Ethical Medical Practice Income Opportunities Keep the Doors Open

Beyond Laws, Ethical Standards Still Exist

In the United States,the medical profession is under attack from multiple directions, particularly since the beginning of the implementation of the Affordable Care Act. Changes in coverage, what must be performed, what information must be developed and maintained, 10 codes, EMR, new costs for the patient, new rules, new dynamics from the markets. Liability is not going down, rules aren't making anything better, and patients still need care.

It wasn't that many years ago the doctor's son would finally decide he wanted to have nice things too so he would say OK to his parents and agree to work hard and get into a good medical school. Upon graduation, he would plan on buying into an independent practice somewhere he liked where the girls were pretty and the pay was great. He'd own his share of the practice over a dozen years or so and begin preparing for that day when he could sell his share to some kid getting out of college and go off to do what old retired doctors do. Not anymore.

Today's doctor, as likely to be a she as a he, has no interest in the paradigm of going into debt to own a share of a shrinking independent practice. He/she wants to work 9-5, see a reasonable number of patients 4 days a week, have one day for admin and no weekends or nights. Surely you don't expect them to do rounds because that is for hospitalists brought here from Nigeria or the Sudan, right? Even if their medical knowledge isn't perfect they have pretty accents.

But you still have those doctors who are fighting it out in the trenches and haven't been purchased up by the local mega-hospital group. Although tempting, they see their independence having great value and are willing to work to maintain it. Sure, the hours are longer, the pain of working as a business manager adds to the stress of the day, but they feel like they are still doing good medicine. They aren't "owned." But even those who have been brought into the bowels of that mega-hospital group may have organized their little cut of the game to fit themselves. And because of that are financially responsible for keeping that area alive and well. So they work themselves to death.

The doctor has always had to cover all his costs - and he could if he was a good doctor and word of mouth got the news around that if this hurts call Doctor Smith because he fixed my Aunt Joline. He could borrow money to build a practice in - 3 times larger than he would ever need and rent out the other 2/3 to a pharmacy and a prosthetic retailer. Banks were happy to loan the money because the doctor could easily produce what would be needed to cover that cost, along with the cost of that group of nurses, MAs, PAs, accountants, cleaning ladies, repair techs, and pay the liability insurance. A one man operation could carry all this hundreds of times over in a relatively small town too.

How do we expect that to happen today? It is likely not to happen the way we experienced it as children - not for the doctor and not for the patient. With the ACA all things have changed and it isn't over yet. A doctor is limited to what he can and cannot do - and limited to who he can see and can't. Insurance isn't what it was and doesn't pay what it did - even though the patient is paying more, in most cases, than they ever have. The share making it to the doctor doesn't come close to what it was just 10 years ago. So how can a physician who wants to do the right thing and stay on the side of ethical and legal actions make it today?

Legitimate Practice Income Opportunities

What are "legitimate" practice income opportunities and how can doctors, particularly private practice doctors, take advantage of them to keep their doors open and their patients treated? Obviously there are a number of things doctors must do for their patients, and even some mandated actions in order to receive payments from some government payers. The ACA enacted some rules that initially were optional but had incentive pay attached - taking patient vitals on every visit, for example. Not exactly what neurosurgeons normally do, they have deeper thoughts going on, but just like OB/GYN insurance requirements for men, the neurosurgeon, orthopedist, podiatrist, or cardiologist has to take your temp, your blood pressure and check your color (pale, blushed, sickly appearance) and height/weight. There are other rules they must comply with even before getting down to the issue or issues at hand.

When a neurologist, physiatrist, orthopedist, pain management, rural general practitioner has a patient of their state something like "I am getting dizzy when I stand up out of a chair," that is a very important clue. This may result in the patient being referred out to and ENT who often deals with inner-ear/dizziness issues. But wait, why do that if you don't have to? This is your patient, you know their history, you know their family, why aren't you doing the testing?

VNG testing, the state of the art product by InBalance, is fully reimbursable by even Medicare. Why would Medicare do this? Because it costs Medicare a few hundred dollars to have you diagnose what is going on with their patient that is causing them to be dizzy so that might be fixed - and the patient might not have a bone breaking fall. That bone breaking fall, along with the associated hospital stay, rehabilitation time, will cost tens of thousands of dollars - so catching the problem earlier and fixing it - a valuable service. But how much does it cost the practice to do it? If you don't add on the physical therapy portion, under $40,000 and you are in business - and the payments can be made with 2 Medicare patients a month being tested. More than that is legitimate practice income. You don't have to be and ENT to perform this testing or diagnosis. Add on the physical therapy portion for $12,000 and bring in a PT for that part of the additional income - now help a lot more patients IN-HOUSE and quit farming/losing them out to others.

Biowave Plus PENS testing is coming to a market near you. If you have a patient presenting with pain, let's say two points on their back, one just above the scapula and the other to the left of the lumbar. It hurts, but they aren't sure what to do about it. They may have tried injections, heat therapy, insaids, physical therapy, but nothing has helped. As a good physician, you have heard about spinal cord and peripheral nerve stimulators as being helpful for some patients with myofacial and neuropathic pain but you have no means to test them, until now. An SCS or PNS can cost tens of thousands of dollars and take from a week to a month. The neurologist, pain management doctor, spine orthopedist, rural GP, neurosurgeon, and more can bring in a Biowave Plus and their new percutaneous electrodes that actually penetrate the skin and simulate what the SCS or PNS will do. This is done over a 4 week period, as much as 2X per week, at which time you can diagose whether this patient is a good candidate for that SCS or PNS trial and later implant. Again, for a few thousand dollars the patient, doctor and payer now know they are a good candidate or not so good candidate for a prosthetic device that costs tens of thousands of dollars. All win, and in the mean time the practice has had some reasonable income for doing the testing.

ANS-QSART

Without getting into specifics, this is yet another means of providing real testing that have great meaning and improve the knowledge a doctor has of his patient opening up ideas of how to approach treatments and the continuum of care. The cost can be mitigated against reasonable deferred payment, but ultimately the income for the practice can be recognized and it doesn't have to be a cardiologist that does the testing.

Stem Cells

The term Stem Cells evokes a lot of different ideas depending on who you are talking to. The FDA says you probably should not even mention these in a treatment schedule. However, there are sources of products derived from the placenta of live births that contain very high levels of product that work very hard at enhancing the healing in specific areas of injection. Utilizing these products for pain management, personal injury cases, any cash based patients can help to rapidly aid healing and eliminate the need for additional prednisone or cortical steroid shots.

Pain Pump

Probably not the best name for something to remove pain, but I sell the very best on the market for $125 for the pump and $40 for a catheter (some specialty catheters for hemorrhoids, others). Just need an order. Save a ton of money over competitors and can come with Leur Lock connection.

What about Patient Funding?

What happens when your patient needs something - and the new deductible and copay they are working on locks them out of that procedure, whatever it is? There are options for them, of course. Care Credit, GM has a product, HELP Financial also is out there. How many of these get in your knickers if you go forward? If you do a procedure for $1,000 do you walk away up front with $880...and the patient gets soaked with 29% interest or more...if they are even able to qualify?

I can announce a new program, Funding U. The doctor makes a one-time buy-in of a reasonable amount, then pays a whopping $15 a month maintenance fee. Patients can get $500 to $3500 credit simply by providing a pay stub and last months bank statement. No credit check, just verifying stability, and they can do this at home or at the office online. Then you can move forward with the procedure. How many lost opportunities to help your patients are lost and you could do these now? Call me.

How Do I Get These?

I thought you would never ask...yes, I am a distributor for all of the above and will work with you just about anyplace in the country - with a few territory restrictions. In those - I'll find you someone to make it work there too. I am here to help your practice stay in business. I'll find the ways to provide financing, products and delivery on anything I sell. Email me at ed.fickey@featherbonemedical.com or call at 404-316-7821.

In addition to these products, I have ex-fix for lower and upper extremities, allograft for all needs!

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