Arch City Foot & Ankle

I’m in private practice in St. Louis, MO and I’m noticing a trend that is beginning to annoy me, deductibles are getting higher and higher. This is caused by businesses trying to cut costs and lowering employee benefits, which is costing the patient and the doctors. My practice is growing and I’m getting busier and busier, but insurance companies are sending checks to my office with lower amounts, and asking the patients to pay out of pocket costs. This is delaying the time that the doctor collects their money and thus causing significant stress on small and middle sized medical businesses. For example, rent is paid each month, employees want to be paid every 2 weeks, phone and internet cost have to be made each month, medical supplies have to be continually added and paid for on a weekly basis, etc. It takes about 3-4 weeks from when a patient is seen to process a claim, but when a deductible is not met, it will take about 6-12 weeks to receive payment from a patient. Why should insurance companies receive the benefits and cost the patient and doctors the trouble? Most patients don’t understand and the doctors have to spend the time and money to explain it to the patient. The insurance company sends each patient 100+ page manuals (only if they request it) about their insurance plans, without explaining the plan to each patient. It should not be the doctors responsibility to explain to the patient why their insurance did not pay for their visit to the doctor or why it only covered part of the allowed amount. This only makes the patient mad at the doctor, when instead, they should be mad at their insurance company.

This situation is going to eventually hurt the patient. Small practices and large groups will not be able to stay in business if this continues to happen. What will have to happen is you will begin to see doctors’ offices like a McDonald’s restaurant. Patient will have to pay up front and order their evaluation and treatment first, then the doctor will be able to take care of you. “Can I take your order please?”

Health care reform has been a important and popular topic during President Obama’s reign as leader of the United States. Due to recent the statement that was released by the UnitedHealth Group on March 4, 2010, I have decided to express my opinion. First, I want to explain what UHC stated. You can visit this link to read the entire statement. Basically stated, “The majority of our medical cost increases will be from hospitals and doctors charging higher prices and, to a lesser extent, from increased treatment volumes.” This is a confusing statement and misleading the public. Simply, doctors who are under contract with all insurance companies, are bound by a fee schedule that is set by each insurance company. Therefore, how can we say that doctors are charging more and that is why costs have increased? What is happening is insurance companies are making more money. UHC statement continues to state that they have only a 4.4% profit increase in 2009 and are rank “only” 87 out of 215 from other health insurances. I would consider that they are doing very well considering the down economy in 2009.

However, doctors are not totally off the hook. We are at fault as well. Insurance companies are wrong about stating that doctors are charging more, but they are partially right about doctors causing “increased treatment volumes”. There has been an increase quantity of physician owned surgery centers and MRI centers during the last 8-10 years. In order for doctors to continue their participation in ownership, collect monthly dividends and profit sharing they have pressure to perform more procedures and tests. This has become a losing battle for both parties.

The answer is simple, but not going to be easy. Both the insurance companies and doctors will have to sacrifice whether our health system becomes run by the government or not. One thing is for sure, that humans will always need doctors, therefore, make the doctors happy or the human race will be greatly devastated.

After being in solo-practice as a physician, I have learned quite a few things. Some good and some bad. I have begun my practice from scratch without any experience in the business side of medicine and have learned by mostly trial and error. I have gotten some assistance from other close friends in the same profession, but mainly from my own mistakes on how to manage a medical practice. There is one thing that I have learned, that cannot be taught, politics. I’m not one who likes to “kiss others’ behinds” just to get ahead in life and I believe that if you are confident in yourself and have the solid medical training, that your practice will succeed. I also am not one who would put someone else down, just to get ahead of them. However, here are some examples that show we must begin to evaluate and take a stand.

Here are 3 examples of patients that I have recently seen for a second opinion, who have been provided poor medical care only for significant financial benefits:

Case #1: 17 year old female with pain in both feet who had surgery performed by a local podiatrist. This patient had a metal implants placed into both feet into her sub-talar joints (arthroeresis, a common procedure for correcting flat feet in children between ages of 8-12). In all the years of my training and schooling, I was taught that this procedure is mainly used for children between ages of 8-12, but can be used only in addition to other procedures such as achilles tendon lengthening, midfoot fusions (Hoke procedure), lateral midfoot fusions or osteotomies (Evans procedure), tendon repairs. In this particular case it was done as a single procedure and now this patient is only 6 months after her surgery and in more pain than before.

Case #2: 40 year old female that presents with toenail fungus. However, I noticed surgical scars on 8 different toes. After interviewing this patient, she states that a surgeon (same surgeon from case #1) performed procedures 8 different times in a 2 month time frame. Since 4 toes were surgically corrected per foot, that include fixing the toe on the first procedure with a metal pin followed by a 2nd procedure to remove the pin from the toe on a separate day. Why would a doctor make a patient go through the risks of 8 separate anesthesia events, and 8 seperate trips to the surgery center (owned and run by the same surgeon), and 8 different medical claims that could results in significant payments to the insurance company and the patient? These simple procedures could have been, in my surgical experience, performed in 2 different occasions not 8! Is this ethical? No. Is this something we should worry about? Yes. This is one reason why medical insurance premiums and our malpractice premiums are going up because of money hungry, non-trained, surgeons, who have learned how to manipulate the system until the system is empty.

Case #3: 83 year old female with painful ankles and feet and numbness. This lady had surgery performed just like in Case #1 and had metal implants placed into her sub talar joints of both feet. If you remember from case #1, these implants are only mainly indicated in children between ages of 8-12, but sometimes can be used in adults, only as an adjunctive procedure. In this case, the implants, were only used alone and after reviewing the Xrays, I noticed that the implants were not even close to the corrected position. The implants were so inappropriately placed by this surgeon, that the radiologist reading the xrays thought they were in the bone and not in the joint space. Secondly, this lady is now 83 years old and still has a flat feet and and additionally has numb, painful feet. What made this doctor deciede to do this kind of procedure on a 81 year old when the procedure is not indicated for that age group?

Do these doctor’s have the training to perform these type of procedures? Supposedly, these doctor’s have certification in foot and ankle surgery, but how did they get it? Is being certified enough to proof that we are good, ethical doctors? I don’t think so. I think, its time to start policing ourselves and put politics behind us. Take a stand and make our world of medicine better and safer. It will decrease our malpractice premiums, make our us and our patients happier and we will be able to sleep easier knowing that we did the right thing to help our patients and not just to put money in our pockets.

What is the Difference between a Podiatric Surgeon and a Foot & Ankle Orthopedic surgeon?

A common question…..simple answer…..Podiatric physicians and orthopedic physicians go through same undergraduate programs and learn the same academic classes in medical school. However, most podiatric surgeons are more specifically trained on the foot than an orthopaedic surgeon.

Please see information on the Pathway to Certification for podiatric physicians by clicking here.

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