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How much market left?

Posted by Pauline on 4/04/01 at 15:37 (043590)

Scott,
With Healthronics going gang busters how much of the market will be left for the other companies. Dornier expects FDA approval perhaps as early as May. If Norland doesn't provide documation soon the Orbasone could be left out of the market especially if insurers will only cover FDA approved
devices.

Re: How much market left?

Dr. Zuckerman on 4/04/01 at 18:26 (043611)

Hi Pauline,

This is a very good question and I am glad you asked this. If there is no change in the method of Classification for ESWT machines the largest market that will be left out is the poor patient who won't be able to pay for the treatment

The payment for ESWT has very little to do with univeral payment of ESWT payments.

I just can't see how any company is going to pay for treatment of plantar fasciitis when the complete cost to the insurance company is close to five thousand dollars this is something we should be talking about.

I am going to start a new thread because you frankness is needed and you help could change this .

Re: How much market left?

Dr. Marlene Reid on 4/04/01 at 21:46 (043648)

Unfortunately, it is a supply and demand issue. The demand is high and the supply is currently limited to 1 company (for FDA approved devices for PF). I do think this will change once Donier gets approval. The costs are similar to surgery. Please remember this procedure is in place of surgery. It has all the benefits and none of the drawbacks. In fact, it has more benefits. I think the $$ issue at heelspurs.com has totally gotten out of hand. I understand a lot of you have paid out of pocket for this, but there is an option that is approved by most insurance companies. My office manager today told me she scheduled 3 more OssaTron cases because she got the approvals from the insurance companies. It does take some time, but we are getting approval for the OssaTron. And we still do not know what they are going to pay. Just because people pay $2500 for the Orbasone doesn't mean that is what the insurances are going to tell us the appropriate charges are. I know one person who uses the Orbasone who also charges a machine/facility fee for it. So again, the $$ issues are NOT orbasone vs OssaTron! Neither is the anesthesia issue (see my other posts from today or yesturday).

Re: How much market left?

Pauline on 4/04/01 at 22:36 (043653)

This is probably not the correct board, but I wonder what the true cost the insurance companies will end up paying if you go to what they call a participating doctor. I know for instance in my case if I have a procedure at the skin doctors---he charges a certain fee, by the time it is discounted for him being a participating doctor with my insurance co.
the cost is sometimes cut in half or less. In any case my cost out of pocket is usually 20% however that seems to change too to a lower cost sometimes. I never really know how all the discounts work, just glad they are there. If my insurance ends up covering ESWT it may be $5,000 dollars on paper but in reality end up a lot lower.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 10:10 (043696)

The cost issue is exactly what is going to control the market. The ossatron is $550,000 dollars and some body is going to have pay for the cost of this machine. Whether it be the patient or the insurance company the money has to come from some where. The fact that it is in an ASC is another cost factor.

Very simple too much money reduces the opportunity for insurance coverage and the ability for patients to pay for this.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 10:16 (043701)

I would very much like to see exactly what the cost of the ASC is and the other costs. Costs is going to pay a very big factor for future markets.

If one company such as heathronics charges alot for ASC and other charges the insurance companies are going to provide univerisal coverage. I l know medicare isn't going to pay this hugh amount of money. Use common sense and you will see that in the future the insurance companies will stop paying for a procedure that is costing too much money to provide.

So if and when more companies enter the market and there still is money on the table you will see insurane companies paying . So let call a spade a spade. The money is very important.

Just the fact that I do this in my office with the orbasone and some one else does this in an ASC. Well the cost is going to be alot different.

Re: How much market left?

Pauline on 4/05/01 at 12:03 (043711)

While this could end up to be correct with ESWT, this was not the case with the Plastic Surgeon that I had attend a mole removal. He prefers to use a surgical center and although my costs were the same if I had the procedure done in his office, I chose to go to the center. In my case a possible bleeding situation made it safer to use the center.

Re: To Dr. Reid

Pauline on 4/05/01 at 12:08 (043712)

Since you are actually one of the Dr. using the ossatron, did you have to purchase it outright. I thought Healthronics was putting it in surgical centers and physicians using it bought into it, not footing the entire bill. The physicians did however have to have privileges at the surgical center but it was kind of a group thing. Is this correct?

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 16:24 (043734)

We have to remember that the total cost in the end determines increases in insurance costs . So if it costed more to do in the ASC then in the office then your costs were increased in the long term. I am making no judgement about whether your excision of your mole could of been removed in the office

I am making a judgement about the use of ESWT in a surgical center. This is a non-invasive procedure. Yes there may be patients that should be done in an ASC due to systemic medical problems for example hypertension.

But then again proper medical evaluation and work up determined and does prevent systemic complication.s So maybe if the patient have systemic medical problems the procedure choice should be re-evaluated. In plain English maybe the pateint should have any procedure done at all.

Re: To Dr. Reid

Dr. Zuckerman on 4/05/01 at 16:27 (043735)

Pauline I can tell you my opportunity . It is a limited partnership with the doctor having the opportunity to buy into the partnership. Hasn't been determined yet if it meets Federal Stark laws. This is ok at this time due to no medicare coverage of ESWT by any company, machine period. I am not an attorney but this may be a potential problem if and when Medicare and Medicaid think about covering ESWT.

Re: How much market left?

Dr. Marlene Reid on 4/05/01 at 17:34 (043741)

The cost is 450,00. It is no different then any other new technology. How much were the LASER's. How much was your fluro? What about a hospital c-arm. Or for mammograms. Or the cost of the MRI. Competition, once there is some, will bring the cost of the machine down. So will increased production.

Re: To Dr. Z

Pauline on 4/05/01 at 17:55 (043745)

Ambulatory Surgical Centers (ASC) I think are already exempt from Stark II
provisions so I don't think there would a big problem for medicare patients should coverage come.

Re: How much market left?

Pauline on 4/05/01 at 18:12 (043746)

I personally think in the end all will be covered as long as the equipment meets all the necessary Government regulation. It will just be which manufacturer grabed the largest share of the market. Who has the most machines in place they will get the most use. Build it an they will come. Patients are looking for a cure they will go to who ever is offering it as long as their insurance will cover the cost. This could prove to be a horse race. Healthtronics has the lead with the most machines in place. We'll have to see what happens when the other companies get their approvals.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 18:31 (043748)

Well,
If what you state happens there will be NO INSURANCE COVERAGE AT ALL. This is what happened in Germany.

I still remember the days and the attitudes of patients well as long as my insurance covers this then let's go for this very expense treatment. This is
one of the reasons why there is now HMO's and the restriction that they provide.

The doctor must reduce his fees to a fair fee, The companies that provide high technology need to reduce their fees and THE PATIENT MUST STOP WITH SO LONG AS MY INSURANCE COVERS THEN LETS GO FOR IT. I will finish by saying that I told you so when there is either a very long wait for ESWT or there is very little coverage. PLease tell Dr. Z how insurance companies are going to pay for the hugh expense that the osaatron has brought to the ESWT market of plantar fasciitis. You see the quick buck is there but who is going to be left in the end it is you the patient. Don't ever forget this

Re: To Dr. Z

Dr. Zuckerman on 4/05/01 at 18:32 (043749)

We are talking about ESWT machines and the partnership between doctors and the limited partnership companies. We are talking about ASC's

Re: How much market left?

Pauline on 4/05/01 at 20:49 (043769)

Anyway you look at it we will all find out in the end for better or for worse and you know what? 'Both doctors and patients will live with it'.

Re: How much market left?

Dr. Zuckerman on 4/06/01 at 09:57 (043806)

I agree, the doctor can live with this because he has options. The patients don't have the same options as the doctor. Either way the doctor wins,only one way the poor patient loses. The last time the public waited it was called Managed Care. You the patient have the ability to take control of this situation if you want to . Just let me know if you want to know how and I will be very happy to tell you.

Re: How much market left?

Dr. Zuckerman on 4/04/01 at 18:26 (043611)

Hi Pauline,

This is a very good question and I am glad you asked this. If there is no change in the method of Classification for ESWT machines the largest market that will be left out is the poor patient who won't be able to pay for the treatment

The payment for ESWT has very little to do with univeral payment of ESWT payments.

I just can't see how any company is going to pay for treatment of plantar fasciitis when the complete cost to the insurance company is close to five thousand dollars this is something we should be talking about.

I am going to start a new thread because you frankness is needed and you help could change this .

Re: How much market left?

Dr. Marlene Reid on 4/04/01 at 21:46 (043648)

Unfortunately, it is a supply and demand issue. The demand is high and the supply is currently limited to 1 company (for FDA approved devices for PF). I do think this will change once Donier gets approval. The costs are similar to surgery. Please remember this procedure is in place of surgery. It has all the benefits and none of the drawbacks. In fact, it has more benefits. I think the $$ issue at heelspurs.com has totally gotten out of hand. I understand a lot of you have paid out of pocket for this, but there is an option that is approved by most insurance companies. My office manager today told me she scheduled 3 more OssaTron cases because she got the approvals from the insurance companies. It does take some time, but we are getting approval for the OssaTron. And we still do not know what they are going to pay. Just because people pay $2500 for the Orbasone doesn't mean that is what the insurances are going to tell us the appropriate charges are. I know one person who uses the Orbasone who also charges a machine/facility fee for it. So again, the $$ issues are NOT orbasone vs OssaTron! Neither is the anesthesia issue (see my other posts from today or yesturday).

Re: How much market left?

Pauline on 4/04/01 at 22:36 (043653)

This is probably not the correct board, but I wonder what the true cost the insurance companies will end up paying if you go to what they call a participating doctor. I know for instance in my case if I have a procedure at the skin doctors---he charges a certain fee, by the time it is discounted for him being a participating doctor with my insurance co.
the cost is sometimes cut in half or less. In any case my cost out of pocket is usually 20% however that seems to change too to a lower cost sometimes. I never really know how all the discounts work, just glad they are there. If my insurance ends up covering ESWT it may be $5,000 dollars on paper but in reality end up a lot lower.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 10:10 (043696)

The cost issue is exactly what is going to control the market. The ossatron is $550,000 dollars and some body is going to have pay for the cost of this machine. Whether it be the patient or the insurance company the money has to come from some where. The fact that it is in an ASC is another cost factor.

Very simple too much money reduces the opportunity for insurance coverage and the ability for patients to pay for this.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 10:16 (043701)

I would very much like to see exactly what the cost of the ASC is and the other costs. Costs is going to pay a very big factor for future markets.

If one company such as heathronics charges alot for ASC and other charges the insurance companies are going to provide univerisal coverage. I l know medicare isn't going to pay this hugh amount of money. Use common sense and you will see that in the future the insurance companies will stop paying for a procedure that is costing too much money to provide.

So if and when more companies enter the market and there still is money on the table you will see insurane companies paying . So let call a spade a spade. The money is very important.

Just the fact that I do this in my office with the orbasone and some one else does this in an ASC. Well the cost is going to be alot different.

Re: How much market left?

Pauline on 4/05/01 at 12:03 (043711)

While this could end up to be correct with ESWT, this was not the case with the Plastic Surgeon that I had attend a mole removal. He prefers to use a surgical center and although my costs were the same if I had the procedure done in his office, I chose to go to the center. In my case a possible bleeding situation made it safer to use the center.

Re: To Dr. Reid

Pauline on 4/05/01 at 12:08 (043712)

Since you are actually one of the Dr. using the ossatron, did you have to purchase it outright. I thought Healthronics was putting it in surgical centers and physicians using it bought into it, not footing the entire bill. The physicians did however have to have privileges at the surgical center but it was kind of a group thing. Is this correct?

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 16:24 (043734)

We have to remember that the total cost in the end determines increases in insurance costs . So if it costed more to do in the ASC then in the office then your costs were increased in the long term. I am making no judgement about whether your excision of your mole could of been removed in the office

I am making a judgement about the use of ESWT in a surgical center. This is a non-invasive procedure. Yes there may be patients that should be done in an ASC due to systemic medical problems for example hypertension.

But then again proper medical evaluation and work up determined and does prevent systemic complication.s So maybe if the patient have systemic medical problems the procedure choice should be re-evaluated. In plain English maybe the pateint should have any procedure done at all.

Re: To Dr. Reid

Dr. Zuckerman on 4/05/01 at 16:27 (043735)

Pauline I can tell you my opportunity . It is a limited partnership with the doctor having the opportunity to buy into the partnership. Hasn't been determined yet if it meets Federal Stark laws. This is ok at this time due to no medicare coverage of ESWT by any company, machine period. I am not an attorney but this may be a potential problem if and when Medicare and Medicaid think about covering ESWT.

Re: How much market left?

Dr. Marlene Reid on 4/05/01 at 17:34 (043741)

The cost is 450,00. It is no different then any other new technology. How much were the LASER's. How much was your fluro? What about a hospital c-arm. Or for mammograms. Or the cost of the MRI. Competition, once there is some, will bring the cost of the machine down. So will increased production.

Re: To Dr. Z

Pauline on 4/05/01 at 17:55 (043745)

Ambulatory Surgical Centers (ASC) I think are already exempt from Stark II
provisions so I don't think there would a big problem for medicare patients should coverage come.

Re: How much market left?

Pauline on 4/05/01 at 18:12 (043746)

I personally think in the end all will be covered as long as the equipment meets all the necessary Government regulation. It will just be which manufacturer grabed the largest share of the market. Who has the most machines in place they will get the most use. Build it an they will come. Patients are looking for a cure they will go to who ever is offering it as long as their insurance will cover the cost. This could prove to be a horse race. Healthtronics has the lead with the most machines in place. We'll have to see what happens when the other companies get their approvals.

Re: How much market left?

Dr. Zuckerman on 4/05/01 at 18:31 (043748)

Well,
If what you state happens there will be NO INSURANCE COVERAGE AT ALL. This is what happened in Germany.

I still remember the days and the attitudes of patients well as long as my insurance covers this then let's go for this very expense treatment. This is
one of the reasons why there is now HMO's and the restriction that they provide.

The doctor must reduce his fees to a fair fee, The companies that provide high technology need to reduce their fees and THE PATIENT MUST STOP WITH SO LONG AS MY INSURANCE COVERS THEN LETS GO FOR IT. I will finish by saying that I told you so when there is either a very long wait for ESWT or there is very little coverage. PLease tell Dr. Z how insurance companies are going to pay for the hugh expense that the osaatron has brought to the ESWT market of plantar fasciitis. You see the quick buck is there but who is going to be left in the end it is you the patient. Don't ever forget this

Re: To Dr. Z

Dr. Zuckerman on 4/05/01 at 18:32 (043749)

We are talking about ESWT machines and the partnership between doctors and the limited partnership companies. We are talking about ASC's

Re: How much market left?

Pauline on 4/05/01 at 20:49 (043769)

Anyway you look at it we will all find out in the end for better or for worse and you know what? 'Both doctors and patients will live with it'.

Re: How much market left?

Dr. Zuckerman on 4/06/01 at 09:57 (043806)

I agree, the doctor can live with this because he has options. The patients don't have the same options as the doctor. Either way the doctor wins,only one way the poor patient loses. The last time the public waited it was called Managed Care. You the patient have the ability to take control of this situation if you want to . Just let me know if you want to know how and I will be very happy to tell you.