ACOs and bundled payments

[callmeanesthesia]

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I've seen my fair share of patients with severe stenosis that have only axial lbp without neurogenic claudication. Their back pain is worse with extension, prolonged standing and walking. Universally these guys have not responded consistently to facet interventions as one would expect (b/c that's what I initially targeted in my first 7-8 years in practice). Had I not obtained the MRI, I would have had no idea that they had severe multifactorial stenosis. In addition, doing an interlaminar at a level of severe stenosis could cause more harm than good.

I have seen this as well in terms of lower efficacy in the presence of stenosis, but I’d still try MBB/RF for them before sending them off to a surgeon. An MRI isn’t going to change that. I counsel patients on that, tell them that we can get an MRI to see if there is stenosis, or just do the MBBs which we would most likely do after the MRI anyway. Most choose to wait on the MRI.

 

[Ducttape]

You can quote all the studies you like, Hawkeye.

I am providing preprocedure determination that essentially mandates that I order mri prior to esi for patients that have insurance that uses evicore.

if I don’t follow their rules, their patients don’t get insurance coverage.

a real world conundrum.

 

[drusso]

You can quote all the studies you like, Hawkeye.

I am providing preprocedure determination that essentially mandates that I order mri prior to esi for patients that have insurance that uses evicore.

if I don’t follow their rules, their patients don’t get insurance coverage.

a real world conundrum.

It's like working for the post office!

 

[Dr. Ice]

As long as Liz and bern are still out of the White House, we are gonna have to deal with insurance companies to do procedures and many of them mandate mri prior to injection. It’s really that simple

 

[deleted993114]

You can quote all the studies you like, Hawkeye.

I am providing preprocedure determination that essentially mandates that I order mri prior to esi for patients that have insurance that uses evicore.

if I don’t follow their rules, their patients don’t get insurance coverage.

a real world conundrum.

Well.............. if they mandate it, then it is out of your hands and of course you are forced to comply. There are many things like that we are compelled to do, due to the demands of insurance companies, whether they make sense or not.

However, many of those "mandates" will be changing to control costs.

 

[deleted993114]

I've seen my fair share of patients with severe stenosis that have only axial lbp without neurogenic claudication. Their back pain is worse with extension, prolonged standing and walking. Universally these guys have not responded consistently to facet interventions as one would expect (b/c that's what I initially targeted in my first 7-8 years in practice). Had I not obtained the MRI, I would have had no idea that they had severe multifactorial stenosis. In addition, doing an interlaminar at a level of severe stenosis could cause more harm than good.

So if you got the MRI and it showed stenosis, and they have only back pain, what are you going to do about it?

 

[Ferrismonk]

You can quote all the studies you like, Hawkeye.

I am providing preprocedure determination that essentially mandates that I order mri prior to esi for patients that have insurance that uses evicore.

if I don’t follow their rules, their patients don’t get insurance coverage.

a real world conundrum.

But then they'll deny the MRI if the patient hasn't done a million PT sessions in the last couple months but no PT place will take their insurance and their insurance transportation is always late so they get discharged from PT for no-shows when do they do find one. #Medicaid

 

[hyperalgesia]

But then they'll deny the MRI if the patient hasn't done a million PT sessions in the last couple months but no PT place will take their insurance and their insurance transportation is always late so they get discharged from PT for no-shows when do they do find one. #Medicaid

Exactly. In my area, all mris require preauth by an entity that is contracted by the insurance company. Of course this vendor has a spotty website that doesn't always work. When the anger finally boils over, the insurance carrier will be shocked by all this and terminate their contract. And of course the contractor will immediately shut down and a new and renamed business will be formed.

It's a totally crooked system.

 

[clubdeac]

So if you got the MRI and it showed stenosis, and they have only back pain, what are you going to do about it?

MILD of course 😉 honestly anecdotally some of these guys get a good 3 months of relief with an ILESI one level below the level of stenosis. So that may be what I try, before or after mbbs even though I know my yield with those will be lower than had they not had severe stenosis. I also tell them to let me know if they develop any progressive LE weakness, bb dysfunction or leg pain as these may be indications to see the surgeon

 

[Ducttape]

But then they'll deny the MRI if the patient hasn't done a million PT sessions in the last couple months but no PT place will take their insurance and their insurance transportation is always late so they get discharged from PT for no-shows when do they do find one. #Medicaid

welcome to my world.