More Office Based Shenanigans and Junk

[heybrother]

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I've been meaning for awhile to post things that people/reps whatever drop off claiming they'll be a huge revenue generator for the practice. My hope is to later hear more about people going to jail etc.

"Safe Balance"
-If I understand it correctly you use some sort of computer work flow process to risk score the patient for fall risk. It takes at least 8 minute of asking elderly people questions.
***I'm going to add this now because you are thinking about it - there isn't a word about selling braces here. What a bunch of noobs. Where's the balance brace vertical integration.***
-Then you bill them 2 units of 97750. Medicare appears to pay $33 for 1 unit of this code.
-They charge a licensing fee of $25 per person.
***$25/$66 = 38% - that's more than a podiatry associate gets paid. Who do they think they are!?
-According to their paperwork if I subject 6000 patients to this I will generate a whopping $740K.
-I can already hear the patients now - I came here for my nails to be trimmed. Why are you asking me these questions about how I hold a cane?

The rep has hand written onto the sheet that the above represents the numbers for a large orthopedic practice and they would be happy to provide me specific numbers.

I will apparently need to add at least 1-2 MAs to be dedicated to and only perform this service. I'll need a Safe Balance room. They provide the laser printer for my 4 page report that will not only tell me how the patient will fall but how severely.

The report appears to generate super useful information for the patient like - "Fall Risk Score 11" - "Remove all hazards which may include throw rugs or clutter in hallways. Make sure all areas of travel and common interaction remain clear of objects which may be hazardous. Have maintenance professionals address loose carpeting and other uneven surfaces to a more manageable and safe platform to reduce tripping hazards."

Life changing. Podiatry you've done it again!?

Is anyone working for an orthopedic practice adding this valuable life saving service to their practice?

 

[SouthPod7]

I will never forget being approached by a rep company for rechargeable orthotics.

 

[Feli]

For most things, if they don't make sense or try to fill a 'need' that doesn't even really exist, then you can stop there and go no further.
"If it doesn't make sense, it's usually not true" is cliché for a reason.

So yeah, I can hear a few words about balance a$$essment, biopsy for every freckle or diabetic normal skin, re-packaging of past failed implants like soft first MPJ implant or roping bunions or Lisfranc, amniotic product$ heal$ all, total ankle implants, 99% of wound care hocus pocus, a jig to do Lapidus or reduce calc fx or stuff that isn't that hard to do freehand, blah blah blah, and simply stop right there. There is no need for it, or it simply doesn't even make sense (due to cost/time/alternatives, etc).

PS, make an office/personal policy that you don't see reps unless you invited them and arranged the meeting/lunch (that should be rare assuming you use reputable companies... their stuff sells itself and they will be busy). Legit stuff like appt texting software to remind pts, website design and SEO, basic office supplies or medical supplies pricing, new implants from your regular fixation company or soft tissue anchor/rope company, etc that are possible upgrades to services or goods you have to own or have to use? Sure, ok, those make sense... let your office mgr scope it out. Just remember: don't call me, I'll call you. 🙂

 

[heybrother]

Fluid Flow Amnion allograft

-Apparently a flowable amnion graft product has been awarded a Q code of Q4206.
-They have an app.
-I'm given 1 sheet of a Medicare EOB showing a charge of $4000 for 2 units of this stuff paid at $3200.
-They also show an injection of 20550 with a fee schedule charge of $331. Lovely.
***People used to say things to me like - man, if I could just do 5-10 matrixectomies a day and nothing else my life would be so easy. To that I say. So dumb! Do 1 amnion injection a day. 5 matrixectomies!? That's working too hard.***
-The patient apparently picked up an $800 coinsurance charge.
-The promotional materials include some sort of planned procedure in which dysvascular feet will be injected with this to prove it induces new blood vessels to form. It doesn't appear to have been done yet.
-They don't tell me what they'd charge me.

 

[heybrother]

For most things, if they don't make sense or try to fill a 'need' that doesn't even really exist, then you can stop there and go no further.
"If it doesn't make sense, it's usually not true" is cliché for a reason.

So yeah, I can hear a few words about balance a$$essment, biopsy for every freckle or diabetic normal skin, re-packaging of past failed implants like soft first MPJ implant or roping bunions or Lisfranc, amniotic product$ heal$ all, total ankle implants, 99% of wound care hocus pocus, a jig to do Lapidus or reduce calc fx or stuff that isn't that hard to do freehand, blah blah blah, and simply stop right there. There is no need for it, or it simply doesn't even make sense (due to cost/time/alternatives, etc).

PS, make an office/personal policy that you don't see reps unless you invited them and arranged the meeting/lunch (that should be rare assuming you use reputable companies... their stuff sells itself and they will be busy). Legit stuff like appt texting software to remind pts, website design and SEO, basic office supplies or medical supplies pricing, new implants from your regular fixation company or soft tissue anchor/rope company, etc that are possible upgrades to services or goods you have to own or have to use? Sure, ok, those make sense... let your office mgr scope it out. Just remember: don't call me, I'll call you. 🙂

Agree. I haven't spoken to any of these. They show up on my desk. I used to throw them in the trash. Now I generate content for bored SDN readers!

I had a laugh the other day. I got everything setup for my main hardware company at a new hospital. The rep calls me to tell me the hospital was very pleased by how low their prices were - lower than many people they currently use.
I want to do a lapidus next week
Would you like to use our new jig and nail
No, I would like to use the plates and screws I've used everytime.
*Me thinking but not saying it - you know the one you just told me the hospital was pleased about.

I've been too polite. I'm done talking to bone stimulator reps and grafts and all that. And I definitely hung up on a whole life sales person.

 

[wakaflocka88]

My favorite part was and is asking reps about their wound care products and what percentage of the graft is actually viable, living, flowing, regenerative-capable cells. They always just respond - don't worry, it has lots of growth factors and mesenchymal cells!

Breaks my heart new grads and new-ish grads continue to fall sucker for these miraculous advances in technology.

 

[Pronation]

Epidermal nerve fiber density

 

[heybrother]

Epidermal nerve fiber density

Obviously done before and after treatment to quantify improvement. Saw that during an interview. I think I talked about that in the last shenanigans thread.

 

[GreenHousePub]

It takes at least 8 minute of asking elderly people questions.

That's an eternity. Where I'm at now no one has even heard of balance braces. When I was up in the PNW all the private practice guys I knew were all about doing the giant risk assessment checklists required for them.

We don't do any amniotic grafts now, after eating the cost of one of them due to slightly off documentation/justification we said to hell with it.

 

[heybrother]

That's an eternity. Where I'm at now no one has even heard of balance braces. When I was up in the PNW all the private practice guys I knew were all about doing the giant risk assessment checklists required for them.

We don't do any amniotic grafts now, after eating the cost of one of them due to slightly off documentation/justification we said to hell with it.

I thought the whole thing sounded fishy as hell just from the details I had but after I read more it's even worse. That code they want you to bill two units of is actually essentially a physical therapy code that bills in units of 15 minutes. I think they're supposed to be something approaching 30 minutes of care and very specifically if you don't deliver at least eight minutes you can't actually bill the code. So when they were telling me in the paperwork 8 minutes they are essentially attempting to ensure that you cross the billing threshold. That is what I understand from skimming some physical therapy related questions about the code.

The math on it is even worse than what I've described. Let's say you do get paid $66. You are still likely going to have to pay some sort of biller or coder or whatnot. My office has an unfavorable contract with Athena for 8%. So let's say $60 now. Take away $25 for them is $35. But you have a dedicated MA in the room. I think our lowest paid now is $15 an hour. Obviously that varies in different places and can be more or less. But the values are fantasy based on this idea of cranking out a huge number of a lower reimbursing procedure where they essentially get half the money. Just absurd.

My residency hospital botched the billing on a whole bunch of graft type products and essentially forbade everyone from using them after they lost thousands of dollars.

 

[Pronation]

Obviously done before and after treatment to quantify improvement. Saw that during an interview. I think I talked about that in the last shenanigans thread.

Ah yes. Need to see if the vitamins and essential oils are working or not. Also important to see if perhaps there’s a vascular component with yearly padnet testing on patients with strong pedal pulse

 

[GreenHousePub]

That code they want you to bill two units of is actually essentially a physical therapy code that bills in units of 15 minutes.

A guy I knew (he sold his practice and left) had "physical therapy" rooms where he would just put the patients in stainless steel leg whirlpools so he could bill for physical therapy encounters - or something. I'm sure those things didn't get cleaned like they should.

 

[air bud]

One of the best parts of being rural - no reps for this BS. They aren't driving 5-7 hours seeking me out. Even legit hardware reps - I have like 3 who call on me. One new grad who I string along and will never use. They other two are great, know their stuff and dependable. No pharma reps, no hocus pocus.

 

[deleted285117]

Anyone have the reps who touted their foot bath + TENS unit demo for neuropathy? Essentially it stims the muscle while submerged. Watching them on conference videochat, I was just waiting for the test patient to get electrocuted...

Needless to say was quite humorous and I did not call them back.

 

[heybrother]

One of the best parts of being rural - no reps for this BS. They aren't driving 5-7 hours seeking me out. Even legit hardware reps - I have like 3 who call on me. One new grad who I string along and will never use. They other two are great, know their stuff and dependable. No pharma reps, no hocus pocus.

Reps Log

Drove out to see new Dr. AirBud today. In general, podiatrists are sucker imbeciles who will use anything a rep offers them as long as they get a sandwich first. Its a bit of a drive, but I think he and I will be best friends since no one pursues rural doctors for their business. I arrive unannounced. Interestingly, no shoe carousel in his office. Is he even a podiatrist? He seems initially amused that I drove all this way to see him. I proudly show him my company's many excellent products. Tylenol infused dressings. Cotton and copper staples, for people who love copper fit dressings and drainage. He tells me he is sure he will have a LOT of use for my 4th-5th TMTJ joint fusion wedge and that he definitely wants to talk to some of his friends about it. We share a manly laugh. Walking back to my car I remember I did not tell him about my 1st MPJ "REVIZER" implant for replacing former bone implants. I return to the office only to find a large printed sign indicating product representatives must schedule their appointments ahead of time. His secretary informs me he has already gone home for the day. It is 1:15 pm. I'm confident our first meeting went well. I shall continue to pursue the old rep trick - get 'em to use it once and they'll keep coming back for more!

----

I have been calling Dr. Airbud's office for several weeks now trying to arrange an appointment to discuss what I can do for him. We've finally arranged a lunch meeting however I think he might have me confused with a Favor driver. I asked him if I could bring him a sandwich or lunch from the city but instead he has sent me a list of groceries to be purchased at many stores. He asks if I have a Costco membership? He promises me a fat tip and much future business. I'm going through my pitch in my mind when his wife arrives. I notice that she is wearing a holstered pistol and a sweater that says "No Thanks". She is wearing aviators and seems relatively disinterested in me as a person. Its probably because of Covid's effect on society. She has me load the groceries in the back of her SUV. Afterwards, she places a stick of gum in my shirt pocket and tells me there's more where that came from before driving away. I head back to Dr. Airbud's office knowing today is the day I get a firm commitment. "I'm sorry bud" he says" - "I have to head over to the hospital urgent to help Dr. Hyrule". I note a Nintendo Switch is in his hand. It is 1:15 pm. I begin the process of enrolling to become a Favor driver. I will win his business.

----

Phonecalls just don't seem to be working. I drive to Dr. Airbud's office today not to see him - but to speak to his secretary and make her put me on the schedule.

What does tomorrow's schedule look like I ask?
About 8 patients she says.
Well, have him fit me in between one of those?
I'm sorry sir, all of Airbud's appointments are hour long 99205 visits. There just isn't time. Here is his grocery list though. He will need it done this week.

----

Dr. Airbud has generously agreed that I may accompany him to the OR. He might, maybe use one of my products if he is able to and it is free. I'm breaking through. Its happening. One and done baby. Another product rep is also there. As we change into scrubs I note that airbud and this man are wearing matching gold friendship bracelets. I will need to get one of those.

The OR scrub seems to be on a first name basis with this rep. They ask me over and over again - "who are you again?"

Throughout the case I note Dr. Airbud stopping to ponder and consider whether my hardware would be appropriate. Sadly, at each procedure he proceeds with the simple plates and screws of the other rep.

"Wouldn't you like to try my hammertoe implant?"
"Sorry bud, the patient told me they prefer k-wires"

"How about my tylenol infused dressings?"
"Sorry bud, the patient is allergic to tylenol. Also, we already opened these regular gauze and the hospital is very strict on not wasting supplies."

As I load his groceries into his wife's car again I ponder what I could have done to make the sale. I won't give up though.

----

I arrive at Dr. Airbud's office unannounced. No one is there so I let myself in. I walk through the empty hallways - nothing. No one.

"Hey bud, did we a meeting today?"

I turn to find Dr. Airbud walking towards me.

"I was hoping to talk about the other day in the OR to see if I could find something to help you."

"Oh sure. Well I have a staff meeting right now - just wait here and I'll be out to talk to you soon."

He opens a nearby door - inside I see all of his staff wearing party hats. There is a birthday cake and candles on the table. Everyone is laughing.

Two hours later his staff inform me he had an emergency and left through a side door. It is 1:15pm.

My boss would like to know what progress I have made.

-----

It unpleasantly cold as I drive out to BFE. I should be working on my Favor route. People don't like to go shopping on days like this. I have been fired from my rep job but today I'm going to make a sale to show the world what I'm capable of. I'm going to let this DPM son of a batch know that if he doesn't want my business we are done.

As I pull into town I note a man standing in light blue scrubs deep in a field. He seems to be field dressing a deer.

I pull over to the side of the road and walk back to where I saw the man. There is no one there. I proceed deeper into the field. Still no one. In the distance I hear the sound of a shotgun being fired.

A cold fog begins to descend. My pants begin to feel wet from walking through knee high grass.

I get lost but ultimately I return to my car. It has been keyed with the words "Air Bud". There is blood on my windshield and a deer antler has been stuck through my front left tire. The car won't start.

Help. I have now decided he doesn't want my products.

 

[wakaflocka88]

Reps Log

Drove out to see new Dr. AirBud today. In general, podiatrists are sucker imbeciles who will use anything a rep offers them as long as they get a sandwich first. Its a bit of a drive, but I think he and I will be best friends since no one pursues rural doctors for their business. I arrive unannounced. Interestingly, no shoe carousel in his office. Is he even a podiatrist? He seems initially amused that I drove all this way to see him. I proudly show him my company's many excellent products. Tylenol infused dressings. Cotton and copper staples, for people who love copper fit dressings and drainage. He tells me he is sure he will have a LOT of use for my 4th-5th TMTJ joint fusion wedge and that he definitely wants to talk to some of his friends about it. We share a manly laugh. Walking back to my car I remember I did not tell him about my 1st MPJ "REVIZER" implant for replacing former bone implants. I return to the office only to find a large printed sign indicating product representatives must schedule their appointments ahead of time. His secretary informs me he has already gone home for the day. It is 1:15 pm. I'm confident our first meeting went well. I shall continue to pursue the old rep trick - get 'em to use it once and they'll keep coming back for more!

----

I have been calling Dr. Airbud's office for several weeks now trying to arrange an appointment to discuss what I can do for him. We've finally arranged a lunch meeting however I think he might have me confused with a Favor driver. I asked him if I could bring him a sandwich or lunch from the city but instead he has sent me a list of groceries to be purchased at many stores. He asks if I have a Costco membership? He promises me a fat tip and much future business. I'm going through my pitch in my mind when his wife arrives. I notice that she is wearing a holstered pistol and a sweater that says "No Thanks". She is wearing aviators and seems relatively disinterested in me as a person. Its probably because of Covid's effect on society. She has me load the groceries in the back of her SUV. Afterwards, she places a stick of gum in my shirt pocket and tells me there's more where that came from before driving away. I head back to Dr. Airbud's office knowing today is the day I get a firm commitment. "I'm sorry bud" he says" - "I have to head over to the hospital urgent to help Dr. Hyrule". I note a Nintendo Switch is in his hand. It is 1:15 pm. I begin the process of enrolling to become a Favor driver. I will win his business.

----

Phonecalls just don't seem to be working. I drive to Dr. Airbud's office today not to see him - but to speak to his secretary and make her put me on the schedule.

What does tomorrow's schedule look like I ask?
About 8 patients she says.
Well, have him fit me in between one of those?
I'm sorry sir, all of Airbud's appointments are hour long 99205 visits. There just isn't time. Here is his grocery list though. He will need it done this week.

----

Dr. Airbud has generously agreed that I may accompany him to the OR. He might, maybe use one of my products if he is able to and it is free. I'm breaking through. Its happening. One and done baby. Another product rep is also there. As we change into scrubs I note that airbud and this man are wearing matching gold friendship bracelets. I will need to get one of those.

The OR scrub seems to be on a first name basis with this rep. They ask me over and over again - "who are you again?"

Throughout the case I note Dr. Airbud stopping to ponder and consider whether my hardware would be appropriate. Sadly, at each procedure he proceeds with the simple plates and screws of the other rep.

"Wouldn't you like to try my hammertoe implant?"
"Sorry bud, the patient told me they prefer k-wires"

"How about my tylenol infused dressings?"
"Sorry bud, the patient is allergic to tylenol. Also, we already opened these regular gauze and the hospital is very strict on not wasting supplies."

As I load his groceries into his wife's car again I ponder what I could have done to make the sale. I won't give up though.

----

I arrive at Dr. Airbud's office unannounced. No one is there so I let myself in. I walk through the empty hallways - nothing. No one.

"Hey bud, did we a meeting today?"

I turn to find Dr. Airbud walking towards me.

"I was hoping to talk about the other day in the OR to see if I could find something to help you."

"Oh sure. Well I have a staff meeting right now - just wait here and I'll be out to talk to you soon."

He opens a nearby door - inside I see all of his staff wearing party hats. There is a birthday cake and candles on the table. Everyone is laughing.

Two hours later his staff inform me he had an emergency and left through a side door. It is 1:15pm.

My boss would like to know what progress I have made.

-----

It unpleasantly cold as I drive out to BFE. I should be working on my Favor route. People don't like to go shopping on days like this. I have been fired from my rep job but today I'm going to make a sale to show the world what I'm capable of. I'm going to let this DPM son of a batch know that if he doesn't want my business we are done.

As I pull into town I note a man standing in light blue scrubs deep in a field. He seems to be field dressing a deer.

I pull over to the side of the road and walk back to where I saw the man. There is no one there. I proceed deeper into the field. Still no one. In the distance I hear the sound of a shotgun being fired.

A cold fog begins to descend. My pants begin to feel wet from walking through knee high grass.

I get lost but ultimately I return to my car. It has been keyed with the words "Air Bud". There is blood on my windshield and a deer antler has been stuck through my front left tire. The car won't start.

Help. I have now decided he doesn't want my products.

Your stories are the best, please continue.

 

[lomaric]

Reps Log

Drove out to see new Dr. AirBud today. In general, podiatrists are sucker imbeciles who will use anything a rep offers them as long as they get a sandwich first. Its a bit of a drive, but I think he and I will be best friends since no one pursues rural doctors for their business. I arrive unannounced. Interestingly, no shoe carousel in his office. Is he even a podiatrist? He seems initially amused that I drove all this way to see him. I proudly show him my company's many excellent products. Tylenol infused dressings. Cotton and copper staples, for people who love copper fit dressings and drainage. He tells me he is sure he will have a LOT of use for my 4th-5th TMTJ joint fusion wedge and that he definitely wants to talk to some of his friends about it. We share a manly laugh. Walking back to my car I remember I did not tell him about my 1st MPJ "REVIZER" implant for replacing former bone implants. I return to the office only to find a large printed sign indicating product representatives must schedule their appointments ahead of time. His secretary informs me he has already gone home for the day. It is 1:15 pm. I'm confident our first meeting went well. I shall continue to pursue the old rep trick - get 'em to use it once and they'll keep coming back for more!

----

I have been calling Dr. Airbud's office for several weeks now trying to arrange an appointment to discuss what I can do for him. We've finally arranged a lunch meeting however I think he might have me confused with a Favor driver. I asked him if I could bring him a sandwich or lunch from the city but instead he has sent me a list of groceries to be purchased at many stores. He asks if I have a Costco membership? He promises me a fat tip and much future business. I'm going through my pitch in my mind when his wife arrives. I notice that she is wearing a holstered pistol and a sweater that says "No Thanks". She is wearing aviators and seems relatively disinterested in me as a person. Its probably because of Covid's effect on society. She has me load the groceries in the back of her SUV. Afterwards, she places a stick of gum in my shirt pocket and tells me there's more where that came from before driving away. I head back to Dr. Airbud's office knowing today is the day I get a firm commitment. "I'm sorry bud" he says" - "I have to head over to the hospital urgent to help Dr. Hyrule". I note a Nintendo Switch is in his hand. It is 1:15 pm. I begin the process of enrolling to become a Favor driver. I will win his business.

----

Phonecalls just don't seem to be working. I drive to Dr. Airbud's office today not to see him - but to speak to his secretary and make her put me on the schedule.

What does tomorrow's schedule look like I ask?
About 8 patients she says.
Well, have him fit me in between one of those?
I'm sorry sir, all of Airbud's appointments are hour long 99205 visits. There just isn't time. Here is his grocery list though. He will need it done this week.

----

Dr. Airbud has generously agreed that I may accompany him to the OR. He might, maybe use one of my products if he is able to and it is free. I'm breaking through. Its happening. One and done baby. Another product rep is also there. As we change into scrubs I note that airbud and this man are wearing matching gold friendship bracelets. I will need to get one of those.

The OR scrub seems to be on a first name basis with this rep. They ask me over and over again - "who are you again?"

Throughout the case I note Dr. Airbud stopping to ponder and consider whether my hardware would be appropriate. Sadly, at each procedure he proceeds with the simple plates and screws of the other rep.

"Wouldn't you like to try my hammertoe implant?"
"Sorry bud, the patient told me they prefer k-wires"

"How about my tylenol infused dressings?"
"Sorry bud, the patient is allergic to tylenol. Also, we already opened these regular gauze and the hospital is very strict on not wasting supplies."

As I load his groceries into his wife's car again I ponder what I could have done to make the sale. I won't give up though.

----

I arrive at Dr. Airbud's office unannounced. No one is there so I let myself in. I walk through the empty hallways - nothing. No one.

"Hey bud, did we a meeting today?"

I turn to find Dr. Airbud walking towards me.

"I was hoping to talk about the other day in the OR to see if I could find something to help you."

"Oh sure. Well I have a staff meeting right now - just wait here and I'll be out to talk to you soon."

He opens a nearby door - inside I see all of his staff wearing party hats. There is a birthday cake and candles on the table. Everyone is laughing.

Two hours later his staff inform me he had an emergency and left through a side door. It is 1:15pm.

My boss would like to know what progress I have made.

-----

It unpleasantly cold as I drive out to BFE. I should be working on my Favor route. People don't like to go shopping on days like this. I have been fired from my rep job but today I'm going to make a sale to show the world what I'm capable of. I'm going to let this DPM son of a batch know that if he doesn't want my business we are done.

As I pull into town I note a man standing in light blue scrubs deep in a field. He seems to be field dressing a deer.

I pull over to the side of the road and walk back to where I saw the man. There is no one there. I proceed deeper into the field. Still no one. In the distance I hear the sound of a shotgun being fired.

A cold fog begins to descend. My pants begin to feel wet from walking through knee high grass.

I get lost but ultimately I return to my car. It has been keyed with the words "Air Bud". There is blood on my windshield and a deer antler has been stuck through my front left tire. The car won't start.

Help. I have now decided he doesn't want my products.

Thank you, this make my week

 

[air bud]

That was something...

For the record I now work 5 days a week. I don't know how you people do this....although I have to say being employed vs being an owner (well non-associate. You see, non-podiatrists don't think they deserve a chunk of what you earn. Ortho says hey, you pay your way, help us cut our overhead and we are good. Technically for the first year they get xray and DME. But after that all mine. I pay fixed overhead, 6% billings and 3% for supplies. Keep the rest.) is way different. I actually care and try. To clarify I care about my patients always, I just don't care about making my employer happy. And driving home when it is dark? That **** is crazy. I see as many patients a day with ortho as I do in a week with the MSG. Unsure how I can keep this up.

 

[619]

I see as many patients a day with ortho as I do in a week with the MSG. Unsure how I can keep this up.

Congrats! Time for you to hire an associate and pay him/her $85k a year with 25% "bonus".