More About The Stimulus Package and Pediatrics

I don’t like to think about the blog on weekends – hey, we’re busy preparing for Nowruz! – but I saw this post from Dr. Russell Libby and had to share it.  I wish I had thought to do a similar calculation, but the credit goes to him:

No question about the “new” math.  If a practice has no Medicaid
patients because the state pays at 30% less than their ins reimbursed
rates and they decide to go after the stimulus $ what happens?  If we
gross $5Mil/yr in a 10 FTE practice and could find enough Medicaid
patients in our neighborhood to reach 20% of our revenues (it would
be impossible to identify them as 20% of our patient population) that
would be, assuming 2500pts and 5000 visits/FTEMD/yr, that would be
5000  new Medicaid patients and  10,000 visits for the group to have
all of the docs qualify for the EMR money.  (I would consider it a
true banner year if I could find so many new patients and get them in
at such a frequency.)  Assuming that the average  revenue/pt visit is
$110  (taken from the most recent surveys in the AAP database), a 30%
hit on that average ticket would be $330K and that would be on a
yearly basis, so that over the 5 years you got the, let’s be
unrealistic and optimistic, $70K/MD or $700K  to the practice, it
would cost $1.65 mil in lost revenue.  I know, too many assumptions,
but the reality is that no matter how you dice it, for those of us
who can’t afford to have a large Medicaid patient population, the
stimulus money is not really anywhere near the table.

The OCD part of me wishes to point out a few things:

  • I don’t think the pediatric average revenue/visit is $110;
  • I think the average visits/FTEMD should be higher;
  • I think most pediatric practices have some Medicaid already, so their need to increase to get >20% is non-existent or smaller;

 

BUT IT DOESN’T MATTER. His premise is still completely correct, the nitpicks above actually negate each other (I’m sure he knew that and was trying to keep it simple), and I applaud him for pointing out the issue.  Good work.

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