PCR shutdown....

[air bud]

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We use PCR over at the wound care center for micro none of this BS about nail fungus... But we just got notification they're closing up shop immediately Medicare has not been paying.... This is why you don't hop on that hot new trend in private practice and think that it's going to last forever. Remember that job that we talked about in Virginia or wherever where they were offering like 350 a year in private practice and everybody was saying there's no way...

 

[Sybly]

We use PCR over at the wound care center for micro none of this BS about nail fungus... But we just got notification they're closing up shop immediately Medicare has not been paying.... This is why you don't hop on that hot new trend in private practice and think that it's going to last forever. Remember that job that we talked about in Virginia or wherever where they were offering like 350 a year in private practice and everybody was saying there's no way...

Podiatrist will move to next over utilizing code

 

[Adam Smasher]

In fairness, the PCR party ended for PP a year or two ago.

 

[air bud]

Podiatrist will move to next over utilizing code

This is how the lobster has survived for hundreds of millions of years @Adam Smasher

 

[heybrother]

"You have to ride the wave"
-Redditor describing using wound grafts.

 

[Feli]

Things change every year... at least you found out relatively quick.

My state MCR plan by a (the?) major brand carrier that tons of retirees choose doesn't cover 1105x callus codes as of this new year. That is beyond HUGE for PP... a top 10 or top 5 code set for many pods. I have a ton of those pts... lost more than a few pts over that $75 or whatever now being uncovered. They tend to pay the bill but cancel their next appointment... tell us we "must have coded it wrong" or "it's always been covered before"... but no, the coding is same and the payer just DQ'd it now.

A lot of people don't realize their plan changes every year.
This particular plan also started doing a TON more prior auths for advanced imaging and expensive Rx meds from the PCPs I talked to.
I just let them go if they don't see the $75 value... might start to cut into my backlog of appointments at some point 🙂

 

[Adam Smasher]

This is how the lobster has survived for hundreds of millions of years @Adam Smasher

It's a malthusian population phenomenon

During the lag phase, a CPT is created but is not widely used. Before long, however, the code is discovered and the lobsters undergo logarithmic population expansion. Eventually, the lobster population hits its carrying capacity of opportunities to use the code and it is overused. At the end of this stationary phase, the CPT code is discontinued or at least severely limited, and the lobster population dies off and pre-health students look into other professional schools to attend.

 

[air bud]

It's a malthusian population phenomenon
View attachment 415928

During the lag phase, a CPT is created but is not widely used. Before long, however, the code is discovered and the lobsters undergo logarithmic population expansion. Eventually, the lobster population hits its carrying capacity of opportunities to use the code and it is overused. At the end of this stationary phase, the CPT code is discontinued or at least severely limited, and the lobster population dies off and pre-health students look into other professional schools to attend.

We are where?

 

[Bored Snorlax]

First skin grafts, then DME, and now PCR.

Next headline: “Nail nippers now require Medicare prior auth. Please allow 61 days for processing."

 

[air bud]

First skin grafts, then DME, and now PCR.

Next headline: “Nail nippers now require Medicare prior auth. Please allow 61 days for processing."

From your mouth to God's ears

 

[Bored Snorlax]

From your mouth to God's ears

Classic scapegoating. Allegedly a certain canine DPM stole Oz’s girlfriend in the golden podiatric era of 1998, and now we’re taking the heat from CMS.

If they dare come for nail nippers, I’m barricading the clinic and living behind the autoclave. Let the Great Nipper Revolution begin.

 

[Hybrocure]

Someone needs to invite Dr Oz out to a golf game and tell him there’s a bee on his hat (sopranos reference - classic Dr golf scene)

 

[DYK343]

Ive said it before on here. Its really a matter of time before medicare doesnt cover nails. Maybe not anytime soon. But eventually that has to get cut. Its ridiculous they pay for it in the first place

Things change every year... at least you found out relatively quick.

My state MCR plan by a (the?) major brand carrier that tons of retirees choose doesn't cover 1105x callus codes as of this new year. That is beyond HUGE for PP... a top 10 or top 5 code set for many pods. I have a ton of those pts... lost more than a few pts over that $75 or whatever now being uncovered. They tend to pay the bill but cancel their next appointment... tell us we "must have coded it wrong" or "it's always been covered before"... but no, the coding is same and the payer just DQ'd it now.

Copay in my area doubled for specialty care. I have seen a steep dropoff in my patient volume after Jan 1st. Its "that time of year" where we get slow. But I have had plenty of patients tell me they cant afford the copay to see me.

A lot of people don't realize their plan changes every year.
This particular plan also started doing a TON more prior auths for advanced imaging and expensive Rx meds from the PCPs I talked to.
I just let them go if they don't see the $75 value... might start to cut into my backlog of appointments at some point 🙂

The amount of prior auths I have had to do in the last 6 months is insane.
I have maybe done 1-2 in the previous 5 years. I do at least 1 a week now.

 

[Hybrocure]

Ive said it before on here. Its really a matter of time before medicare doesnt cover nails. Maybe not anytime soon. But eventually that has to get cut. Its ridiculous they pay for it in the first place


Copay in my area doubled for specialty care. I have seen a steep dropoff in my patient volume after Jan 1st. Its "that time of year" where we get slow. But I have had plenty of patients tell me they cant afford the copay to see me.

The amount of prior auths I have had to do in the last 6 months is insane.
I have maybe done 1-2 in the previous 5 years. I do at least 1 a week now.

The problem with insurance covering nails is pedicure places refuse to work on diabetics or our typical types of gnarly feet.

So they get sent to us.

If nail care doesnt get covered there’s going to be a whole lot of angry boomers. But honestly as lobster as it is, it really is a needed care for the “high risk” population and for those who meet the Q modifier criteria it should deserve to be covered by insurance.

It’s cool to goof on nails if you’re the 5% who never has to deal with them. But the reality is our career would be ****ed if routine care stopped being covered by insurance.

I recently spoke to a medicine resident at a “high powered” pod residency hospital, level 1 trauma, asking if they knew any of the pods who I know there. They said “idk I just consult them for nails” (true story btw)

 

[Feli]

...If nail care doesnt get covered there’s going to be a whole lot of angry boomers... ..the reality is our career would be ****ed if routine care stopped being covered by insurance.

I recently spoke to a medicine resident at a “high powered” pod residency hospital, level 1 trauma, asking if they knew any of the pods who I know there. They said “idk I just consult them for nails” (true story btw)

Nails won't go away... plenty of retired ppl have need for it and can+will pay reasonable out of pocket. I will take that (until I can be done, lol).
I fully expect many of the ppl I've "lost" right now to be back in a year. They are simply mad right now at something MCR Advantage covered.... and now not covered.
The RFC does have its place, and many people can't safely do it themselves. The serious threat is it goes cash pay and RNs or NP or whoever undercut pricing.
But grand scheme, anyone in PP owner/partner should either be A) retiring soon or B) trending at least somewhat to cash pay for RFC.

...For hospital pods, there will always be the diabetic slop/pus/wound. No MD wants that... not gen surg, not vasc, definintely not ortho.
There will be some ortho stuff for DPMs in some places also... mostly the ones where ortho is not on staff or stays super busy with elective and bigger joints.
I think many of us have seen how fast any (non-DM) ankle fx and Achilles and other injuries will dry up if ortho come in and wants them from ER and refers, though.
The mystery to me is how hospitals get paid (and pay DPMs) for so many of the low/not insured DM infections. (I realize they do make it from the stays and MRI and everything, but it sure doesn't work in most PP to be doing so much MCA and uninsured wound care and f/u).

All these pitfalls when we have a job that can be done completely by other health professions already (derm, vasc, ortho, pedorthists, nail techs, PCPs, etc). We get the stuff they basically pass on doing. 🙂 🦞 🙂

 

[air bud]

YOU DONT HAVE TO CUT THEIR NAILS

 

[Feli]

YOU DONT HAVE TO CUT THEIR NAILS

Thank you air bud... our 1 percenter correspondant coming to us live from the 9th moon land of no ortho (or cooperative ones) and a unicorn stream of bone/joint F&A elective recon refers.

 

[Sole Badguy]

God forbid that health insurance does what people pay it to do

 

[DYK343]

The serious threat is it goes cash pay and RNs or NP or whoever undercut pricing.

This is exactly what the future holds. $20 nail care RN visits.

Medicare doesnt pay to cut your hair. Patients cant safely cut their own hair. They pay to have it done

Same will fall true with nails. Might be awhile. But medicine pays for less and less as time goes on.

The DPM "gravy train" will eventually end.

...For hospital pods, there will always be the diabetic slop/pus/wound.

Ill take my ~500k a year job with great benefits riding the pus bus.
7-4PM out the door by 5 with notes done.

 

[Hybrocure]

YOU DONT HAVE TO CUT THEIR NAILS

Yes. Yes I do

 

[Hybrocure]

Nails won't go away... plenty of retired ppl have need for it and can+will pay reasonable out of pocket. I will take that (until I can be done, lol).
I fully expect many of the ppl I've "lost" right now to be back in a year. They are simply mad right now at something MCR Advantage covered.... and now not covered.
The RFC does have its place, and many people can't safely do it themselves. The serious threat is it goes cash pay and RNs or NP or whoever undercut pricing.
But grand scheme, anyone in PP owner/partner should either be A) retiring soon or B) trending at least somewhat to cash pay for RFC.

...For hospital pods, there will always be the diabetic slop/pus/wound. No MD wants that... not gen surg, not vasc, definintely not ortho.
There will be some ortho stuff for DPMs in some places also... mostly the ones where ortho is not on staff or stays super busy with elective and bigger joints.
I think many of us have seen how fast any (non-DM) ankle fx and Achilles and other injuries will dry up if ortho come in and wants them from ER and refers, though.
The mystery to me is how hospitals get paid (and pay DPMs) for so many of the low/not insured DM infections. (I realize they do make it from the stays and MRI and everything, but it sure doesn't work in most PP to be doing so much MCA and uninsured wound care and f/u).

All these pitfalls when we have a job that can be done completely by other health professions already (derm, vasc, ortho, pedorthists, nail techs, PCPs, etc). We get the stuff they basically pass on doing. 🙂 🦞 🙂

I live in a fairly decent metro area and nobody who isn’t a podiatrist wants anything to do with feet. I don’t think that mentality will change.

PAs, NPs don’t go to school thinking about spending their career working with feet. Neither do MDs or DOs. That is their power of having scope. Something we do not have.

If for some reason you have a PA or NP working for you in podiatry I guarantee you they’re on a stepping stone to leaving the job for a better one.

 

[msion]

I think many of us have seen how fast any (non-DM) ankle fx and Achilles and other injuries will dry up if ortho come in and wants them from ER and refers, though.

The mystery to me is how hospitals get paid (and pay DPMs) for so many of the low/not insured DM infections. (I realize they do make it from the stays and MRI and everything, but it sure doesn't work in most PP to be doing so much MCA and uninsured wound care and f/u).

Yeah the first one is already happening. I have noticed the new orthos joining the group want foot and ankle stuff as well, at least in my local hospital. Of course they will still call me for a Pilon in a Charcot patient. Diabetes is what makes podiatry podiatry. I was entertaining joining an ortho group a while back and they kinda introduced me as the "diabetic surgeon" when I was touring their clinic and other facilities. I guess that's how they see us. I was 30% offended at that introduction.

Regarding the second one. Remember hospitals don't thrive just on facility fees. For inpatients they usually get a bundled flat rate fee based on a single or a few diagnoses (DRG). This is typically the case now for most insurance plans. That's the base rate. And the insurance plans adjust the rates based on length of stay, readmission ratios, labor cost, number of procedures performed and such. A DRG for cellulitis vs. a DRG for gangrene resulting in amputation will be drastically different in total payout. CMS has a web app called PPS Web Pricer if you want to enter a specific hospital claim and see how much the hospital can receive.

 

[Adam Smasher]

Crazy how this turned into a toenail thread overnight.

Anyway, it strikes me as bizarre. A 75 year old is brought in by their 50 y/o son or daughter. How much of a time commitment is this for them? They have to:
Go to mom/dad's house (10 min drive)
Get mom/dad ready for their podiatrist appt (20 min)
Drive to my office (15min)
Wait for me because I'm always backed up (10 min)
The actual visit (2 min)
Take mom/dad home (15 min)

Over 1h out of your day to take your aging parent to have their nails cut. Why not buy the tools and try doing it for mom/dad yourself?

But that's why toenails will never go away. I can see reimbursement continually decline, yes, but never to 0.

 

[Weirdy]

Copay in my area doubled for specialty care. I have seen a steep dropoff in my patient volume after Jan 1st. Its "that time of year" where we get slow. But I have had plenty of patients tell me they cant afford the copay to see me.

Same. Had a patient I was seeing for something mundane. New year hit and their copay went 2x at next appointment.
Felt bad but at the same time I have no control over any of that.

 

[Adam Smasher]

For those of you feeling twinges of sympathy for patients who claim they can't afford their copays remember the following:

• "can't afford" really means "I don't want to pay for it"
• you are providing a professional service, not a spa treatment, and deserve to be compensated for your expertise
• none of these ungrateful patients are coming to your funeral
• copays are set by insurance companies and you are contractually obligated to charge them, so they're the real bad guys in all of this

 

[dtrack22]

God forbid that health insurance does what people pay it to do

God forbid health “insurance” actually function like an “insurance” product and just cover accidental/unavoidable catastrophic dx/conditions with patients paying for their own routine maintenance and upkeep. Imagine how expensive your car insurance would be if they were expected to pay for everyobody’s fluid/belt/part changes and repairs.

This is exactly what the future holds. $20 nail care RN visits.

Good. If there is a market where RNs will cut toenails for $20 it should only cost $20 for an RN to cut toenails. You don’t need a doctorate level degree and 3 years of surgical residency training to cut someone’s toenails. And most of the patients using federal tax dollars to receive this service should be paying out of pocket. Keep the Q7 modifier covered, fine, but everyone else should be paying for the service.

 

[Bored Snorlax]

Crazy how this turned into a toenail thread overnight.

Anyway, it strikes me as bizarre. A 75 year old is brought in by their 50 y/o son or daughter. How much of a time commitment is this for them? They have to:
Go to mom/dad's house (10 min drive)
Get mom/dad ready for their podiatrist appt (20 min)
Drive to my office (15min)
Wait for me because I'm always backed up (10 min)
The actual visit (2 min)
Take mom/dad home (15 min)

Over 1h out of your day to take your aging parent to have their nails cut. Why not buy the tools and try doing it for mom/dad yourself?

But that's why toenails will never go away. I can see reimbursement continually decline, yes, but never to 0.

IMO it’s a quick nail trim, but the real reason is safety + dignity. Many elderly pts would rather see a doc than have family do hygiene care, and their kids don’t want to risk a nick (esp if they’re on thinners) or carry the guilt if it turns into an infxn. So it’s not really “just nails” it’s risk reduction + outsourcing responsibility.

 

[Bluecollarmed]

As stated above, there will always be people who want a doctor to do it even though some have spent their entire lives going to nail salons to have it done. I do think it'll be a race to the bottom type thing for pricing though. Docs command a premium if done through ABNs but nurses/techs/mobile it'll be advertisement and low cost to get people in the door versus a competitors.

 

[Sybly]

Things change every year... at least you found out relatively quick.

My state MCR plan by a (the?) major brand carrier that tons of retirees choose doesn't cover 1105x callus codes as of this new year. That is beyond HUGE for PP... a top 10 or top 5 code set for many pods. I have a ton of those pts... lost more than a few pts over that $75 or whatever now being uncovered. They tend to pay the bill but cancel their next appointment... tell us we "must have coded it wrong" 😑 ok or "it's always been covered before"... but no, the coding is same and the payer just DQ'd it now.

A lot of people don't realize their plan changes every year.
This particular plan also started doing a TON more prior auths for advanced imaging and expensive Rx meds from the PCPs I talked to.
I just let them go if they don't see the $75 value... hi bi b u by by u i s bi bi no

might start to cut into my backlog of appointments at some point 🙂

I feel your pain.. where is APMA ? Not around

 

[Sybly]

I feel your pain.. where is APMA ? Not around

This is nation wide problem- Medicare advantage and similar-stopping payment on mycotic nails and callous

 

[Sybly]

Things change every year... at least you found out relatively quick.

My state MCR plan by a (the?) major brand carrier that tons of retirees choose doesn't cover 1105x callus codes as of this new year. That is beyond HUGE for PP... a top 10 or top 5 code set for many pods. I have a ton of those pts... lost more than a few pts over that $75 or whatever now being uncovered. They tend to pay the bill but cancel their next appointment... tell us we "must have coded it wrong" or "it's always been covered before"... but no, the coding is same and the payer just DQ'd it now.

A lot of people don't realize their plan changes every year.
This particular plan also started doing a TON more prior auths for advanced imaging and expensive Rx meds from the PCPs I talked to.
I just let them go if they don't see the $75 value... might start to cut into my backlog of appointments at some point 🙂

Nationwide problem with Medicare advantage

 

[air bud]

IMO it’s a quick nail trim, but the real reason is safety + dignity. Many elderly pts would rather see a doc than have family do hygiene care, and their kids don’t want to risk a nick (esp if they’re on thinners) or carry the guilt if it turns into an infxn. So it’s not really “just nails” it’s risk reduction + outsourcing responsibility.

This statement brought to you by the APMA

 

[Boba Foot]

God forbid health “insurance” actually function like an “insurance” product and just cover accidental/unavoidable catastrophic dx/conditions with patients paying for their own routine maintenance and upkeep. Imagine how expensive your car insurance would be if they were expected to pay for everyobody’s fluid/belt/part changes and repairs

Kinda weird to see a medical professional advocating against accessible preventative care tbh.

We all know many people won’t go to yearly checkups if they’re paying a $150 minimum office visit. This is how we get consulted on people with a 15 A1C and full neuropathy finding out “oh ****, I’m diabetic?”

HDHP’s already do function like that and they’re kinda bull**** unless you’re young, healthy and need the tax advantage of an HSA.

 

[Adam Smasher]

Kinda weird to see a medical professional advocating against accessible preventative care tbh.

We all know many people won’t go to yearly checkups if they’re paying a $150 minimum office visit. This is how we get consulted on people with a 15 A1C and full neuropathy finding out “oh ****, I’m diabetic?”

HDHP’s already do function like that and they’re kinda bull**** unless you’re young, healthy and need the tax advantage of an HSA.

People will pay their tax accountants $150 every year to fill out their 1099s for them. If your health is truly depending on it, why wouldn't you spend $150? That's less than what you would spend per year on streaming services.

Granted, we tried the car insurance analogy back in 2008 and the American voters didn't buy it.

I know I sound like a victim-blamer, but individual patients 100% need to exercise agency for their own health outcomes. OK fine if you were born with cystic fibrosis or something horrible, yes I feel terrible for you. But the US healthcare system isn't going bankrupt over cystic fibrosis. They're going bankrupt over people who don't want to exercise, don't want to eat their vegetables, don't want to quit smoking and drinking, and develop all sorts of chronic disease over the course of their lifetimes. One of the things I've noticed while I'm trimming toenails is that you have two kinds of toenail patients. One is the 80-90 year olds who maybe have some PAD findings but other than that made good choices over their lives and probably have decades more to go. The other group is the 60 year old obese diabetics whose bodies are gradually breaking down under the pressure of all the advanced comorbid disease they've accumulated as a result of decades of their own bad decisions, and will spend the next few years of their lives sucking up hundreds of thousands of tax dollars until they meet their end. And that's it, you either make good decisions or bad decisions. You can't legislate good decisions, unless you want the nanny state. But don't act like $150 is all that's standing between a patient and good glycemic control.

 

[ParNoMoney]

This is nation wide problem- Medicare advantage and similar-stopping payment on mycotic nails and callous

You probably mean callus. Callous people are probably seen by behavioral health

 

[Boba Foot]

People will pay their tax accountants $150 every year to fill out their 1099s for them. If your health is truly depending on it, why wouldn't you spend $150? That's less than what you would spend per year on streaming services.

Granted, we tried the car insurance analogy back in 2008 and the American voters didn't buy it.

I know I sound like a victim-blamer, but individual patients 100% need to exercise agency for their own health outcomes. OK fine if you were born with cystic fibrosis or something horrible, yes I feel terrible for you. But the US healthcare system isn't going bankrupt over cystic fibrosis. They're going bankrupt over people who don't want to exercise, don't want to eat their vegetables, don't want to quit smoking and drinking, and develop all sorts of chronic disease over the course of their lifetimes. One of the things I've noticed while I'm trimming toenails is that you have two kinds of toenail patients. One is the 80-90 year olds who maybe have some PAD findings but other than that made good choices over their lives and probably have decades more to go. The other group is the 60 year old obese diabetics whose bodies are gradually breaking down under the pressure of all the advanced comorbid disease they've accumulated as a result of decades of their own bad decisions, and will spend the next few years of their lives sucking up hundreds of thousands of tax dollars until they meet their end. And that's it, you either make good decisions or bad decisions. You can't legislate good decisions, unless you want the nanny state. But don't act like $150 is all that's standing between a patient and good glycemic control.

You’re talking to rational sane people who have the knowledge and foresight to take care of themselves. You know half our patient population, and you know they won’t. And when those people constantly drain resources because they didn’t take care of themselves, those are the ones heavily loading the system. They will show up at the ER with gas gangrene and 15 A1C before they pay $150 for an office visit. That is why accessible preventative care is a necessity.

And once again, look around to other first world countries and ask yourself why they don’t have these problems…

 

[Flip-flop-flerpity]

You’re talking to rational sane people who have the knowledge and foresight to take care of themselves. You know half our patient population, and you know they won’t. And when those people constantly drain resources because they didn’t take care of themselves, those are the ones heavily loading the system. They will show up at the ER with gas gangrene and 15 A1C before they pay $150 for an office visit. That is why accessible preventative care is a necessity.

And once again, look around to other first world countries and ask yourself why they don’t have these problems…

This reminds me of one of my favorite quotes: "think about how dumb the average person is... Half of all people are dumber than that" (yes know average isn't median but still)

 

[Adam Smasher]

You’re talking to rational sane people who have the knowledge and foresight to take care of themselves. You know half our patient population, and you know they won’t. And when those people constantly drain resources because they didn’t take care of themselves, those are the ones heavily loading the system. They will show up at the ER with gas gangrene and 15 A1C before they pay $150 for an office visit. That is why accessible preventative care is a necessity.

And once again, look around to other first world countries and ask yourself why they don’t have these problems…

Other first world countries don't have these problems because their societal norms dictate that people should live their lives making good decisions. Give it a generation and the excesses of America will creep in and erode their health outcomes.

If you want to argue, in so many words, that people are too stupid to put down their cheeseburgers and go jogging 3x a week, then the only other logical conclusion is the nanny state. If pts can't hold themselves accountable, someone needs to.

 

[Boba Foot]

So you're telling me that we're the only first-world country with people getting bankrupted by health care while simultaneously being the only first-world country who has lower life expectancy, but it's the fault of the libertarian boogeyman "nanny state"? Because we're the only ones having to pay extensively out of pocket for this **** and getting bad outcomes from it. It seems to me like those who are being "nannied" by their state are lapping us on health outcomes currently.

If you choose to argue that it's the fault of "cheeseburgers and [not] jogging 3x a week", then how is making healthcare more inaccessible the answer? Is it not the job of a physician to tell people to cut that **** out? I understand we can get jaded with our everyday patient interactions, but c'mon man. You know better.

If you cost-restrict health care you have 3 outcomes:
1) Those with money will pay, follow-up, and remain healthy.
2) Those without money but are still insured won't follow-up because they can't afford it, go to the ER because the **** hits the fan, get admitted, still can't afford it and just skip all their bills. They don't have money, credit is already ****, so why do they care if there's 6 physician groups taking them to collections. But their insurance theoretically takes up some of that bill, raising the costs on everyone else.
3) Those without money and aren't insured who meet the same fate as #2 but skip the part of paying a $100-300 premium monthly that really does nothing anyway but pay into a bloated system.

What if, instead of those three outcomes, the biggest health insurer in the country-- that BOOGEYMAN!--- THE NANNY STATE!!--- uses its collective bargaining power to make healthcare affordable for everyone. But instead of disguising the costs as monthly premiums taken out of your paycheck while tying your health to your employment status and also charging your employer 75% of that cost, they just pass that cost on as a tax. On everyone. Not just those who can afford health care. Oh ****!! TAXES??? AMERICANS HATE TAXES!!! Newsflash bozo-- you and your employer are already getting taxed, it's just by a private health insurance corporation passing on bonuses to the C-suite funded by denying your care.

And yeah, yeah-- "government sponsored health care sounds awful! Waiting times! DEATH PANELS!!" Good news, libertarians! Most countries with socialized health care, such as France (FREEDOM FRIES!!!!) offer a private insurance option and if you're dissatisfied with your state provided health plan, you can carry a private option to cover whatever you may need outside of that. And it's still cheaper than what those American rubes are paying and dying at younger ages for!

 

[Adam Smasher]

Firstly I'm not a bozo and we're not enemies, we just have different opinions. Or am I the first person you've ever met who disagreed with you about something? So make yourself a cup of hot cocoa, put on some inspirational music, and settle down for a bit.

I treat a lot of Medicare and a lot of medicaid. These people are not cost restricted, they get their toenail trimmings and free shoes, and somehow still are not exactly pinnacles of health. Or maybe the ones who are don't need to see me. I don't know, but I doubt it.

I think we're talking past one another. I'll concede your point that access to preventative care is important to an extent. There are definitely diminishing returns to how much state money you can to throw around.

My point is that Ultimately, the individual patient has to want to make good choices. You can't put that on the doctor. Their doctor can't move in with then and dump all their sugar-sweetened beverages down the sink. They need to exercise their own agency. You say that's impossible, people lack the knowledge/willpower. Fine. Then the nanny state has to do it for them.

 

[air bud]

You’re talking to rational sane people who have the knowledge and foresight to take care of themselves. You know half our patient population, and you know they won’t. And when those people constantly drain resources because they didn’t take care of themselves, those are the ones heavily loading the system. They will show up at the ER with gas gangrene and 15 A1C before they pay $150 for an office visit. That is why accessible preventative care is a necessity.

And once again, look around to other first world countries and ask yourself why they don’t have these problems…

And that's where I come in....

 

[Feli]

Kinda weird to see a medical professional advocating against accessible preventative care tbh. ...

You guys should start that "gub ment is the solution" versus "naw, see gub mint is dee problem" thing again.

Never gets old. 😆

 

[Boba Foot]

Firstly I'm not a bozo and we're not enemies, we just have different opinions. Or am I the first person you've ever met who disagreed with you about something?

Bozo wasn't meant as an @. It was more of a generality. You're one of the most prolific posts on here, you have nothing but respect from me. Sometimes I forget I'm not posting on Reddit. But I do think you're missing the point when you say "patients have to want to make good choices". They wouldn't be in your office if they didnt want to make good choices. Education, what social status people were born into, "social determinants of health", etc. all play into that. And that's why preventative medicine is actually there. Sure 80% of patients turn it into a nail care appointment, but it's our job to try to connect to some of these folks before the hallux -> 5th digit -> partial met -> TMA -> BKA cascade begins. Sometimes it works, sometimes it doesn't. That doesn't mean it shouldn't exist.

You guys should start that "gub ment is the solution" versus "naw, see gub mint is dee problem" thing again.

Funny part is that the "government is the problem" people are now in charge and cronyism is more rampant than ever. Biggest problem is people turn politics into a team sport rather than actually evaluating how policy effects them and their life. But I digress-- this is a board that we talk about toenails on. So uhh... how do yall feel about PCR?

 

[Adam Smasher]

Since this has turned into the health economics thread, another story:

Yesterday I had a pt with heel pain. Guy's address is from a good part of town. Zillow listing on his property is 1.4M. Within the 5-10 min I spent taking his history, he mentioned to me that he:
-had a personal trainer who had been training him on calf strengthening exercises
-had a massage therapist who advised him on stretching
-went to the good feet store and spent $1600 (!) on orthotics

So I figure this is someone with some disposable income, possibly looking for better advice than "stretch more." So I make my sales pitch on shockwave therapy. He balks! Why do people shell out $$$ for garbage treatments but the minute they set foot in my office everything should be free? Why is health care the one professional service that should cost you nothing?

 

[Creflo]

I recently went on a cruise, and they had one of their gym workers/trainers give a presentation every day about foot health (it was printed on the daily cruise activities schedule). It was actually a talk to sell good feet orthotics. I decide to go and listen. I was the only one at the talk that day, and he had me stand on a mapping device, he had a carbon plate/paper thing that basically printed out a copy of my footprint. He then began to explain to me some foot biomechanics and anatomy. To a layperson it would sound impressive, but he was way off in terms of anatomy and biomechanics. He mixed up basic anatomic descriptions badly. Then he had me stand on the ground and put my hands cupped in front of me and then behind me. He pressed downward and I moved forward and backward, respectively. Then he pulled out one of their prefab devices, and I stood on them. He repeated the test, and I did not move forward or backwards. I've tried this test in my office and it didn't work - my patients are just as unstable with or without orthtoics for this test. So I assumed that either their orthotics are truly magical, or they are putting a forward and backward vector direction when they push when you are not on their orthotics (then when you are on the orthtoics, they press downward only, not with a forward or backward vector). I assumed the latter.

 

[Weirdy]

-went to the good feet store and spent $1600 (!) on orthotics

I've had 3 patients come in who spent north of 1k on good feet store orthotics as well.
Didn't realize it was that bad...

 

[Creflo]

$1600 sounds low compared to what some of my patients have told me.

 

[Boba Foot]

So I make my sales pitch on shockwave therapy. He balks! Why do people shell out $$$ for garbage treatments but the minute they set foot in my office everything should be free? Why is health care the one professional service that should cost you nothing?

I would tell him “this is the treatment that I think would have the best chance of getting you pain free. I’m sorry your insurance doesn’t want to pay for it. Maybe you should contact them and ask why.”

Redirect the patient’s annoyance to the insurance companies who are the actual problem.