Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 What a great conversation and I can see both sides. I have had those arguments before (mostly with myself) about just because a procedure is paid for doesn’t mean it’s necessary or adds any knowledge about or benefit to the patient. Probably why I don’t make much money. I have an EKG but rarely use it just because it’s such a pain. But I know that certain organizations do recommend yearly EKGs for some people. My Aetna contract actually specifies that I must own an EKG machine. I have Spirometry and rarely use it for the same reason, I have a hard time getting people to return regularly for their routine visits; when they do, they usually have saved up a list of minor complaints that didn’t require them to seek a separate appointment but the entire time is used dealing with them and the Spirometry gets postponed once again. At the last AAFP annual meeting, a new hearing test was all the rage because “insurance pays for it”, Auditory aucustic reflex or something like that that works on the same basis as the newborn screening done in the hospital and requires no cooperation from the patient. It’s very expensive, probably pays moderately but who needs it. I have very few really little kids that need screenings done and the rest of them cooperate. So I decided that was not a direction I can “branch out” into. On the other hand, as much as we counsel patients that they need to exercise, or quit smoking, or take this expensive cholesterol pill that requires blood work every 3 months to prevent a heart attack or stroke, patients respond to real evidence far better than possibilities. And they love tests that give clear answers. I can’t tell you how many geriatric patients I have that pay $200 for their “Lifescan” screening tests and are so reassured to hear that they don’t have an aneurysm or blockages in their carotids or only mild bone loss even when they had no risks for them anyway (which is why I didn’t order the screening). But, the other side of the argument is, what if that “positive” test or “early abnormalities” is the impetus the patient needs to make those life style modifications. We can tell people until we are blue in the face to quit smoking because it “might” lead to problems. But telling them they have the lung age of an 80 year old when they are 50 seems to have more meaning. Or a abnormal ABI, “you are losing circulation” vs “you might lose circulation”. Anyway, I can’t do aethetics in principle. It would kill me and does kill me when patient’s can’t afford their meds but will save up $100 to get skin tags removed. It kills me more when they then try to get you to bill insurance because they called and were told that if I would just “write a letter” it might be covered, “remember how I told you they get sore and irritated in the summer…” Sorry about the length, when I see these come across the list I always save until later as too long. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 What a great conversation and I can see both sides. I have had those arguments before (mostly with myself) about just because a procedure is paid for doesn’t mean it’s necessary or adds any knowledge about or benefit to the patient. Probably why I don’t make much money. I have an EKG but rarely use it just because it’s such a pain. But I know that certain organizations do recommend yearly EKGs for some people. My Aetna contract actually specifies that I must own an EKG machine. I have Spirometry and rarely use it for the same reason, I have a hard time getting people to return regularly for their routine visits; when they do, they usually have saved up a list of minor complaints that didn’t require them to seek a separate appointment but the entire time is used dealing with them and the Spirometry gets postponed once again. At the last AAFP annual meeting, a new hearing test was all the rage because “insurance pays for it”, Auditory aucustic reflex or something like that that works on the same basis as the newborn screening done in the hospital and requires no cooperation from the patient. It’s very expensive, probably pays moderately but who needs it. I have very few really little kids that need screenings done and the rest of them cooperate. So I decided that was not a direction I can “branch out” into. On the other hand, as much as we counsel patients that they need to exercise, or quit smoking, or take this expensive cholesterol pill that requires blood work every 3 months to prevent a heart attack or stroke, patients respond to real evidence far better than possibilities. And they love tests that give clear answers. I can’t tell you how many geriatric patients I have that pay $200 for their “Lifescan” screening tests and are so reassured to hear that they don’t have an aneurysm or blockages in their carotids or only mild bone loss even when they had no risks for them anyway (which is why I didn’t order the screening). But, the other side of the argument is, what if that “positive” test or “early abnormalities” is the impetus the patient needs to make those life style modifications. We can tell people until we are blue in the face to quit smoking because it “might” lead to problems. But telling them they have the lung age of an 80 year old when they are 50 seems to have more meaning. Or a abnormal ABI, “you are losing circulation” vs “you might lose circulation”. Anyway, I can’t do aethetics in principle. It would kill me and does kill me when patient’s can’t afford their meds but will save up $100 to get skin tags removed. It kills me more when they then try to get you to bill insurance because they called and were told that if I would just “write a letter” it might be covered, “remember how I told you they get sore and irritated in the summer…” Sorry about the length, when I see these come across the list I always save until later as too long. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
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