Diagnosing Knee Problems over the Phone - Medicare

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toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Wed Jan 09, 2019 11:58 pm

Teague wrote:
Wed Jan 09, 2019 11:30 pm
TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
You bring up an interesting point about PCP's interpreting imaging. In my experience, the PCP will read the radiologist's findings and impressions and take those as the result of the imaging study. The radiologist is not usually specialized in whatever body part was studied. Qualified yes, but specialized, not usually. And the poor PCP doesn't stand a chance of interpreting any but the most basic imaging studies without that radiology report.

Give the same imaging study and radiology report to a specialist, an orthopedist in this case, and the radiologist's report may not get more than a cursory glance, if that. The orthopedist or other specialist is likely to pull up the actual images and interpret those images with the eye of an expert in the diagnosis and treatment of that body part. They are less likely to completely rely on the opinion of some locum radiologist they've never heard of before.

And this presents a bit of a bind for the patient. The person best qualified to interpret the study doesn't want to see the patient until that study has already been interpreted by a generalist to suggest a need for surgery. The generalist may misinterpret the findings to some degree, and therefore never refer the patient to the person - the specialist - who could best formulate the diagnosis and treatment plan.

A bit of a Catch-22, no?
I'm a surgeon (not orthopedic) and I look at the images myself since they let me know what type of surgery (if needed) will work and also for anatomic issues that might change my approach. The radiologist report is rarely useful and I give only a cursory look at the radiologist report just to make sure they don't see an unrelated "incidentaloma" that requires attention.

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ram
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by ram » Thu Jan 10, 2019 3:18 am

https://www.statnews.com/2017/03/15/may ... e-medcaid/

The information in the above link may be of interest to many people.

Many/ most medical practices lose money when they see medicare patients.

Medicare payment is typically greater than the variable cost associated with seeing a patient but usually lesser than the total of fixed and variable costs.

It makes economic sense to see a medicare patient when there are open slots available.

If there are adequate commercially insured patients available to fill all slots then seeing medicare patients does not make economic sense.

Not all health care systems make the economic criteria the most important in making policy decisions but a larger proportion of them have been forced to consider economic implications. Over the years the ability and willingness of the commercially insured patient to subsidize the medicare insured patient has been diminishing.
Ram

Rotarman
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Rotarman » Thu Jan 10, 2019 7:39 am

jayk238 wrote:
Wed Jan 09, 2019 1:12 pm
Rupert wrote:
Wed Jan 09, 2019 1:10 pm
vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
Would the old PCP call and make an appointment for her? A referral may not be required for payment by your insurance but may be required by the specialist.
Most orthopods in my area will reject a referral without a note showing an eval and appropriate imaging.
Agree, you really should see your PCP first. If you need imaging or labs before specialist evaluation, you're essentially wasting both their and your time. That being said, I think they handled it very poorly. I'd be hesitant to go somewhere that would "consider" whether they'll see me.

IngognitoUSA
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by IngognitoUSA » Thu Jan 10, 2019 8:23 am

The way I see it, there is an artificial shortage of Orthopedic surgeons. Since when do we ration in America, we always find a solution.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Thu Jan 10, 2019 9:11 am

IngognitoUSA wrote:
Thu Jan 10, 2019 8:23 am
The way I see it, there is an artificial shortage of Orthopedic surgeons. Since when do we ration in America, we always find a solution.
What do you mean by "artificial" shortage?
And of course we ration in America. Google Narrow Networks. Insurance companies ration by limiting the number of in-network doctors per specialty. The big health system in my area only has 2 surgeons of my specialty in a 500 mile radius. When I asked about joining them they told me they were not looking for more of my specialty. I know those 2 surgeons and they are booked out for 6 months. Let's say each doctor can provide 1000 office visits each year. So with only 2 doctors, the insurance company only has to pay for 2000 visits in a year, but if they had 5 doctors the insurance could be on the hook for up to 5000 visits per year. This is the heart of narrow networks and has been called "Rationing by Inconvenience".

carolinaman
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by carolinaman » Thu Jan 10, 2019 9:25 am

Teague wrote:
Wed Jan 09, 2019 11:30 pm
TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
You bring up an interesting point about PCP's interpreting imaging. In my experience, the PCP will read the radiologist's findings and impressions and take those as the result of the imaging study. The radiologist is not usually specialized in whatever body part was studied. Qualified yes, but specialized, not usually. And the poor PCP doesn't stand a chance of interpreting any but the most basic imaging studies without that radiology report.

Give the same imaging study and radiology report to a specialist, an orthopedist in this case, and the radiologist's report may not get more than a cursory glance, if that. The orthopedist or other specialist is likely to pull up the actual images and interpret those images with the eye of an expert in the diagnosis and treatment of that body part. They are less likely to completely rely on the opinion of some locum radiologist they've never heard of before.

And this presents a bit of a bind for the patient. The person best qualified to interpret the study doesn't want to see the patient until that study has already been interpreted by a generalist to suggest a need for surgery. The generalist may misinterpret the findings to some degree, and therefore never refer the patient to the person - the specialist - who could best formulate the diagnosis and treatment plan.

A bit of a Catch-22, no?
+1. Very well stated and I can cite several instances for me and my family where misinterpretation by non specialists occurred.

montanagirl
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by montanagirl » Thu Jan 10, 2019 9:38 am

jayk238 wrote:
Wed Jan 09, 2019 1:12 pm
vested1 wrote:
Wed Jan 09, 2019 1:06 pm
livesoft wrote:
Wed Jan 09, 2019 12:54 pm
Sounds like your spouse got a free consult.
Great. I'll tell her to just ignore the pain and be thankful she still has legs.
Dude. With all due respect there is a reason why we have pcps. She may have to wait till she sees one. Orthopedic surgeons do not want to do the work of a pcp. That means evaluting the knee, ordering imaging (which is necessary priro to the surgery anyway) and ordering physical therapy or doing knee injections. All of which I do. I understand your frustration w this system but only in america do we get to circumvent the primary care. In europe you usually have to go through them. Im sorry for your wifes pain but this may be her only option.

I empathize and sympathize for your wifes suffering and I wish her a speedy recovery and hope she gets care asap.
I've had two different knee procedures and I initiated both at an orthopedic group and they did all the preliminary xrays, PT recommendations, MRI etc and eventually the surgeries. Though the second group now uses PA's to do all the initial screenings. Big change from 20 years ago.

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Thu Jan 10, 2019 10:59 am

yousha wrote:
Thu Jan 10, 2019 7:49 am
I'd check out a specialist that provides PRP and Stem Cell procedures as an alternative treatment option. Not covered by insurance, however, if the patient is appropriate for this form of treatment, the procedure is less invasive and takes a shorter time for a positive recovery.
Well, the effectiveness of those procedures depend on what the actual knee problem is.

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Thu Jan 10, 2019 11:04 am

montanagirl wrote:
Thu Jan 10, 2019 9:38 am
jayk238 wrote:
Wed Jan 09, 2019 1:12 pm
vested1 wrote:
Wed Jan 09, 2019 1:06 pm
livesoft wrote:
Wed Jan 09, 2019 12:54 pm
Sounds like your spouse got a free consult.
Great. I'll tell her to just ignore the pain and be thankful she still has legs.
Dude. With all due respect there is a reason why we have pcps. She may have to wait till she sees one. Orthopedic surgeons do not want to do the work of a pcp. That means evaluting the knee, ordering imaging (which is necessary priro to the surgery anyway) and ordering physical therapy or doing knee injections. All of which I do. I understand your frustration w this system but only in america do we get to circumvent the primary care. In europe you usually have to go through them. Im sorry for your wifes pain but this may be her only option.

I empathize and sympathize for your wifes suffering and I wish her a speedy recovery and hope she gets care asap.
I've had two different knee procedures and I initiated both at an orthopedic group and they did all the preliminary xrays, PT recommendations, MRI etc and eventually the surgeries. Though the second group now uses PA's to do all the initial screenings. Big change from 20 years ago.
The way your second group works is how the ortho folks I use now work. Appointment or walk-in, and you'll see a PA (who has probably seen more knee/shoulder/etc problems in a month than a PCP in a year because that is what they do, all day long). The PA will do an initial diagnosis, X-ray if it makes senses, and then prescribe PT (either via a therapist or suggested at-home exercises) and so forth. Or schedule an immediate appointment with the doctor if the problem looks more severe.

And after a while if your problem doesn't get better they can schedule the MRI and a subsequent appointment with surgeon to discuss options.

I get why some people think we should go through PCP first for these things, but my experience has been the above approach saves time over starting with a PCP, and I'm not sure it costs anybody any more money.

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Thu Jan 10, 2019 11:10 am

carolinaman wrote:
Thu Jan 10, 2019 9:25 am
Teague wrote:
Wed Jan 09, 2019 11:30 pm
TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
You bring up an interesting point about PCP's interpreting imaging. In my experience, the PCP will read the radiologist's findings and impressions and take those as the result of the imaging study. The radiologist is not usually specialized in whatever body part was studied. Qualified yes, but specialized, not usually. And the poor PCP doesn't stand a chance of interpreting any but the most basic imaging studies without that radiology report.

Give the same imaging study and radiology report to a specialist, an orthopedist in this case, and the radiologist's report may not get more than a cursory glance, if that. The orthopedist or other specialist is likely to pull up the actual images and interpret those images with the eye of an expert in the diagnosis and treatment of that body part. They are less likely to completely rely on the opinion of some locum radiologist they've never heard of before.

And this presents a bit of a bind for the patient. The person best qualified to interpret the study doesn't want to see the patient until that study has already been interpreted by a generalist to suggest a need for surgery. The generalist may misinterpret the findings to some degree, and therefore never refer the patient to the person - the specialist - who could best formulate the diagnosis and treatment plan.

A bit of a Catch-22, no?
+1. Very well stated and I can cite several instances for me and my family where misinterpretation by non specialists occurred.
In fact, with two different injuries I've had, the surgeon's take on the problem (this is important, this is not) is different from what the radiologist seemed to be saying. Or put another way, the surgeon was like "yeah, all those things mentioned in the radiologist report are 'true' but only these two things are important and affecting you."

If you do an MRI on the joint (shoulder, knee, whatever) of a middle-aged active person, you are not going to see a pristine joint .... in general the surgeon didn't seem to pay much attention to the radiologist write-ups (though I'm sure he/she looks for major red flags). This with two different injuries, different surgeons.

As others have noted, I find it standard practice in my area for the ortho folks to cheerfully do all the workup, including the preliminary exam.

IngognitoUSA
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by IngognitoUSA » Thu Jan 10, 2019 11:16 am

toofache32 wrote:
Thu Jan 10, 2019 9:11 am
IngognitoUSA wrote:
Thu Jan 10, 2019 8:23 am
The way I see it, there is an artificial shortage of Orthopedic surgeons. Since when do we ration in America, we always find a solution.
What do you mean by "artificial" shortage?
And of course we ration in America. Google Narrow Networks. Insurance companies ration by limiting the number of in-network doctors per specialty. The big health system in my area only has 2 surgeons of my specialty in a 500 mile radius. When I asked about joining them they told me they were not looking for more of my specialty. I know those 2 surgeons and they are booked out for 6 months. Let's say each doctor can provide 1000 office visits each year. So with only 2 doctors, the insurance company only has to pay for 2000 visits in a year, but if they had 5 doctors the insurance could be on the hook for up to 5000 visits per year. This is the heart of narrow networks and has been called "Rationing by Inconvenience".
I am curious, is there a price point you can be at, where out-of-network coverage is competitive with in-network coverage?
Many patients would be happy to see an out-of-network Orthopedic in 2 days instead of waiting for 6 months for an in-network.

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cheese_breath
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by cheese_breath » Thu Jan 10, 2019 11:18 am

I guess times have changed. I had a knee issue way back in '97 or '98 and didn't have any problem getting in to see a specialist while on Medicare.
The surest way to know the future is when it becomes the past.

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goodenyou
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Thu Jan 10, 2019 11:44 am

cheese_breath wrote:
Thu Jan 10, 2019 11:18 am
I guess times have changed. I had a knee issue way back in '97 or '98 and didn't have any problem getting in to see a specialist while on Medicare.
The economics of medicine changes in dog years.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Thu Jan 10, 2019 11:47 am

IngognitoUSA wrote:
Thu Jan 10, 2019 11:16 am
toofache32 wrote:
Thu Jan 10, 2019 9:11 am
IngognitoUSA wrote:
Thu Jan 10, 2019 8:23 am
The way I see it, there is an artificial shortage of Orthopedic surgeons. Since when do we ration in America, we always find a solution.
What do you mean by "artificial" shortage?
And of course we ration in America. Google Narrow Networks. Insurance companies ration by limiting the number of in-network doctors per specialty. The big health system in my area only has 2 surgeons of my specialty in a 500 mile radius. When I asked about joining them they told me they were not looking for more of my specialty. I know those 2 surgeons and they are booked out for 6 months. Let's say each doctor can provide 1000 office visits each year. So with only 2 doctors, the insurance company only has to pay for 2000 visits in a year, but if they had 5 doctors the insurance could be on the hook for up to 5000 visits per year. This is the heart of narrow networks and has been called "Rationing by Inconvenience".
I am curious, is there a price point you can be at, where out-of-network coverage is competitive with in-network coverage?
Many patients would be happy to see an out-of-network Orthopedic in 2 days instead of waiting for 6 months for an in-network.
Yes. My practice is completely out of network with all insurance (but we always go to an in-network hospital). In addition, I don't have any PAs or nurse practitioners. I do all my own workups, H&Ps, consents, post-op visits, wound care, and even suture removal. Every patient has my cell phone number. Not a nurse they never met but the same number my wife calls me on. I opened my office on Christmas Eve last month for a patient who was having problems from surgery 2 months prior. My fees must be competitive enough because I stay busy. My fees are roughly 4x Medicare rates.

jayk238
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by jayk238 » Thu Jan 10, 2019 12:11 pm

TN_Boy wrote:
Thu Jan 10, 2019 11:04 am
montanagirl wrote:
Thu Jan 10, 2019 9:38 am
jayk238 wrote:
Wed Jan 09, 2019 1:12 pm
vested1 wrote:
Wed Jan 09, 2019 1:06 pm
livesoft wrote:
Wed Jan 09, 2019 12:54 pm
Sounds like your spouse got a free consult.
Great. I'll tell her to just ignore the pain and be thankful she still has legs.
Dude. With all due respect there is a reason why we have pcps. She may have to wait till she sees one. Orthopedic surgeons do not want to do the work of a pcp. That means evaluting the knee, ordering imaging (which is necessary priro to the surgery anyway) and ordering physical therapy or doing knee injections. All of which I do. I understand your frustration w this system but only in america do we get to circumvent the primary care. In europe you usually have to go through them. Im sorry for your wifes pain but this may be her only option.

I empathize and sympathize for your wifes suffering and I wish her a speedy recovery and hope she gets care asap.
I've had two different knee procedures and I initiated both at an orthopedic group and they did all the preliminary xrays, PT recommendations, MRI etc and eventually the surgeries. Though the second group now uses PA's to do all the initial screenings. Big change from 20 years ago.
The way your second group works is how the ortho folks I use now work. Appointment or walk-in, and you'll see a PA (who has probably seen more knee/shoulder/etc problems in a month than a PCP in a year because that is what they do, all day long). The PA will do an initial diagnosis, X-ray if it makes senses, and then prescribe PT (either via a therapist or suggested at-home exercises) and so forth. Or schedule an immediate appointment with the doctor if the problem looks more severe.

And after a while if your problem doesn't get better they can schedule the MRI and a subsequent appointment with surgeon to discuss options.

I get why some people think we should go through PCP first for these things, but my experience has been the above approach saves time over starting with a PCP, and I'm not sure it costs anybody any more money.
It sure does! And evidence shows that pcps refer less to orthopedic surgeons meaning fewer unnecessary procedures. Do you think your pa has your interests vs the ortho in hand? And what experience does the pa have understanding the exams and the accuracy of the tests? How frequently do rhey order imaging vs pcp? I suspect higher rate and a higher referral to ortho.
Also they charge more to insurance which burdens the marketplace even more. The cost is not borne by you except when you have excess procedures done. Knee replacements are not harmless surgeries. What happens when the surgery fails and pt needs to get a spacer placed and a revision. Or Fails pt afterwards or needs long term antibiotic care? Do you think the ortho guy is gonna spend all that time on you? I sure hope so.

fru-gal
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by fru-gal » Thu Jan 10, 2019 12:44 pm

TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
An ortho diagnosed my hip problem, based on an x-ray, as mild arthritis. I had a lot of trouble walking and finally my internist ordered an mri and had the results sent to another ortho who called her back almost immediately and said the hip was stress fractured and I should not be walking on it. By that point I had screwed up both knees trying to compensate, leading to a lot of other ortho stuff including an ankle.

In my experience, mris are vastly superior to x-rays when diagnosing ortho problems.

Teague
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Teague » Thu Jan 10, 2019 2:51 pm

fru-gal wrote:
Thu Jan 10, 2019 12:44 pm
In my experience, mris are vastly superior to x-rays when diagnosing ortho problems.
Unfortunately, that's not as generalizable as one may think. For example, a foot orthopedist might say a weight-bearing x-ray is usually superior to an MRI. It's very specific to the patient and their condition, in my estimation.
Semper Augustus

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Thu Jan 10, 2019 2:55 pm

jayk238 wrote:
Thu Jan 10, 2019 12:11 pm
TN_Boy wrote:
Thu Jan 10, 2019 11:04 am
stuff deleted ..

The way your second group works is how the ortho folks I use now work. Appointment or walk-in, and you'll see a PA (who has probably seen more knee/shoulder/etc problems in a month than a PCP in a year because that is what they do, all day long). The PA will do an initial diagnosis, X-ray if it makes senses, and then prescribe PT (either via a therapist or suggested at-home exercises) and so forth. Or schedule an immediate appointment with the doctor if the problem looks more severe.

And after a while if your problem doesn't get better they can schedule the MRI and a subsequent appointment with surgeon to discuss options.

I get why some people think we should go through PCP first for these things, but my experience has been the above approach saves time over starting with a PCP, and I'm not sure it costs anybody any more money.
It sure does! And evidence shows that pcps refer less to orthopedic surgeons meaning fewer unnecessary procedures. Do you think your pa has your interests vs the ortho in hand? And what experience does the pa have understanding the exams and the accuracy of the tests? How frequently do rhey order imaging vs pcp? I suspect higher rate and a higher referral to ortho.
Also they charge more to insurance which burdens the marketplace even more. The cost is not borne by you except when you have excess procedures done. Knee replacements are not harmless surgeries. What happens when the surgery fails and pt needs to get a spacer placed and a revision. Or Fails pt afterwards or needs long term antibiotic care? Do you think the ortho guy is gonna spend all that time on you? I sure hope so.
I think you misinterpreted most of my comments, but perhaps my post was badly written. I'll try again.

Some context -- I have good health insurance, I live in an area with a good supply of doctors (both GPs and specialists), and I'm pretty active.

For most of my recent orthopedic issues, rather than starting with my PCP (whom I think is pretty good incidentally) I have chosen to start with an orthopedic group. They are not over-scheduled, so I can usually get an appointment quickly, or even walk-in (the clinic is staffed for walk-ins). The ortho group is associated with a university teaching hospital (doctors on university faculty), and works with area college teams as well as regular patients.

For an initial visit, I'll usually see a PA, but the PA is an orthopedic specialist, and works with orthopedic doctors and surgeons all the time. As I said in my original note, I imagine the PAs there see more orthopedic problems in a month than a PCP does in a year -- that's all the clinic does. I get a preliminary diagnosis and a preliminary treatment plan. This might be a cortisone shot, it might be a PT referral, it might be a print out of PT stuff to try at home. The clinic has X-ray facilities on-site, so if the problem merits it, they can do the X-ray on that initial visit. I believe, but am not certain, that if the problem looks bad enough (or interesting enough .. ) they might be able to get an orthopedic doctor to see me that day, albeit with more waiting.

And with one problem I had, the PT referral solved the issue. In two other cases, we had to move to the next step, getting the MRI (because the basic conservative treatments didn't work). The MRI was done at the teaching hospital. The reading of the MRI and the suggested course of action after seeing the imaging was done by an orthopedic doctor (I don't know why you assumed the PA was doing that). I had the imaging and saw a doctor only if needed.

Do I think the PA has my best interests at heart? Why, yes I do. I also think my PCP has my best interests at heart, and frankly, I even thought the orthopedic doctors did also! None of them was trigger-happy about aggressive treatment or surgery. I did have the option of asking for an MRI almost on demand -- but I had shoulder and knee issues, and well, you really cannot diagnose some shoulder and knee problems without proper imaging. We didn't pull the MRI trigger until trying other things, though it would have saved some physical therapy money if we had done the MRI quicker for one problem -- the MRI showed an issue that PT cannot fix.

I don't know why you are going on about knee replacements and such. Or assume that an orthopedic specialist won't give sufficient attention. I had followups out to 10 weeks with one surgery (spaced relatively far apart as all was going well). And the doctors cell in case things went badly. Zero problems getting all the help I needed.

As far as the profit motive around imaging, I'm aware that studies show when a doctor's group owns an imagining center, they tend to do more imaging. In my case, the orthopedic group is part of the same large network of physicians that my PCP is associated with. If my PCP or the orthopedic group requests imaging* ..... it will probably happen at the same teaching hospital no matter who requests it. I doubt, but do not know for sure, that either the ortho group or the PCP gets any sort of financial reward from requesting imaging.

You seem to have had bad experiences with orthopedic doctors. Sorry about that.

* One could argue that I, as the patient, should have shopped around for the cheapest MRI; I suspect the teaching hospital is a higher cost provider, so that cost both me and the insurance company money. But it was nice getting the MRI 3 days after I requested it (and again, by the time we asked for an MRI, I'd had the problem for weeks/months and tried various things ..... the problem wasn't going away and was impacting my life).

yousha
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by yousha » Thu Jan 10, 2019 3:57 pm

TN_Boy wrote:
Thu Jan 10, 2019 10:59 am
yousha wrote:
Thu Jan 10, 2019 7:49 am
I'd check out a specialist that provides PRP and Stem Cell procedures as an alternative treatment option. Not covered by insurance, however, if the patient is appropriate for this form of treatment, the procedure is less invasive and takes a shorter time for a positive recovery.
Well, the effectiveness of those procedures depend on what the actual knee problem is.
Most definitely!

neilpilot
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Location: Memphis area

Re: Diagnosing Knee Problems over the Phone - Medicare

Post by neilpilot » Thu Jan 10, 2019 5:32 pm

yousha wrote:
Thu Jan 10, 2019 3:57 pm
TN_Boy wrote:
Thu Jan 10, 2019 10:59 am
yousha wrote:
Thu Jan 10, 2019 7:49 am
I'd check out a specialist that provides PRP and Stem Cell procedures as an alternative treatment option. Not covered by insurance, however, if the patient is appropriate for this form of treatment, the procedure is less invasive and takes a shorter time for a positive recovery.
Well, the effectiveness of those procedures depend on what the actual knee problem is.
Most definitely!
Also depends on the qualifications and technique of the stem cell practitioner. I won't go into the medical aspects except to say that the source of stem cells can also make a vast difference.

My DW's knee issues had been going on for years, and included meniscus surgery and other treatments. After a few years she was advised by her orthopedic group that knee replacement was her only alternative. I urged her to see another orthopedist, she underwent stem cell treatment, and after 18 months her knee is still going strong and she has no pain. Unfortunately she's now recovering from a hip fracture, but that's a different story.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Thu Jan 10, 2019 5:44 pm

toofache32 wrote:
Wed Jan 09, 2019 10:09 pm
vested1 wrote:
Wed Jan 09, 2019 1:56 pm
Thanks to all for your suggestions. It seems that one of the advertised benefits of our Medicare supplemental of "Not needing a referral" is simply a marketing tool that doesn't stand up to reality. I will stop being penny wise and pound foolish in trying to avoid what I perceived was an unnecessary step in obtaining a referral.
I think you're completely misunderstanding what a "referral" is. This has nothing to do with a "referral". A "referral" is simply a request from one doctor asking another to see a patient. It is used simply when some insurance companies require patients to see their (less expensive) PCP prior to going to a (more expensive) specialist. Medicare should absolutely require referrals and it irritates me that they do not. The issue you are missing is that no workup has been done at all. No physical exam, no xrays. The orthopedic surgeon wants to see patients who need surgery. They don't need a "referral". They need documentation that your wife is a candidate for surgery.
And the patient wants the pain to stop.

Since my wife's first appointment with her PCP in two weeks is still 5 weeks prior to when she could get in to see the specialist your argument is moot in her case. If the specialist would have required a pre-certification of eligibility for surgery that would have added another 2 weeks (9 weeks) to see the specialist, which wouldn't be particularly bad... unless it was you having the pain. She will talk this over with her PCP and follow his advice.

I can see both sides of this issue, but disagree with a couple of the comments implying that a doctor who would refuse to see someone in a certain category (a new Medicare patient), when they advertise as accepting new Medicare patients, is violating his/her Hippocratic Oath. IMHO any doctor who agrees to accept Medicare knowing that most other doctors do not is making a sacrifice that qualifies for that distinction.

Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.

livesoft
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by livesoft » Thu Jan 10, 2019 5:55 pm

vested1 wrote:
Wed Jan 09, 2019 8:03 pm
Thanks again to everyone for their helpful advice, as always. I certainly learned some things. This issue is now resolved ....
There is no guarantee that any medical treatment will help your wife. That's certainly your expectation, but I think you should lower your expectation.

You don't know me from Adam, but I have had several outpatient surgeries including 5 performed by orthopedists, so my expectations are rather low nowadays. I do know that I tolerate anesthesia extremely well.
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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Thu Jan 10, 2019 6:03 pm

toofache32 wrote:
Wed Jan 09, 2019 10:39 pm
fru-gal wrote:
Wed Jan 09, 2019 2:02 pm


The only reason I can see about your former primary not renewing a prescription is that there is some Medicare gotcha that limits fees if a doctor treats any Medicare aged patient and maybe the renewal counts as that.
The reason that doctor is no longer refilling medications is because the OP's wife is no longer a patient there. The doctor-patient relationship was terminated when the patient refused to pay for services provided.
vested1 wrote:
Wed Jan 09, 2019 2:22 pm

Central coast of California. We have a great number of doctors and specialists, but due to the level of wealth there are relatively few doctors who accept Medicare. When I complained to my previous employer some years back that there were few doctors who would accept their insurance I was told by them that was because we were so rural and didn't have many doctors to choose from. I sent them a list of over 300 doctors within a 5 mile radius.
Few doctors accepted your employer's plan because your employer cheaped out and bought a crappy plan that paid low rates. As far as Medicare.....it's Medicare. It pays barely more than Medicaid. When a doctor's practice gets busy enough it's the first one they drop. It pays less than half of commercial insurance on average. Why would they continue taking Medicare unless they are a salaried hospital employee? As I have said before, this is why Medicare and Medicaid are being relegated to institutional settings instead of private practices. Institutional settings like hospitals and universities can bill facility fees while a private office cannot.
#1 Nice assumption, but the billing issue didn't even come up because we hadn't received a bill before the previous PCP eliminated her as a patient after discovering their error. She was terminated because she went on Medicare, something his receptionist and office didn't point out when she showed up for her appointment. I had every right to dispute the bill because the office failed to inform us or even bill Medicare. I'm an honest guy and would have discussed it with them and compromised, but I was treated rudely instead. He still has all her records and knows all her prescriptions. A simple fax to the new prescription provider, even for a newly "terminated" patient who may be in danger of running out is customary according to our new insurance company.

#2 Kinda sounds like the 2 page handwritten letter he wrote me.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Thu Jan 10, 2019 6:10 pm

livesoft wrote:
Thu Jan 10, 2019 5:55 pm
vested1 wrote:
Wed Jan 09, 2019 8:03 pm
Thanks again to everyone for their helpful advice, as always. I certainly learned some things. This issue is now resolved ....
There is no guarantee that any medical treatment will help your wife. That's certainly your expectation, but I think you should lower your expectation.

You don't know me from Adam, but I have had several outpatient surgeries including 5 performed by orthopedists, so my expectations are rather low nowadays. I do know that I tolerate anesthesia extremely well.
No, but I've enjoyed both your wisdom and your wit over the years. Sorry if I reacted too strongly.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by CherryBlues » Fri Jan 11, 2019 12:20 am

The purpose of a GOOD PCP is to be an advocate for your health. They triage your problems and quarterback it to the right person.

They do the initial work up to make sure it's a legitimate concern and to see if it can be controlled with medical management. If it's outside their scope they can refer to someone who specializes in the problem they can't fix.

Imagine walking into the DMV and going straight to a counter because you know what you want. They would tell you to go back to the beginning of the line with the appropriate paperwork and follow the due process. It's not the most efficient way but you can imagine what a cluster mess things would be if people just did whatever they wanted.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Fri Jan 11, 2019 9:55 am

vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by neilpilot » Fri Jan 11, 2019 10:09 am

toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
+1

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by bottlecap » Fri Jan 11, 2019 10:21 am

vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
Advocating to use of force to make someone to give you something for less than they are willing to provide it to you IS politics. Even if you say you don’t intend it that way.

It is theoretically outside of permissible forum topics.

JT

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by cheese_breath » Fri Jan 11, 2019 10:45 am

toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
While us old folks eat their food. Sounds good to me. :wink:
The surest way to know the future is when it becomes the past.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Big Dog » Fri Jan 11, 2019 10:59 am

I had a knee issue way back in '97 or '98 and didn't have any problem getting in to see a specialist while on Medicare.
It also depends on how long the doc has been practicing, i.e., where they are in the growth curve of their practice. A younger guy/gal starting out is more likely to take all comers. Someone who has been practicing 30 years can be more selective in case/insurance management. For example, my internist and ortho no longer take new Medicare patients, but readily continue to see us patients that aged into Medicare.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by cheese_breath » Fri Jan 11, 2019 11:27 am

Big Dog wrote:
Fri Jan 11, 2019 10:59 am
I had a knee issue way back in '97 or '98 and didn't have any problem getting in to see a specialist while on Medicare.
It also depends on how long the doc has been practicing, i.e., where they are in the growth curve of their practice. A younger guy/gal starting out is more likely to take all comers. Someone who has been practicing 30 years can be more selective in case/insurance management. For example, my internist and ortho no longer take new Medicare patients, but readily continue to see us patients that aged into Medicare.
Mine had been practicing quite long and was reputed to be one of the best in the area.
The surest way to know the future is when it becomes the past.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Fri Jan 11, 2019 11:34 am

toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Finally something we can agree on /s. Let them eat cake.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Fri Jan 11, 2019 12:39 pm

cheese_breath wrote:
Fri Jan 11, 2019 11:27 am
Big Dog wrote:
Fri Jan 11, 2019 10:59 am
I had a knee issue way back in '97 or '98 and didn't have any problem getting in to see a specialist while on Medicare.
It also depends on how long the doc has been practicing, i.e., where they are in the growth curve of their practice. A younger guy/gal starting out is more likely to take all comers. Someone who has been practicing 30 years can be more selective in case/insurance management. For example, my internist and ortho no longer take new Medicare patients, but readily continue to see us patients that aged into Medicare.
Mine had been practicing quite long and was reputed to be one of the best in the area.
You do realize that was 20 years ago? Medicare, like most things, was very different then in policies, payment structures, fee schedules, etc.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by fru-gal » Fri Jan 11, 2019 4:24 pm

vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
Actually what I would like to see is Medicare paying doctors a fair amount of money, not having doctors work at a loss.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Fri Jan 11, 2019 6:40 pm

vested1 wrote:
Fri Jan 11, 2019 11:34 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Finally something we can agree on /s. Let them eat cake.
I'm curious as to how much free work you did each week prior to retirement?

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Erwin007 » Fri Jan 11, 2019 9:13 pm

fru-gal wrote:
Thu Jan 10, 2019 12:44 pm
TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
An ortho diagnosed my hip problem, based on an x-ray, as mild arthritis. I had a lot of trouble walking and finally my internist ordered an mri and had the results sent to another ortho who called her back almost immediately and said the hip was stress fractured and I should not be walking on it. By that point I had screwed up both knees trying to compensate, leading to a lot of other ortho stuff including an ankle.

In my experience, mris are vastly superior to x-rays when diagnosing ortho problems.
Maybe that’s the reason they cost 12-20x more than X-rays. But seems like poor financial decision making to get an MRI on everyone who needs a joint problem figured out.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Erwin007 » Fri Jan 11, 2019 9:26 pm

toofache32 wrote:
Fri Jan 11, 2019 6:40 pm
vested1 wrote:
Fri Jan 11, 2019 11:34 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Finally something we can agree on /s. Let them eat cake.
I'm curious as to how much free work you did each week prior to retirement?
But don’t you know? Doctors make too much money and are all just greedy so it’s ok to expect them to work some for free... :oops:

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Turbo29 » Fri Jan 11, 2019 10:07 pm

toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Not the same. There are large barriers to entry into the profession due to state licensure requirements. This results in a higher income for physicians. When it comes to the practice of medicine (or cosmetology and many other professions for that matter) a free market does not exist. If the state wishes to require that persons being granted and utilizing that license accept certain patients that is well within their power. If the person doesn't agree, they don't have to pursue that license and profession.

Whether they should require it or not is a question that cannot be discussed on this board.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Fri Jan 11, 2019 10:18 pm

Erwin007 wrote:
Fri Jan 11, 2019 9:13 pm
fru-gal wrote:
Thu Jan 10, 2019 12:44 pm
TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
An ortho diagnosed my hip problem, based on an x-ray, as mild arthritis. I had a lot of trouble walking and finally my internist ordered an mri and had the results sent to another ortho who called her back almost immediately and said the hip was stress fractured and I should not be walking on it. By that point I had screwed up both knees trying to compensate, leading to a lot of other ortho stuff including an ankle.

In my experience, mris are vastly superior to x-rays when diagnosing ortho problems.
Maybe that’s the reason they cost 12-20x more than X-rays. But seems like poor financial decision making to get an MRI on everyone who needs a joint problem figured out.
I don't know the "right" answer to when an MRI should be done, but I do know that for certain injuries, they cannot be sure what is wrong without one. I know this because I have had two such injuries (actually ... three ... though two of them were on the same joint, just separated in time). An MRI can tell a surgeon whether or not surgery can fix a problem. If you don't care whether or not the person ever gets better, well, you don't have to do the MRI! And no, X-rays were not good enough in any of my three injuries. Had to have the MRI to know what was going on.

In my experience, they usually won't reach for the MRI (for a non-acute injury) until things like PT have been tried. Many problems will get better with time and perhaps PT. Note that the cost analysis is not always in favor of delay. As I mentioned in another post, I had one problem for which I tried home PT for two or three weeks, then PT with a therapist (at $85 a pop) for a while. The MRI showed that I could have done PT for the rest of my life and it wasn't going to get better. The fix was surgery, period. In the other two cases, the MRI showed that surgery was not useful in one case, and a judgement call in the other.

MRI costs can also vary a lot, though I think it difficult for a consumer to shop around for the MRI, coordinate with the doctor wanting the imaging, etc.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Fri Jan 11, 2019 11:02 pm

Turbo29 wrote:
Fri Jan 11, 2019 10:07 pm
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Not the same. There are large barriers to entry into the profession due to state licensure requirements. This results in a higher income for physicians. When it comes to the practice of medicine (or cosmetology and many other professions for that matter) a free market does not exist. If the state wishes to require that persons being granted and utilizing that license accept certain patients that is well within their power. If the person doesn't agree, they don't have to pursue that license and profession.

Whether they should require it or not is a question that cannot be discussed on this board.
Oh but it IS the same. Grocery stores require licenses too, but that's not the point.
My point is....Do you really want your doctor to resent you? For your doctor's employer to have an incentive to cut corners and get by with as little care as possible? This is incredibly short-sighted and a perfect way to ruin the doctor/patient relationship.

Higher income for physicians? I'm not sure what that has to do with anything since I have many Medicare patients with nicer homes and cars than me. And my income is still not as high as the owner of Kroger, but there is no outcry for Kroger to feed our hungry geriatrics. This is why Medicare is called an "entitlement".

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by fru-gal » Sat Jan 12, 2019 7:51 am

toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
This is why Medicare is called an "entitlement".
Only certain people call Medicare an entitlement, the ones who like to ignore the fact that people have been taxed for it all their working lives.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Sat Jan 12, 2019 9:47 am

fru-gal wrote:
Sat Jan 12, 2019 7:51 am
toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
This is why Medicare is called an "entitlement".
Only certain people call Medicare an entitlement, the ones who like to ignore the fact that people have been taxed for it all their working lives.
Not every taxpayer pays enough to cover their healthcare consumption. It’s not even a fraction in most cases. Consumption with continued deficits and demanding access to providers that don’t want to participate is the entitlement.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Sat Jan 12, 2019 10:00 am

toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
Turbo29 wrote:
Fri Jan 11, 2019 10:07 pm
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Not the same. There are large barriers to entry into the profession due to state licensure requirements. This results in a higher income for physicians. When it comes to the practice of medicine (or cosmetology and many other professions for that matter) a free market does not exist. If the state wishes to require that persons being granted and utilizing that license accept certain patients that is well within their power. If the person doesn't agree, they don't have to pursue that license and profession.

Whether they should require it or not is a question that cannot be discussed on this board.
Oh but it IS the same. Grocery stores require licenses too, but that's not the point.
My point is....Do you really want your doctor to resent you? For your doctor's employer to have an incentive to cut corners and get by with as little care as possible? This is incredibly short-sighted and a perfect way to ruin the doctor/patient relationship.

Higher income for physicians? I'm not sure what that has to do with anything since I have many Medicare patients with nicer homes and cars than me. And my income is still not as high as the owner of Kroger, but there is no outcry for Kroger to feed our hungry geriatrics. This is why Medicare is called an "entitlement".
Do the grocery stores that participate in food stamps lower their prices to the government agencies that reimburse them? If not, why not?
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by samsoes » Sat Jan 12, 2019 10:18 am

toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by sophie1 » Sat Jan 12, 2019 11:09 am

It depends on where you are exactly. Here in NYC, PCPs are rare and next to useless - they won't even fill prescriptions or order simple imaging studies. I'm an MD myself and I don't even have a PCP. It's because the population here is dead set on seeing specialists for everything, and of course there are a ton of specialists around competing for business.

In an area like Central CA where there are relatively few specialists, you are more likely to see patient screening like what you experienced, else workups that could be done by a PCP will end up crowding out people who genuinely need specialist attention. It's completely reasonable. The orthopedist is there to do knee replacement surgery or ligament repairs - but you're not at that stage yet. She may end up needing to be managed by a rheumatologist, depending on the diagnosis, or may be easily manageable with NSAIDs and physical therapy by a PCP willing to order/recommend such things. You have a PCP appointment in 2 weeks, so that's perfect timing.

In the meantime, simple over the counter stuff like Advil/Tylenol and heat packs are worth a shot. If they don't help, that's one more useful bit of info for the PCP. BTW a note about knee replacement surgery: a very good reason not to jump to that is that they are not a forever fix. They last maybe 20 years and then need to be redone.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by cheese_breath » Sat Jan 12, 2019 11:36 am

goodenyou wrote:
Sat Jan 12, 2019 9:47 am
fru-gal wrote:
Sat Jan 12, 2019 7:51 am
toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
This is why Medicare is called an "entitlement".
Only certain people call Medicare an entitlement, the ones who like to ignore the fact that people have been taxed for it all their working lives.
Not every taxpayer pays enough to cover their healthcare consumption....
That's the same with any type of insurance. But with private insurance pools some use less than they pay for to cover those who use more.

But I'm surprised nobody has mentioned ponzi scheme yet. (Or maybe I missed it.) Medicare and social security are both ponzi schemes. My parents collected both because my generation paid for it. I'm collecting both now because the next generation's paying for it. I don't blame the people in my generation who thought paid for healthcare when they got old. And I don't blame the physicians whose Medicare reimbursements don't cover their expenses. Like any ponzi scheme both Medicare and SS are reaching the point where there's not enough new money coming in to pay the earlier subscribers.
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goodenyou
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Sat Jan 12, 2019 11:48 am

cheese_breath wrote:
Sat Jan 12, 2019 11:36 am
goodenyou wrote:
Sat Jan 12, 2019 9:47 am
fru-gal wrote:
Sat Jan 12, 2019 7:51 am
toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
This is why Medicare is called an "entitlement".
Only certain people call Medicare an entitlement, the ones who like to ignore the fact that people have been taxed for it all their working lives.
Not every taxpayer pays enough to cover their healthcare consumption....
That's the same with any type of insurance. But with private insurance pools some use less than they pay for to cover those who use more.

But I'm surprised nobody has mentioned ponzi scheme yet. (Or maybe I missed it.) Medicare and social security are both ponzi schemes. My parents collected both because my generation paid for it. I'm collecting both now because the next generation's paying for it. I don't blame the people in my generation who thought paid for healthcare when they got old. And I don't blame the physicians whose Medicare reimbursements don't cover their expenses. Like any ponzi scheme both Medicare and SS are reaching the point where there's not enough new money coming in to pay the earlier subscribers.
The pool is different. If commercial insurance companies were insuring a vast majority of extremely high utilizers, like Medicare, it would be as insolvent as Medicare. The insurance companies don’t have the advantage of having a printing press to cover their losses.
As far as your other comments, it would be crossing the line of interesting but verboten discussion. Unfortunately, it’s probably gone there already.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Sat Jan 12, 2019 12:14 pm

samsoes wrote:
Sat Jan 12, 2019 10:18 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
If a practice accepts Medicare, it gives seniors a discount. Does the restaurant have a cadre of people trying to collect money from patrons after they eat? Let them walk out and then give them a discount when you try to collect and see how willing you will be to be so “charitable “. Up front cash discounts are very common in medical practices.
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by samsoes » Sat Jan 12, 2019 12:41 pm

goodenyou wrote:
Sat Jan 12, 2019 12:14 pm
samsoes wrote:
Sat Jan 12, 2019 10:18 am
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
If a practice accepts Medicare, it gives seniors a discount. Does the restaurant have a cadre of people trying to collect money from patrons after they eat? Let them walk out and then give them a discount when you try to collect and see how willing you will be to be so “charitable “. Up front cash discounts are very common in medical practices.
Allow me to finish the first highlighted sentence:
If a practice accepts Medicare, it gives seniors a discount, otherwise the business will go elsewhere.

When I worked for Multi-State Mega Hospital, adherence to the slightest Medicare rule, no matter how bureaucratic, was vital. If, due to a violation, if the hospital was kicked-out of the Medicare program, the hospital wouldn't be able to survive, or so said the MD/CEO. Seniors' health dollars are substantial.

And, regarding the second highlighted sentence, I've never been chased by a "cadre" after patronizing a restuarant. I once was chased by a server who mistook the dollar coins I left her as a tip for quarters. I suppose that counts.
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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Sat Jan 12, 2019 1:06 pm

toofache32 wrote:
Fri Jan 11, 2019 6:40 pm
vested1 wrote:
Fri Jan 11, 2019 11:34 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
Finally something we can agree on /s. Let them eat cake.
I'm curious as to how much free work you did each week prior to retirement?
Every individual makes their own assessment as to the need to give back (or not) when they have reached a point where they feel assured that they and their family will succeed. Some even give back when that success isn't guaranteed. Doctors who accept Medicare are giving back, and should be acknowledged for doing so. As long as it doesn't create a failure to succeed, any profession should have its advocates for the greater good IMHO. Lawyers, for example, who are almost universally reviled (however unjustly), choose to do the occasional pro bono work which tends to be ignored by critics.

As for my own previous 50 years of employment I did what I could when I could, which helped me sleep at night. Would I have more had I chosen not to exercise my desire to give back? Most certainly. I have noticed during my interactions with various physicians that most are caring and thoughtful, while others have a laser focus on profitability. While there is no mandate in the health care profession that imposes personal sacrifice, the uninformed layman wonders if a Porsche would be sufficient, rather than a Lamborghini. I can almost hear the eyes rolling at this point.

Doctors are human too however, and should be given the latitude that we all deserve when making our personal choices. I agree with another member who said that Medicare payments should be higher and not result in a loss to the physician at the very least, but failing that, what is the average senior citizen to do when faced with a medical issue and scant choices to address it? Go back in time and make better financial choices? Current choices are governed by reality, and unfortunately, most seniors find their choices dwindling toward non-existence.

I can appreciate your point that the onus for this problem should not be laid at the doorstep of the health care provider however.

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