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Survey do you want to see ESWT an in-office procedure and why

Posted by Dr. Zuckerman on 12/29/00 at 18:20 (035591)

As you I do ESWT in my office and at this time without any needles. I believe that ESWT should be done in the office with the patient walking in and out. I believe there is no need for IV sedation and or Ambulatory Surgical center's routine use of ESWT.

Taking the following facts into consideration . There is proper training and certification and credentialing and control of ESWT use in the office.
do you believe that this is the best setting if you can give a pain- less or very comfortable procedure for the patient.

Where do you feel that ESWT should be done . The procedure was comfortable and certification etc was in place.

Please give a why . IF you think this is too soon to even comment then ignore the entire question and I will come back to this down the road.

Let me know if you think that this question is too soon. to ask . We have an ossatron that is only ASC available maybe I am asking this question too soon and should wait and see what happens. There is the orthowave being done with local in an office type setting if I am not mistaken

I just want to survey the desires for in-office use of ESWT from the patients view point.

Thanks,

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/29/00 at 21:28 (035598)

Ok,

I will survey myself . The best place to have ESWT is in the office without general anesthesia and or IV sedation. I think the surgical center experience is too young for me to comment on. The cost will increase due to the place of service. The abuse of the procedure may be greater in an office setting. But then again I operate in a Surgical Center with no one ever watching except the nurse . I guess they are doing the grading.

Each year I fill out a form and back to the surgical center. Maybe we could have yearly testing and training CME's for ESWT yearly. The Medical boards could charge a fee for re-certification or something like this.

Re: Survey do you want to see ESWT an in-office procedure and why

Jen Ross on 12/30/00 at 11:43 (035626)

Dr. Z,

In my opinion, there is no reason that ESWT needs to be done in a hospital. With or without the local anestetic, I found the office setting to be more comfortable, without the hassles that go along with going to a hospital (Parking, walking long distances, usually behind schedule, etc., etc., etc.). Believe me, I know all about these hassles...my husband's had 5 knee surgeries in 5 years. I don't know about anyone else, but I hate hospitals and avoid them at all costs.

I do think the training and re-certification on a yearly basis is a good idea, though. I also think that by keeping the procedure an in-office procedure, it keeps the cost down, which in turn may help to get more insurance companies to cover it.
Sincerely,
Jen Ross

Re: Survey do you want to see ESWT an in-office procedure and why

Nancy N on 12/30/00 at 15:21 (035639)

Dr. Z--

The OrthoWave study is definitely in an office environment. It's part of Montefiore, but it's just like going to any other doctor's office. I don't see any reason why you'd want to do it any other way (except perhaps that the noise from the OrthoWave might scare patients who don't know what the noise is!). All you need is a regular exam room, though that's slightly cramped with the machine in there, too. I would think that making it a hospital procedure would increase the complexity of everything but the treatment itself--paperwork, precertification, etc. I would think the insurance companies would want to keep it simple so their expense would be lower, but then they tend to do things in exactly the opposite way I would think they would :)

Re: Survey do you want to see ESWT an in-office procedure and why

AnnabelM on 12/30/00 at 18:36 (035653)

ESWT should be kept an office procedure. Otherwise, lots of paperwork hazzels. That's my vote.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/30/00 at 18:43 (035654)

We use the same headphones that they use on a gun shooting range. Please tell your doctors to get them. It won't hurt the patient not to use them, but the doctors will start to get headaches or maybe hearing lost. I even find that blocking out the sound when treating helps me pin point the point where shocks are going into. I can concentrate on feeling the shock wave as opposed to hearing them. Maybe I am crazy but just trying to use another one of my sense maybe the shock wave sound has finally gone to me.

Many years ago the insurance companies were willing ot pay for in-office surgery at a high rate but for some reason it didn't happen. I believe this was due to the lack of control by regulatory boards to control safety, overuse etc. I don't know why. ESWT is the perfect in-office procedure.

You can even use mild sedation such as laughing gas (nitrous oxide) to help the patient thru this procedure. just like teeth cleaning if you want to.

I need the gas when I go to the Dentist so I do understand fear and anxiety during any procedure even simple teeth cleaning.

If the current trend to charge for ESWT at a surgical center continues the price is going to go off the roof and no insurance company will pay for this. Did you know that in addition to the use of the ESWT machine there is the doctor charge, the anesthesia charge, and supply charge

So when you hear that ossatron is $6000 is that just the machine or is that the complete fee.

I hope that I Don't have to ever consider doing ESWT in an ASC.

I use to do all of my procedure in the office with a local and if necessary mild sedation but the insurances reduced the fee so low that I couldn't afford to perform alot of procedure in the office.

I have been in situation where it cost $5000 to do a surgical procedure such as minimial incision heel spur operation in an ASC. The insurance company yes Medicare would only pay DR. Z $400 dollars but would pay an ASC $5000. My fluroscope that I use for mis surgey and ESWT position is over sixteen years old. If it should go and it will. The replacement cost is used 25,000 new 75,000. An ASC buys that when they have the extra money to waste. Trust me i have seen this.

I am going to have buy a service contract for the orbasone in the very near future which is going to cost me somewhere between 25,000 and 50,000
What will I do. It takes alot to beat DR. Z down but it the price of service contract go up and the payment continual to go down well the ASC will win . They beatme in the end in the battle to bring more procedure to the office. . I hope that the insurance companies don't beat me in this war. Either they have to only allow ESWT in an office setting that is well controlled with specific standards. or the cost of EWST will to expensive for any doctor to be able to buy and maintance in an office setting

I hear that the orthowave is going to go for about $250,000/ Could you put in a good word for Dr. Z at your next appointment. Maybe I could a good deal on an extended service contract.

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman, DPM on 12/30/00 at 20:29 (035660)

Dr. Z
As practioners we all know that most procedures done in the office wll be reimbursed by insurance companies at a reduced fee and that you can't charge for use of the machine,ie.laser and eswt machinery. Charging for anesthesia is also not allowed by most companies. Therefore the cost will be born by the patient if it is a non-covered service or if covered, the fee from the insurance company will not cover the overhead cost of the machine.
To try and keep a procedure as an office procedure only, could end up hurting the patients ability to have the procedure performed. There are many people with heel pain who cannot afford $2500, but who have excellent insurance coverage thru their employer. To suggest that it may be better to keep it in the office may be doing these people a diservice.
Plus, we need to think about other procedures with which these types of machines will be used. The use of ESWT for non-union fractures cannot possibly be performed in an office setting. The best thing that could happen is for all of us to fight for insurance coverage of the procedure. If we fight to keep it in the office the price of the equipment will keep most physicians from be able to afford to own the machine.
Also lets remember when you quote a fee of $6000.00, that is what is charged but as we all know that it not what the insurance companies reimburse.
After performing the procedure on many patients for the last two months and seeing excellant results. We should not do anything that could limit any person from receiving this type of non-invasive treatment.

Re: Survey do you want to see ESWT an in-office procedure and why

JudyS on 12/30/00 at 21:25 (035669)

I'm not certain that I've studied this ongoing discussion well enough but...do I read correctly that the real problem re: ESWT treatment in hospital vs treatment in-office is a good old Catch-22? We have a better chance of insurance coverage if it's in hospital but a better chance of lower-cost and number of facilities if it's in-office?

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman, DPM on 12/31/00 at 09:48 (035686)

You will have a greater chance of of having the procedure performed if it is covered by insurance. This is not necessarily a catch-22.
Whats wrong with insurance companies paying for healthcare. Thats there function. Let's not forget that.People pay there premiums for care.If they have to pay for care out of there pocket it just adds to the amount people spend on there health care. The bottom line is if this procedure is covered by insurance then the majority of the people will have acsess to this type of care vs a small percentage of the population who can afford to pay out of there pocket. This is a form of discrimination. So far in Missouri we are finding the majority of insurance companies are covering the Ossatron.

Re: Survey do you want to see ESWT an in-office procedure and why

Cr. Zuckerman on 12/31/00 at 10:24 (035696)

Hi,

Would you be more specific as to which insurance companies are paying and what specific codes are being used. This way the patients will know and be able to let the insurance companies know what they want. In addition they will be able to give examples to insurance that aren't paying ESWT. Insurance companies don't want to lose subscribers so they will always take a look at what their competition is covering and what isn't being covered.

IF one starts paying and other don't this creates competition between insurance companies and in my opinion starts the payment game going .

This insurance payment game has many different phases In order to get more companies paying then patients must be able to prove to their insurance company that their competitors are paying .

Please don't look at me at a competitor in this conversation. This is important information that the patients need to know in order to pick up the speed of insurance companies wanting to get into the game covering ESWT and must be a better insurance company. This is the way they think with elective procedures.

Have a happy and healthy New Year and cure as many pf suffers out there that you can.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 10:44 (035698)

Hi,

The fee that the treating doctor gets is, has, been and always will be the same fee. In fact some insurance companies won't allow the procedure to done in the hospital. The six thousand dollars isn't the doctor fee. It is the charge to do it in the ASC

There is only so much money that the health insurance industry can afford to pay. ESWT for pf in the office is still cheaper period. The fact that you are charging for a facility fee for a procedure that can be done in the office is what is bring the cost up In Canada, Europe, my office, there is proof that it can be safety done in the office setting. The first Ossatron in North American is in Toronto Canada. Dr. Galea and Dr. Gordon don't do this in the hospital.

Yes ESWT is great and has and will benefit many patients but the fact that it is very expensive and will only be in certain areas will keep the cost up . The fact that there is an ASC will keep the cost. up.

Bone fracture healed by ESWT do need general anesthesia but until this phase comes up this is the question being.

I do know that I am only one doctor and the fact that this movement is going toward the higher cost ASC site has is a going to make the cost go up and up until more lower cost machines come on to the market

Re: DR. Z opinion on how to get more insurance companies to pay for ESWT

dr. Zuckerman on 12/31/00 at 10:55 (035700)

We need to know what insurance companies are paying for ESWT and what codes they are paying.
Insurance companies will only start paying when their competition insurance companies start to pay.

ESWT may follow in the path of Lasik surgery. If one insurance company starts to pay and the patients have this information then more and more will start to pay.

There is still a limited amount of the pie for payment for elective procedures such a ESWT.

Insurance companies look at payment for elective procedures such as ESWT and Lasik eye surgery as a way to bring in subscribers and to market their benefits over another insurance companies.

So what we need is to know what insurance companies are paying and which codes are being use. This will help the doctors help the patients to put pressure on their insurance. company. I just though of another idea. Take a look at the new post

You see if the competition insurance company is paying for ESWT I bet you that the other competition insurance companies will take a look.

Dr. Kaufman please don't look at my views on ASC as competition . I truely am looking for a way to spread ESWT to the doctors and patients. I only am looking at in-office from how the patients like it and how the cost can come down.

ESWT has a place in both sites. I just don't think that pf ESWT or any insertional treatment of the upper and lower extremity needs to be done in an ASC.

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 12/31/00 at 14:01 (035710)

Judy S---I believe you have hit the proverbial nail on the head. I have an example to give. A few years back I had several 'lumps' (no big deal) removed from my scalp. I wanted it done in the office for my own convenience and had to convince one of the docs I work with to do it there. My insurance paid the 240 dollars (total charge). Since I work in an ambulatory setting of a hospital, I have seen the same thing being done on an outpatient basis. The patient comes in an hour ahead, waits for the local room and the doctor to be ready, has the surgery, gets his vitals taken, instructions given, and out he goes. I am estimating that the charge for this, including the doctor, is AT LEAST two thousand dollars, also paid by insurance. Charges are for supplies, surgical assistant, nurse, sterile equipment, 15 minutes of nurse time after the procedure, and the doctor. Same procedure as I had, only I spent an hour at the doc's office and this other patient spent three hours and a ton of money. I think this is the same thing being discussed on this thread. I would rather have the ESWT done in the office but there are lots of players in this deal and all of them are more interested in the bottom line than anything else. (not you, Dr. Z) I have found that everything connected with healthcare is more and more about the bottom line and less and less about the patient. I don't blame the doctors--they have had to do more for less for many years--but the big insurance companies are ruling this roost, so to speak, and from what I am seeing, nothing good is coming of it. I have had the treatment, paid for it myself, and don't think it needs to be such a big deal---going to sleep (charge for anesthesia and anesthesiologist) is going way overboard as far as I am concerned.
Okay. I am stepping down from my soapbox.
Kay

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman on 12/31/00 at 14:29 (035711)

But what about the people who cant afford$2500 . Is there heel pain any less than someone who has the cash. Lasik surgery is an excellant example. People who have lasik surgery can afford to pay out of there pocket but if you cant afford lasik surgery you wear glasses.But if you have heel pain and cant afford eswt what do wear to stop the pain? Lets not be deceived, thereare reasons for everything. Lets not try and limit peoples ability to get care. I wont tell you all of my motives are because I am such a great philanthropist.I expect to be paid for my services just like any one else. I just think that if more people can get treatment everyone benifits,the patient most of all ,the physician and the EsWT company who manufactured the machine.

Re: Survey do you want to see ESWT an in-office procedure and why

MarthaB. on 12/31/00 at 14:57 (035718)

Since I can speak from experience since I have had the ossatron,I vote for the in office route. As I have said many times before-the last 3 minutes were fairly painful but others thought it was almost painless.
The reason I still post is that I am only too aware that people tend to talk about the MAJOR pain they have which I have certainly done myself. I want others to know of my great improvement since having ESWT.
Dr. Z-I am one of those teeth cleaning ladies that you are frightened of! Come to Texas and I will clean yours for free-nitrous included!
HAPPY NEW Y'ALL!!

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 15:12 (035720)

I still think of the martharon man with Dustin Hoffman. My first visit to the dentist I asked her to let just talk about the treatment . I never had a cavity as a child so the whole dentist and cleaning was very new to me.

One of the thing that is important before ESWT is to demonstrate the noise to the patient . This will eliminate the fear and unknown to the patient.
So they should run the machine first and let the patient watch the the light and hear the noise.

Didn't work for me i stil hate the dentist and the teeth cleaning lady.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 19:13 (035738)

So what do we do when all of the insurance money is used up for procedures that cost $6000 dollars because of the way they decided to market the machine in the USA.

Every day I have patients asking me what can they do about the increase in insurance premiums and how they are going up and up and up. They do this because there are elective procedures that should be done in the office or some type of facility that doens't cost $6000 . Who do you think is paying this $6000?? It is the patient who pays the premiums.

If you make a business decision in your practice that is wrong such as ESWT never needed to be a class three device and is really a theurapeutic vibrator such as the orbasone and then go ahead and spends millions of dollars who is should have to pay. They are investors who gambled on how a machine should be marketed and now we the public have to pay due to this decision. That is the argument the ossatron is class third and the orbasone people feel that all ESWT machines for pf should be classs one.

Let's not forget who really pays for all of this it is you, me and the rest of the public. The money doens't come from outer space. However I still think that insurance companies take our insurance claims and send them into outer space to delay payments.

Just remember plantar fasciitis public it is me , you and everyone that is going to pay that $6000 dollars.

If you are reallly serious about this write to the FDA and let them know they you want ESWT but that it should not be at $6000 .

This will probaby cost me any chance at ever using the ossaton in the future but I will always speak my feelings .

The orbasone in my opinion and experience is just as good as the ossatron for the treatment of insertional plantar fasciitis ( painful) . I want you to know that I don't work for any company. I work at the war for chronic pf. Right now if there is one machine out right you the public will have to pay pay pay.

There is a solution to this. I would like to see Healthronics buy Norland and then have two markets. One hospital and one office. The ossatron which is going to be used for bone fracture etc can be used in the hospital and the orbasone can be used for in-office.

There isn't going to be any competition between the two machine when we talk about bone fractures because the ossatron is the machine to use when it comes to bone fracture. Why the ossatron didn't start with bone fracture healing and then pf , tennnis elbow I don't understand.

Just remember when you use your insurance dollars it is you that own them . So you should know how much things cost and expect an answer. The answer should be don't worry your insurance company will pay for this.
You have the right to this information and I will think that you would expect it

Sorry about this but I have seen insurance problem just be passed and passed around. The only way the price of anything is going to come down is if the public demands it. There is no other way.

This is my last message for the New Years's

Re: Compared to an MRI, how loud is it?

Beverly on 12/31/00 at 20:37 (035741)

As I continue to contemplate EWST, I'm curious, how loud is it? Say, in comparison to an MRI? I found the MRI to be loud but with ear plugs it wasn't bothersome.
Thanks,
Beverly

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 1/01/01 at 11:51 (035759)

Dr. Kaufman: I wish I had addressed that point---about not being able to pay. I do understand that a LOT of people cannot afford 2500. for the treatment. However, most of us who have paid out-of-pocket don't have 2500 dollars just laying around either. We have just decided to do without some other things in order to be ABLE to afford it. (most of us have decided we'd rather not eat than have this pain!) And yes, I think it is important that everyone who needs it has access to these treatments. The point I was trying to make was that insurance companies could cover the cost of having ESWT done in the office and it would be much, much less expensive. But the other players in this deal don't want to see that loss of money, so they fight hard to keep it in the ASC's or hospitals and out of the offices so they can get a bigger share of the money.
I used to work in an oncology area, and sometimes patients would have to stay overnight after their chemo because otherwise their insurance wouldn't pay. I also know of people who couldn't get their labs drawn at their chemo office (where they were getting their treatment) and if the doc ordered a K+ on the day of chemo, the patient had to go across town to another site for the lab draw. All of these things are not patient-centered, but all about who is going to get the money.
Nothing good has happened since people with business knowledge but no medical knowledge have taken over making the rules. I liked it better when the doctors decided what needed to be done and then did it. The problem came when abuses of the system got out of hand. Now we are stuck with a person who doesn't know the first thing about medical conditions deciding what we can and can't have.
I am very grateful that I am in a position to be able to have the treatment, whether or not my insurance will pay. I don't want to spend that much money, but I don't want the pain to win either!

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 1/01/01 at 11:52 (035760)

P.S. I wear glasses.

Re: Compared to an MRI, how loud is it?

Kay S on 1/01/01 at 12:14 (035761)

Beverly--you can wear those fancy earphones if you want. To me, the Eswt sound was annoying because it was repetitive (3000 times to be exact!)and was in perfect rhythm, over and over. It's like a 'shot' sound, only once it's fired it doesn't reverberate so it's kinda flat. My husband said 'like two pieces of wood being smacked together, over and over' but even that doesn't describe it exactly. We will try to think of another analogy. But whatever it sounds like, if it helps, WHO CARES? I'd let someone smack me in the head 3000 times to get rid of this foot pain!
Of course, if I got smacked in the head that many times, I probably wouldn't have the sense to care about how much my feet hurt!
Happy New Year, and let's hope us pf sufferers will find some relief in 2001!
Kay

Re: Compared to an MRI, how loud is it?

Barbara TX on 1/01/01 at 22:11 (035781)

I thought that the sound of the Orbasone was much less annoying than the MRI, but then, I was surrounded by the MRI. However, the sound drove Dr. Z. nuts. He went out of the room a couple times just to get a little relief in the hall... I think that next time I am going to bring him the ear protectors that we use here in TX at the range. To me the sound is like a pop-gun popping. If my ear mits can muffle a 357, they can handle the Orbasone. Some people have more sensitive ears than others. I, however, have been conditioned by my toddlers to withstand anything. B.

Re: Compared to an MRI, how loud is it?

Dr. Zuckerman on 1/04/01 at 18:33 (035926)

We now have the ear protectors that even stop the machine of 357.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/29/00 at 21:28 (035598)

Ok,

I will survey myself . The best place to have ESWT is in the office without general anesthesia and or IV sedation. I think the surgical center experience is too young for me to comment on. The cost will increase due to the place of service. The abuse of the procedure may be greater in an office setting. But then again I operate in a Surgical Center with no one ever watching except the nurse . I guess they are doing the grading.

Each year I fill out a form and back to the surgical center. Maybe we could have yearly testing and training CME's for ESWT yearly. The Medical boards could charge a fee for re-certification or something like this.

Re: Survey do you want to see ESWT an in-office procedure and why

Jen Ross on 12/30/00 at 11:43 (035626)

Dr. Z,

In my opinion, there is no reason that ESWT needs to be done in a hospital. With or without the local anestetic, I found the office setting to be more comfortable, without the hassles that go along with going to a hospital (Parking, walking long distances, usually behind schedule, etc., etc., etc.). Believe me, I know all about these hassles...my husband's had 5 knee surgeries in 5 years. I don't know about anyone else, but I hate hospitals and avoid them at all costs.

I do think the training and re-certification on a yearly basis is a good idea, though. I also think that by keeping the procedure an in-office procedure, it keeps the cost down, which in turn may help to get more insurance companies to cover it.
Sincerely,
Jen Ross

Re: Survey do you want to see ESWT an in-office procedure and why

Nancy N on 12/30/00 at 15:21 (035639)

Dr. Z--

The OrthoWave study is definitely in an office environment. It's part of Montefiore, but it's just like going to any other doctor's office. I don't see any reason why you'd want to do it any other way (except perhaps that the noise from the OrthoWave might scare patients who don't know what the noise is!). All you need is a regular exam room, though that's slightly cramped with the machine in there, too. I would think that making it a hospital procedure would increase the complexity of everything but the treatment itself--paperwork, precertification, etc. I would think the insurance companies would want to keep it simple so their expense would be lower, but then they tend to do things in exactly the opposite way I would think they would :)

Re: Survey do you want to see ESWT an in-office procedure and why

AnnabelM on 12/30/00 at 18:36 (035653)

ESWT should be kept an office procedure. Otherwise, lots of paperwork hazzels. That's my vote.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/30/00 at 18:43 (035654)

We use the same headphones that they use on a gun shooting range. Please tell your doctors to get them. It won't hurt the patient not to use them, but the doctors will start to get headaches or maybe hearing lost. I even find that blocking out the sound when treating helps me pin point the point where shocks are going into. I can concentrate on feeling the shock wave as opposed to hearing them. Maybe I am crazy but just trying to use another one of my sense maybe the shock wave sound has finally gone to me.

Many years ago the insurance companies were willing ot pay for in-office surgery at a high rate but for some reason it didn't happen. I believe this was due to the lack of control by regulatory boards to control safety, overuse etc. I don't know why. ESWT is the perfect in-office procedure.

You can even use mild sedation such as laughing gas (nitrous oxide) to help the patient thru this procedure. just like teeth cleaning if you want to.

I need the gas when I go to the Dentist so I do understand fear and anxiety during any procedure even simple teeth cleaning.

If the current trend to charge for ESWT at a surgical center continues the price is going to go off the roof and no insurance company will pay for this. Did you know that in addition to the use of the ESWT machine there is the doctor charge, the anesthesia charge, and supply charge

So when you hear that ossatron is $6000 is that just the machine or is that the complete fee.

I hope that I Don't have to ever consider doing ESWT in an ASC.

I use to do all of my procedure in the office with a local and if necessary mild sedation but the insurances reduced the fee so low that I couldn't afford to perform alot of procedure in the office.

I have been in situation where it cost $5000 to do a surgical procedure such as minimial incision heel spur operation in an ASC. The insurance company yes Medicare would only pay DR. Z $400 dollars but would pay an ASC $5000. My fluroscope that I use for mis surgey and ESWT position is over sixteen years old. If it should go and it will. The replacement cost is used 25,000 new 75,000. An ASC buys that when they have the extra money to waste. Trust me i have seen this.

I am going to have buy a service contract for the orbasone in the very near future which is going to cost me somewhere between 25,000 and 50,000
What will I do. It takes alot to beat DR. Z down but it the price of service contract go up and the payment continual to go down well the ASC will win . They beatme in the end in the battle to bring more procedure to the office. . I hope that the insurance companies don't beat me in this war. Either they have to only allow ESWT in an office setting that is well controlled with specific standards. or the cost of EWST will to expensive for any doctor to be able to buy and maintance in an office setting

I hear that the orthowave is going to go for about $250,000/ Could you put in a good word for Dr. Z at your next appointment. Maybe I could a good deal on an extended service contract.

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman, DPM on 12/30/00 at 20:29 (035660)

Dr. Z
As practioners we all know that most procedures done in the office wll be reimbursed by insurance companies at a reduced fee and that you can't charge for use of the machine,ie.laser and eswt machinery. Charging for anesthesia is also not allowed by most companies. Therefore the cost will be born by the patient if it is a non-covered service or if covered, the fee from the insurance company will not cover the overhead cost of the machine.
To try and keep a procedure as an office procedure only, could end up hurting the patients ability to have the procedure performed. There are many people with heel pain who cannot afford $2500, but who have excellent insurance coverage thru their employer. To suggest that it may be better to keep it in the office may be doing these people a diservice.
Plus, we need to think about other procedures with which these types of machines will be used. The use of ESWT for non-union fractures cannot possibly be performed in an office setting. The best thing that could happen is for all of us to fight for insurance coverage of the procedure. If we fight to keep it in the office the price of the equipment will keep most physicians from be able to afford to own the machine.
Also lets remember when you quote a fee of $6000.00, that is what is charged but as we all know that it not what the insurance companies reimburse.
After performing the procedure on many patients for the last two months and seeing excellant results. We should not do anything that could limit any person from receiving this type of non-invasive treatment.

Re: Survey do you want to see ESWT an in-office procedure and why

JudyS on 12/30/00 at 21:25 (035669)

I'm not certain that I've studied this ongoing discussion well enough but...do I read correctly that the real problem re: ESWT treatment in hospital vs treatment in-office is a good old Catch-22? We have a better chance of insurance coverage if it's in hospital but a better chance of lower-cost and number of facilities if it's in-office?

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman, DPM on 12/31/00 at 09:48 (035686)

You will have a greater chance of of having the procedure performed if it is covered by insurance. This is not necessarily a catch-22.
Whats wrong with insurance companies paying for healthcare. Thats there function. Let's not forget that.People pay there premiums for care.If they have to pay for care out of there pocket it just adds to the amount people spend on there health care. The bottom line is if this procedure is covered by insurance then the majority of the people will have acsess to this type of care vs a small percentage of the population who can afford to pay out of there pocket. This is a form of discrimination. So far in Missouri we are finding the majority of insurance companies are covering the Ossatron.

Re: Survey do you want to see ESWT an in-office procedure and why

Cr. Zuckerman on 12/31/00 at 10:24 (035696)

Hi,

Would you be more specific as to which insurance companies are paying and what specific codes are being used. This way the patients will know and be able to let the insurance companies know what they want. In addition they will be able to give examples to insurance that aren't paying ESWT. Insurance companies don't want to lose subscribers so they will always take a look at what their competition is covering and what isn't being covered.

IF one starts paying and other don't this creates competition between insurance companies and in my opinion starts the payment game going .

This insurance payment game has many different phases In order to get more companies paying then patients must be able to prove to their insurance company that their competitors are paying .

Please don't look at me at a competitor in this conversation. This is important information that the patients need to know in order to pick up the speed of insurance companies wanting to get into the game covering ESWT and must be a better insurance company. This is the way they think with elective procedures.

Have a happy and healthy New Year and cure as many pf suffers out there that you can.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 10:44 (035698)

Hi,

The fee that the treating doctor gets is, has, been and always will be the same fee. In fact some insurance companies won't allow the procedure to done in the hospital. The six thousand dollars isn't the doctor fee. It is the charge to do it in the ASC

There is only so much money that the health insurance industry can afford to pay. ESWT for pf in the office is still cheaper period. The fact that you are charging for a facility fee for a procedure that can be done in the office is what is bring the cost up In Canada, Europe, my office, there is proof that it can be safety done in the office setting. The first Ossatron in North American is in Toronto Canada. Dr. Galea and Dr. Gordon don't do this in the hospital.

Yes ESWT is great and has and will benefit many patients but the fact that it is very expensive and will only be in certain areas will keep the cost up . The fact that there is an ASC will keep the cost. up.

Bone fracture healed by ESWT do need general anesthesia but until this phase comes up this is the question being.

I do know that I am only one doctor and the fact that this movement is going toward the higher cost ASC site has is a going to make the cost go up and up until more lower cost machines come on to the market

Re: DR. Z opinion on how to get more insurance companies to pay for ESWT

dr. Zuckerman on 12/31/00 at 10:55 (035700)

We need to know what insurance companies are paying for ESWT and what codes they are paying.
Insurance companies will only start paying when their competition insurance companies start to pay.

ESWT may follow in the path of Lasik surgery. If one insurance company starts to pay and the patients have this information then more and more will start to pay.

There is still a limited amount of the pie for payment for elective procedures such a ESWT.

Insurance companies look at payment for elective procedures such as ESWT and Lasik eye surgery as a way to bring in subscribers and to market their benefits over another insurance companies.

So what we need is to know what insurance companies are paying and which codes are being use. This will help the doctors help the patients to put pressure on their insurance. company. I just though of another idea. Take a look at the new post

You see if the competition insurance company is paying for ESWT I bet you that the other competition insurance companies will take a look.

Dr. Kaufman please don't look at my views on ASC as competition . I truely am looking for a way to spread ESWT to the doctors and patients. I only am looking at in-office from how the patients like it and how the cost can come down.

ESWT has a place in both sites. I just don't think that pf ESWT or any insertional treatment of the upper and lower extremity needs to be done in an ASC.

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 12/31/00 at 14:01 (035710)

Judy S---I believe you have hit the proverbial nail on the head. I have an example to give. A few years back I had several 'lumps' (no big deal) removed from my scalp. I wanted it done in the office for my own convenience and had to convince one of the docs I work with to do it there. My insurance paid the 240 dollars (total charge). Since I work in an ambulatory setting of a hospital, I have seen the same thing being done on an outpatient basis. The patient comes in an hour ahead, waits for the local room and the doctor to be ready, has the surgery, gets his vitals taken, instructions given, and out he goes. I am estimating that the charge for this, including the doctor, is AT LEAST two thousand dollars, also paid by insurance. Charges are for supplies, surgical assistant, nurse, sterile equipment, 15 minutes of nurse time after the procedure, and the doctor. Same procedure as I had, only I spent an hour at the doc's office and this other patient spent three hours and a ton of money. I think this is the same thing being discussed on this thread. I would rather have the ESWT done in the office but there are lots of players in this deal and all of them are more interested in the bottom line than anything else. (not you, Dr. Z) I have found that everything connected with healthcare is more and more about the bottom line and less and less about the patient. I don't blame the doctors--they have had to do more for less for many years--but the big insurance companies are ruling this roost, so to speak, and from what I am seeing, nothing good is coming of it. I have had the treatment, paid for it myself, and don't think it needs to be such a big deal---going to sleep (charge for anesthesia and anesthesiologist) is going way overboard as far as I am concerned.
Okay. I am stepping down from my soapbox.
Kay

Re: Survey do you want to see ESWT an in-office procedure and why

Kurt Kaufman on 12/31/00 at 14:29 (035711)

But what about the people who cant afford$2500 . Is there heel pain any less than someone who has the cash. Lasik surgery is an excellant example. People who have lasik surgery can afford to pay out of there pocket but if you cant afford lasik surgery you wear glasses.But if you have heel pain and cant afford eswt what do wear to stop the pain? Lets not be deceived, thereare reasons for everything. Lets not try and limit peoples ability to get care. I wont tell you all of my motives are because I am such a great philanthropist.I expect to be paid for my services just like any one else. I just think that if more people can get treatment everyone benifits,the patient most of all ,the physician and the EsWT company who manufactured the machine.

Re: Survey do you want to see ESWT an in-office procedure and why

MarthaB. on 12/31/00 at 14:57 (035718)

Since I can speak from experience since I have had the ossatron,I vote for the in office route. As I have said many times before-the last 3 minutes were fairly painful but others thought it was almost painless.
The reason I still post is that I am only too aware that people tend to talk about the MAJOR pain they have which I have certainly done myself. I want others to know of my great improvement since having ESWT.
Dr. Z-I am one of those teeth cleaning ladies that you are frightened of! Come to Texas and I will clean yours for free-nitrous included!
HAPPY NEW Y'ALL!!

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 15:12 (035720)

I still think of the martharon man with Dustin Hoffman. My first visit to the dentist I asked her to let just talk about the treatment . I never had a cavity as a child so the whole dentist and cleaning was very new to me.

One of the thing that is important before ESWT is to demonstrate the noise to the patient . This will eliminate the fear and unknown to the patient.
So they should run the machine first and let the patient watch the the light and hear the noise.

Didn't work for me i stil hate the dentist and the teeth cleaning lady.

Re: Survey do you want to see ESWT an in-office procedure and why

Dr. Zuckerman on 12/31/00 at 19:13 (035738)

So what do we do when all of the insurance money is used up for procedures that cost $6000 dollars because of the way they decided to market the machine in the USA.

Every day I have patients asking me what can they do about the increase in insurance premiums and how they are going up and up and up. They do this because there are elective procedures that should be done in the office or some type of facility that doens't cost $6000 . Who do you think is paying this $6000?? It is the patient who pays the premiums.

If you make a business decision in your practice that is wrong such as ESWT never needed to be a class three device and is really a theurapeutic vibrator such as the orbasone and then go ahead and spends millions of dollars who is should have to pay. They are investors who gambled on how a machine should be marketed and now we the public have to pay due to this decision. That is the argument the ossatron is class third and the orbasone people feel that all ESWT machines for pf should be classs one.

Let's not forget who really pays for all of this it is you, me and the rest of the public. The money doens't come from outer space. However I still think that insurance companies take our insurance claims and send them into outer space to delay payments.

Just remember plantar fasciitis public it is me , you and everyone that is going to pay that $6000 dollars.

If you are reallly serious about this write to the FDA and let them know they you want ESWT but that it should not be at $6000 .

This will probaby cost me any chance at ever using the ossaton in the future but I will always speak my feelings .

The orbasone in my opinion and experience is just as good as the ossatron for the treatment of insertional plantar fasciitis ( painful) . I want you to know that I don't work for any company. I work at the war for chronic pf. Right now if there is one machine out right you the public will have to pay pay pay.

There is a solution to this. I would like to see Healthronics buy Norland and then have two markets. One hospital and one office. The ossatron which is going to be used for bone fracture etc can be used in the hospital and the orbasone can be used for in-office.

There isn't going to be any competition between the two machine when we talk about bone fractures because the ossatron is the machine to use when it comes to bone fracture. Why the ossatron didn't start with bone fracture healing and then pf , tennnis elbow I don't understand.

Just remember when you use your insurance dollars it is you that own them . So you should know how much things cost and expect an answer. The answer should be don't worry your insurance company will pay for this.
You have the right to this information and I will think that you would expect it

Sorry about this but I have seen insurance problem just be passed and passed around. The only way the price of anything is going to come down is if the public demands it. There is no other way.

This is my last message for the New Years's

Re: Compared to an MRI, how loud is it?

Beverly on 12/31/00 at 20:37 (035741)

As I continue to contemplate EWST, I'm curious, how loud is it? Say, in comparison to an MRI? I found the MRI to be loud but with ear plugs it wasn't bothersome.
Thanks,
Beverly

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 1/01/01 at 11:51 (035759)

Dr. Kaufman: I wish I had addressed that point---about not being able to pay. I do understand that a LOT of people cannot afford 2500. for the treatment. However, most of us who have paid out-of-pocket don't have 2500 dollars just laying around either. We have just decided to do without some other things in order to be ABLE to afford it. (most of us have decided we'd rather not eat than have this pain!) And yes, I think it is important that everyone who needs it has access to these treatments. The point I was trying to make was that insurance companies could cover the cost of having ESWT done in the office and it would be much, much less expensive. But the other players in this deal don't want to see that loss of money, so they fight hard to keep it in the ASC's or hospitals and out of the offices so they can get a bigger share of the money.
I used to work in an oncology area, and sometimes patients would have to stay overnight after their chemo because otherwise their insurance wouldn't pay. I also know of people who couldn't get their labs drawn at their chemo office (where they were getting their treatment) and if the doc ordered a K+ on the day of chemo, the patient had to go across town to another site for the lab draw. All of these things are not patient-centered, but all about who is going to get the money.
Nothing good has happened since people with business knowledge but no medical knowledge have taken over making the rules. I liked it better when the doctors decided what needed to be done and then did it. The problem came when abuses of the system got out of hand. Now we are stuck with a person who doesn't know the first thing about medical conditions deciding what we can and can't have.
I am very grateful that I am in a position to be able to have the treatment, whether or not my insurance will pay. I don't want to spend that much money, but I don't want the pain to win either!

Re: Survey do you want to see ESWT an in-office procedure and why

Kay S on 1/01/01 at 11:52 (035760)

P.S. I wear glasses.

Re: Compared to an MRI, how loud is it?

Kay S on 1/01/01 at 12:14 (035761)

Beverly--you can wear those fancy earphones if you want. To me, the Eswt sound was annoying because it was repetitive (3000 times to be exact!)and was in perfect rhythm, over and over. It's like a 'shot' sound, only once it's fired it doesn't reverberate so it's kinda flat. My husband said 'like two pieces of wood being smacked together, over and over' but even that doesn't describe it exactly. We will try to think of another analogy. But whatever it sounds like, if it helps, WHO CARES? I'd let someone smack me in the head 3000 times to get rid of this foot pain!
Of course, if I got smacked in the head that many times, I probably wouldn't have the sense to care about how much my feet hurt!
Happy New Year, and let's hope us pf sufferers will find some relief in 2001!
Kay

Re: Compared to an MRI, how loud is it?

Barbara TX on 1/01/01 at 22:11 (035781)

I thought that the sound of the Orbasone was much less annoying than the MRI, but then, I was surrounded by the MRI. However, the sound drove Dr. Z. nuts. He went out of the room a couple times just to get a little relief in the hall... I think that next time I am going to bring him the ear protectors that we use here in TX at the range. To me the sound is like a pop-gun popping. If my ear mits can muffle a 357, they can handle the Orbasone. Some people have more sensitive ears than others. I, however, have been conditioned by my toddlers to withstand anything. B.

Re: Compared to an MRI, how loud is it?

Dr. Zuckerman on 1/04/01 at 18:33 (035926)

We now have the ear protectors that even stop the machine of 357.