Amputee billing

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Hi Everyone!
We have recently had a RCF request for reduced fee for amputee, based solely on the fact that the facility received a reduced fee 3 years ago...

I am interested in other peoples views on this topic. It makes me feel compromised, unappreciated and reducing a fee at request compromises professional integrity.

or is this being too harsh on a patient population who have had the misfortune of loosing a toe/limb?? how do we balance compassion and professionalism?

 

I saw this same circumstance happen on one of my placements.

I guess I can appreciate the view that it is not so much that there is only one limb/foot to treat; but rather, the cost involved in still using a single pack of sterile instruments which needs to be accounted for.

I'd be interested in your thoughts (and many thanks for replying to my last post re: care plans).

 

Do Dentist give you a discount if you are missing teeth?......I think not

 

I'd take into account the time you spend with the patient and if they already recieve a pension/concession.
It also depends how much of a reduction they are asking for and how you value job satisfaction?

 

Have you ever had one of those moments where 2 hours later you had the ultimate come back and wish you could go back in time.

...this is NOT one of those moments. It was a moment that I was spot on at the exact moment I needed to be and tell this story to many patients.

In my first year of solo private practice I had a patient with a prosthetic limb from a motor vehicle accident. On his remaining limb he required some sort of nail care and boldly asked if he would be eligible for a half off discount. My reply with out even thinking was "I change for the first toe, the rest are free."
He seemed to like the answer and the treatment provided. I use this story or even just the statement as often as needed if a patient does not need a lot of treatment.

 

I am glad everyone seems to have the same stance on this as me...
One of the interesting things I am finding, and have come accross in other threads re: admin is the concept that we are billing for expertise, not time. I dont know of many health professions that actually do bill per minute/hour.
Where this is trickier to manage in RCF's where it isnt in the community, is that in the community they can access community health, whereas Low Care residents in RCF's it is much more difficult for them to receive these not for profit services

And how do you reduce fees on the grounds of being compassionate, and still justify it for those who can afford it?? Robin Hood anyone?

 

There are many times in practice where we only need to treat one foot such as in ingrown toenail or a corn. I would use the same billing procedures for amputees.

If they have a health care card, a pensioner discount may be available, or after their first consult charge them for a short appointment.

 

I worked with a colleague who when asked this same question replied
that as the patient only had one leg left it was of greater value to the patient
and as a result the fee for tt should be greater!

Food for thought.

 

I am an amputee and, whilst I would certainly not agree with the above, I see no reason why they should be charged a reduced fee (unless they are 'financially embarrassed', which should IMHO apply to everyone). The reason being is that you can give podiatric care to residual limbs - prostheses don't always fit well and you can develop HD's and HMill's all sorts of places, not just on your feet. The only exceptions to this rule would be someone who had either an hip-disarticulation or an hemipelvectomy.

Having said that, treating a residual limb is quite different the normal podiatric type of treatment as it requires knowledge of things such as potential skin fragility, the stresses that are exerted on the limb when it's in the prosthesis and the emotional vulnerability that some amputees have when they allow someone to treat their residual limb. In my experience, under-operating is the preferable option.

 

Lusnanlaogh - thanks so much for your reply. It has been very interesting to read everyones different views. And your input particularly regarding 'emotional vulnerability' is a very important one. I often feel that we place too much emphasis on treating the physical complaint and not the emotional, you have absolutely hit the nail on the head.

I have one resident in a facility who wont let me treat her because her husband was diabetic, went to podiatrist, they apparently cut his toe, he lost a limb and died. Tomorrow morning I will see her about 830am while she is having breakfast as a 'pedicurist'...

 

The remaining limb is indeed worth more than the other because it is more prone to amputation and has to protected far more judiciously, so the rationale that it takes less to care for it s erroneous. And it is not just the foot at risk, but the patient's very life since the cardiac load is significantly increased with limb loss

Charity care is another matter and far more complex, especially in the States where you are at a greater risk for litigation from those you tried to help. I experienced the joy of medical expense induced poverty as a child, so I am fairly sensitive to providing care to those in need - and am working at a free clinic this evening. But, that doesn't mean the very ones you help won't bite the hand that treats them.

And the bigger and interminable discussion would be the irony of trying to appeal to morality in a relativistic society where all morals are now seen as equal - so why should we even worry about seeking the "good" when they have agreed there is no such thing?


Rick Kuhn
Valley, Alabama, USA

 

My apologies, I was focusing on the residual limb. Yes, of course, the remaining foot would be more at risk - even the best amputee gait is abnormal and so loading on the 'intact limb' would be unique, to say the least.

And, Airlie - I agree with you about us, all too often, focusing on the the physical. However, I've noticed, when you're aware of the emotional side it's often easier to approach the physical.