Bunion Gimmicks

[CutsWithFury]

Just when I thought bunion surgery couldn’t get any dumber after Lapiplasty the industry does this….

https://redpointmedical3d.com/videos/RedPointMed_BetterBunion.mp4

CT scans for bunions + custom 3-D model jig to make bone cuts.

We are at the point of no return

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[Pronation]

Great. Can’t wait for patients to come in demanding this.

 

[Sweatshirt]

I knew a guy that got CT's for all bunions and he's currently on suspension from the hospital under contract review

Edit: just watched the video, the surgeon had a white coat and stethoscope. He must be totally legit

 

[HardRoadPaved]

"bunion surgery does not need to be overly complex".... that's the starting line for the video? I thought they were gonna pitch no-fixation MIS at first with that line

 

[ExperiencedDPM]

Amazing. Can’t wait to see the cost of this “process”. I’m sure the insurance companies are going to love this one. Not to mention surgery centers who won’t allow it due to the expense.

Yep, really simplified.

 

[NatCh]

Wow, bespoke surgical hardware. Very fancy! Looks expensive. It might be too deluxe for us country docs. It doesn't include the actual plate and screws though? Eesh.

I do like the idea of step 4 ("Execute") though. From now on during surgery when I'm about to cut bone I will loudly proclaim, "Surgical team... EXECUTE!"

 

[wakaflocka88]

For those that use lapiplasty and all these expensive sets, how does/do your ASCs justify the cost of it?

 

[NatCh]

For those that use lapiplasty and all these expensive sets, how does/do your ASCs justify the cost of it?

Mine says that they enjoy my company so much that they'll pay whatever it takes to keep me coming there.

 

[de Ribas]

What happens is these companies pretty much drive how you do certain procedures. Patients think that if it looks cool, new, innovative than it means better results and quality. And if you as a provider don't use such an approach, you are either not skilled, old, outdated. Therefore, companies and patients drive those "innovative" approaches and make providers do them.

There are so many different implants and instruments for bunion nowadays. If one of them is truly great why other companies keep producing different ones claiming that their competitor's product is not that great. Seems to me they are all about the same. The idea behind lapidus is simple. Why everyone is overcomplicating this procedure with so many different jigs and devices?

Recently we tried out new product to us at the hospital for lapidus and I thought it was overly complicated, long and confusing approach despite reps praising their product. I just don't get how anyone could use it to make a procedure so much harder, longer and more complicated.

 

[NatCh]

What happens is these companies pretty much drive how you do certain procedures. Patients think that if it looks cool, new, innovative than it means better results and quality. And if you as a provider don't use such an approach, you are either not skilled, old, outdated.

That's accurate. I've had so many people asking specifically about the Lapiplasty (even if their problem wasn't even a bunion). Treace has done an incredible marketing job really.

 

[Poddy2Hotty]

That's accurate. I've had so many people asking specifically about the Lapiplasty (even if their problem wasn't even a bunion). Treace has done an incredible marketing job really.

Seriously. Skechers, Dr. Scholl's, and Treace --> all star marketing teams.

They all bring me business haha

 

[air bud]

What happens is these companies pretty much drive how you do certain procedures. Patients think that if it looks cool, new, innovative than it means better results and quality. And if you as a provider don't use such an approach, you are either not skilled, old, outdated. Therefore, companies and patients drive those "innovative" approaches and make providers do them.

There are so many different implants and instruments for bunion nowadays. If one of them is truly great why other companies keep producing different ones claiming that their competitor's product is not that great. Seems to me they are all about the same. The idea behind lapidus is simple. Why everyone is overcomplicating this procedure with so many different jigs and devices?

Recently we tried out new product to us at the hospital for lapidus and I thought it was overly complicated, long and confusing approach despite reps praising their product. I just don't get how anyone could use it to make a procedure so much harder, longer and more complicated.

Honestly I am much faster now with with lapiplasty than I was before doing plates and screws.... although I will have help and my new place and they have already told me I can't use it ...anyone taking more than 1.5 hr lapiplasty probably doesn't know how to do a regular lapidus. For the record should take you less than 1.5....but that is the upper limit.

 

[Utvolsdpm]

Seriously. Skechers, Dr. Scholl's, and Treace --> all star marketing teams.

They all bring me business haha

Reminds me of a favorite Mitch Hedberg joke:
“

Dr. Scholl is a doctor, which means he spent nine years in med school. That man wasted his time. It took him nine years to learn that cushions make shoes comfortable. I would have bought that **** from a Mr. Scholl. Maybe even a Senor Scholl.”​

 

[NatCh]

Reminds me of a favorite Mitch Hedberg joke:
“

Dr. Scholl is a doctor, which means he spent nine years in med school. That man wasted his time. It took him nine years to learn that cushions make shoes comfortable. I would have bought that **** from a Mr. Scholl. Maybe even a Senor Scholl.”​

Haha! A little racist maybe, but still funny.

 

[NatCh]

Honestly I am much faster now with with lapiplasty than I was before doing plates and screws.... although I will have help and my new place and they have already told me I can't use it ...anyone taking more than 1.5 hr lapiplasty probably doesn't know how to do a regular lapidus. For the record should take you less than 1.5....but that is the upper limit.

I've already stated so in another thread, but I like their orange clamp.

 

[ExperiencedDPM]

For those that use lapiplasty and all these expensive sets, how does/do your ASCs justify the cost of it?

Many ASCs are NOT allowing the set to be used. It’s too expensive and the ASC would take a beating.

I was called in for my opinion for a young doc who said he HAD to use the set or it was compromising patient care.

I basically said that the patient can come to me and I guarantee the results will be excellent and there will be no compromise.

He had never performed a “free hand” Lapidus which CAN successfully correct the deformity in multiple planes.

 

[CutsWithFury]

Lapiplasty is for people who can’t operate. Like seriously. You can’t operate if you rely on this system. This is why it’s so popular with DPMs. Not a coincidence.

Secondly I’ve seen a TON of dorsiflexed first rays when lapiplasty is used by novice surgeons. Once the jig is locked on you can’t fine tune the sagittal plane. If you are not paying attention it’s pretty easy to fuse in a mal position.

 

[PatchAdamsFan]

Many ASCs are NOT allowing the set to be used. It’s too expensive and the ASC would take a beating.

I was called in for my opinion for a young doc who said he HAD to use the set or it was compromising patient care.

I basically said that the patient can come to me and I guarantee the results will be excellent and there will be no compromise.

He had never performed a “free hand” Lapidus which CAN successfully correct the deformity in multiple planes.

Well he's not wrong then - if he's never done a free hand Lapidus, then a jig-less surgery will definitely "compromise his patient care"

 

[diabeticfootdr]

That's accurate. I've had so many people asking specifically about the Lapiplasty (even if their problem wasn't even a bunion). Treace has done an incredible marketing job really.

This happens to me all the time with maggot therapy. Supposedly I’m a “maggot expert” listed on their website. People see it on Discovery channel and come in for osteomyelitis or advanced gangrene and ask for maggot therapy. But I’ve been able to keep all those patients by recommending the appropriate treatment, which is usually surgery.

So the marketing may work for you even if you don’t use the product being marketed. Use it as an opportunity!

 

[NatCh]

This happens to me all the time with maggot therapy. Supposedly I’m a “maggot expert” listed on their website. People see it on Discovery channel and come in for osteomyelitis or advanced gangrene and ask for maggot therapy. But I’ve been able to keep all those patients by recommending the appropriate treatment, which is usually surgery.

So the marketing may work for you even if you don’t use the product being marketed. Use it as an opportunity!

For sure! I let them know if they’re a good candidate or if I think another procedure would be better for them. I can do a Lapidus “free hand” or using the Treace hardware so I like to think I’m versatile that way.

 

[Pronation]

This happens to me all the time with maggot therapy. Supposedly I’m a “maggot expert” listed on their website. People see it on Discovery channel and come in for osteomyelitis or advanced gangrene and ask for maggot therapy. But I’ve been able to keep all those patients by recommending the appropriate treatment, which is usually surgery.

So the marketing may work for you even if you don’t use the product being marketed. Use it as an opportunity!

It’s not like many of those patients with rotting pus feet are going elsewhere if you refuse the maggots. Not really an apples to apples comparison of the housewife that rolls up in her Bentley asking for lapiplasty…

 

[diabeticfootdr]

It’s not like many of those patients with rotting pus feet are going elsewhere if you refuse the maggots. Not really an apples to apples comparison of the housewife that rolls up in her Bentley asking for lapiplasty…

Listen, you don’t have to be negative about everything.

Just be happy a patient is coming in asking your opinion and if you can offer them something better, great. This isn’t unique to podiatry. You can’t be threatened by patients getting their own information through marketing or the internet.

 

[heybrother]

I did a bilateral cash pay lapiplasty on a South American trophy wife for an older farmer.

I told him - it might be cheaper with insurance. He told me insurance was stupid expensive and unnecessary and that I should just get the surgery center to give him a cash pay price.

They didn't bat and eye when I said our fee schedule price was $2500. Not sure what other people charge but the highest reimbursing insurance we receive is $1700. A lot that could be said about that. Do people with the money to pay cash care if its $2500, $5000, or $10000. That said, how silly does it look to charge $10000 for something that Medicare reimburses at like $550.

 

[Pronation]

Listen, you don’t have to be negative about everything.

Just be happy a patient is coming in asking your opinion and if you can offer them something better, great. This isn’t unique to podiatry. You can’t be threatened by patients getting their own information through marketing or the internet.

I'm not entirely negative. This one time I took a crazy trip to Thailand and now I'm positive.

 

[ExperiencedDPM]

I did a bilateral cash pay lapiplasty on a South American trophy wife for an older farmer.

I told him - it might be cheaper with insurance. He told me insurance was stupid expensive and unnecessary and that I should just get the surgery center to give him a cash pay price.

They didn't bat and eye when I said our fee schedule price was $2500. Not sure what other people charge but the highest reimbursing insurance we receive is $1700. A lot that could be said about that. Do people with the money to pay cash care if its $2500, $5000, or $10000. That said, how silly does it look to charge $10000 for something that Medicare reimburses at like $550.

There are MDs at Hospital for Special Surgery in NYC who are out of network and non participating that charge up to $40,000 for a bunionectomy.

 

[CutsWithFury]

The bunion king out of NYC charges $2500 per bunion cash up front and also bills your insurance. I’m sure his rates are more now.

 

[AttackNME]

The bunion king out of NYC charges $2500 per bunion cash up front and also bills your insurance. I’m sure his rates are more now.

I didn't know you could bill additional fees on top of insurance. Is this legal in all states?

 

[deleted1138023]

The bunion king out of NYC charges $2500 per bunion cash up front and also bills your insurance. I’m sure his rates are more now.

The bunion king lmao

 

[CutsWithFury]

I didn't know you could bill additional fees on top of insurance. Is this legal in all states?

Pretty sure you can do whatever you want if the patient signs off on paying the out of pocket fee up front. It is probably in his new patient paperwork.

 

[heybrother]

Pretty sure you can do whatever you want if the patient signs off on paying the out of pocket fee up front. It is probably in his new patient paperwork.

The answer is to be out of network. Consider the following contractual text which presumably is found in every single contract with a large company. Note the garbage ambiguous terms - "or based on our reimbursement policies and methodologies" - which can mean anything and which results in you being unable to charge the customer even though they rendered the service and potentially followed the patient through a 90 day global.

Meanwhile, out of Network means - no contract. You can set your fee schedule to whatever you want and collect full payment up front if you desire. You can charge large up front values and then try to bill the patient's out of network benefits (albeit you may not like the amount).

 

[NatCh]

Good Lord, someone actually calls himself "Bunion King?" Better than Pimple Pauper I guess.

 

[ExperiencedDPM]

Look on his website at his before and after pictures, and let me know if you’d be happy to post those results.

This isn’t his website, but this tells the entire story. 17,000 bunions in 16 years?

No comment.

 

[heybrother]

I obviously don't have his x-rays but I find the above strange - that doesn't look like a lapidus to me.

 

[ExperiencedDPM]

View attachment 360725
I obviously don't have his x-rays but I find the above strange - that doesn't look like a lapidus to me.

You can see the proximal scar. But Mother Nature will not allow that gap between the hallux and 2nd toe to remain. A shoe will end up pushing the hallux over and before you know it the medial bump will look as prominent as it was pre op.

Not impressed.

 

[wakaflocka88]

Look on his website at his before and after pictures, and let me know if you’d be happy to post those results.

This isn’t his website, but this tells the entire story. 17,000 bunions in 16 years?

No comment.

He used to be at Kaiser in NorCal for a while before he branched off to this.

 

[CutsWithFury]

He used to be at Kaiser in NorCal for a while before he branched off to this.

Nothing beats great marketing.

 

[Feli]

He used to be at Kaiser in NorCal for a while before he branched off to this.

Ya, Blitz was actually big on acfas circuit and pub a lot when I was in school and residency. Some good ideas on early WB lapidus. Interesting turn out in NY.

Gotta do what you've gotta do to get the clients. Not easy to keep those wannabe real housewives and NYC wealthy fancy boys in their Gucci and Louboutin and Blahnik shoes?

...I do a lot of bunions and revis myself. It's hard to get it right (from all the eff ups I see). I should talk to marketing... make a YT of me with my Bulova watch and rez dogs and Nissan Altima and testimonials... launch a "bunion fresh prince of new mex" campaign?

Nah fuggedit... waiting room ain't exactly empty.