In office procedure profitablity

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

UVAallday

Full Member
10+ Year Member
Joined
Jun 26, 2010
Messages
69
Reaction score
0
In general what are the most profitable in office procedures?

Members don't see this ad.
 
how about MIS (minimal incision surgery) procedures?? seems like if you could do lots of hammer toes and heal spurs in office you could pull in some decent profits. My grandpa used to fix corns that way as well, shorten the metatarsal just a hair so it didn't protrude further than the rest, with a burr in office.
 
Members don't see this ad :)
how about MIS (minimal incision surgery) procedures?? seems like if you could do lots of hammer toes and heal spurs in office you could pull in some decent profits. My grandpa used to fix corns that way as well, shorten the metatarsal just a hair so it didn't protrude further than the rest, with a burr in office.

With all due respect to your grandfather, although performing "MIS" in your office can certainly be a money maker, I can't think of one other reason to perform the procedures you mentioned.

The majority (not all) of the doctors who I have known over my many years of practice who performed MIS, were doctors who did not have formal surgical training or did not have hospital privileges.

About the only time I believe MIS is acceptable is when a patient has a small bony prominence/exostosis that needs to be smoothed down.

The problem with MIS surgery is that you are placing a high speed burr (usually a Shannon 44) into a small hole BLINDLY and you have no idea what tissue you are destroying. Many people have anomalous anatomical findins, and sticking a burr in a hole blindly can "wrap" a nerve, blood vessel, tendon, etc, around the burr.

One of the first things I was ever taught in surgery is to never put your blade where you can't see it, and in MIS surgery that's exactly what you're doing.

Please do not confuse MIS with laparoscopic or endoscopic surgery. In those procedures you are visualizing the surgery on a screen, not working blind.

And that's just the beginning of why I believe this type of surgery is dangerous. The ONLY good thing about this type of surgery is that I've made a lot of money correcting and fixing the major problems it has caused.
 
Ive heard of these issues but had also read that with modern technology (scopes) MIS could see a rebirth of sorts.

Sent from my SPH-D600 using SDN Mobile
 
Ive heard of these issues but had also read that with modern technology (scopes) MIS could see a rebirth of sorts.

Sent from my SPH-D600 using SDN Mobile

I haven't actually looked it up but I would imagine that this equipment would carry a pretty hefty price tag. I don't think it would be financially prudent. Maybe one of the attendings could chime in on this.
 
thats a great article, thanks!

Sent from my SPH-D600 using SDN Mobile
 
Many people have anomalous anatomical findins, and sticking a burr in a hole blindly can "wrap" a nerve, blood vessel, tendon, etc, around the burr.


Sounds delightful...... :eek:
 
Ive heard of these issues but had also read that with modern technology (scopes) MIS could see a rebirth of sorts.

Sent from my SPH-D600 using SDN Mobile

That's why I recommended that you don't confuse MIS with arthroscopic or endoscopic surgery. With endoscopic and arthroscopic surgery, although there is a small incision, the structures are still being visualized.

With the "old" MIS that was performed by DPM's,, it was blind surgery.
 
Big surgeons make big incisions
 
yeah, I believe the blind approach was what my grandfather was doing in the 70's and 80's but during the 90's he began using a scope and heartily recommends that approach. (he retired in 2000).

And yes, he did not have a surgical residency and MIS was the way for him to get in on the surgical side of things.
 
In general what are the most profitable in office procedures?

Today, every single procedure and surgery done in your office/surgical center will be more profitable than going to the nearby hospital.
 
Last edited:
  • Like
Reactions: 1 user
Members don't see this ad :)
Today, every single procedure and surgery done in your office/surgical center will be more profitable than going to the nearby hospital.
It depends what materials are needed for the specific procedure... you don't get paid for the suture, bandages, drapes, chemicals, etc etc.
 
It depends what materials are needed for the specific procedure... you don't get paid for the suture, bandages, drapes, chemicals, etc etc.

Lets say that you have a surgical center in your office that is equipped to do almost any podiatric surgical procedure. Give me an example where doing a procedure in the hospital instead would be more profitable.
 
Lets say that you have a surgical center in your office that is equipped to do almost any podiatric surgical procedure. Give me an example where doing a procedure in the hospital instead would be more profitable.

Are you talking about an in office suite or a medical building that has a surgical center that your office is located in? You make it seem like you are referring to a suite in your very own office in which case....

Who is paying for the screw(s) you are using? Plates? Have you bought your own arthroscopic equipment to do scopes with? Casting materials?

Any of those will eat into or completely erode any profit you made on the procedure. Of course you can use k-wires to save money but then I can rattle off a ton of procedures that you wouldn't be able to do.
 
Lets say that you have a surgical center in your office that is equipped to do almost any podiatric surgical procedure. Give me an example where doing a procedure in the hospital instead would be more profitable.

Any procedure with an expensive implant might cost you more than what you'd make. Make $1000 for the procedure, spend $3000 for the implant.

BTW, when I read "in office" procedure it means to me something you'd do in one of the treatment rooms rather than in a surgical center attached to your office. i.e., a matricectomy, not a Lapidus.
 
somewhat o/t but for the less informed, how does one make money on a procedure that pays 1k and needs 3k of implants?

Sent from my SPH-D600 using SDN Mobile
 
somewhat o/t but for the less informed, how does one make money on a procedure that pays 1k and needs 3k of implants?

Sent from my SPH-D600 using SDN Mobile

You do the procedure in a hospital or surgery center and let them pay for the implants. Hospitals can bill insurance for implants. Surgery centers absorb the cost.
 
I see, why cant a surgery center?

Sent from my SPH-D600 using SDN Mobile
 
I see, why cant a surgery center?

Sent from my SPH-D600 using SDN Mobile

Them's the rules.

Both the hospital and the surgery center bill an O.R. fee though. As long as your case doesn't cost more to do than the O.R. fee, the surgery center can make a profit. If you have a surgery center in your office but it's not an accredited surgery center, you can't bill for that O.R. fee. In that case you absorb all costs.
 
Last edited:
yea i was more talking about procedures done in office not including surgery centers/suites. Like an ingrown toenail was a good example of an in office procedure.
 
Think about it this way. The surgeon gets paid surgeon's fee for the procedure billed to the patient (small fee). The hospital or surgery center bills for the facility fee based on the allowable by insurance based on the procedure code complexity. The anesthesiologist group bills their fee for services. The facility also bills for DME dispensed, meds, and ancillaries/materials. For implants the facility buys the implant from the implant company and bills the patient. So in the end for say a bunionectomy the patient may get billed $1000 and insurance allows/pays $500. Also patient gets billed maybe $6000-$7000 by the facility for these other services. At one of my hospitals they refuse to allow me and a fellow orthopod from another group do TARs because the cost of the implant itself is cost-prohibitive so they feel they don't make enough or lose money on those cases. So I take those cases to another hospital that wants me to do them because it is a good advertisement for their facility.
 
this type of information is worth more than gold to me. it gives me a better understanding of how the US medical industrial complex works and thats not something I can just google, its not really out there for public consumption, thanks.

Sent from my SPH-D600 using SDN Mobile
 
Not to hijack this thread, but our office has recently been experiencing a great way to LOSE your profits.

We have recently had a run of deaf patients come to our office demanding that they be provided with an interpreter. In the past, we attempted to make every accommodation possible (we even had a staff member who "signed") and handed out pads of paper to help with communication. If that wasn't helpful to the patient, we would get an interpreter to allow the patient to feel more comfortable.

Now we have had a large amount of deaf patients who won't try that approach and insist on an interpreter. That interpreter cost US (not the patient) $150 an hour, with a one hour minimum. So if we see a patient with a Medicaid type insurance, where we receive about 35 bucks or less for an office visit, we are in the red for $115. If that patient needs to be seen weekly, etc., WE have to cover that cost.

I am very sensitive to the needs of these patients, but feel that we should have the ability to at least have the patient attempt to communicate with pad and paper. If that is not helpful for the patient, there should be government programs to pay for the interpreter. After all, we are not in business to lose money every visit.

I feel it's ironic that these programs will pay for custom orthoses (if the patient goes to an approved facility) for just about any minor or major foot pathology, but they won't pay for an interpreter.

This requirement to provide an interpreter is part of the American Disabilities Act. I'm not saying these patients don't require/need/deserve an interpreter, I just think it's absurd that the doctor has to cover the cost.
 
Last edited:
This requirement to provide an interpreter is part of the American Civil Disabilities Act. I'm not saying these patients don't require/need/deserve an interpreter, I just think it's absurd that the doctor has to cover the cost.


I'll say it: These patients don't deserve an interpreter. I don't understand how you have to use your personal property to pay for their mishap...

Can you refuse treatment to this patient? Or is that illegal too?
 
Last edited:
Carefully tread here... We have a large deaf patient population and had a lawsuit filed against the practice many years ago. If you do not make reasonable accommodations they will make you bend over backwards and do all sorts of additional things that you will think are way above and beyond what is considered reasonable and you will have to pay for it. We offer the patient the option of communicating via pen and pad or having an interpreter present and yes we have to pay for it and our deaf patient volume is high. I personally see 1 to 2 per week every week on average. The interpreter cost is high. I recommended to the practice that we start up an independent company that provides this service so we can make some money off of it. The interpreters generally work part time for these groups. You cannot avoid it. There are videoconferencing services that provide the service as well but then there's a cost for equipment involved. Some patients can lip read well and some use their blackberries to type. We also have an international languages phone service to make accommodations for non English speaking patients and yes that costs a lot as well.
 
Can you just refer them to someone else? Maybe a practice where they have people who sign?
 
Can you just refer them to someone else? Maybe a practice where they have people who sign?

No, that's discrimination. It would be no different than referring out all your Asian patients, all your Muslim patients, all your Jewish patients, all your Hispanic patients, etc., etc. In the eyes of the law, it's discrimination. If you're in the game (practice) you have to play by the rules, and not make them up as they suit you. Basically, it's the price of doing business.
 
No, that's discrimination. It would be no different than referring out all your Asian patients, all your Muslim patients, all your Jewish patients, all your Hispanic patients, etc., etc. In the eyes of the law, it's discrimination. If you're in the game (practice) you have to play by the rules, and not make them up as they suit you. Basically, it's the price of doing business.

I understand.
 
Great thread. My question is, if a deaf patient comes to your office - are you given a reasonable time frame to accommodate them, as in - you will see them once you find an interpreter? Legally, how long do you as a practice have to set this up? Or is it a must you call an interpreter the day they came to see you?

Can a practice hire someone who isn't an official sign language interpreter to perform signing?
 
Great thread. My question is, if a deaf patient comes to your office - are you given a reasonable time frame to accommodate them, as in - you will see them once you find an interpreter? Legally, how long do you as a practice have to set this up? Or is it a must you call an interpreter the day they came to see you?

Can a practice hire someone who isn't an official sign language interpreter to perform signing?

I'm not an attorney, so my answer is simply based on my experiences, and not my knowledge of the actual laws.

We have had different scenarios. We've had deaf patients enter the office willing to simply use a pad and pen, and read lips during the visit. Some have requested interpreters on follow up visits and some new patients call ahead (or a service calls for them) and requests an interpreter. YOU have the option of providing an interpreter or hiring the one the patient recommends, but the patient can not insist on his/her interpreter. If you have to pay his/her interpreter X amount of dollars, and you can find an interpreter that will do the job for 1/2 X, you choose who you want, as long as the job gets done.

We actually had a staff member who "signed", since both her parents are deaf. When the deaf patient came to the office, the patient had known our employee since she was a child. The visit went very smoothly, but the patient requested a DIFFERENT interpreter during follow up visits, since she didn't want our employee to know her medical problems, etc. However, our employee did not look over her records, she simply interpreted for the patient who had heel pain (it wasn't exactly like she had a rare venereal disease!). Our staff signs privacy agreements, and as a result we did NOT have to comply and let her bring in her own interpreter. We provided an interpreter who signed a privacy agreement and that's who we insisted on using, or the patient was given the option of finding another provider.

So, you are not expected to have an interpreter on hand. When receive a call requesting an interpreter, you then have to make the appropriate arrangements for the patient's visit.
 
I'm not an attorney, so my answer is simply based on my experiences, and not my knowledge of the actual laws.

We have had different scenarios. We've had deaf patients enter the office willing to simply use a pad and pen, and read lips during the visit. Some have requested interpreters on follow up visits and some new patients call ahead (or a service calls for them) and requests an interpreter. YOU have the option of providing an interpreter or hiring the one the patient recommends, but the patient can not insist on his/her interpreter. If you have to pay his/her interpreter X amount of dollars, and you can find an interpreter that will do the job for 1/2 X, you choose who you want, as long as the job gets done.

We actually had a staff member who "signed", since both her parents are deaf. When the deaf patient came to the office, the patient had known our employee since she was a child. The visit went very smoothly, but the patient requested a DIFFERENT interpreter during follow up visits, since she didn't want our employee to know her medical problems, etc. However, our employee did not look over her records, she simply interpreted for the patient who had heel pain (it wasn't exactly like she had a rare venereal disease!). Our staff signs privacy agreements, and as a result we did NOT have to comply and let her bring in her own interpreter. We provided an interpreter who signed a privacy agreement and that's who we insisted on using, or the patient was given the option of finding another provider.

So, you are not expected to have an interpreter on hand. When receive a call requesting an interpreter, you then have to make the appropriate arrangements for the patient's visit.

Great insights. Thanks.
 
FYI this morning at the surgery center I did 3 cases - 2 ankle ORIFs and a LisFranc's ORIF. I looked at the LisFranc's billing because the ore-auth was in the chart and total bills out to near $13K. Insurance expected to pay around $5K.
 
No, that's discrimination. It would be no different than referring out all your Asian patients, all your Muslim patients, all your Jewish patients, all your Hispanic patients, etc., etc. In the eyes of the law, it's discrimination. If you're in the game (practice) you have to play by the rules, and not make them up as they suit you. Basically, it's the price of doing business.

What's the Muslim language?
 
After reading the comments above, it's apparent that the poster wasn't implying there was a Muslim language, a Jewish language, and so on. The analogy appeared to be that denying services to a patient who has special needs is no different than denying services to a Muslim patient, Jewish patient, African-American patient, Asian patient.......... At least that's my interpretation of the comments.
 
Top