WASHINGTON, D.C.—Rheumatologists can do better—not in practicing medicine, but in managing their practices, said Herbert S. B. Baraf, MD, clinical professor of medicine at George Washington University, Washington, D.C., and managing partner at Arthritis and Rheumatism Associates, a 15-physician practice.
Rheumatologists need to recognize when they have poor contracts with payers and take steps to fix them, whether that means withdrawing from a bad arrangement or negotiating a better deal, said Dr. Baraf, who spoke here at the 2012 ACR/ARHP Annual Meeting, held November 9–14.
Dr. Baraf addressed attendees during a session titled, “Deal Breakers in Payer Contract Negotiations,” on how doctors can improve the management of the business end of their practices.
“You can provide great care, but if you don’t have enough [revenue] to keep your doors open, it won’t be for long,” Dr. Baraf said. “Providing effective care has costs, and failure to define the value of one’s services may sink a practice and all the good that it does.”
A Look at the Numbers
He said that it’s clear there’s room for improvement in the financial landscape of rheumatology: There’s a three-month waiting list on average to see a rheumatologist, so rheumatologists are in demand. But that demand isn’t reflected by income—the mean income for rheumatologists is $180,000 a year, Dr. Baraf said, compared to more than $300,000 for radiologists and cardiologists and the upper $200s for dermatologists and ophthalmologists.
Plus, rheumatologists work long hours—36% more than dermatologists, 28% more than endocrinologists and internists, and 13% more than cardiologists.
“Relative to other specialties, rheumatologists’ incomes are low,” he said. A dermatologist makes 50% more but works significantly less, he said.
He said the survival of rheumatology depends on attracting new physicians. Because new physicians have high costs from education loans, they might be less likely to choose rheumatology because of the relatively low income. So, in the context of the big picture, tending to their economic health is critical for rheumatologists.
Make a Better Plan
There are ways to improve the bottom line. Doctors can see more patients, they can reduce overhead, or they can develop ancillary services. But those all have effects on workload or expenses. He suggests that improving your contracts with payers can lead to better reimbursement with no added costs in staff or equipment.
“There’s no investment involved in that—it’s just having an agreement with the payer to give you more, and it’s all money at the margin,” he said. “Negotiation is really the key to our success.”