Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Wow, thanks for the tips. Nice side job... I may look into that as there is an audiologist and a nursing home just up the road (and I know the director). Funny, but I agree about ear wax removal being satisfying. I suspect it's due to the immediate improvement noted. So many of our treatments don't give true relief but are for lessening long term risk. I was hoping the Welch-Allyn model would be LESS messy with the drain directly into the sink. Bummer. Other folks getting similar mess? I'll check that elephant ear washer. It sounds similar to what we used in my residency with a flexible IV tip at the end of a 30cc syringe. My current office has the traditional metal syringe and due to time restraints I'll usually ask a patient to use some otc wax softener a few days and follow up with a nurse appt to flush. Can't wait until I get to " share the joy " of cerumen flushing with the patients again! Tim > I don't know if I posted before about this, but for the last year I > have been supplementing my practice (so I can open my own!)by working > for an audiologist who contracts with nursing homes. I go and visit > people with ear or hearing complaints and mostly remove cerumen. I will > often see 30-50 patients in a short day once a week and remove cerumen > from at least half of them. There is something about getting older, > less mobile and wearing hearing aides that makes some SERIOUS cerumen! > Anyway, in the last year I have become an absolute pro at removing > cerumen. I can remove enormous rock hard plugs in less than 3 minutes > generally and I can do this now because of the tools. I tried the welch > allyn system and it was messy, expensive and not all that hot, > especially for the over $300. The absolute best tools are 1. The > elephant ear washer, from doctor easy, I think the web site is > doctor-easy.com. It is like a spray bottle with a little > disposable iv catheter on the end (flexible) and it costs about $25, > the tips come in a big bag, I think they are around 50 cents each. I > would also be lost without my Hartman alligator forceps, little teeny > guys, I can often grap and pull big plugs. I used to use a miltex > irrigation syringe and tried a spring loaded utility syringe as well, > but this is, without a doubt, the best. Don't waste your money on the > Welch Allyn. > > Also, I know it sounds like a gross way to spend a morning, but I have > to say, I really LOVE it. Its a simple procedure, with very > satisfying results for Doctor and patient. I really like geriatric > patients but would be overwhelmed as medical director at a nursing > home. This way I get to chat with them, treat their ears and not have > to manage their care. Medicare and most insurances pay A LOT for this > service. I generally see people at the nursing homes a little over a > half day once a week and then go to my office. I am > contracted with this audiologist and get 45% of my collections for this > and make around $5000 a month doing it (if I am running a full schedule > for him). To me this worked a lot better than urgent care moonlighting. > For those of you who are looking for extra income, you might try to > sell this service to some nursing homes. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Wow, thanks for the tips. Nice side job... I may look into that as there is an audiologist and a nursing home just up the road (and I know the director). Funny, but I agree about ear wax removal being satisfying. I suspect it's due to the immediate improvement noted. So many of our treatments don't give true relief but are for lessening long term risk. I was hoping the Welch-Allyn model would be LESS messy with the drain directly into the sink. Bummer. Other folks getting similar mess? I'll check that elephant ear washer. It sounds similar to what we used in my residency with a flexible IV tip at the end of a 30cc syringe. My current office has the traditional metal syringe and due to time restraints I'll usually ask a patient to use some otc wax softener a few days and follow up with a nurse appt to flush. Can't wait until I get to " share the joy " of cerumen flushing with the patients again! Tim > I don't know if I posted before about this, but for the last year I > have been supplementing my practice (so I can open my own!)by working > for an audiologist who contracts with nursing homes. I go and visit > people with ear or hearing complaints and mostly remove cerumen. I will > often see 30-50 patients in a short day once a week and remove cerumen > from at least half of them. There is something about getting older, > less mobile and wearing hearing aides that makes some SERIOUS cerumen! > Anyway, in the last year I have become an absolute pro at removing > cerumen. I can remove enormous rock hard plugs in less than 3 minutes > generally and I can do this now because of the tools. I tried the welch > allyn system and it was messy, expensive and not all that hot, > especially for the over $300. The absolute best tools are 1. The > elephant ear washer, from doctor easy, I think the web site is > doctor-easy.com. It is like a spray bottle with a little > disposable iv catheter on the end (flexible) and it costs about $25, > the tips come in a big bag, I think they are around 50 cents each. I > would also be lost without my Hartman alligator forceps, little teeny > guys, I can often grap and pull big plugs. I used to use a miltex > irrigation syringe and tried a spring loaded utility syringe as well, > but this is, without a doubt, the best. Don't waste your money on the > Welch Allyn. > > Also, I know it sounds like a gross way to spend a morning, but I have > to say, I really LOVE it. Its a simple procedure, with very > satisfying results for Doctor and patient. I really like geriatric > patients but would be overwhelmed as medical director at a nursing > home. This way I get to chat with them, treat their ears and not have > to manage their care. Medicare and most insurances pay A LOT for this > service. I generally see people at the nursing homes a little over a > half day once a week and then go to my office. I am > contracted with this audiologist and get 45% of my collections for this > and make around $5000 a month doing it (if I am running a full schedule > for him). To me this worked a lot better than urgent care moonlighting. > For those of you who are looking for extra income, you might try to > sell this service to some nursing homes. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Got the elephant ear wash but was not so impressed with it. I just stick with the 30 cc syringe with the flexible tip on the end. It's amazing what a little liquid colace in the ear will do 5-10 minutes prior to removal. rocky --- " Malia, MD " wrote: > Wow, thanks for the tips. Nice side job... I may look into that as > there > is an audiologist and a nursing home just up the road (and I know the > director). Funny, but I agree about ear wax removal being > satisfying. I > suspect it's due to the immediate improvement noted. So many of our > treatments don't give true relief but are for lessening long term > risk. > > I was hoping the Welch-Allyn model would be LESS messy with the drain > directly into the sink. Bummer. > Other folks getting similar mess? > > I'll check that elephant ear washer. It sounds similar to what we > used in > my residency with a flexible IV tip at the end of a 30cc syringe. My > current office has the traditional metal syringe and due to time > restraints I'll usually ask a patient to use some otc wax softener a > few > days and follow up with a nurse appt to flush. Can't wait until I get > to > " share the joy " of cerumen flushing with the patients again! > Tim > > > I don't know if I posted before about this, but for the last year I > > have been supplementing my practice (so I can open my own!)by > working > > for an audiologist who contracts with nursing homes. I go and visit > > people with ear or hearing complaints and mostly remove cerumen. I > will > > often see 30-50 patients in a short day once a week and remove > cerumen > > from at least half of them. There is something about getting > older, > > less mobile and wearing hearing aides that makes some SERIOUS > cerumen! > > Anyway, in the last year I have become an absolute pro at removing > > cerumen. I can remove enormous rock hard plugs in less than 3 > minutes > > generally and I can do this now because of the tools. I tried the > welch > > allyn system and it was messy, expensive and not all that hot, > > especially for the over $300. The absolute best tools are 1. The > > elephant ear washer, from doctor easy, I think the web site is > > doctor-easy.com. It is like a spray bottle with a little > > disposable iv catheter on the end (flexible) and it costs about > $25, > > the tips come in a big bag, I think they are around 50 cents each. > I > > would also be lost without my Hartman alligator forceps, little > teeny > > guys, I can often grap and pull big plugs. I used to use a miltex > > irrigation syringe and tried a spring loaded utility syringe as > well, > > but this is, without a doubt, the best. Don't waste your money on > the > > Welch Allyn. > > > > Also, I know it sounds like a gross way to spend a morning, but I > have > > to say, I really LOVE it. Its a simple procedure, with very > > satisfying results for Doctor and patient. I really like geriatric > > patients but would be overwhelmed as medical director at a nursing > > home. This way I get to chat with them, treat their ears and not > have > > to manage their care. Medicare and most insurances pay A LOT for > this > > service. I generally see people at the nursing homes a little > over a > > half day once a week and then go to my office. I am > > contracted with this audiologist and get 45% of my collections for > this > > and make around $5000 a month doing it (if I am running a full > schedule > > for him). To me this worked a lot better than urgent care > moonlighting. > > For those of you who are looking for extra income, you might try > to > > sell this service to some nursing homes. > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Got the elephant ear wash but was not so impressed with it. I just stick with the 30 cc syringe with the flexible tip on the end. It's amazing what a little liquid colace in the ear will do 5-10 minutes prior to removal. rocky --- " Malia, MD " wrote: > Wow, thanks for the tips. Nice side job... I may look into that as > there > is an audiologist and a nursing home just up the road (and I know the > director). Funny, but I agree about ear wax removal being > satisfying. I > suspect it's due to the immediate improvement noted. So many of our > treatments don't give true relief but are for lessening long term > risk. > > I was hoping the Welch-Allyn model would be LESS messy with the drain > directly into the sink. Bummer. > Other folks getting similar mess? > > I'll check that elephant ear washer. It sounds similar to what we > used in > my residency with a flexible IV tip at the end of a 30cc syringe. My > current office has the traditional metal syringe and due to time > restraints I'll usually ask a patient to use some otc wax softener a > few > days and follow up with a nurse appt to flush. Can't wait until I get > to > " share the joy " of cerumen flushing with the patients again! > Tim > > > I don't know if I posted before about this, but for the last year I > > have been supplementing my practice (so I can open my own!)by > working > > for an audiologist who contracts with nursing homes. I go and visit > > people with ear or hearing complaints and mostly remove cerumen. I > will > > often see 30-50 patients in a short day once a week and remove > cerumen > > from at least half of them. There is something about getting > older, > > less mobile and wearing hearing aides that makes some SERIOUS > cerumen! > > Anyway, in the last year I have become an absolute pro at removing > > cerumen. I can remove enormous rock hard plugs in less than 3 > minutes > > generally and I can do this now because of the tools. I tried the > welch > > allyn system and it was messy, expensive and not all that hot, > > especially for the over $300. The absolute best tools are 1. The > > elephant ear washer, from doctor easy, I think the web site is > > doctor-easy.com. It is like a spray bottle with a little > > disposable iv catheter on the end (flexible) and it costs about > $25, > > the tips come in a big bag, I think they are around 50 cents each. > I > > would also be lost without my Hartman alligator forceps, little > teeny > > guys, I can often grap and pull big plugs. I used to use a miltex > > irrigation syringe and tried a spring loaded utility syringe as > well, > > but this is, without a doubt, the best. Don't waste your money on > the > > Welch Allyn. > > > > Also, I know it sounds like a gross way to spend a morning, but I > have > > to say, I really LOVE it. Its a simple procedure, with very > > satisfying results for Doctor and patient. I really like geriatric > > patients but would be overwhelmed as medical director at a nursing > > home. This way I get to chat with them, treat their ears and not > have > > to manage their care. Medicare and most insurances pay A LOT for > this > > service. I generally see people at the nursing homes a little > over a > > half day once a week and then go to my office. I am > > contracted with this audiologist and get 45% of my collections for > this > > and make around $5000 a month doing it (if I am running a full > schedule > > for him). To me this worked a lot better than urgent care > moonlighting. > > For those of you who are looking for extra income, you might try > to > > sell this service to some nursing homes. > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 The real advantage of the elephant ear washer is that it holds like 20 oz of water and you can just keep pumping in those short bursts. I think it is a huge improvement over a syringe. You get much more power with this set up. The problem with the welch allyn is that all ears have different calibers and you never get a good seal. Also, I most frequently see these big cerumen "rocks" that completely occlude the canal and they don't fall apart with the water. They generally come out intact and there is no way they would go through the welch allyn. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 I have done hundreds of these over the last year and have never ruptured a tm. I also giggle whenever I think of washing an elephant's ear. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 I always get paid for both with the modifier -25. In the nursing home I even get a consult fee with the procedure code. Medicare reimburses around $50 in Ohio just for the procedure. . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Some great pointers. I do a couple ears a week, and would love to be more efficient. I'm going to try the elephant ear set up and the alligator forceps as well (nice zoo imagery). The plastic loops with the light source are a nice tool as well. One question, however: I overheard a couple of older docs talking about abandoning the procedure b/c of unfortunate experiences with ruptured TMs. Anyone have any insight, experience? Thanks, again, Joe PS , I'm assuming you have no financial ties to Doctor-Easy. Sorry for the question. It's just hard not to be a little skeptical today. > >Reply-To: >To: >Subject: Cerumen Management >Date: Sat, 28 Jan 2006 12:21:10 -0000 > >I don't know if I posted before about this, but for the last year I >have been supplementing my practice (so I can open my own!)by working >for an audiologist who contracts with nursing homes. I go and visit >people with ear or hearing complaints and mostly remove cerumen. I >will often see 30-50 patients in a short day once a week and remove >cerumen from at least half of them. There is something about getting >older, less mobile and wearing hearing aides that makes some SERIOUS >cerumen! Anyway, in the last year I have become an absolute pro at >removing cerumen. I can remove enormous rock hard plugs in less than >3 minutes generally and I can do this now because of the tools. I >tried the welch allyn system and it was messy, expensive and not all >that hot, especially for the over $300. The absolute best tools are >1. The elephant ear washer, from doctor easy, I think the web site >is doctor-easy.com. It is like a spray bottle with a little >disposable iv catheter on the end (flexible) and it costs about $25, >the tips come in a big bag, I think they are around 50 cents each. I >would also be lost without my Hartman alligator forceps, little teeny >guys, I can often grap and pull big plugs. I used to use a miltex >irrigation syringe and tried a spring loaded utility syringe as well, >but this is, without a doubt, the best. Don't waste your money on >the Welch Allyn. > >Also, I know it sounds like a gross way to spend a morning, but I >have to say, I really LOVE it. Its a simple procedure, with very >satisfying results for Doctor and patient. I really like geriatric >patients but would be overwhelmed as medical director at a nursing >home. This way I get to chat with them, treat their ears and not have >to manage their care. Medicare and most insurances pay A LOT for >this service. I generally see people at the nursing homes a little >over a half day once a week and then go to my office. I am >contracted with this audiologist and get 45% of my collections for >this and make around $5000 a month doing it (if I am running a full >schedule for him). To me this worked a lot better than urgent care >moonlighting. For those of you who are looking for extra income, you >might try to sell this service to some nursing homes. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Some great pointers. I do a couple ears a week, and would love to be more efficient. I'm going to try the elephant ear set up and the alligator forceps as well (nice zoo imagery). The plastic loops with the light source are a nice tool as well. One question, however: I overheard a couple of older docs talking about abandoning the procedure b/c of unfortunate experiences with ruptured TMs. Anyone have any insight, experience? Thanks, again, Joe PS , I'm assuming you have no financial ties to Doctor-Easy. Sorry for the question. It's just hard not to be a little skeptical today. > >Reply-To: >To: >Subject: Cerumen Management >Date: Sat, 28 Jan 2006 12:21:10 -0000 > >I don't know if I posted before about this, but for the last year I >have been supplementing my practice (so I can open my own!)by working >for an audiologist who contracts with nursing homes. I go and visit >people with ear or hearing complaints and mostly remove cerumen. I >will often see 30-50 patients in a short day once a week and remove >cerumen from at least half of them. There is something about getting >older, less mobile and wearing hearing aides that makes some SERIOUS >cerumen! Anyway, in the last year I have become an absolute pro at >removing cerumen. I can remove enormous rock hard plugs in less than >3 minutes generally and I can do this now because of the tools. I >tried the welch allyn system and it was messy, expensive and not all >that hot, especially for the over $300. The absolute best tools are >1. The elephant ear washer, from doctor easy, I think the web site >is doctor-easy.com. It is like a spray bottle with a little >disposable iv catheter on the end (flexible) and it costs about $25, >the tips come in a big bag, I think they are around 50 cents each. I >would also be lost without my Hartman alligator forceps, little teeny >guys, I can often grap and pull big plugs. I used to use a miltex >irrigation syringe and tried a spring loaded utility syringe as well, >but this is, without a doubt, the best. Don't waste your money on >the Welch Allyn. > >Also, I know it sounds like a gross way to spend a morning, but I >have to say, I really LOVE it. Its a simple procedure, with very >satisfying results for Doctor and patient. I really like geriatric >patients but would be overwhelmed as medical director at a nursing >home. This way I get to chat with them, treat their ears and not have >to manage their care. Medicare and most insurances pay A LOT for >this service. I generally see people at the nursing homes a little >over a half day once a week and then go to my office. I am >contracted with this audiologist and get 45% of my collections for >this and make around $5000 a month doing it (if I am running a full >schedule for him). To me this worked a lot better than urgent care >moonlighting. For those of you who are looking for extra income, you >might try to sell this service to some nursing homes. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 I think it depends on the insurance company. I tried to use the modifier -25 with Blue Cross and Blue Shield and they denied it, saying that it will only pay for the Cerumen removal and not the office visit. They only paid around $ 40 dollars ...so it is better to charge the office visit. Lee Re: Cerumen Management I always get paid for both with the modifier -25. In the nursing home I even get a consult fee with the procedure code. Medicare reimburses around $50 in Ohio just for the procedure. . Quote Link to comment Share on other sites More sharing options...
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