I beg to differ. What the fee represents is both the cost of materials (minisule for xrays) AND the cost of your time care skil judgment and knowledge and responsibility for reading the images, interpreting them and presenting the diagnosis and consequences for the patient.
Sandy White
Sander White DDS
2193 West Chester Pike
Broomall, PA 19008
610-353-6161
"Who is wise? He who learns from everyone.
Who is rich? He who is happy with what he has.
Who is strong? He who is able to control his emotions.
Who is honored? He who honors others."
Ben Zoma, Pirke Avot
From: acesthetics@googlegroups.com [mailto:acesthetics@googlegroups.com] On Behalf Of Jack Weiss
Sent: Tuesday, January 29, 2013 12:08 PM
To: David R. Boag DDS
Cc: <acesthetics@googlegroups.com>
Subject: Re: [ACEsthetics] PANX vx. FMX Question
I agree as far as the SOC is concerned. With digital radiographs, the cost is virtually $0.00 (except for paying for the machine, itself). I give away a ton of x-rays to get the shot I need. The only cost for a new pan is the electricity and the little plastic sheet that goes over the mouth prop.
Jack
From: "David R. Boag DDS" <spikedds@gmail.com>
Date: Tuesday, January 29, 2013 10:10 AM
To: Jack Weiss <drjackpweiss@gmail.com>
Cc: <spikedds@gmail.com>, "<acesthetics@googlegroups.com>" <ACEsthetics@googlegroups.com>
Subject: Re: [ACEsthetics] PANX vx. FMX Question
I hear what yer saying, Jack, however, the SOC for patients with periodontitis IS a full mouth series including PAs. To my knowledge, that standard has not changed. My periodontist confirms that. If we send him a pt and we don't have an FMX taken, he takes one. Even if I had a PANX from another source. (Example: Pt just had PANX taken by previous dentist. Now comes to see us. Because I had the PANX and insco would not cover FMX if I did one, I do 4 BWX and any PAs I deem necessary on 1st visit. If I send that pt to a periodontist, they will still take a FMX. Why? Standard of care.
I am not asking you to be contemptuous I promise, but rather to ask you if you have asked yourself what I am asking myself: Does the standard of care matter enough to you with regard to this issue to go beyond what inscos pay for? For myself, I want to practice above the SOC, or AT BARE MINIMUM at the level of SOC, not below it. But by doing so, conflicts will arise. Is holding to that standard worth the conflicts? Are we better off not charging for STANDARD TREATMENT just to avoid those conflicts? It'd be another thing if these views were "extra" views that I just "wanted" to get for my own standard. Not so here.
So do you just comp one set in the name of avoiding conflicts?
Is there value to being a doctor that truly practices at the SOC?
On Jan 29, 2013, at 10:51 AM, Jack Weiss <drjackpweiss@gmail.com> wrote:
Pan and BW for pts. PA's only when we want the apex or we see something on the pan. Isn't a BW better for perio than PA's since you are getting the proper angulation and can read the bone level more accurately? A PA shows the bone at an improper angle.
Jack
From: "David R. Boag DDS" <spikedds@gmail.com>
Reply-To: <spikedds@gmail.com>
Date: Tuesday, January 29, 2013 8:38 AM
To: "<acesthetics@googlegroups.com>" <ACEsthetics@googlegroups.com>
Subject: [ACEsthetics] PANX vx. FMX Question
I recently had a digital PANX installed. Never had one before in my office. All this time, we've taken FMX as standard on every adult patient.
Now we have the choice though, but it brings up a conflict: the standard of care is a FMX every 3-5 years. That is ALSO the SOC for a PANX, though. My PLAN was to take a PANX and 4BWX for a new adult patient, and then a FMX on a future visit if we saw either signs of periodontitis or were suspicious of anterior caries. But when I told my assistant that was what I wanted her to do, her response was (and there was no arrogance or disrespect in her tone when she asked this): "Well, since such a high percentage of our patients have periodontitis (~75%), wouldn't it be better to just take the FMX and wait on the PANX rather than the other way around? And without the anterior PA's, and knowing that a PANX doesn't show decay on front teeth very well, when will we get pictures of those teeth to ensure no decay there? With a PANX you miss parts of the bone. With a FMX you miss the details of the front teeth. Which is more likely to be a problem? Seems like a FMX might be the better one to start with."
I dunno. She's got a point. The other side of that coin is that I'm still supposed to be looking at the rami for pathology and sinuses as well. I've never had the ABILITY to do that before now, so I didn't. But it's still important, and you know I'm a pathology guy. Since we need to do that on EVERYBODY, and we don't NEED anterior PA's or FMX on SOME people, perhaps it's better to take the PANX and 4BWX rather than the FMX first.
The other thing (that I wish wouldn't be an issue, but it still IS) is that insurance only covers ONE of the two, not both. So the patient is gonna have to come out of pocket for the second one, whichever it is. I know to some it may seem petty or "money-grubbing" to do and charge for both, but the fact is that this new machine runs $700 per month for a few years. I do need to cover that cost. Giving them away for free doesn't help me there.
We DO sometimes, as part of a marketing campaign, give initial x-rays for free with exam and perio tx (S/RP or prophy--whichever is indicated). I have been doing that for a while. The good news with that is that it makes it easy IF they end up needing both--they get the first set free, and then the second one should be covered by insurance--no conflicts, but also no increased revenue to cover machine costs. But I also wasn't paying $28,000 for those intraoral sensors--about a quarter of that, actually. When I purchased this machine I did it to improve our ability to assess our patients' health/condition, but I also did it to increase revenue to some degree. I want to find the right balance.
How do you all do it? What works best for you?
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