex, senastion, dermatomes, UMN)

5 - DVT (use Well's scale)

I've rank ordered these according to their prevalence but the big payoff will

come with routine cardio screening - outpatient PTs in a busy clinic can send

1-2 patients per week back to primary care for a workup.

Your cardio screen will catch 2-3 per year where you'll need to activate EMS.

One question I have is this: Do we really want these folks exercising in our

clinics with these risk factors?

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

> Jim -

> Thanks for your post. I agree that there is value in the inpatient acute

> arena, and that many Directors aren't able to access the appropriate numbers

> to calculate it. In many organizations, finance and planning functions look

> askance if the PT Director begins to dig into the numbers.

>

> Since Medicare includes the reimbursement for inpatient PT with its bulk

> payment, some managers assume that there is no distinct identifiable value

> to inpatient PT. However, when I had a hip replacement with an Aetna PPO,

> at a hospital where I had been System Director, I learned that there is

> indeed tracable revenue to IP PT. My PT charges were $880 out of a $33,000.

> bill. When my explanation of charges arrived, I found that Aetna had paid

> $22,000. Obviously, the hospital had a contract with Aetna for 2/3 of

> charges, and my PT charges represented $600 of their revenue.

>

> My recommendation to any IP provider is to grab 10-15 discharged, paid

> patients' non-Medicare bills and charts ...and audit them. You will find

> that there is indeed some revenue somewhere for your department. My last

> year working there, the system made $21 million on about $2.5 billion on

> gross charges. Of that, our outstanding rehab leaders' departments produced

> $21 million in receipts to the System, on $14 million in expenses, including

> all administrative and general allocations. So, our therapists provided a

> third of the System's revenues in excess of expenses, which would be called

> " profit " in other circumstances.

>

> Not every organization... or every department... every year. But it is

> definitely worth calculating. Our therapists are entitled to the respect

> they've earned.

>

> Dick Hillyer, DPT, MBA, MSM

>

>

>

> Dr. W. Hillyer

> Hillyer Consulting

> Cape Coral, FL 33914

>

>

>

> _____

>

> From: PTManager [mailto:PTManager ] On Behalf

> Of JIMDPT@...

> Sent: Sunday, March 21, 2010 12:09 PM

> To: PTManager

> Subject: Re: Do We Wonder Why PTs Have Trouble Competing in a

> Hospital Dominated Market?

>

>

>

>

>

>

> I agree with the premise that the doctors pen is a powerful financial tool.

> Where PTs sometimes get fuzzy is in what their role is in various

> environments and from there determine their worth. Since no direct income is

> generated by PT services in acute care, one has to look at their value added

> role to the system. If through their treatment a patient can go home instaed

> of to a sub acute or acute rehab, the cost savings are immense for the

> system. This is where one are needs to be studied to " revalue " in salry

> dollars the PT's worth. antoher area would be decreasing the LOS of cases,

> which could save each facility thousands a day, agian calling for a re

> evaluating of the PT worth to the system and adjusting the pay accordingly.

> these are 2 areas that we need intensive study. Anecdotally, I would say

> from a worth standpoint, the ranges you cited for MDs and hospitals, as a

> percentage of salry, would be similar if not greater for the PT.

>

> Foundation for PT are you listening? Lets get some bucks thrown at this

> practice arena as well

>

> Jim Dunleavy PT, MS

> Administrative Director, Rehabilitation Services

> Trinitas Regional Medical Center

>

> Do We Wonder Why PTs Have Trouble Competing in a

> Hospital Dominated Market?

>

> [image: Need a Real Sponsor here]

>

> - MARCH 17, 2010, 8:29 AM ET

>

> Putting a Dollar Figure on a Doctor's Worth to a Hospital

>

> [image: doc]What's a doctor worth to a hospital in terms of annual

> revenue?

> And what specialties average the most and the least in hospital revenue

> generation?

>

> The answer to the first question averages about $1.54 million a year,

> based

> on 114 U.S. hospital responding to a survey by physician recruiters

> Merritt

> Hawkins. That's up slightly from the $1.5 million a year per doc that

> hospitals averaged in revenue in 2007, the last time the recruiting

> outfit

> took the survey. (Revenue here means net inpatient and outpatient

> dollars

> derived from referrals, tests and procedures done in the hospital.)

>

> Merritt Hawkins also asked about revenue generation in the last 12

> months by

> 17 doctor specialties. Not all 114 hospitals replied for all specialists

> but

> below are the averages for the responses received. Also included is a

> list

> of average annual salaries that came from other Merritt Hawkins data:

>

> *Hospital Annual Revenue per Doctor by Specialty*

>

> *Specialty* ------------ *Avg. Revenue* / *Avg. Salary*

> Neurosurgery ------------ $2,815,650 / $571,000

> Cardiology/Invasive ------ $2,240,366 / $475,000

> Orthopedic Surgery ------- $2,117,764 / $481,000

> General Surgery ---------- $2,112,492 / $321,000

> Internal Medicine -------- $1,678,341 / $186,000

> Family Practice ---------- $1,622,832 / $173,000

> Hematology/Oncology ------ $1,485,627 / $335,000

> Gastroenterology --------- $1,450,540 / $393,000

> Urology ------------------ $1,382,704 / $401,000

> OB/GYN ------------------- $1,364,131 / $266,000

> Cardiology/Non-Invasive -- $1,319,658 / $419,000

> Psychiatry --------------- $1,290,104 / $200,000

> Pulmonology -------------- $1,204,919 / $293,000

> Neurology ---------------- $ 907,317 / $258,000

> Pediatrics --------------- $ 856,154 / $171,000

> Ophthalmology ------------ $ 842,711 / $282,000

> Nephrology --------------- $ 696,888 / $240,000

>

> " The most powerful tool in healthcare remains the physician's pen, "

>

> President Mark of Merritt Hawkins, a unit of AMH Healthcare

> Services,

> said in a statement with the survey. " Patients are not admitted to the

> hospital or discharged, tests ordered, or procedures performed without a

> physician's signature. "

>

> Kovacek, PT, MSA

> PKovacekPTManager (DOT) <mailto:PKovacek%40PTManager.com> com

> <mailto:PKovacek%40PTManager.com>

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