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MD figurehead + Chiro + PT = Vax-D

Discussion in 'Pain Medicine' started by PMR 4 MSK, Jun 3, 2008.

  1. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor 5+ Year Member

    Oct 1, 2007
    Do you guys have any clinics in town like we have here - They have fancy-sounding names, often including "Pain Management" or "Rehabilitation" in their name, advertising in the yellow pages as an MD clinic, when in reality, the MD is little more than a figurehead who sees the patients so that the treatment-go-round has a better chance of getting covered by insurance?

    Usually, the patient's see the MD once, and then eveyone gets the same Rx for their neck or back pain - Chirproactic treatment 5x/wk x 6-8 weeks, then 3x/wk x 8-12 weeks, and slowly weaning from there, with daily multi-level adjustments, + 5-6 units of PT (usually Hot pack + US + massage + Estim + 1 or 2 units of therapeutic exercise) with a licensed PT, plus the daily "Stretchy Machine." (I.e. some computerized form of traction such as the Vax-D).

    I think we have at least 4 or 5 of these clinics in the area. Whenever I drive past them, parking lots are always full. I frequently see their failures, but at least one of the clinics advertises on TV with the MD stating they have an "86% success rate." Often, by the time they see me, their yearly PT benefits are exhausted, their yearly out-of-pocket maximum is maxxed and they still hurt.

    When I get copies of their records, they're filled with dozens of impossible to understand tests, with wonderful impressions like "Right L1 radiculopathy, Right L2 radiculopathy, Right and Left L4 radiculopathy, Right and Left L5 radiculopathy, Left S1 radiculopathyand Right S3 radiculopathy." They get all these tests done at least weekly. I imagine the billed costs must be in the nature of $5000 - $10,000 per week. Notes are either all handwritten and illegible, or so computerized and standardized that every day on every patient reads the same.

    Most seem to avoid opioids, thank god. I used to be near one in my old practice that had a similar clinic nearby that did all the above + added in vicodensomaxanax for everyone, then when their benefits were exhausted, dumped them to me.
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  3. Tenacious DO

    Tenacious DO Member 10+ Year Member

    Nov 2, 2005
    I am familiar with some of these practices.

    While the multidisciplinary approach is designed to promote more effective & efficient treatment, the patient outcomes & billing sheet can point to the contrary.

    In order to address all aspect of LBP, a team approach can be helpful. I would love to hear if some of you have examples of successful interdisciplinary teams that are not just cookie-cutter operations to turn out charges.

    Please include the disciplines, primary roles, commuication...
    Last edited: Jun 3, 2008
  4. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

    May 30, 2005
    Canton GA
    The Atlanta area is full of crooked DC's with an FP to ghost sign, PT, massage, and an Acuspina or Vax-D.

    I do not allow patients with exhausted benefits to get dumped in my practice.
    Strip the PIP was invented in Atlanta. THere are still plenty of DC's that advertize on television, have booths for marketing at car washes, etc.

    Want real care, see a real doctor.
  5. Tenesma

    Tenesma Senior Member 10+ Year Member

    Jun 11, 2002
    i have seen quite the share of Vax-D patients who spent ungodly amounts of money without improvement - and quite a few of them had ribcage injuries to boot from that device....

    however, these are the same patients who fork over 4k for Vax-D but when they get my bill for them to cover $8.62 after medicare pays they flip out.... go figure

    what can i say... there are a lot of charlatans -
  6. ampaphb

    ampaphb Interventional Spine 10+ Year Member

    May 13, 2007
    New Orleans, LA
    I actually spoke to a reputable spine surgeon the other day who I thought had a novel approach - he has a vax-d equivalent in his office (his was called spine-med, I think).

    He was of the impression that the series of treatments was necessary, and that patients needed a carrot and stick in order to get them to continue coming to a 20 visit regimen. He charged somewhere between $2500-4,000 (I have both numbers stuck in my head). The deal was, if you competed the full course of treatment, and did not significantly improve, you got your money back (of course, at that point, he would offer you injections and/or surgery).

    Seemed like a reasonable way to use the technology, other than the occasional patient who might deny improvement to get the treatment for free.
  7. Tenesma

    Tenesma Senior Member 10+ Year Member

    Jun 11, 2002
    it is obviously a cheap gimmick - does he refund patients who don't do better with their 360 fusion?
  8. ampaphb

    ampaphb Interventional Spine 10+ Year Member

    May 13, 2007
    New Orleans, LA
    it would be a gimmick if he advertised the guarantee - which he doesn't

    Plus as I recall most of these distraction devices are not covered by insurance, while obviously the fusion is
    Last edited: Jun 5, 2008
  9. Tenesma

    Tenesma Senior Member 10+ Year Member

    Jun 11, 2002
    ahh... well it turns out insurance co. pays for "neuro-muscular re-education" (which is a PT code) but is frequently billed by physicians AND chiropractors for using any type of modality on a patient (whether it is traction in a VAXD, or massage in a massage chair or whatever)...

    there was one guy in the big city who placed massage chairs in the waiting room... he would bill for neuro-muscular education - the patients LOVED IT!!!

    is that legit?

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