owning a bariatric post-op clinic in massachusetts

[problem child]

I am a physician assistant with experience in bariatric surgery, particularly outpatient clinical post-op follow-up. I can take care of both band and gastric bypass patients.

 

 

I think I could succeed in starting my own practice to see post-op bariatric patients bc many surgeons find their schedules clogged with follow-up visits, and this is obviously less lucrative for them than seeing new patients heading to the OR.

 

 

Is there anyone on the forum who has insight into the particulars of starting a PA-owned practice in Massachusetts? I have just begun noodling on this idea and I think it could be very successful, and a welcome resource for my area's bariatric surgeons.

[coloradopa]

I am a physician assistant with experience in bariatric surgery, particularly outpatient clinical post-op follow-up. I can take care of both band and gastric bypass patients.

 

 

I think I could succeed in starting my own practice to see post-op bariatric patients bc many surgeons find their schedules clogged with follow-up visits, and this is obviously less lucrative for them than seeing new patients heading to the OR.

 

 

Is there anyone on the forum who has insight into the particulars of starting a PA-owned practice in Massachusetts? I have just begun noodling on this idea and I think it could be very successful, and a welcome resource for my area's bariatric surgeons.

The problem is that the surgeon is already being paid for follow up care. Why should someone pay you?

[KMD16]

The problem is that the surgeon is already being paid for follow up care. Why should someone pay you?

 

Very true. Hence the terms bundle payment by insurance per surgery.

[ventana]

bundling only applies if the same surgeon sees the patient in follow up

 

If you see some one different they still get paid......

 

It actually might be workable

 

I started http://www.berkshiremobilemedicine.com in MASS and it is possible to do

 

The biggest problem - if you are going to bill medicare you need to have a doc as co-owner 1% (might be able to get an NP but I got a doc) due to state laws

 

But with a doc owner you have to have legal papers drawn up..... $$$

 

If you are not going to bill medicare you might be able to incorp with you owning 100% and then bill for the PA visit, but you have to have a corp set up as MASS bans a PA from direct billing

[KMD16]

Interesting. Appreciate your take on the issue.

[jmj11]

The biggest problem - if you are going to bill medicare you need to have a doc as co-owner 1% (might be able to get an NP but I got a doc) due to state laws

 

I think that is a fed law. But it simply states that a PA can't be 100% owner . . . anyone else, save your dog, can be the other 1%. I know of people who made their wives the other 1%.

[ventana]

I think that is a fed law. But it simply states that a PA can't be 100% owner . . . anyone else, save your dog, can be the other 1%. I know of people who made their wives the other 1%.

the 1% is actually a medicare guideline

 

in MASS there is a law that restricts the "corporate practice of medicine" and therefor any medical corp must be a PC (professional corp) and in order to do this you have to be a licensed medical provider - hence only PA and Doc for sure, but I think you could make the arguement for NP co-owner, but would not be able to make it your wife.....

 

State law + Medicare guidelines = PA with minority Doc ownership (1%)

 

 

course if you are in MASS and not going to bill Medicare you could just own 100%

 

Or just own 100% and hope to never get audited (bad idea)

[discogenic]

Why bariatric surgery may be a good way to go:

http://www.biomedcentral.com/1756-0500/6/213/abstract

 

[h=4]Conclusions[/h]Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.

 

 

In other words, ramping up the level of patient education, follow-ups, encouragement etc doesn't make a difference. At least in this study.

 

For those who work in bariatrics, are the dietary interventions that are pursued pre-surgically simply fulfilling requirements for surgery, or is there some expectation that patients might actually be able to avoid surgery?

[problem child]

For those who work in bariatrics, are the dietary interventions that are pursued pre-surgically simply fulfilling requirements for surgery, or is there some expectation that patients might actually be able to avoid surgery?

 

in practices where I have worked before, the dietary requirements were partly imposed by the insurance companies (to insure that patients had made a diligent effort - and, usually, failed - to lose weight the "traditional" way), and also sometimes required by the surgeon for two reasons: 1) for increased overall intraoperative safety and 2) reduction of the size of the (typically fatty) liver, to make more visual room for surgery.

[problem child]

I don't think the surgeons are paid in perpetuity by the bundle. bariatric patients are followed for life, and they then have a co-pay each time they visit. band adjustments are billable procedures, and by pass patients need regular labs. both patients might at times need either an UGI if a band slip is suspected, or EGD if the patient has stenosis or anastomotic leaks. and any of them might need surgical intervention at times if a band erodes, or if the patient wants it out, or if they need a pouch revision, etc. in these cases, I would send the patient back to their surgeon.