Point of Care Ultrasound

[TexasPA28]

On 12/29/2019 at 11:40 AM, rev ronin said:

After four months of use, I'm on track to recoup the cost, both hardware and CME, based on actual reimbursement, in under a year. Of course, as a part-time 1099, the probe and CME cost come off of my net profit, so there's some tax advantages there, but then revenue sharing for procedures is not direct either...

Beware of billing insurance companies for fancy new toys: 

1.  After awhile the insurance companies are going to look at you side-eye for ordering/billing a bunch of scans that other providers don't order

2.  After awhile the ins cos are doing to start cutting your reimbursement.

3.  After awhile they are going to cut you out of any performance based contracts or ACOs for "excessive utilization" or "poor cost performance"

 

[rev ronin]

2 hours ago, TexasPA28 said:

Beware of billing insurance companies for fancy new toys: 

1.  After awhile the insurance companies are going to look at you side-eye for ordering/billing a bunch of scans that other providers don't order

2.  After awhile the ins cos are doing to start cutting your reimbursement.

3.  After awhile they are going to cut you out of any performance based contracts or ACOs for "excessive utilization" or "poor cost performance"

Noted, but I'm not too worried:

1) They might, but I'm averaging 2-3 per week in family medicine/walk-in, each with a clear indication supported in the chart documentation.  At $50-100 per scan actual reimbursement, that's not that much of a blip in total compensation.

At my most extravagant, I did three scans (Abd/Pelvic/Retroperitoneal) on a female with abdominal pain, Since the reimbursement rate is 50% for subsequent procedures in the same visit, that would end up being $200ish more on top of the $150ish level four office visit. (everything is rounded to the nearest $50 today).  In doing that, we reassured her and me that it was most likely just gas by surveying the grossly normal other anatomy.  So, $350 at a family medicine walk in... vs. $1500 to walk in the door at the ED.

2) I think this is systemic and inevitable as POCUS becomes ubiquitous. The Butterfly iQ is $2000; you only have to do at most 40 billable scans to make it pay for itself--that's a pretty favorable rate of return, which I believe reflects when U/S machines were quite a bit spendier.

3) I don't really care about that, either. I've seen other practices do downright criminal, medically fraudulent things in specialty medicine and get away with it for years. But this is the opposite of #2: as everyplace begins to deploy POCUS, I won't remotely be an outlier.

Ultimately, it's about acquiring a relevant new skill to keep myself employable, getting faster access to some imaging for my patients in certain circumstances, and recouping my investment in a relatively short time, before the rules all change and the window to do so closes.  So far, it's been an all-around win.