Do Hospital Doctors get Burned by No Pays?

A few years ago my daughter fell off a horse and broke her clavicle. It happened at a ranch outside of town which meant they had to fly her via helicopter to the ER, after the ambulance arrived and said it was too risky to drive her. The injury wasn’t life threatening, but it did require surgery. When she was released a few days later she was handed a bill for $30,000 which seems a little excessive for Tulsa, OK, but what do I know since I have never had hospital surgery.

Since she never paid a penny to the hospital (she was broke, didn’t have a job or medical insurance at the time) the hospital settled for $0. The hospital can write off the room and supplies that were used, and I assume the nurses get paid whether the patient pays or not, but what happens to the surgeon who had to do the surgery and the anesthesiologist? Do they have to eat it, or do they both get paid by the hospital no matter what? Are they employees or independent contractors?

Yes, the doctors generally get burned. They usually bill separately from the hospital, and their income comes from the amount collected in total minus expenses. Hospitals sometimes have agreements where they guarantee a certain amount of income for a doctor for a certain year, etc, in order to attract doctors to positions where the patient pool doesn’t pay enough.

I wouldn’t sweat it - if she can’t pay, she can’t pay. The hospital and doctors overcharge everyone by about 10 times in order to try to compensate for this.

I’m not sweating it, not my circus, not my monkeys, and this was year ago. It seems unfair to ER doctors since they have to deal with whatever comes in the door and some percentage of those patients won’t pay, while a regular (non ER) doctor can verify the patient can pay before they choose to work on them.

This is one reason they overcharge massively. ERs may receive subsidies from the rest of the hospital to stay in business, as well. (as I understand it, hospitals offering certain services have to have an ER, so in order to offer expensive moneymaker procedures, they have to keep a loss leader ER open)

But yes, ER physicians make less money than doctors with comparable skills who do only procedures for pay.

Hospital and associated physician billing is immensely complicated. The ER, and the ER physician’s base pay, is one of the things that the proverbial “$10 for an Aspirin!” on your bill pays for, if you have insurance. Along with the payments on the surgical unit, the MRI machine, the maintenance workers, the admin, the IT staff, the medicare discounts… everything that isn’t a profit center.
The whole system is insane. And that isn’t even including the contract billing, the Federal and state regulations…
I program software for hospital billing systems. I don’t think ANYBODY understands the whole mess.

More to the point: Most hospitals that have a big ER population have a base pay rate for ER physicians to guarantee that they will actually be willing to work ER. That and the interns, who are required to work it.

ER doctors are not surgeons. It is my understanding the ER doctors get paid by the hospital and do not bill separately.

That depends on where you are. I’ve always received a separate bill from a separate entity for physician services in the ER, in exactly the same way that the surgeon bills separately from the hospital. I don’t know exactly what the relationship is between the hospital and the physician group that bills me nor the relationship between that group and the doctors ( maybe the hospital guarantees the group a certain minimum income and/or the group guarantees the doctor the same). See this story - Arizona News . You can’t end up with this situation without separate billing.

ER physicians bill separately (generally as a practice group), just like surgeons. Hospitals and physicians are required to bill Medicare separately for facility-level versus professional charges under CMS’ Outpatient Prospective Payment System, and they bill private insurance and uninsured patients the same way because it’s simpler to maintain a common system.

Not here (Texas). When we’ve had medical stuff done in hospitals (knee surgery, regular birth and a c-section), it seems like the only stuff that’s actually billed by the hospital is basic stuff like housekeeping, nursing, in-hospital PT, supplies and the like. All the doctors are external providers- ER, radiology, anesthesiology, etc… except at the teaching hospitals, where they’re on staff. Pathology sends a separate bill, as does the lab.

So for my emergency knee surgery, I got a bill from the ER doc, the radiologist, the hospital itself, the anesthesiologist, the lab, the orthopedic surgeon and his nurse.

Where it gets really screwy is when insurance companies get bitchy about what and who they’ll pay, and what’s in and out of network. Which sucks, because patients rarely have visibility into that, and without that visibility, it’s hard to mandate that you only get in-network everything.

And when you are incapacitated or unconscious you can’t very tell them which hospital to take you to so you stay in network. Sometimes they will do a wallet biopsy to see what insurance carrier you have, but normally they take you to the nearest ER that will accept you as a patient.

What was worse, is that in my case, I was awake, and the nearest hospital was in network. But the actual on-call orthopedic surgeon wasn’t, and it’s not like I had any choice, considering that my injury was of the kind where sooner is better in terms of outcomes.

My go round 1996 with emergency medicine in Tulsa.

My go round with emergency medicine in Tulsa.

There are various payment formulas for doctors. For emergency medicine docs there’s often a base salary or hourly rate. This may or may not be supplemented by some measure of your productivity or a percentage of your professional billing. EM docs may be independent contractors, part of a group practice or hospital employees. If you came in to my ED whether or not you pay your bill has no impact on how much I get paid but it does affect how much the department gets and therefore the department budget. I don’t know much about compensation formulas for other hospital based physicians.

Pendgwen, emergency medicine doctor