Earlier quoted context omitted.
You said physicians get paid a couple hundred bucks for each visit. I provided the source that says how much a physician gets paid by medicare for an established outpatient visit. An outpatient visit for a new patient (99203) is 1.42 wRVU + 1.48 facility RVU + 0.13 malpractice RVU = 2.14 RVUs = $109 for Medicare. A complex new visit (99205) is 3.17 wRVU + 2.40 facility RVU + 0.28 malpractice RVU = 5.85*36.06 = 210 do…
And like I said, billing for normal patients isn't determined on medicare/medicaid rates and those are widely noted to be far lower than break-even let alone private billing rates. > The researchers found the gap between the prices Medicare and private insurers pay hospitals increased from 2015 to 2017. Specifically, the researchers found private insurers in 2015 on average paid 236% of Medicare rates, and by 2017 th…
I'm not trying to change the topic from office visit to heart attack. I provided the RVU calculation for the outpatient visits. That is how much the physicians are getting paid. You said that physicians are making a couple hundred bucks of each outpatient visit, which I don't believe is accurate, and I provided the calculation of why I don't think that is accurate. The total cost of the visit can be $250, but the physician is not getting anywhere near that.
I don't think it's accurate to say that they will be able clear $1000/hr. There is additional time needed to document each patient (often equal to the amount of time seeing the patient). I think seeing 3 visits in that time is plausible, but the physician is not getting that whole $250 (which is the point I'm trying to make). The clinic revenue may be $750 for that hour, but that needs to cover all of the overhead, and the physician will get whatever is left.
Make sure you are looking for sources that compare how much the private insurance pays physicians compared to medicare in particular vs how much they pay hospitals compared to medicare. The numbers will be different.
The $53,384 is what the hospital charges for the heart attack. The physician only gets the wRVUs for the services they provide in the hospital (if they're employed), so the 12.56 wRVU for the cardiac revascularization + the admission history and physical (2.61 wRVU CPT 99222) however many days of progress notes (2.00 wRV 1x each day - CPT 99233) in the hospital and the discharge summary (1.28 wRVU - CPT 99238) they write for the patient. So if a patient got revascularized and were in the hospital for 4 days before being discharged that's 12.56 + 2.61 (admission day) + 2 * 2.00 (2 inpatient days) + 1.28 (discharge day) = 20.45 wRVUs for the admission = $737 for the physician for that hospitalization.
I'm trying to make the distinction here between how much the hospital gets paid vs. the physician who provided the care. It's not accurate to say the physician is making $53,384 for the heart attack hospitalization, that is what the hospital is charging. The physician may make ~$1000 for an admission like that. If the physician is self-employed or in a group, they will charge for the facility RVUs and malpractice RVUs as well, because they need to cover the overhead of having a clinic to see the patient after the hospitalization.
If your bill breaks down the overhead for the clinic separate from the physician charge, then I'll agree that the physician made the $250 straight cash, but I don't think that is in any way the average amount any kind of doctor will make off an outpatient visit. Look at what you're suggesting, that a physician makes $1000/hr * 2080 workable hours in a year (not likely a physician only works 40hrs a week..) = $2+ million a year.