Echocardiogram and FM

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elfmonkey

elfmonkey

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Hello everyone,
Can FP`s get the appropriate CME in order to perform and read Echocardiograms ?
I know FP`s can do that with U/S.
Thanks
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I would like to know this as well. What is the reimbursement for reading one (Echo), any idea?
 
Most hospitals will not let a PCP read its echo's. I suppose a PCP could buy an echo machine for his own office (and echo tech). This might be feasible for a large FP group.
 
Last edited:
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I would skip the echo for more valuable and easily reimbursable US modalities. AAA screening, testicular, breast, OB, soft tissue, odd lumps, DVT, carotid. Skip thyroid too unless you are gonna do FNA.
 
raptor5 said:
I would skip the echo for more valuable and easily reimbursable US modalities. AAA screening, testicular, breast, OB, soft tissue, odd lumps, DVT, carotid. Skip thyroid too unless you are gonna do FNA.
Click to expand...

An elderly w Hx of AF and you suspect heart failure now, you can do an echo for them at your office and get the EF%. Eventually, you are going to manage them not the cardiologist.
A treadmill and U/S should be in every Family medicine practice.
 
Blue Dog said:
I don't see the point simply from the liability perspective.
Click to expand...

I completely agree.

An echo is a very technically complex study, and not something you can pick up in a weekend course. Not good for your patients.

From a liability perspective: what cardiologist is going to support you in court if you miss something important ?

Big no no.
 
ghost dog said:
I completely agree.

An echo is a very technically complex study, and not something you can pick up in a weekend course. Not good for your patients.

From a liability perspective: what cardiologist is going to support you in court if you miss something important ?

Big no no.
Click to expand...

I see. I just thought that there is a way to be proficient at it as a FP.
 
elfmonkey said:
I see. I just thought that there is a way to be proficient at it as a FP.
Click to expand...

Besides, the cardiologist may or may not read them, usually the radiologist does. Don't see how you are going to be able to read them yourself? I've seen in rural practice where the test was done on site for the convenience of the patient by the travelling echo tech, but the films get sent out to be read by the radiologist and then forwarded to the cardiologist should the patient need to travel for the referral.
 
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cabinbuilder said:
Besides, the cardiologist may or may not read them, usually the radiologist does. Don't see how you are going to be able to read them yourself? I've seen in rural practice where the test was done on site for the convenience of the patient by the travelling echo tech, but the films get sent out to be read by the radiologist and then forwarded to the cardiologist should the patient need to travel for the referral.
Click to expand...

In my area, a cardiologist usually reads echo's. In my area, it is not the usual practice for radiologists to read echocardiograms
 
michaelrack said:
In my area, a cardiologist usually reads echo's. In my area, it is not the usual practice for radiologists to read echocardiograms
Click to expand...

If a radiologist can read an echo, then FP`s should be able to do it as well. It`s a non-invasive procedure, FP`s need no one but a tech at most. I did some training in a semi-rural family practice, many pt`s were well above 65 y/o w multiple issues, mainly CAD, CHF and Arrhythmia. I really wished if we could`ve done it ourselves instead of referring every pt to a cardiologist for just an echo.
I also think that most xrays can be interpreted by FP`s independently.
 
With teleradiology, there is no reason for an FP to be reading echoes, even in a remote location.

There's no way you're going to get enough experience or volume to be proficient unless you're essentially practicing as a non-invasive cardiologist, nor are you likely to be able to afford a trained and competent echo tech and up-to-date equipment. That takes volume. Serious volume.

Healthcare is a team effort. Spend your time doing the stuff you're trained to do. You'll be better off, and...most importantly...the patient will be better off. It's not like you don't have enough else to do.
 
cabinbuilder said:
Besides, the cardiologist may or may not read them, usually the radiologist does. Don't see how you are going to be able to read them yourself? I've seen in rural practice where the test was done on site for the convenience of the patient by the travelling echo tech, but the films get sent out to be read by the radiologist and then forwarded to the cardiologist should the patient need to travel for the referral.
Click to expand...

I have never seen an echo report that was read by anyone other than a cardiologist, but then I've never experienced rural medicine. Maybe things work differently.
 
Frankly, as an FP, you can do more good for patients (and the system) by not ordering unnecessary echocardiograms rather than adding to the problem of over-testing for profit.
 
wooster201106 said:
I have never seen an echo report that was read by anyone other than a cardiologist, but then I've never experienced rural medicine. Maybe things work differently.
Click to expand...

Depends on the location with rural medicine. Many times there isn't a cardiologist available and you get a quicker report through radiology due to distance. I've seen it both ways.
 
elfmonkey said:
Hello everyone,
Can FP`s get the appropriate CME in order to perform and read Echocardiograms ?
I know FP`s can do that with U/S.
Thanks
Click to expand...

I draw the line at performing my own ECGs, as I have my own RN and thus it requires no effort on my part to do so from a technical perspective.

Even then, ECGs can be very complex. I find it interesting to order this study, as I feel I am qualified to do so, and it is in the best interests of my patients to have it done (eg. long hx of DM + not very compliant hypertensive pt + PVD, etc.)

Doing echos ?

1. These machines cost 50 - 100 grand.
2. You need a tech - more dolla bills.
3. Where are you gonna get the pts to make up for the above insane overhead ? Echo all your pts ??
4. And then there is the not so insignificant matter of competence.

No.
 
I really hate hearing this. There is really no need for FP's to see kids, there are plenty of pediatricians. There is no need for FP's to deliver babies, there are plenty of OB's. There is no need for FP's to manage DM, there are endocrinologists out there. It's all a bunch of crap. Just what should FP's do? Where do you draw the line?

We are generalists. There is not a single procedure or condition we manage that does not fall under the scope of some other specialty.

I perform colonoscopies. The local GI doesn't like that much. He fought very hard to deny my privileges, and eventually made a play to change the hospital bylaws, so only GI's could maintain privileges. I called his bluff. I requested my cecal intubation rate and adenoma detection rate on my first 500 cases be compared to his last 500. My cecum rate was 99.5%, his was 91%. My adenoma detection rate was 42%, his was 28%. You could argue there is no need for me to do them. He's not always available, but it's rare to have an emergent colonoscopy. There is not a GI that will support me if I have a complication. However, it may be a sickness, but genuinely love endoscopy. My patients are better off because of it. Competition makes everyone better.

Can you do ECHO's? Yes.

Should you do them? I don't know.

It won't boost your practice revenue. It will take a tremendous amount of effort to learn; if you are truly passionate about cardiology and are willing to make sacrifices in other area of your practice you can do it.

There is a local internist who performs echos and nuclear stress in his office. I can't speak to whether he is good, appropriately ordering tests, or if it is lucrative.
 
EdibleEgg said:
I really hate hearing this. There is really no need for FP's to see kids, there are plenty of pediatricians. There is no need for FP's to deliver babies, there are plenty of OB's. There is no need for FP's to manage DM, there are endocrinologists out there. It's all a bunch of crap. Just what should FP's do? Where do you draw the line?
Click to expand...

Right on !
 
Blue Dog said:
You read the rest of his post, right...?
Click to expand...

Yes, I did. I know it is tough out there. I just love being an old fashioned "General Practitioner" or a "Family Physician" who can get the job done when he is needed.
P.S. In England, they let nurses do colonoscopies.
 
elfmonkey said:
In England, they let nurses do colonoscopies.
Click to expand...

They "let" them do it here, too.

http://www.ncbi.nlm.nih.gov/pubmed/21637086

Any monkey can be taught to do a procedure. That doesn't mean they should.

aman171l.jpg
 
Blue Dog said:
Frankly, as an FP, you can do more good for patients (and the system) by not ordering unnecessary echocardiograms rather than adding to the problem of over-testing for profit.
Click to expand...

Agreed. Same for specialists.
 
EdibleEgg said:
I really hate hearing this. There is really no need for FP's to see kids, there are plenty of pediatricians. There is no need for FP's to deliver babies, there are plenty of OB's. There is no need for FP's to manage DM, there are endocrinologists out there. It's all a bunch of crap. Just what should FP's do? Where do you draw the line?

We are generalists. There is not a single procedure or condition we manage that does not fall under the scope of some other specialty.

I perform colonoscopies. The local GI doesn't like that much. He fought very hard to deny my privileges, and eventually made a play to change the hospital bylaws, so only GI's could maintain privileges. I called his bluff. I requested my cecal intubation rate and adenoma detection rate on my first 500 cases be compared to his last 500. My cecum rate was 99.5%, his was 91%. My adenoma detection rate was 42%, his was 28%. You could argue there is no need for me to do them. He's not always available, but it's rare to have an emergent colonoscopy. There is not a GI that will support me if I have a complication. However, it may be a sickness, but genuinely love endoscopy. My patients are better off because of it. Competition makes everyone better.

Can you do ECHO's? Yes.

Should you do them? I don't know.

It won't boost your practice revenue. It will take a tremendous amount of effort to learn; if you are truly passionate about cardiology and are willing to make sacrifices in other area of your practice you can do it.

There is a local internist who performs echos and nuclear stress in his office. I can't speak to whether he is good, appropriately ordering tests, or if it is lucrative.
Click to expand...

Putting aside the very significant issue of competence, where is the OP going to recruit patients to feed your echo machine ? Unless they are very rural I don't see this working out.

As I indicated previously the machine is not cheap, and you need a tech. This just doesn't sound like a good idea at all to me. If you want to make extra money, do ER work, Botox, insurance / IMEs, pilot physicals, etc.

There are so many other ways to generate extra revenue that won't get you into hot water.
 
Putting aside the very significant issue of competence.
You shouldn't. It it very important, but don't imply FP's can't be competent. Not through a weekend course, but it is possible.

Where is the OP going to recruit patients to feed your (not mine, endo is my passion, not echo) echo machine ? Unless they are very rural I don't see this working out.

It depends. I did some locums work for a large practice (~25 FP's) just after residency in a city of ~700K. One of them read ECHO's. They had a huge patient base and also did CT's, MRI's, mammo's, etc.
I work in a rural area, it's still not easy to recruit patients. I pulled a buch of chicken bones out of uninsured patients at three in the morning before the other guys in town started sending patients my way.

As I indicated previously the machine is not cheap, and you need a tech.

Buying a machine isn't the only option, there are lease agreements, shared ownership, and other ways to decrease overhead.

This just doesn't sound like a good idea at all to me.
It probably isn't a good idea for you, but it's not a bad idea for everyone.

If you want to make extra money, do ER work, Botox, insurance / IMEs, pilot physicals, etc.
All of these things can get you "into hot water," too.

There are so many other ways to generate extra revenue that won't get you into hot water.

Do it if you love it, not for extra income.
 
I have heard of non-cardiologists reading echos. I can't say that I've ever seen it in person, or that it would be all that common. But, there is a lot more to reading an echo than just getting an EF (valvular diseases, structural disease, clots etc). The training, for cardiology fellows at least, requires a significant number of echos to be read, as well as performed ourselves (not just the tech), before we can go out into the world and read independently. The level two COCATS requirements are 6 months of training, 150 echos performed, and 300 echos interpreted - just to give you an idea of the volume and time that is put into it. It isn't like a weekend course is comparable or anything. Now, you might be able to convince a rural hospital to give you privileges and get reimbursed, but if you ever make a mistake you can be sure that they'll cite those numbers if it comes to a lawsuit.
 
EdibleEgg said:
Putting aside the very significant issue of competence.
You shouldn't. It it very important, but don't imply FP's can't be competent. Not through a weekend course, but it is possible.

Where is the OP going to recruit patients to feed your (not mine, endo is my passion, not echo) echo machine ? Unless they are very rural I don't see this working out.

It depends. I did some locums work for a large practice (~25 FP's) just after residency in a city of ~700K. One of them read ECHO's. They had a huge patient base and also did CT's, MRI's, mammo's, etc.
I work in a rural area, it's still not easy to recruit patients. I pulled a buch of chicken bones out of uninsured patients at three in the morning before the other guys in town started sending patients my way.

As I indicated previously the machine is not cheap, and you need a tech.

Buying a machine isn't the only option, there are lease agreements, shared ownership, and other ways to decrease overhead.

This just doesn't sound like a good idea at all to me.
It probably isn't a good idea for you, but it's not a bad idea for everyone.

If you want to make extra money, do ER work, Botox, insurance / IMEs, pilot physicals, etc.
All of these things can get you "into hot water," too.

There are so many other ways to generate extra revenue that won't get you into hot water.

Do it if you love it, not for extra income.
Click to expand...


Hang on a minute: now you're saying that family MDs are reading CT scans and MRIs
( as the final read, and billing for it ) ?

What would be the rationale for this , when teleradiology is such a viable option ?

Radiology residents don't do 5 years of training just for the fun of it . Maybe I misread what you wrote.
 
No, they owned the scanners. They also had an endo suite and a pharmacy. I just mentioned that to show they had a large enough patient base to self refer. They were by far the biggest game in town.
 
Just in case anyone is wondering about the financial end of things, it's worth noting that Medicare reimburses less for interpreting a color-flow echocardiogram than they do for seeing a typical established patient in your office (99214).

Echo: $53.01 + $27.49 (color flow add-on) = $80.50
99214: $102.10

Fees are for Virginia. Other locales are not appreciably different.

http://www.midmark.com/Marketing Collateral/CPT-Stress.pdf

http://www.cms.gov/Medicare/Medicar...Sched/index.html?redirect=/PhysicianFeeSched/
 
Blue Dog said:
Just in case anyone is wondering about the financial end of things, it's worth noting that Medicare reimburses less for interpreting a color-flow echocardiogram than they do for seeing a typical established patient in your office (99214).

Echo: $53.01 + $27.49 (color flow add-on) = $80.50
99214: $102.10

Fees are for Virginia. Other locales are not appreciably different.

http://www.midmark.com/Marketing Collateral/CPT-Stress.pdf

http://www.cms.gov/Medicare/Medicar...Sched/index.html?redirect=/PhysicianFeeSched/
Click to expand...

Like I said, don't do it for the money. Do it because you enjoy it and you are truly interested in cardiac physiology.

My monthly income is higher than my partner mostly because of endoscopy. However, when you look at life time income, she is ahead. I did a fellowship for a year making 50K, while she was making an attending's income. I come to work about an hour earlier than she does four days a week. I enjoy the time out of the office. I enjoy the variety. I think my patients are better off because of it.

If your primary motivator is money, then family medicine was a poor choice in general.
 
I found higher reimbursements for echo's:

http://www.cms4hearts.com/billing___reimbursements.asp

Many procedures (such as sleep studies) can be billed either globally or the technical (-TC) and professional interp (-26) can be billed separately.

For a diagnostic sleep study, the codes would be 95810 OR 95810-26 and 95810-TC (if the doctor and the facility were billing separately)

It looks like the figures posted by Blue Dog may only be for the interp. I would imagine that an FP who is using his own echo machine would bill globally.
 
EdibleEgg said:
No, they owned the scanners. They also had an endo suite and a pharmacy. I just mentioned that to show they had a large enough patient base to self refer. They were by far the biggest game in town.
Click to expand...

This raises all sorts of other ethical issues.

On the one hand, why not have the pt get imaging on the premises ?

On the other : there is significant potential for abuse / misuse of the system when a person or group stands to gain financially from using their machines.
 
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