This is a really good post overall, but I am not sure about this part.
If there is anything that seriously needs weekly f/u (cellulitis, dehiscence, injury during post-op, pain or vasc or issue that needs refer, etc), then you simply break the global and you do get paid for that E&M or any related procedures (I&D blister or wound debride, etc) with -24 mod.
Maybe I'm crazy, but I usually see any post-op patient at:
4-7d for bandage and incision check and XR
~2wks for sutures and XR
~4wks for progress check and XR and DME progression
~2mo for progress and XR and PT and/or orthotics molding (can break E&M for that - unless surgery was plantar fascia)
...and then the global is over.
If they need a cast (basically any RRA), then it's every 2-3wks for XR and cast. If they use a CAM boot, then you got that $ and you still get the XRs. The point is: all of those visits above get at least a bit of trickle income except for maybe the first two visits that are incision care for a soft tissue procedure (neuroma, plantar fasciotomy, etc) where the XR isn't indicated. So, in other words, basically all f/u post-op visits are making RVUs in some form - even if it's something as simple as an Austin.
What percentage of your RRA/Complex patients are actually compliant and don't need to be handled with kid gloves so they don't start threatening to or outright sue you? If you deal with a lot of Medicaid or community clinic patients (which also are the ones that tend to need these procedures, somehow), I would geusstimate, at least, half. And that means late calls at night, and lots of office visits taking up space that could be used for paying patients.
For the basic forefoot type stuff and even some of the less involved rearfoot procedures like Retros, Kidners, Peroneal repairs, Scopes, Braustroms and the like, I would absolutely agree with you. But here's the thing. You start catering to those "big cases" people love to talk about here, your practice will start heading in that direction. Next thing you know, half your cases are the complex stuff, like Charcot Recons, Pilon Fractures, Triples, Pan Talars, Ankle Replacement, etc. Which is really what your OP is aimed towards.
THIS is precisely where the argument about big cases making good money falls apart. Yep, I see a post op bunion exactly 3 times before the global expires. Quick dressing change, then suture removal, back in a shoe and then a few weeks later for f/u. Sometimes that's it.
Don't get me wrong. If you design a group practice properly, this isn't even a consideration. You have one or two people at most who do that stuff, and the rest either only do bread and butter and general office podiatry, or no surgery at all, and you're golden. But any thoughts of doing this in solo private practice....yeah....okay. And even in group setting, eventually someone will start poking at those numbers. Time to payment ratio is very low the more complex the case gets. No one can argue differently. Sorry.
www.ncbi.nlm.nih.gov
