WTF are ya doin ?

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If your comminity docs are your standard of care, I can do anything I want.

3 LESIs in one week? Check.
400 mg Depomedrol in one ESI? Check.
RFA q 2-3 months? Check.
LESI for axial pain? Check.
100 mg Methadone QID? Check.
200 mg Oxycontin TID + 8 mg Dilaudid Q4H? Check.
Implant pump for fibromyalgia? Check.
Implant third SCS in one year because the first two got infected? Check.
SGB at least 8 times in 3 weeks, each time with 160 mg Depomedrol? Check.

I can get away with anything. I'm always w/i these standards.

Originally Posted by ampaphb

LAMMICO, my local malpractice carrier, gave a seminar this year advocating that no physician ever use the phrase "standard of care" in any context.

The phrase is fact specific, and a LEGAL term of art, Unless you want to someday have some off the cuff webpost used against you if and when you have a complication, find an alternate medical phrase to use, and leave "standard of care" for the courtroom.

I appreciate your feedback; I don't use the phrase "standard of care" when talking to other docs.

I try to avoid presenting my point of view in an adversarial manner ( as much as I can ). However, sometimes this is challenging, particularly, when a doc is doing something that isn't very logical (i.e. scripting 15 percocet / day for constant pain, scripting ultra high dose narcs to an ulta high risk pt without even knowing the pt's background hx, etc. ).

Originally Posted by PMR 4 MSK

If your comminity docs are your standard of care, I can do anything I want.

3 LESIs in one week? Check.
400 mg Depomedrol in one ESI? Check.
RFA q 2-3 months? Check.
LESI for axial pain? Check.
100 mg Methadone QID? Check.
200 mg Oxycontin TID + 8 mg Dilaudid Q4H? Check.
Implant pump for fibromyalgia? Check.
Implant third SCS in one year because the first two got infected? Check.
SGB at least 8 times in 3 weeks, each time with 160 mg Depomedrol? Check.

I can get away with anything. I'm always w/i these standards.

All of that is so freaking scary.

It's because of yahoos like that, that pain procedures are being so tightly regulated.

Seriously though 3 ESI on the same patient in a week?
pump for fibro?
SGB with particulate steroid?

Sounds like you have a few doctors not meeting the "standard of care"

Originally Posted by PMR 4 MSK

If your comminity docs are your standard of care, I can do anything I want.

3 LESIs in one week? Check.
400 mg Depomedrol in one ESI? Check.
RFA q 2-3 months? Check.
LESI for axial pain? Check.
100 mg Methadone QID? Check.
200 mg Oxycontin TID + 8 mg Dilaudid Q4H? Check.
Implant pump for fibromyalgia? Check.
Implant third SCS in one year because the first two got infected? Check.
SGB at least 8 times in 3 weeks, each time with 160 mg Depomedrol? Check.

I can get away with anything. I'm always w/i these standards.

Do these physicians get preauthorization or just do them and hope they get reimbursed?

Originally Posted by Louisville04

Do these physicians get preauthorization or just do them and hope they get reimbursed?

The one who did 3 in one week asked me to precert them for him, then asked me to rpecert the facet joint injections he decided to do after that. The patient's insurance would not pay for her injections to be done anywhere except one ASC I don't have privileges at, or in a doctor's office. I don't have fluoro in the office, so I asked this guy to do one LESI. He did 3 in one week - M-W-F, then FJI the next. WE declined to do the preauth and he has never received another referral from me.

The rest I don't know. I hope they did not get paid.

Originally Posted by PMR 4 MSK

The one who did 3 in one week asked me to precert them for him, then asked me to rpecert the facet joint injections he decided to do after that. The patient's insurance would not pay for her injections to be done anywhere except one ASC I don't have privileges at, or in a doctor's office. I don't have fluoro in the office, so I asked this guy to do one LESI. He did 3 in one week - M-W-F, then FJI the next. WE declined to do the preauth and he has never received another referral from me.

The rest I don't know. I hope they did not get paid.

Saw a doozy few days ago:

Pts comes to the office smelling of ETOH. I know right away it's going to suck:

Referring genius scripting 2000 MED ( no I didn't slip a zero on my computer), and just had his narc license yanked. Said genius conveniently "forgot" to send me his med list ( but sent me all his other documentation ! ). Pt had already been on methadone in the past prior to experiencing chronic pain. I mean serious folks, WTF is this guy thinking ?

Methadone referral ? Refused.
Interventional therapy ? Refused.

Make friends with the door intervention ? Accepted !

What a waste of time.