Responses to Doctor/Provider relationship Part III
Jeremy Sprouse
Description
Collection
Title:
Responses to Doctor/Provider relationship Part III
Creator:
Jeremy Sprouse
Date:
2/12/2015
Text:
Jeremy,
Did you know that the AHRQ, the federal Agency for Healthcare Research and
Quality, recognizes that there is an absence of evidence relating to
properly addressing shear forces on the limb after hyperbaric treatment?
I just got off of the phone with an Anthem nurse case manager and offered to
provide their case management division with documentation showing how to
reduce healing time for amputees by 1 month, how to improve return to work
rates by 600%.
Medicare states in their documents that amputation is a high priority.
Medicare has a patient bill of rights.
You have a congressman (I have a patient who went to his last week to get a
hi fi socket from the VA).
Do nothing without documentation from the patient.
Go to the county medical ombudsman to explore consequenses.
Have nothing in writing and talk to the chief of staff or the CEO of the
hospital (keep it friendly at first).
I have found that this happened locally and the other facility has a history
of alginating sockets for years (26 years of alginating is the most so far).
The lack of competition will result in poor outcomes.
Start thinking outside the box and good luck.
-------------------------------
I would recommend you contact the medical board of you state and advise them
of this, doctor threats to the patients. Plus contact all the other people
you listed.
I do not believe the doctor has any way to influence the insurance
companies.
---------------------------
I see some of the same.
Compile your facts and go to Medicare.
---------------------------
If the patient is willing to file a complaint to Medicare, that is the ideal
situation. The patient can say they don't understand why the doctor is
threatening/forcing them to work with a provider they don't feel comfortable
with. There is clearly SOME kind of kickback here. There are whistleblower
programs you can report through (check with AOPA if you're a member, they
have great resources for this). But Medicare will definitely respond to a
patient complaint faster than a provider complaint, mainly because the
provider has a financial interest in the outcome of the complaint, and a
patient only has a personal health interest.
We have similar scenarios here in Orlando. It's extremely frustrating, so I
can completely sympathize with your dilemma. We've trudged along ourselves,
but we do encourage patients to complain to Medicare or their insurance
company whenever they are unhappy with the services being made available to
them.
---------------------------
Given the info you put out here it appears this guy has a vested interest in
directing pts that goes beyond him making sure they get 'good' care. He
seems to also be a bully and uses his status as a physician to push people
to do do what he wants them to. First, you're never going to be friendly
with him so don't try. Second, he cannot stop pts from going where they want
for treatment of any kind. True, he can refuse to fill out paperwork for
services he does not condone but I think there are other Dr.s in your area,
are there not? I'm going to guess with tactics like he employees these other
Drs. may not care for him or his group either. These guys are called your
'friends'. Don't act like you NEED to deal with this guy. And no he cannot
prevent an insurer from covering devices for someone if they go where he
pushes them to go. That statement alone, if the pt will be honest and put it
in writing is cause for a lawsuit. This is the only language people like
this understand, a third party mediating what is fair and what is over the
line. You are being bullied. Stop acting like this guy is special because he
is a dr. What would you do if another prosthetist did this stuff to you? You
should go to his office and in front of as many people as possible call him
out on what he's doing but if that's a bit much get a lawyer to file a cease
and desist order on him. BTW, I'm not a litigious guy, but come on already
dude, don't take this without fighting back. Too many of us succumb to
feeling like someone has to tell us what to do professionally because we
have a low image of ourselves compared to other professions. That's changing
as the more educated people enter P&O. You will be treated the way you
allow people to treat you. Not everyone is a nice guy! Stand up to this
aggression. For all of us.
---------------------------
Call your medicare Ombudsman!
Keep in mind, if the patient has commercial insurance (not medicare), then
it's possible that the PCP controls all of the authorizations for said
patient, not the vascular doc. (Therefore, the surgeon would not actually
control the insurance payment of the prosthesis despite what he said to the
patient).
Also, don't forget that a vascular surgeon is not the only doc who can
document medical necessity for a prosthesis. Is there a physiatrist in your
area who might be willing to help you document medical necessity? Does the
patient have an established/treating PCP? Explore other options where
possible.
I would attempt to set up a meeting with that practice. Yes, they may
refuse you, but in your complaint it will show that you at least attempted
to set up a meeting in order to meet the patient's needs. Why document
that? Because the goal of health care is to take care of patients, not to
command or monopolize referrals. Thus, you would be documenting your
attempt to do the former.
Additionally, as a patient, I would not want to receive my limb care from an
institution that amputates the incorrect digits...has the patient thought of
how this news might affect his limb care in the future? What if he needs a
revision??? Have you asked him these questions?
Also. If what you say is true, then the vascular practice is very likely in
the process of being sued for malpractice. Therefore, in my opinion it's
the perfect time to saddle them with more complaints. Don't forget that
David won the battle with Goliath by the simple act of throwing a few stones
at the right moment. :-)
--------------------------
Did you know that the AHRQ, the federal Agency for Healthcare Research and
Quality, recognizes that there is an absence of evidence relating to
properly addressing shear forces on the limb after hyperbaric treatment?
I just got off of the phone with an Anthem nurse case manager and offered to
provide their case management division with documentation showing how to
reduce healing time for amputees by 1 month, how to improve return to work
rates by 600%.
Medicare states in their documents that amputation is a high priority.
Medicare has a patient bill of rights.
You have a congressman (I have a patient who went to his last week to get a
hi fi socket from the VA).
Do nothing without documentation from the patient.
Go to the county medical ombudsman to explore consequenses.
Have nothing in writing and talk to the chief of staff or the CEO of the
hospital (keep it friendly at first).
I have found that this happened locally and the other facility has a history
of alginating sockets for years (26 years of alginating is the most so far).
The lack of competition will result in poor outcomes.
Start thinking outside the box and good luck.
-------------------------------
I would recommend you contact the medical board of you state and advise them
of this, doctor threats to the patients. Plus contact all the other people
you listed.
I do not believe the doctor has any way to influence the insurance
companies.
---------------------------
I see some of the same.
Compile your facts and go to Medicare.
---------------------------
If the patient is willing to file a complaint to Medicare, that is the ideal
situation. The patient can say they don't understand why the doctor is
threatening/forcing them to work with a provider they don't feel comfortable
with. There is clearly SOME kind of kickback here. There are whistleblower
programs you can report through (check with AOPA if you're a member, they
have great resources for this). But Medicare will definitely respond to a
patient complaint faster than a provider complaint, mainly because the
provider has a financial interest in the outcome of the complaint, and a
patient only has a personal health interest.
We have similar scenarios here in Orlando. It's extremely frustrating, so I
can completely sympathize with your dilemma. We've trudged along ourselves,
but we do encourage patients to complain to Medicare or their insurance
company whenever they are unhappy with the services being made available to
them.
---------------------------
Given the info you put out here it appears this guy has a vested interest in
directing pts that goes beyond him making sure they get 'good' care. He
seems to also be a bully and uses his status as a physician to push people
to do do what he wants them to. First, you're never going to be friendly
with him so don't try. Second, he cannot stop pts from going where they want
for treatment of any kind. True, he can refuse to fill out paperwork for
services he does not condone but I think there are other Dr.s in your area,
are there not? I'm going to guess with tactics like he employees these other
Drs. may not care for him or his group either. These guys are called your
'friends'. Don't act like you NEED to deal with this guy. And no he cannot
prevent an insurer from covering devices for someone if they go where he
pushes them to go. That statement alone, if the pt will be honest and put it
in writing is cause for a lawsuit. This is the only language people like
this understand, a third party mediating what is fair and what is over the
line. You are being bullied. Stop acting like this guy is special because he
is a dr. What would you do if another prosthetist did this stuff to you? You
should go to his office and in front of as many people as possible call him
out on what he's doing but if that's a bit much get a lawyer to file a cease
and desist order on him. BTW, I'm not a litigious guy, but come on already
dude, don't take this without fighting back. Too many of us succumb to
feeling like someone has to tell us what to do professionally because we
have a low image of ourselves compared to other professions. That's changing
as the more educated people enter P&O. You will be treated the way you
allow people to treat you. Not everyone is a nice guy! Stand up to this
aggression. For all of us.
---------------------------
Call your medicare Ombudsman!
Keep in mind, if the patient has commercial insurance (not medicare), then
it's possible that the PCP controls all of the authorizations for said
patient, not the vascular doc. (Therefore, the surgeon would not actually
control the insurance payment of the prosthesis despite what he said to the
patient).
Also, don't forget that a vascular surgeon is not the only doc who can
document medical necessity for a prosthesis. Is there a physiatrist in your
area who might be willing to help you document medical necessity? Does the
patient have an established/treating PCP? Explore other options where
possible.
I would attempt to set up a meeting with that practice. Yes, they may
refuse you, but in your complaint it will show that you at least attempted
to set up a meeting in order to meet the patient's needs. Why document
that? Because the goal of health care is to take care of patients, not to
command or monopolize referrals. Thus, you would be documenting your
attempt to do the former.
Additionally, as a patient, I would not want to receive my limb care from an
institution that amputates the incorrect digits...has the patient thought of
how this news might affect his limb care in the future? What if he needs a
revision??? Have you asked him these questions?
Also. If what you say is true, then the vascular practice is very likely in
the process of being sued for malpractice. Therefore, in my opinion it's
the perfect time to saddle them with more complaints. Don't forget that
David won the battle with Goliath by the simple act of throwing a few stones
at the right moment. :-)
--------------------------
Citation
Jeremy Sprouse, “Responses to Doctor/Provider relationship Part III,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237118.
