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03/01/2016
RESPONSES/COMMENTS (ETHICS)
From: Jeffrey Kass, DPM
Dr. Matlin presents a different take on this situation (office emergency) than the comments that preceded his. While I find it interesting and applaud him for the marketing tactic and business acumen that he would apply to the situation, some of us wouldn't want to do this. Leaving aside any possible HIPAA violation, there are some of us who just want to do our job and get paid for what we do, and don't crave or desire the hoopla of being in the media. I previously opined that I would bill. I still hold that opinion. Other opinions asked "bill for what?" as the foot may not have been evaluated.
Part of an evaluation are constitutional findings, vital signs, etc. If you provide a service, you should get paid. What level code do you think an MD in the same scenario would bill out if s(he) provided the exact same service? Is one going to now suggest that taking a patient's blood pressure is out of scope?
Jeffrey Kass, DPM, Forest Hills, NY
Other messages in this thread:
02/22/2017
RESPONSES/COMMENTS (ETHICS) - PART 1B
From: Eric Edelman, DPM
This is not an ethical dilemma. A discourse on euthanasia can present an ethical dilemma. In this case, you have assumed care for this patient, come to a diagnosis, and have a recommended/planned course of treatment. You have a fiduciary duty to place your patient's interest ahead of your own. It's part of the doctor - patient relationship.
If you are unhappy with the $237 fee for the surgery (and I would be too), consider dropping Amerigroup in the future. Or work a little more efficiently, devote 3 hours to the case and post-op care (17 year olds usually do pretty well with anything), and you're at $79 an hour. Almost as much as plumbers' wages!
Eric Edelman, DPM, Syracuse, NY
02/22/2017
RESPONSES/COMMENTS (ETHICS) - PART 1A
From: Thomas Graziano, DPM, MD
I encourage anyone doing surgery to opt out of these low paying private insurance plans. It's not worth the liability exposure. When you do opt out, your case volume will go down but your income will increase. Another interesting dynamic you'll find is that insurance companies will be contacting you to negotiate your fees. They'll ask you to accept a lower fee. My favorite and most gratifying thing is to tell them that when I was in-network they never negotiated my fees.
So now I won't be negotiating. Guess what? They have to pay you. I urge you to take more pride in the services you provide and stop being abused by the insurance industry.
Thomas Graziano, DPM, MD, Clifton, NJ
02/21/2017
RESPONSES/COMMENTS (ETHICS) - PART 1B
From: Freddie Edelman, DPM
If you do the procedure and get your $237 and all goes well, there is no problem except that you are underpaid. Your liability, of course, does not go away with underpayment, so if things don't go so well, how will you feel spending time on litigation? If I make a charitable contribution (and that is what this procedure will be), I like to choose the charity.
I would not treat this problem, because that enables the insurer to continue to underpay. You always have the right to get a pre-approval and have your fee as part of it.
Freddie Edelman, DPM, Syracuse, NY
02/21/2017
RESPONSES/COMMENTS (ETHICS) - PART 1A
From: Robert S. Steinberg, DPM, Gerald Mauriello Jr., DPM, MA
I think you are asking the wrong question. You should be asking yourself why you are participating in Amerigroup?
Robert S. Steinberg, DPM, Schaumburg, IL
Do the surgery. I've been paid way too much for some cases and way too little for others. In the end, it all washes out. We have an obligation to our patients.
Gerald Mauriello Jr., DPM, MA, Freehold, NJ
03/03/2016
RESPONSES/COMMENTS (ETHICS)
From Michael G. Warshaw, DPM
With all due respect to Dr. Kass, I am in the dark. What exactly do you think that you should be able to bill for an office emergency? In order to bill an E/M service, three key components need to be addressed, assuming that this is a new patient. They are history, examination, and medical decision-making. A podiatrist can perform the appropriate levels of history and medical decision-making. Where podiatrists fall short is the examination component.
The examination component is NOT based upon what you can examine, but what you are LICENSED to examine and treat. We are limited scope practitioners. We can only evaluate and manage a presenting problem based upon our scope of license. We can’t treat and bill for a cardiac issue. An MD can certainly bill for an office emergency. An MD is not a limited scope practitioner. This is tantamount to a pregnant lady going into childbirth in the waiting room of a podiatrist. If the podiatrist delivers the baby, can the podiatrist bill for that service? I think not.
Michael G. Warshaw, DPM, Lady Lake, FL
02/29/2016
RESPONSES/COMMENTS (ETHICS)
From: Stephen R. Matlin, DPM, MS
I can't believe you were talking about billing when you have a golden opportunity for tremendous PR and practice building. If I were you, I would immediately have one of my office personnel call the local newspaper and TV station to rave about your expertise and quick action which saved a stranger's life. You would then write up your notes describing the event, your examination findings, differential diagnosis, and final action. Make sure any patients in the vicinity are aware that you have just saved the stranger's life. Initially, you will get newspaper articles and TV news videos. Make sure you get copies of these for future use. These are excellent tools for lectures at schools, clubs, civic organizations, etc. These are also good tools to send to local and national podiatry organizations for their education to the public. Don't forget hospital newsletters and local neighborhood newspapers.
There is so much a good PR person can do with a story like this. Do not let it go to waste. As far as the billing, register him as a new patient and wave the charges. You could also get some follow-up pictures for newspapers of the two of you after he leaves the hospital, and even celebrate the anniversary of your life-saving efforts.
Stephen R. Matlin, DPM, MS, Century City, CA
02/26/2016
RESPONSES/COMMENTS (ETHICS) - PART 1B
RE: To Bill or Not to Bill?
From: Timothy P. Shea, DPM
I see absolutely no ethical or clinical reason for not billing for this type of encounter. As a treating healthcare provider, you supplied exactly what you are trained to do - "healthcare." Congratulations to you and your staff for picking up the early signs of what appears to be a vascular incident, and following through with the appropriate actions in triaging and referral to the proper setting for treatment.
These type of encounters, although infrequent, sometimes hair-raising, and definitely disruptive, are also the ones which give the best sense of satisfaction in the field we practice in. Clinically and ethically, you acted...
Editor's note: Dr. Shea's extended-length letter can be read here.
02/26/2016
RESPONSES/COMMENTS (ETHICS) - PART 1A
RE: To Bill or Not to Bill?
From: Philbert Kuo, DPM
Personally, I would not bill him since nothing was done to his feet. I would tell his family members that you would be glad to follow up with him at the hospital, rehab, or whenever he is ready. Patients are appreciative of your going out of your way to help.
Philbert Kuo, DPM, Chesapeake, VA
02/25/2016
RESPONSES/COMMENTS (ETHICS) - PART 1C
From: Jeffrey Kass, DPM
I opine that you should bill. You exemplified everything it means to be a doctor, and you did evaluate your patient and managed him appropriately. You can elect to put the diagnosis the patient presented with or filled out on your form and bill out an evaluation and management code. I want to congratulate you on your handling of the scenerio. You, sir or madam, are a fine doctor.
Jeffrey Kass, DPM, Forest Hills, NY
02/25/2016
RESPONSES/COMMENTS (ETHICS) - PART 1B
From: Howard R. Fox, DPM
Back in 2008, there was a similar incident on Staten Island that landed on the front page of the local paper. The press made it sound as if the cruel and heartless medical office only cared about collecting their co-pay, not the welfare of the patient. I personally know this was not the case, but the press sensationalized it because the patient called the press to get attention.
It might not be good for business to have a fire truck or ambulance flashing their lights in front of your office, but it’s much worse to get such horrible press that’s written to sell newspapers rather than inform the public of a non-news event. My advice is take the loss, write it off, and go visit your patient in the hospital to see how he’s doing.
Howard R. Fox, DPM, Staten Island, NY
02/25/2016
RESPONSES/COMMENTS (ETHICS) - PART 1A
From: Tip Sullivan, DPM
Where I live, if you were to bill this as a service, you would be at risk for practicing outside of your scope. Many years ago this issue came up. As the president of our state podiatry association I wrote a letter to the attorney for our state board of medical licensure. The question was that if I were ACLS-certified and a patient had an MI in my office, could I as a podiatrist perform ACLS and administer the drugs required. The answer was NO! The reason was that I was a limited licensed practitioner and was not licensed to provide ACLS. It had nothing to do with qualifications or the ACLS certification. In this case, it seems as though you did not actually physically/medically do anything except be the good Samaritan that I am sure you are and help identify your patient's need.
Tip Sullivan, DPM, Jackson, MS
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