MCR has already said they're not paying (cutoff date just got delayed) for the vast majority of these "substitutes."
Nearly all of them are crap with no EBM or maker-sponsored papers. I was fairly bored during covid and read a bit. There is
really no EBM whatsoever. It's just a game to make $ for the product companies and the docs.
In the supergroup I briefly worked with, they'd sent lists of each doc's 'graft-eligible patients' (any wound pt with MCR plus secondary) to all associate DPMs... then tout the docs who had highest collections per visit (aka did most "grafts") to push others to follow suit. I did about zero of them. It was like they were giving out a sales commissions award for a car dealership or a timeshare company during the calls. It was wild.
...I would stay away from any facilities or groups or reps that push you to do certain stuff... particularly high pay stuff that doesn't make intuitive sense. The poor associates/employee DPMs are taking all of the risk here. In my group example, the associates get their 35% or whatever... and that is
net after substantial cost of "grafts" themselves. So, basically the associates are risking fraud/overutilize with their NPI and doing something without EBM ... and for only a crummy 35/65% split or whatever. If the party's over and MCR or payers or whoever comes calling, you can bet that the employer/facility will absolutely dump all possible responsibility on the doc and say they didn't know what the docs and rep were doing.
The same logic follows for the bogus internal referrals for DME, testing, pharma, vasc, etc that promises big pay or kickback or whatever else for referring to where your employer owns or "arranged." If it doesn't make sense, tread very carefully - or just opt out. If it f***ks with your good medical decision making, then f**k it. Jmo.
...substitute skin graft fraud... ...pneumatic CAM boots ...
"...ain't the same ballpark, it ain't the same league, it ain't even the same f***in' sport. "
...There are 100s of legit and EBM uses for CAM boots.