Profit Centers for Primary Care

Last week I made a reference to “profit centers” that are marketed to primary-care physicians as an easy way to increase revenues. In case this term and this concept are unfamiliar, this week I provide a few examples of how vestibular testing and other medical procedures are being presented to primary-care physicians. The next two blocks are website excerpts from companies that market vestibular testing (and other) equipment:

Here are the first few questions addressed on the FAQ page:

Question: Does Medicare and other insurers pay for these services? What are the reimbursement rates?

Answer: Yes, Medicare and other insurers reimburse for both video eye tracking (VENG), comprehensive hearing testing, tympanometry, acoustic reflexes, otoacoustic emissions and vestibular therapy. *Consult your local Medicare office or other insurer for applicable rates in your area and for detailed billing procedures and information.
*For patients who meet Medicare coverage criteria, including a physician order.

 

Question: Who can do this testing?

Answer: Anyone on your staff who has been trained to do VNG and Balance testing can perform these services under the supervision of a physician.

 

 

Question: I don’t know how to read a Video Eng or a balance test. Who will help me with reading and reporting the results?

Answer: We have a staff of professionals to assist you in every phase of testing, therapy, reading and interpretation of all clinical data.

I interpret this as saying, “Don’t worry if you don’t know what you’re doing, Medicare pays for it.”

Here is an excerpt from another website selling Active Head Rotation systems:

Features and Benefits
• Due to the easy-to-perform testing procedure, the VAT is often the first screening test for patients who complain of dizziness or balance problems.
• Make better informed decisions regarding patient’s dizziness and balance issues.
• On-site training completed in less than one day.
• Test can be performed in 7 minutes with current staff, no specialists required.
• FDA approved and reimbursed by Medicare.
• Most practices are reimbursed $415-$700 per test.
• Well-established CPT codes.
• Break even with only two to three patient tests per month.

Wow! An easy-to-perform test, that takes only seven minutes, training is less than one day, and it pays how much? As the saying goes,”If it sounds too good to be true, it probably is.”

This isn’t just about vestibular testing. If you talk to a neurologist who performs nerve conduction studies, you will hear similar experiences about the market being flooded with a lower cost, less accurate facsimile, with resultant dramatic reductions in reimbursement. Click below for examples of companies offering “profit centers” to physicians. You will note the “pays well, easy to do” theme throughout.

If you would like to peruse a couple of these websites, click here or here.

Most of these companies offer a disclaimer regarding their billing advice. Here is one that I enlarged so the text is the same size as the rest of the text. It was not the same size on the website. I think they call that “the fine print.”

General reimbursement information is being provided only as of January 1, 2012, on an “as is” basis. Advanced Clinical Products makes no representation or warranties of any kind to the accuracy or applicability of any content contained herein. The information does not constitute professional or legal advice on coding or reimbursement and should be used at your sole liability and discretion. All coding, policies and reimbursement information is subject to change without notice. Before filing any claims, it is the provider’s responsibility to verify current requirements and policies with the payor.