On a Tuesday evening, Dr. Anna Reyes is offered a partnership in an independent group across town. Accepting means leaving the nonprofit health system that employs her, and the buy-in requires capital within the year. Anna is hypothetical. That night,…
On a Tuesday evening, Dr. Anna Reyes is offered a partnership in an independent group across town. Accepting means leaving the nonprofit health system that employs her, and the buy-in requires capital within the year. Anna is hypothetical.
That night, she opens the statement for the 457(b) deferred compensation plan she has funded for eight years. The balance is about $500,000. She wants to know how much of it she can …
Dennis Hursh, Esq is a health law attorney with more than 40 years of experience and the founder of Physician Agreements Health Law, which reviews physician employment agreements for a fixed fee. He has published 27 essays on KevinMD since…
Dennis Hursh, Esq is a health law attorney with more than 40 years of experience and the founder of Physician Agreements Health Law, which reviews physician employment agreements for a fixed fee. He has published 27 essays on KevinMD since
Ask an independent practice owner who handles the revenue cycle and the answer is usually the name of a billing company. Ask what that company actually does each month and the answer gets shorter. Claims go out. Payments get posted.…
Ask an independent practice owner who handles the revenue cycle and the answer is usually the name of a billing company. Ask what that company actually does each month and the answer gets shorter. Claims go out. Payments get posted. Denials get worked. Statements get mailed. That is medical billing, and it is valuable work. It is not the same thing as managing the revenue cycle, and the space …
In 2024, Medicare cut every physician's rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand. The code is G2211. CMS…
In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.
The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …
An excerpt from Essays and Echoes: Reflections from a Life in Medicine. In the CBS series Blue Bloods, the 2014 episode "Most Wanted" finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm.…
In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is …
Americans give hundreds of billions of dollars to charity each year, making philanthropy a defining feature of our national culture. That generosity benefits more than the organizations and communities receiving support: Research suggests that giving can also improve the donor's…
Americans give hundreds of billions of dollars to charity each year, making philanthropy a defining feature of our national culture. That generosity benefits more than the organizations and communities receiving support: Research suggests that giving can also improve the donor’s happiness, sense of purpose, and connection to others. Our government actively encourages this behavior through charitable tax deductions and other incentives, reflecting a longstanding public-policy judgment that private generosity …
Many physicians believe they can't escape burnout or an unsustainable career until they've become financially independent. Thankfully, it's not true. The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners,…
Many physicians believe they can’t escape burnout or an unsustainable career until they’ve become financially independent. Thankfully, it’s not true.
The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners, financial independence is a mathematical problem to solve. I might be able to run your numbers in a Monte Carlo analysis and demonstrate you have, say, an 84 percent chance of …
Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: "We have a standard package for the whole department. I can't make an exception for you." Most…
Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: “We have a standard package for the whole department. I can’t make an exception for you.”
Most doctors hear that as a brush-off. It isn’t. It’s the most honest thing an administrator will say to you all year.
They genuinely can’t do it. A one-off adjustment creates a parity …
I have been pitched investments in a doctors' lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design. This piece is…
I have been pitched investments in a doctors’ lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design.
This piece is about the specific ways physician money gets lost, and what actually works against each one. Not general advice about saving more. Named failure modes, with the fix for each. I have …
Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in…
Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in the practice management system as a negative number on a patient or payer account, it rarely triggers an alert, and it quietly inflates the bank balance the owner looks at …
A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not…
A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not describing a job. He was describing a sentence he had to serve.
That word, trapped, comes up more than exhaustion does.
This piece is about that feeling and what the evidence actually …
A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient's face changes. The staffer wasn't hired for this conversation and doesn't have…
A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient’s face changes. The staffer wasn’t hired for this conversation and doesn’t have much beyond “that’s what the system says you owe.”
This exact scene runs in practices everywhere, multiple times a day, and almost nobody standing at that desk was ever specifically trained …
Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in…
Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in modern health care.
There is a sentence I hear almost every week from young clinicians, and it sounds so responsible that nobody ever questions it: “I’ll think about ownership once my …
I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart. Then a fund pitch lands…
I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart.
Then a fund pitch lands in your inbox and the habit disappears. The deck opens with a big number, and most of us read that number the way we would never read an abstract.
The letter says denied. It's not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there's…
The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there’s no real reason to think this one would be different.
Nothing about that moment is really a decision anymore. It stopped being one a while back, and nobody noticed exactly when.
A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only…
A resignation letter arrives with ninety days written on it. Most practices read that as ninety days to find a replacement, and the search starts that afternoon. What the letter actually started is three clocks running at once, and only one of them speeds up when the practice hires faster. The payer contracts have their own notice terms. The medical records have their own custody obligations. And the replacement physician, …
Your net worth statement is the only financial document in America that routinely counts someone else's money as yours. It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic.…
Your net worth statement is the only financial document in America that routinely counts someone else’s money as yours.
It lists the retirement accounts, the brokerage, the house, the practice interest, and adds them with the quiet confidence of arithmetic. The number is not wrong so much as incomplete. It books your assets at gross, and the largest have a co-owner who has not yet invoiced you. A $5 million pre-tax …
In 2009, a New England Journal of Medicine analysis examined 84,730 patients undergoing inpatient general and vascular surgery and ranked the hospitals by risk-adjusted mortality. The expectation was that the best-performing hospitals would be the ones where less went wrong.…
In 2009, a New England Journal of Medicine analysis examined 84,730 patients undergoing inpatient general and vascular surgery and ranked the hospitals by risk-adjusted mortality. The expectation was that the best-performing hospitals would be the ones where less went wrong.
That is not what the data showed. Major complications occurred in 16.2 percent of patients at hospitals in the lowest-mortality quintile and 18.2 percent at hospitals in the highest. Overall complications …
Your hospital recently adopted a new piece of technology. Maybe it was an EHR module. A patient monitoring upgrade. A documentation tool. A new device in the OR. Think about what happened next. Some of your colleagues embraced it. Others…
Your hospital recently adopted a new piece of technology. Maybe it was an EHR module. A patient monitoring upgrade. A documentation tool. A new device in the OR.
Think about what happened next. Some of your colleagues embraced it. Others resisted. The nurses figured out workarounds within a week. The IT department sent three emails about training sessions that nobody attended. Six months later, half the staff is using the new …
A radiologist flags something on a scan that shouldn't be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system…
A radiologist flags something on a scan that shouldn’t be there. The physician sends a referral to oncology that same day, the kind where a few weeks genuinely matter, not the kind you let sit in a queue. The system logs it, and the chart shows it as clean and complete: sent.
Four months later, at a visit for something unrelated (a sore shoulder, nothing serious), the physician asks how the …
