Kypho in orthopedic group

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Theoretically I will. The spine surgeons want nothing to do with them.
 
I'll be starting them at some point. I'm straight out of fellowship and my plan is to do several in my group's ASC so I can do them under GA or at least heavy sedation to get some more reps in.

I plan to start doing them in office shortly thereafter.
 
BoardingDoc said:
I'll be starting them at some point. I'm straight out of fellowship and my plan is to do several in my group's ASC so I can do them under GA or at least heavy sedation to get some more reps in.

I plan to start doing them in office shortly thereafter.
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If Medicare plans, you will likely lose money on the kit in the ASC. Just FYI
 
SpineandWine said:
Surprising. They take half hour to do for one level in office, make as much as if not more 2 level ACDF for them which is their prized case
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I don’t think they want anything to do with a case under local with light sedation…..especially not where they can’t just walk into an OR with the patient prepped, draped, sedated, and walk out before closing and then let the asc/hospital pacu staff handle the rest.

If it was just popping in for a quick case after the OR or clinic then leaving… that would be one thing… But at least in my set up, this is how it works (which would not be palatable for the surgeons). during my office procedure day, kyphoplasty patients arrive an hour early. Once my assistant gets them into a gown and wheelchair, I stop by between esi/rfa and talk to patient and family, go over consent, give IM antibiotic injection, and instruct them on how to take the po sedative. I do a few more esi/Rfa… check on the patient again re needing more sedative or not. After my last injection, I help my xray tech set up the room and back counter with sterile cover and kypho equipment. Wheel the patient in the room and physically help groggy elderly patient onto the table w xray tech. Prep, drape, local… access/balloon, mix the cement myself. Complete the case, help Xray tech clean up the room. Help the patient off the table into the wheelchair. Intermittently keep an eye on the patient for the next 30 to 60 minutes, before they are safe to go home and transfer into their car with their elderly spouse. Typically I personally spot them while transferring into their car.

Even some of my pmr/pain colleagues say f all that I’ll just do them in OR for no money or send them out (to me…)

Gotta be willing to hustle if you wanna make more $
 
Taus said:
I don’t think they want anything to do with a case under local with light sedation…..especially not where they can’t just walk into an OR with the patient prepped, draped, sedated, and walk out before closing and then let the asc/hospital pacu staff handle the rest.

If it was just popping in for a quick case after the OR or clinic then leaving… that would be one thing… But at least in my set up, this is how it works (which would not be palatable for the surgeons). during my office procedure day, kyphoplasty patients arrive an hour early. Once my assistant gets them into a gown and wheelchair, I stop by between esi/rfa and talk to patient and family, go over consent, give IM antibiotic injection, and instruct them on how to take the po sedative. I do a few more esi/Rfa… check on the patient again re needing more sedative or not. After my last injection, I help my xray tech set up the room and back counter with sterile cover and kypho equipment. Wheel the patient in the room and physically help groggy elderly patient onto the table w xray tech. Prep, drape, local… access/balloon, mix the cement myself. Complete the case, help Xray tech clean up the room. Help the patient off the table into the wheelchair. Intermittently keep an eye on the patient for the next 30 to 60 minutes, before they are safe to go home and transfer into their car with their elderly spouse. Typically I personally spot them while transferring into their car.
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You’re doing too much.
Have the rep help out with setting room, mixing cement etc.
 
SpineandWine said:
You’re doing too much.
Have the rep help out with setting room, mixing cement etc.
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thought you only do these in OR?
Reps of both companies I’ve used have said they’re not allowed to physically assist in any way beyond handing me equipment…. I’ve asked..
 
Taus said:
thought you only do these in OR?
Reps of both companies I’ve used have said they’re not allowed to physically assist in any way beyond handing me equipment…. I’ve asked..
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I do it in HOPD
But if you looked at it, would be hard to tell difference between my location and an office room. It’s not a true OR
 
SpineandWine said:
I do it in HOPD
But if you looked at it, would be hard to tell difference between my location and an office room. It’s not a true OR
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What’s your level of staffing like? I presume more than my bare-bones with xray tech and MA to check patients in and take vitals pre/post?
 
Taus said:
What’s your level of staffing like? I presume more than my bare-bones with xray tech and MA to check patients in and take vitals pre/post?
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Bloat. 4 nurses, 1 X-ray tech, 2 people to check patients in
I sit on a computer until they are ready for me, look at some news or other things
 
SpineandWine said:
Bloat. 4 nurses, 1 X-ray tech, 2 people to check patients in
I sit on a computer until they are ready for me, look at some news or other things
Click to expand...
While you’re may not be a true OR… I would say that is very very different from doing this in a typical private practice office procedure suite where you need to run lean to keep costs down.
 
Taus said:
I don’t think they want anything to do with a case under local with light sedation…..especially not where they can’t just walk into an OR with the patient prepped, draped, sedated, and walk out before closing and then let the asc/hospital pacu staff handle the rest.

If it was just popping in for a quick case after the OR or clinic then leaving… that would be one thing… But at least in my set up, this is how it works (which would not be palatable for the surgeons). during my office procedure day, kyphoplasty patients arrive an hour early. Once my assistant gets them into a gown and wheelchair, I stop by between esi/rfa and talk to patient and family, go over consent, give IM antibiotic injection, and instruct them on how to take the po sedative. I do a few more esi/Rfa… check on the patient again re needing more sedative or not. After my last injection, I help my xray tech set up the room and back counter with sterile cover and kypho equipment. Wheel the patient in the room and physically help groggy elderly patient onto the table w xray tech. Prep, drape, local… access/balloon, mix the cement myself. Complete the case, help Xray tech clean up the room. Help the patient off the table into the wheelchair. Intermittently keep an eye on the patient for the next 30 to 60 minutes, before they are safe to go home and transfer into their car with their elderly spouse. Typically I personally spot them while transferring into their car.

Even some of my pmr/pain colleagues say f all that I’ll just do them in OR for no money or send them out (to me…)

Gotta be willing to hustle if you wanna make more $
Click to expand...
This is pretty similar to me. I try to do these first thing in the morning or maybe over lunch. Never the end of the day, just in case they need a little time to wake up more after the case.

Likewise, my spine surgeon wants nothing to do with a patient who is not fully asleep.
 
Taus said:
While you’re may not be a true OR… I would say that is very very different from doing this in a typical private practice office procedure suite where you need to run lean to keep costs down
Click to expand...

What’s your set up when you see patients in clinic. How many MAs and APPs?
 
Taus said:
While you’re may not be a true OR… I would say that is very very different from doing this in a typical private practice office procedure suite where you need to run lean to keep costs down.
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Taus said:
👍🏻
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RoloTomassi said:
As part of neurosurgery group
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Agast said:
Theoretically I will. The spine surgeons want nothing to do with them.
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callmeanesthesia said:
Yes
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manowar rules said:
✋
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I have some questions for the group

1- do you wear a gown? mask? rest of the room mask, hat etc?
2-do you use a just a fenestrated drape, or half sheet across bottom of patient + 4 small drapes around the entry point?

I will be charged for the materials I use and the employees helping me (and our practice does a separate employee charge for large cases not done in the ASC, so I do have to accept that).

However, my lovely CEO also added some highly questionable charges to the bill I just saw including
1-Utilities cost $50, (which should part of the general overhead)
2-adminstration $150 (which should be part of general overhead)
3- $22 charge for the staff to pull the materials (again should be part of general overhead)
4- $40 charge for scheduling office (again should be part of general overhead)
5- finally the kicker 25% mark up of all kypho supplies, (just because he felt like it) which is ridiculous. This alone is just short of $900

Can each you please comment on what you do for------

1- doctor and staff sterile prep/gown, etc.
2- the patient sterile prep/drapes, etc.
3- Mostly importantly, can you please tell me if your ortho/neurosurg practices charge you any of the 1-5 costs I listed above for utilities, etc.....

I need this information to demonstrate to the new CEO, that the charges proposed by our very old retiring CEO are not the standard around the country. This could save me $1100 per case.

Thank you for your help
 
bedrock said:
I have some questions for the group

1- do you wear a gown? mask? rest of the room mask, hat etc?
2-do you use a just a fenestrated drape, or half sheet across bottom of patient + 4 small drapes around the entry point?

I will be charged for the materials I use and the employees helping me (and our practice does a separate employee charge for large cases not done in the ASC, so I do have to accept that).

However, my lovely CEO also added some highly questionable charges to the bill I just saw including
1-Utilities cost $50, (which should part of the general overhead)
2-adminstration $150 (which should be part of general overhead)
3- $22 charge for the staff to pull the materials (again should be part of general overhead)
4- $40 charge for scheduling office (again should be part of general overhead)
5- finally the kicker 25% mark up of all kypho supplies, (just because he felt like it) which is ridiculous. This alone is just short of $900

Can each you please comment on what you do for------

1- doctor and staff sterile prep/gown, etc.
2- the patient sterile prep/drapes, etc.
3- Mostly importantly, can you please tell me if your ortho/neurosurg practices charge you any of the 1-5 costs I listed above for utilities, etc.....

I need this information to demonstrate to the new CEO, that the charges proposed by our very old retiring CEO are not the standard around the country. This could save me $1100 per case.

Thank you for your help
Click to expand...
What would you be doing during this time if not doing a kypho in office fluoro suite? Ie would you be in there anyway doing esi, rfa etc if not a Kypho? Even if it was office hours, sounds like they’re double-dipping here. The 25% equipt up charge is just nonsensical.

Are any of the surgeons, i.e. hand surgeons, using this room for surgeries that can be done in the office? I.e. is there precedent, or also the issue now of precedent being set for that scenario in future

I personally wear a hat, mask, full gown, avaguard. Patient has a full size fenetrated drape. Shower cap style C arm cover. All very inexpensive. Staff has a mask on, that’s it. Only other people in the room are Xray tech and rep.
 
You need to put your foot down. Don’t let the bone doctors and their croney push you around.

Fenestrated drape
3/4 drape (one to three)
C arm bonnet
Sterile gloves x2
Sterile gown x2
Hat/masks
Chloraprep
Rocephin IM
Nitrous/O2
Disposable circuit and mask

In total that is about $100 real cost and the vast majority is the nitrous and oxygen.
 
BobBarker said:
You need to put your foot down. Don’t let the bone doctors and their croney push you around.

Fenestrated drape
3/4 drape (one to three)
C arm bonnet
Sterile gloves x2
Sterile gown x2
Hat/masks
Chloraprep
Rocephin IM
Nitrous/O2
Disposable circuit and mask

In total that is about $100 real cost and the vast majority is the nitrous and oxygen.
Click to expand...
Taus said:
What would you be doing during this time if not doing a kypho in office fluoro suite? Ie would you be in there anyway doing esi, rfa etc if not a Kypho? Even if it was office hours, sounds like they’re double-dipping here. The 25% equipt up charge is just nonsensical.

Are any of the surgeons, i.e. hand surgeons, using this room for surgeries that can be done in the office? I.e. is there precedent, or also the issue now of precedent being set for that scenario in future

I personally wear a hat, mask, full gown, avaguard. Patient has a full size fenetrated drape. Shower cap style C arm cover. All very inexpensive. Staff has a mask on, that’s it. Only other people in the room are Xray tech and rep.
Click to expand...
Thanks guys. We have an outlying clinic where I do some office based fluoro procedures and some surgeons do simple office based hand surgical cases. This has been billed as an office site POS 11 for many many years for all physician procedures.

6 months ago, the CEO tried to charge all of us a "facility fee" to use the procedure room for an office in which we already pay rent. I brought this up to the orthopods and that was successfully changed back two months ago by the board of partners to just be global fee minus materials and staff costs (because he was also hurting the two surgeons).

That was right before I started kypho cases. I feel the retiring CEO is just trying to be vindictive now because he lost the "facility fee'" for an office procedure discussion two months ago and now he is inventing BS charges for kyphoplasty so I won't make an appropriate profit.
 
bedrock said:
5- finally the kicker 25% mark up of all kypho supplies, (just because he felt like it) which is ridiculous. This alone is just short of $900
Click to expand...
Buy the kit yourself. It comes in a sterile package so you can just keep it in your office. This is predatory nonsense. Is this group a really good gig otherwise? I'd be looking elsewhere if I was dealing with this level of nonsense.
 
I have around $30,000 in credit card points annually. It pays for all of our vacations. It may be more, it isn’t less.
 
Fun fact: pay1040.com charges 1.75% cc fee but I get 2% rewards so that math is easy. Then there is the added benefit that rewards aren’t taxable so there is additional math in my favor on that. As long as the fee is less than 140% the rewards received then it is mathematically in your favor to use the CC.
 
Also, many, many major companies charge no CC fee. Allergan, Stryker, Medtronic, Spinal Simplicity

I also pay my staff and my 1099 physician colleague with the CC.
 
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