Is POCUS going to become a big thing in the outpatient setting?

[deleted979844]

I'm going to be applying for a spot in family medicine this upcoming cycle and I'm fascinated by the technology that is ultrasound. It has limitations but it's cheap and portable with little to no risks. And clinically its applications are massive if you can scan patients in the office on the spot.

It's become routine for EM docs but how far do we see it going in the offices? I feel like patients get sent out for RUQ scans, DVT scans, AAA scans, etc. a lot! But I'm curious how useful this translates to actual practice. Does it actually bring something valuable to your practice and patients? Is it financially worth the time it takes to do the scan and all the training involved?

Also how useful is APCA/ARDMS certification? Is this a gold standard certification or just another expensive piece of paper?

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[Freezeout]

I'm going to be applying for a spot in family medicine this upcoming cycle and I'm fascinated by the technology that is ultrasound. It has limitations but it's cheap and portable with little to no risks. And clinically its applications are massive if you can scan patients in the office on the spot.

It's become routine for EM docs but how far do we see it going in the offices? I feel like patients get sent out for RUQ scans, DVT scans, AAA scans, etc. a lot! But I'm curious how useful this translates to actual practice. Does it actually bring something valuable to your practice and patients? Is it financially worth the time it takes to do the scan and all the training involved?

Also how useful is APCA/ARDMS certification? Is this a gold standard certification or just another expensive piece of paper?

If you’re planning on billing for it the ARDMS certification might be important. I’d also add ultrasound machines, at least a good one, isn’t exactly cheap.

 

[FrustratedFamDoc]

Me personally, I'd never utilize it enough for it to be financially viable. My bread and butter is still the management of chronic illness and knowing that I've got a very expensive piece of machinery in the corner collecting dust wouldn't sit well. I'd be tempted to use it probably more than I truly need to just to justify the dang thing. Secondly, in the age of ever increasing deductibles, I find that it would really soak my patients financially for marginal benefit. How likely would you be to keep 3 and 4 month follow-ups knowing that the last time you complained about calf pain you were billed over $400 for the visit, all out of pocket because your deductible hadn't yet been met.

 

[deleted979844]

If you’re planning on billing for it the ARDMS certification might be important. I’d also add ultrasound machines, at least a good one, isn’t exactly cheap.

Me personally, I'd never utilize it enough for it to be financially viable. My bread and butter is still the management of chronic illness and knowing that I've got a very expensive piece of machinery in the corner collecting dust wouldn't sit well. I'd be tempted to use it probably more than I truly need to just to justify the dang thing. Secondly, in the age of ever increasing deductibles, I find that it would really soak my patients financially for marginal benefit. How likely would you be to keep 3 and 4 month follow-ups knowing that the last timeI you complained about calf pain you were billed over $400 for the visit, all out of pocket because your deductible hadn't yet been met.

Thank you for your responses! I'd definitely be tempted to overuse it.

 

[deleted87716]

Ortho definitely overuses it. I've had patients with high-deductible plans come back to me for joint injections after ortho had done them previously and billed them for US guided injections (we're talking knees and shoulders here, practically no-miss zones).

 

[Freezeout]

Ortho definitely overuses it. I've had patients with high-deductible plans come back to me for joint injections after ortho had done them previously and billed them for US guided injections (we're talking knees and shoulders here, practically no-miss zones).

Ehh depends what you mean by shoulder. If you’re talking actually in the glenohumeral joint I disagree. If you’re talking just subacromial then yea, that’s over the top. Overuse of ultrasound is what has driven its reimbursement down and led to the rolled cpt codes for injections.

 

[deleted87716]

Ehh depends what you mean by shoulder. If you’re talking actually in the glenohumeral joint I disagree. If you’re talking just subacromial then yea, that’s over the top. Overuse of ultrasound is what has driven its reimbursement down and led to the rolled cpt codes for injections.

They use it for pretty much everything, including subacromial. So, yeah.

 

[NomadicLife]

Most FM residency programs are starting to develop some type of POCUS curriculum and it will probably become standard in the near future. Ultrasound is a great skill to have and I encourage you to seek out as much training in it as possible. Especially with the new ultrasound technology coming out (look up Butterfly iQ) it makes it super easy and much more affordable to use in clinic.

 

[teacherman84]

Me personally, I'd never utilize it enough for it to be financially viable. My bread and butter is still the management of chronic illness and knowing that I've got a very expensive piece of machinery in the corner collecting dust wouldn't sit well. I'd be tempted to use it probably more than I truly need to just to justify the dang thing. Secondly, in the age of ever increasing deductibles, I find that it would really soak my patients financially for marginal benefit. How likely would you be to keep 3 and 4 month follow-ups knowing that the last time you complained about calf pain you were billed over $400 for the visit, all out of pocket because your deductible hadn't yet been met.

The new Butterfly is under 2k...I'm confident anyone could use it enough for that. At that price point you could use it for a lot of non-billable applications that just enhance your care and be OK.

There is a time and place for US guided even in hard to miss areas. If I'm putting an 800 visco injection in a knee, I think it's worth having US and seeing the medicine go into the desired space (not that the evidence for visco is convincing enough for its use...but we still use it)

 

[deleted87716]

The new Butterfly is under 2k...I'm confident anyone could use it enough for that. At that price point you could use it for a lot of non-billable applications that just enhance your care and be OK.

Two grand, plus $420/year for an individual license. I'd be concerned about the long-term viability of the Lightning connector version, too. Apple is notorious for abandoning legacy connectors. Additionally, the USB-C version is only compatible with one model of the iPad at this time.

Butterfly Pricing | iQ+, iQ3, & Compass

Explore pricing for Butterfly devices and software.

www.butterflynetwork.com

 

[Freezeout]

The new Butterfly is under 2k...I'm confident anyone could use it enough for that. At that price point you could use it for a lot of non-billable applications that just enhance your care and be OK.

There is a time and place for US guided even in hard to miss areas. If I'm putting an 800 visco injection in a knee, I think it's worth having US and seeing the medicine go into the desired space (not that the evidence for visco is convincing enough for its use...but we still use it)

To further that point, if you’re doing PRP or BMC you should be using ultrasound. I also think there’s utility in knowing you’re in the correct location for instances when the patient has no benefit or short lived benefit. If you’re doing it blind and it doesn’t work....is it because the diagnosis is wrong or because you weren’t where you thought you were. You’d actually be surprised how few injections you have to do a month to pay for/justify an ultrasound machine.

 

[teacherman84]

Two grand, plus $420/year for an individual license. I'd be concerned about the long-term viability of the Lightning connector version, too. Apple is notorious for abandoning legacy connectors. Additionally, the USB-C version is only compatible with one model of the iPad at this time.

Butterfly Pricing | iQ+, iQ3, & Compass

Explore pricing for Butterfly devices and software.

www.butterflynetwork.com

True...I think the annual part is only required the first year...you just dont get "the cloud."

Even minimal use would pay for that...for the 3 probes and quality, you could buy a new one every other year and still be ahead compared to buying a solid laptop style machine with multiple probes.

 

[FamilymedMD]

I've recently switched from a couple of Lumify transducers to the Butterfly and am still very much a learner but I'm finding POCUS frequently useful already.

According to my preceptor, I've already picked up one pneumonia that had a false negative xray. With an inexpensive telerads overread, I've ruled out DVTs on two cash patients that would've been charge hundreds by the local (monopoly) hospital.

I'm going to some musculoskeletal training later this year and expect to be using this more after that.

With an additional $30 app, I can project the image onto my large desktop monitor for patients and family to view during the exam. They seem to like it.

I don't charge extra for POCUS but I'm DPC so I can increase my fees later if I find it adds a lot of work or expense but that seems unlikely so far.

 

[galactus]

POCUS isn't a futuristic option..it's already here. We're teaching it in med schools now. AAFP has seminars on POCUS. Residencies are adding it to their curriculum and there have been a lot of lectures/presentations about it at STFM. For sports medicine fellowships it's a requirement, and is now part of the boards. THis means in the next few years a lot of the fresh med school and FM grads will have decent knowledge on US use. Time to use it!