How do Doctor's get paid?

Reigen · Feb 19, 2010

I am a nurse on a busy neuro/med-surg floor and we have a zillion doctors coming and going ordering a zillion different tests and I was wondering how they get paid. Does anyone know? Do consulted doctors get paid per consult or per test? Do admitting doctors get paid per patient or per test or both? I was just wondering because sometimes I really don't understand why tests are done and also sometimes multiple doctors will order the same tests even though the results are on the chart AND in the computer - it's like they don't even look or talk to the patient (or the nurse HAHAHAHAHAHA I can't imagine most doctors asking the nurse anything) and just order a butt load of tests automatically.
I am just curious - are hospitalists salaried? Is it a commission thing? I have no idea!
Also does anyone know how much the common tests cost per person? Like, how much does a MRI brain w/wo contrast cost? (on average) or an U/S carotids or an Echo or basic chest x-ray? what about labs? How much do these daily CBCs and CMPs cost?
Just wondering. . .thank you for any info :)

Where I work Hosptialsits are salary personnel. Consulting physicians bill insurance for the usual and customary fee rate. Chest x-ray PA and Lat with no reading $250.00 plus the cost of the Radiologist to 'read' and interpret the findings, basic labs CMP CBC will cost between $200.00 and $350.00

Echocardiograms run around $1000.00 and MRI's can run between $4000.00 to $5000.00.

All of these expenses while in the hospital are billed to insurance, unless the patient is private pay, the the total cost is the patient's responsibility.

This is what these cost where I work, other places may charge more or less.

Hope this helps.

core0 · Feb 19, 2010

I am a nurse on a busy neuro/med-surg floor and we have a zillion doctors coming and going ordering a zillion different tests and I was wondering how they get paid. Does anyone know? Do consulted doctors get paid per consult or per test? Do admitting doctors get paid per patient or per test or both? I was just wondering because sometimes I really don't understand why tests are done and also sometimes multiple doctors will order the same tests even though the results are on the chart AND in the computer - it's like they don't even look or talk to the patient (or the nurse HAHAHAHAHAHA I can't imagine most doctors asking the nurse anything) and just order a butt load of tests automatically.
I am just curious - are hospitalists salaried? Is it a commission thing? I have no idea!
Also does anyone know how much the common tests cost per person? Like, how much does a MRI brain w/wo contrast cost? (on average) or an U/S carotids or an Echo or basic chest x-ray? what about labs? How much do these daily CBCs and CMPs cost?
Just wondering. . .thank you for any info :)

Physicians get paid based on the complexity of the patient documented. There are two systems. Medicare/caid and private insurance (which is based off of Medicare). For Medicare the physician is paid for the initial hospital visit and then for each hospital day. They don't get paid any more for ordering test per se but interpreting and ordering tests increases he complexity of the patient. Medicare used to pay consults differently (more) than regular admit days but now pays the same. Private insurance is the same except they still pay for consults in some cases and depending on how the contract is negotiated they may pay a little more.

Hospitalists can be paid under a variety of models. Some work for large corporations and they usually are paid salary plus profit sharing. Others work in groups where they are reimbursed based on what they bill. Others work for academic institutions and get a salary.

As for the costs there is a wide variation. There are a number of tools out there. The one that I like the best is this one:

http://www.comparemricost.com/

It also will compare costs for other procedures and it explains that there are two components to the costs (the facility and professional fee).

As for costs a CBC is probably around $20 and a CMP is probably around $40. Of course what the hospital charges for it and what they are actually reimbursed are two different numbers. Also remember for the most part hospitals are paid for each episode of care based on illness. So all of the extra tests and labs come out of the hospitals bottom line. For a good primer on how hospitals are paid:

http://economix.blogs.nytimes.com/2009/01/23/how-do-hospitals-get-paid-a-primer/

For what its worth many hospital computer systems have entry order screens that warn you if repeat a lab that has already been ordered. If you aren't doing computerized order entry, you deserve what you get.

David Carpenter, PA-C

proudnurseRN · Feb 19, 2010

That was a really good question. I never knew about it, and it has been interesting reading the answers.

Katie5 · Feb 19, 2010

I'm interested as well

firstyearstudent · Feb 19, 2010

As far as I can tell, they get paid based on how rude they are to the nurses. The rudest doctors get paid the most.

platon20 · Feb 19, 2010

I am a nurse on a busy neuro/med-surg floor and we have a zillion doctors coming and going ordering a zillion different tests and I was wondering how they get paid. Does anyone know? Do consulted doctors get paid per consult or per test? Do admitting doctors get paid per patient or per test or both? I was just wondering because sometimes I really don't understand why tests are done and also sometimes multiple doctors will order the same tests even though the results are on the chart AND in the computer - it's like they don't even look or talk to the patient (or the nurse HAHAHAHAHAHA I can't imagine most doctors asking the nurse anything) and just order a butt load of tests automatically.

Generally speaking, doctors do NOT get paid for each test they order. The exceptions are procedures. Cardiologists get paid for each echo they interpret, GI docs get paid for each colonoscopy they do, etc. But no doc gets paid extra for lab work like a CBC or a CMP. Radiologists get paid for each x-ray, MRI they read, but the radiologists are BARRED from ordering the scans themselves, they can only get paid if another doctor orders it.

Consultants get paid for each patient they see. Again, they do not get to determine WHO gets a consult. For example, a consulting cardiologist cant just go see every patient in the hospital that he/she wants and expect to get paid for it. The cardiologist will only get paid if the primary doctor/attending specifically requests a consult.

roser13, ASN, RN · Feb 19, 2010

As far as I can tell, they get paid based on how rude they are to the nurses. The rudest doctors get paid the most.

:yeah: :yeah:

I just knew there was some kind of reward for that behavior....otherwise, the rude wouldn't keep getting ruder!

SweetLikeSugar · Feb 19, 2010

As far as I can tell, they get paid based on how rude they are to the nurses. The rudest doctors get paid the most.

Then surgeons must be really raking it in!!

classicdame, MSN, EdD · Feb 19, 2010

hospitalists are on hospital salary. Private MDs get paid by cash or insurance or other payor (like Worker's comp). Private MD's who read x-rays and lab, etc get paid by whatever the test was they read. They bill the insurance co or patient and are paid depending on the billing code. MDs charge patient/insurance for time doing consults, visiting in the hospital, writing orders and even taking phone calls. All of their time is billable. Just like lawyers. And CPA. And ho's

Kooky Korky, BSN, RN · Feb 19, 2010

Physicians get paid based on the complexity of the patient documented. There are two systems. Medicare/caid and private insurance (which is based off of Medicare). For Medicare the physician is paid for the initial hospital visit and then for each hospital day. They don't get paid any more for ordering test per se but interpreting and ordering tests increases he complexity of the patient. Medicare used to pay consults differently (more) than regular admit days but now pays the same. Private insurance is the same except they still pay for consults in some cases and depending on how the contract is negotiated they may pay a little more.
Hospitalists can be paid under a variety of models. Some work for large corporations and they usually are paid salary plus profit sharing. Others work in groups where they are reimbursed based on what they bill. Others work for academic institutions and get a salary.
As for the costs there is a wide variation. There are a number of tools out there. The one that I like the best is this one:
http://www.comparemricost.com/
It also will compare costs for other procedures and it explains that there are two components to the costs (the facility and professional fee).
As for costs a CBC is probably around $20 and a CMP is probably around $40. Of course what the hospital charges for it and what they are actually reimbursed are two different numbers. Also remember for the most part hospitals are paid for each episode of care based on illness. So all of the extra tests and labs come out of the hospitals bottom line. For a good primer on how hospitals are paid:
http://economix.blogs.nytimes.com/2009/01/23/how-do-hospitals-get-paid-a-primer/
For what its worth many hospital computer systems have entry order screens that warn you if repeat a lab that has already been ordered. If you aren't doing computerized order entry, you deserve what you get.
David Carpenter, PA-C

I doubt this nurse has any control over how her employer chooses for orders to be entered, therefore, why does she deserve "what she gets"? Or did I misunderstand you and you weren't mildly going off on her? Seems that the doctors ought to be the ones doing the computerized order entry. And they should be checking to see what has already been ordered, done, not ordered or done. And it should not fall on the nurse to tell the ordering doctors that some test has already been performed. Nurses are way too busy for all that playing secretary or housemother any more.

lpnflorida · Feb 19, 2010

Surgeons are paid a set fee the visit before the surgery, the surgery, each day seen in the hospital and one follow up appointment are all covered under that one fee. Example, and this is true : removal of one kidney, paid $400.00 and people think surgeons are highly paid.lol