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ESWT reimbursement

Posted by Scott R on 8/18/01 at 18:00 (057115)

Since I've recently learned that HealthTronics is doing only about 7 treatments per day, I'm taking an interest in reimbursement issues. If I can get HealthTronics to advertise on heelspurs.com, I'll build a website dedicated to reimbursement and try to organize the research (including conference videos), patients, doctors, and the various ESWT companies toward this mutually-beneficial goal. Please post in this thread any information or ideas you have that may help. I've emailed Devonne and Argil at HealthTronics about this.

Re: ESWT reimbursement

john h on 8/22/01 at 11:56 (057549)

scott: what if you polled the board and asked how many people would want an ESWT treatment if it was nearby and somewhat affordable. present this info to HealthTronics and see if they were interested in setting up one of their mobile units at some central location with a substantial group of patients wanting the treatment if they qualified. For example you may have 15 or so people in the immediate area OF dallas. they could all be shuttled through one of the HealhTronics qualifed doctors in the area to qualify them and all could be treated over a few days. i do not know about the medical field but there is usuallly a discount when dealing in volume. You are in a unique position to walk up to HealhTronics or one of the other major companies if they are approved and present them with raw numbers of people who seek the treatment. Such a poll would be interesting. The question: 'How many of you would be interested or actually want ESWT treatment if it was nearby and affordable?' of course affordable means different things to different people and you could pose this question in a better format.

Re: ESWT reimbursement

Scott R on 8/22/01 at 14:29 (057566)

John, oh my gosh you gave me an idea. What if patients from heelspurs.com were gauranteed the lowest-priced ESWT treatments available. They would agree to meet in their area of the country for a day of treatments and possibly meeting other heel pain patients. heelspurs.com would get a 15% commission for pooling our strength in numbers (to fight for the lowest fees available) and for orgainizing it. With one of the new small machines coming out that can be more easily transported (maybe even by plane they are so small) and with a doctor on my side .... but I suppose that's on down the road.

Re: ESWT reimbursement for scott

john h on 8/22/01 at 16:15 (057586)

with heelspurs as in war there is strength in numbers. i would not be supprised if there were not at least 100 people who access the board each year who would seriously want some form of ESWT treatment and probably could benefit from it. your board is the place where the rubber meets the road so to speak. somehow we need to get some knowledgeable doctor on a show like the Today Show to discuss PF and new treatments. I tried one time with a letter to them and i shall try again. This problem needs some public awareness and we stand a better chance of getting ESWT treatments approved by insurance companies if this happens. with an estimated 6-9 million new cases a year this is no small problem. I would think it would be hard to get a company rep on a show as it would be viewed as to self serving.

Re: ESWT reimbursement for scott

Dr. Zuckerman on 8/22/01 at 23:09 (057637)

Should I buy a new suit for the Opray show. When there are more machine in the market then the price of the machine will come down and then the price of the procedure will come down and the ball will roll. Time is a factor but we need to write to the FDA and tell them to change their classification system to make the approval process fair and much shorter.

This has been my war cry from day one and the only way I see the price coming down. Remember cell phone costs. Calculator . They came down when the market opened up.

Re: ESWT reimbursement

Lisa C on 8/23/01 at 00:30 (057651)

I think John & Scott should put their heads together and I am sure that they will come up with the winning idea which will get all of us ESWT at a reasonable and fair price. Creative minds! This never would have occured to me. It makes sense! Follow it up, I have faith in you guys! Oh, and start in California!!!

Re: ESWT reimbursement

Dr. Marlene Reid on 8/23/01 at 17:35 (057720)

Scott, I hate to burst your bubble, but it would be irresponsible for any physician to just 'shock and skip' (that sounded better then shock and run). They first have to be evaluated, which may mean have additional testing to rule out differential diagnoses (MANY people think they have PF only to find out the treatment doesn't help because they were misdiagnosed). Follow-up is also important, not only to evaluate the ESW treatment, but to make sure that the proper post ESW protocol is being followed.

By the way, it was nice meeting you in Chicago.

Re: ESWT reimbursement

john h on 8/23/01 at 19:20 (057743)

dr reid: is there a rock solid protocol for the patient following ESWT? i would interested to hear it if it is not to long. do all doctors follow this protocol as far as you know? Would the protocol for a patient who came to you on crutches with ESWT be much different from one who walked in with pain but clearly could walk? my questions are for information only and not ment to challenge you in any way. as a patient who has had 3 ESWT treatments each on both feet i have begun to get a sense of what works and what does not work following treatment and i would like to comapre that with the official protocol. after 7 years of chronic PF i have had the best one month since this all began, My pain level has been at 1. this following my 3rd ESWT treatment on june 15, 2001. i was just discussing with my doctor today about what i have been doing since my last treatment and what he thought i should continue to do to hold on to this improvement and perhaps have no pain level. it would appear to me to be very individualistic because of the many variables in our age,weight,level of activity,mental state,accessability to rehab equipment,etc.

Re: ESWT reimbursement

john h on 8/23/01 at 19:43 (057748)

lisa: what with earthquakes, fires, mud slides, no electricity it might be best to start in texas.

Re: ESWT reimbursement

Dr. Zuckerman on 8/23/01 at 20:20 (057757)

Scott,

I am all ears with this. I now have the ability to travel to do ESWT
It would have to be a state that I have a liscence to practice
in .

As far as follow up and screening. I have had alot of experience
in this area. Of course all potential patients would fully
have to understand that if I felt thatthey couldn't be helped with
ESWT then I wouldn't do the case.

So what you need to do at this point is contact my leader of
ESWT Denise Ashcraft at heelhelp@bee.net .

She could work out a plan where the pt wins heelspurs.com
wins and of course Dr. Z has fun and wins.

Re: ESWT reimbursement

Scott R on 8/23/01 at 20:22 (057758)

Yes, I was taking a naive view of things. Treating it like ultrasound treatment is a long ways off. I know some PTs that wouldn't hesitate at using one they were allowed. And maybe some insurance companies that wouldn't mind paying them instead :)

Well, yes of course i enjoyed meeting you too, dammit :)

Re: ESWT reimbursement

FootPro on 8/23/01 at 22:06 (057764)

The only problem I have with busing people in who 'qualify' is that the performing physician may not have evaluated and initiated their treatment modality prior to their Ossatron Treatment. I have about ten patients that I am trying to get approved right now. So far no insurance company is wanting to pay. Now, if I had seen the patients prior to having them bused into a treatment facility then I would not have a problem with it.

Re: ESWT reimbursement

Lisa C on 8/24/01 at 01:59 (057769)

We could be sure to have a generator for the electricity. Can't do much about acts of God though. Would Texas accept that 'little enough to travel on a plane machine'?

Re: ESWT reimbursement

Dr. Zuckerman on 8/24/01 at 08:43 (057786)

That is the main barrier with this. The treating ESWT doctor may have to tell the patient . Hey you don't have plantar fasciitis and or heel spur
patient. An in-depth telphone evaluation and consultation must be done via
medical records and telephone interview.

Now for anyone out there thinking this is not Kosher. This is done at such
place as the Mayo clinic . I still remember my mother-in-law traveling out to San Franciso for surgery. The doctor examined her one day before to detemine the need for the surgery. This was invasive major surgery.

ESWT isn't life or death surgery. So the major draw back is after the examination the doctor tells the patient sorry Mrs. Jones ESWT would help you.

Re: ESWT reimbursement

Barbara TX on 8/24/01 at 16:16 (057855)

I have to agree. My doctor in TX was fully capable of determining that I needed ESWT and thought it was a great idea, but he had no machine. This happens all the time. It is not as if one doctor needs to be entirely in charge of your care, and often two heads are better than one. My doctor in Texas now works with a Healthtronics machine and no one is getting reimbursed and the treatment is 5000 bucks. So, no improvement in the situation.

We are forgetting here that doctors need to be educated about ESWT and are curious about the technology and would gladly welcome a visiting machine and practitioner.

ESWT is not like performing surgery, and it is not complicated (sorry, but its not!). If you have a machine that can do the low power ranges as well as the high, you don't even need an anesthetic. This is a treatment WITHOUT any known side effects, so what would be the harm in a 'shock and depart' plan? If you need another shock, just travel back to your doctor. It is a totally outpatient procedure. Saying this openly may upset doctors who want to charge a lot, put you under, and make you pay a big facility fee, but its the truth. The future of these machines is that they'll be JUST as portable and easy to use as an ultrasound. Until that happens, patients get taken for a long, expensive ride.

I've heard of a man who was told in CA that his ESWT treatment would be over fifteen thousand dollars. That's a crying shame. No wonder the insurance companies are hesitant to pay. B.

Re: dr z and jeff

john h on 8/24/01 at 19:15 (057868)

i am sure you both are aware that mobile liipotriptor machines are very common. i thin we have two in arkansas. these machines are mores sophisticated,expensive than an ESWT machine. of coures their use requires an anathesiologist and other specialist. i do not know who owns the machines. it could be the hospital. the doctors in the outying areas obviously have the patients and how the charges for the procedure which can run to $10,000 is split i do not know. if they can make these mobile it should be easy to make a mobile sonnocur, orbasone, etc. I have an acquaintence who formed a company with a group of local doctors. They purchase Mri machines which cost in excess of a million dollars and lease them to hospitals on a per use basis. The machines are in use 24/7 as are the lipotriptors. my acquaintenance and the doctors involved have all become mult-millionaires. i do not know if this is good or bad for the public but it is just the way it is.

Re: ESWT reimbursement

john h on 8/24/01 at 19:28 (057872)

barb: i did not look but i would not be supprised if they ran on 120volts.

Re: ESWT reimbursement

Barbara TX on 8/24/01 at 20:54 (057884)

Probably 120 volts. You and I should go into business together. After seeing it done so much I think I could find and shock the ol' F2's as well as the next guy. B.

Re: ESWT reimbursement

Dr. Marlene Reid on 8/24/01 at 21:30 (057889)

Well, nothing is ever rock solid! The protocol I was taught does seem to work. Soft sole shoes with a little heel (no flats), as the first few days only and STRETCH, STRETCH, STRETCH. Dr. Kosova had 4 patients last night that were all 2 weeks after their only Ossatron procedure and all were 100% better. That's not to say they will stay that way. But usually if the don't take a nose dive by the 10th or 12th day the results usually hold. I am finding that people fall into 3 groups. The first third does great from day one and pretty much stays that way, the second does great then nose dives at day 10-12 and then slowly does better and the third just does slowly better. We've only had to do 3 redos, and 2 of those were on a different spot.

A few interesting notes,

I spoke at length to a ultrasonic physician in Chicago who has seen a lot of pre and post ESW for achilles tendonitis and he has not seen any of the healing inflammatory changes you would expect to see post treatment. Not sure why. He also said it does take a few months until the reduction of inflammation can be measured. We have been doing in office ultrasound exams to measure the inflammation as well and did notice some change at the 8 week point and more at the 12 week point.

A few notes from the meeting in Chicago -

Dr. Roumpe (sp??) from Germany found devascularisation using ESW for the achilles and was not encouraged. Dr. Weil, jr found his results for the achilles to be less then for PF, somewhere at 60%. Personally, I am not doing it as healthtronics does NOT want the Ossatron used off label.

In discussing off label use, the problem is there isn't a standard or studies to back up the amount being used. This IS different then using Rx drugs off label, as the dosages are already proven and its usually the affects that are appreciated in different ways. For those that are using ESW off label, what studies are you basing your technique on?? What controls are you using? That IS EXACTLY way we have an FDA in the US.

Also, you all should be clear on the FDA approval of each of the machines. The Ossatron is still the ONLY ESW machine FDA approved to use specifically on PF!!! I am also begining to hear of some complications occuring to the plantar musculature, confirmed by high resolution ultrasound, so I am still convinced that the ESW is not to be used abstractly on body parts without that particular machine being tested. Sorry, I don't have much more information, my source would not devulge any info such as which machine, what settings, etc.....although I am tempted to use it on a few non surgical candidates that have achilles tendonitis....

Re: ESWT reimbursement

Dr. Zuckerman on 8/24/01 at 22:00 (057891)

It is my understanding that you should not use high energy machines such as the ossatron for Achilles tendonitis due to the high energy out put

Does the ossatron have any animal studies showing its effect on bone. The
orbasone did do animal studies on bone which showed that there was no damage to the bone.

Very important to be able to use low energy and not high energy with the
achilles tendon. This is one of the major draw back for the ossatron and why it may not be the machine to be used for achilles tendonitis.

To date the only machine that I am aware of that has maybe caused pf rupture is the ossatron. I am hearing that ESWT certified trained doctors are using whatever ever kv they want. I just read Dr. Smith's article in
Podiatry today where he is going past 20 and 21 kv.

So where is the FDA role in doctor's using the kv setting past what was done the original FDA plantar fasciitis studies

All I have seen is increased costs with FDA studies . Safety is extremely
important and I would like to see any animal studies if they were ever done
or required by the FDA.

Dr. Reid are you aware of any animal studies that were done for the ossatron and are you aware of any limits on kv useage with the ossatron.

Re: ESWT reimbursement

john h on 8/25/01 at 10:37 (057914)

Dr Reid: what stretch do you suggest? Perhaps the runners stretch of the calf and achilles?

Re: ESWT reimbursement

john h on 8/25/01 at 10:39 (057915)

barb i think you and i could easily operate the machine and probably have seen enouhg to place it in the correct spot but we would probaly be administering shock waves to people with gall bladder problems.

Re: ESWT reimbursement

Nancy N on 8/25/01 at 12:07 (057926)

Are they using ESWT (or its relatives) on gallstones now? Wow, that sure would have been more pleasant than surgery, and I would still have a gall bladder now! Or maybe it is better to take it out so that the problem doesn't recur? (Or did you mean kidneys and not gall bladder? :) )

Re: ESWT reimbursement

john h on 8/28/01 at 18:37 (058290)

nancy: they do remove gallstones through a scope these days and it is not near the deal it once was. i think it is in and out in 1 day.

Re: ESWT reimbursement

john h on 8/22/01 at 11:56 (057549)

scott: what if you polled the board and asked how many people would want an ESWT treatment if it was nearby and somewhat affordable. present this info to HealthTronics and see if they were interested in setting up one of their mobile units at some central location with a substantial group of patients wanting the treatment if they qualified. For example you may have 15 or so people in the immediate area OF dallas. they could all be shuttled through one of the HealhTronics qualifed doctors in the area to qualify them and all could be treated over a few days. i do not know about the medical field but there is usuallly a discount when dealing in volume. You are in a unique position to walk up to HealhTronics or one of the other major companies if they are approved and present them with raw numbers of people who seek the treatment. Such a poll would be interesting. The question: 'How many of you would be interested or actually want ESWT treatment if it was nearby and affordable?' of course affordable means different things to different people and you could pose this question in a better format.

Re: ESWT reimbursement

Scott R on 8/22/01 at 14:29 (057566)

John, oh my gosh you gave me an idea. What if patients from heelspurs.com were gauranteed the lowest-priced ESWT treatments available. They would agree to meet in their area of the country for a day of treatments and possibly meeting other heel pain patients. heelspurs.com would get a 15% commission for pooling our strength in numbers (to fight for the lowest fees available) and for orgainizing it. With one of the new small machines coming out that can be more easily transported (maybe even by plane they are so small) and with a doctor on my side .... but I suppose that's on down the road.

Re: ESWT reimbursement for scott

john h on 8/22/01 at 16:15 (057586)

with heelspurs as in war there is strength in numbers. i would not be supprised if there were not at least 100 people who access the board each year who would seriously want some form of ESWT treatment and probably could benefit from it. your board is the place where the rubber meets the road so to speak. somehow we need to get some knowledgeable doctor on a show like the Today Show to discuss PF and new treatments. I tried one time with a letter to them and i shall try again. This problem needs some public awareness and we stand a better chance of getting ESWT treatments approved by insurance companies if this happens. with an estimated 6-9 million new cases a year this is no small problem. I would think it would be hard to get a company rep on a show as it would be viewed as to self serving.

Re: ESWT reimbursement for scott

Dr. Zuckerman on 8/22/01 at 23:09 (057637)

Should I buy a new suit for the Opray show. When there are more machine in the market then the price of the machine will come down and then the price of the procedure will come down and the ball will roll. Time is a factor but we need to write to the FDA and tell them to change their classification system to make the approval process fair and much shorter.

This has been my war cry from day one and the only way I see the price coming down. Remember cell phone costs. Calculator . They came down when the market opened up.

Re: ESWT reimbursement

Lisa C on 8/23/01 at 00:30 (057651)

I think John & Scott should put their heads together and I am sure that they will come up with the winning idea which will get all of us ESWT at a reasonable and fair price. Creative minds! This never would have occured to me. It makes sense! Follow it up, I have faith in you guys! Oh, and start in California!!!

Re: ESWT reimbursement

Dr. Marlene Reid on 8/23/01 at 17:35 (057720)

Scott, I hate to burst your bubble, but it would be irresponsible for any physician to just 'shock and skip' (that sounded better then shock and run). They first have to be evaluated, which may mean have additional testing to rule out differential diagnoses (MANY people think they have PF only to find out the treatment doesn't help because they were misdiagnosed). Follow-up is also important, not only to evaluate the ESW treatment, but to make sure that the proper post ESW protocol is being followed.

By the way, it was nice meeting you in Chicago.

Re: ESWT reimbursement

john h on 8/23/01 at 19:20 (057743)

dr reid: is there a rock solid protocol for the patient following ESWT? i would interested to hear it if it is not to long. do all doctors follow this protocol as far as you know? Would the protocol for a patient who came to you on crutches with ESWT be much different from one who walked in with pain but clearly could walk? my questions are for information only and not ment to challenge you in any way. as a patient who has had 3 ESWT treatments each on both feet i have begun to get a sense of what works and what does not work following treatment and i would like to comapre that with the official protocol. after 7 years of chronic PF i have had the best one month since this all began, My pain level has been at 1. this following my 3rd ESWT treatment on june 15, 2001. i was just discussing with my doctor today about what i have been doing since my last treatment and what he thought i should continue to do to hold on to this improvement and perhaps have no pain level. it would appear to me to be very individualistic because of the many variables in our age,weight,level of activity,mental state,accessability to rehab equipment,etc.

Re: ESWT reimbursement

john h on 8/23/01 at 19:43 (057748)

lisa: what with earthquakes, fires, mud slides, no electricity it might be best to start in texas.

Re: ESWT reimbursement

Dr. Zuckerman on 8/23/01 at 20:20 (057757)

Scott,

I am all ears with this. I now have the ability to travel to do ESWT
It would have to be a state that I have a liscence to practice
in .

As far as follow up and screening. I have had alot of experience
in this area. Of course all potential patients would fully
have to understand that if I felt thatthey couldn't be helped with
ESWT then I wouldn't do the case.

So what you need to do at this point is contact my leader of
ESWT Denise Ashcraft at heelhelp@bee.net .

She could work out a plan where the pt wins heelspurs.com
wins and of course Dr. Z has fun and wins.

Re: ESWT reimbursement

Scott R on 8/23/01 at 20:22 (057758)

Yes, I was taking a naive view of things. Treating it like ultrasound treatment is a long ways off. I know some PTs that wouldn't hesitate at using one they were allowed. And maybe some insurance companies that wouldn't mind paying them instead :)

Well, yes of course i enjoyed meeting you too, dammit :)

Re: ESWT reimbursement

FootPro on 8/23/01 at 22:06 (057764)

The only problem I have with busing people in who 'qualify' is that the performing physician may not have evaluated and initiated their treatment modality prior to their Ossatron Treatment. I have about ten patients that I am trying to get approved right now. So far no insurance company is wanting to pay. Now, if I had seen the patients prior to having them bused into a treatment facility then I would not have a problem with it.

Re: ESWT reimbursement

Lisa C on 8/24/01 at 01:59 (057769)

We could be sure to have a generator for the electricity. Can't do much about acts of God though. Would Texas accept that 'little enough to travel on a plane machine'?

Re: ESWT reimbursement

Dr. Zuckerman on 8/24/01 at 08:43 (057786)

That is the main barrier with this. The treating ESWT doctor may have to tell the patient . Hey you don't have plantar fasciitis and or heel spur
patient. An in-depth telphone evaluation and consultation must be done via
medical records and telephone interview.

Now for anyone out there thinking this is not Kosher. This is done at such
place as the Mayo clinic . I still remember my mother-in-law traveling out to San Franciso for surgery. The doctor examined her one day before to detemine the need for the surgery. This was invasive major surgery.

ESWT isn't life or death surgery. So the major draw back is after the examination the doctor tells the patient sorry Mrs. Jones ESWT would help you.

Re: ESWT reimbursement

Barbara TX on 8/24/01 at 16:16 (057855)

I have to agree. My doctor in TX was fully capable of determining that I needed ESWT and thought it was a great idea, but he had no machine. This happens all the time. It is not as if one doctor needs to be entirely in charge of your care, and often two heads are better than one. My doctor in Texas now works with a Healthtronics machine and no one is getting reimbursed and the treatment is 5000 bucks. So, no improvement in the situation.

We are forgetting here that doctors need to be educated about ESWT and are curious about the technology and would gladly welcome a visiting machine and practitioner.

ESWT is not like performing surgery, and it is not complicated (sorry, but its not!). If you have a machine that can do the low power ranges as well as the high, you don't even need an anesthetic. This is a treatment WITHOUT any known side effects, so what would be the harm in a 'shock and depart' plan? If you need another shock, just travel back to your doctor. It is a totally outpatient procedure. Saying this openly may upset doctors who want to charge a lot, put you under, and make you pay a big facility fee, but its the truth. The future of these machines is that they'll be JUST as portable and easy to use as an ultrasound. Until that happens, patients get taken for a long, expensive ride.

I've heard of a man who was told in CA that his ESWT treatment would be over fifteen thousand dollars. That's a crying shame. No wonder the insurance companies are hesitant to pay. B.

Re: dr z and jeff

john h on 8/24/01 at 19:15 (057868)

i am sure you both are aware that mobile liipotriptor machines are very common. i thin we have two in arkansas. these machines are mores sophisticated,expensive than an ESWT machine. of coures their use requires an anathesiologist and other specialist. i do not know who owns the machines. it could be the hospital. the doctors in the outying areas obviously have the patients and how the charges for the procedure which can run to $10,000 is split i do not know. if they can make these mobile it should be easy to make a mobile sonnocur, orbasone, etc. I have an acquaintence who formed a company with a group of local doctors. They purchase Mri machines which cost in excess of a million dollars and lease them to hospitals on a per use basis. The machines are in use 24/7 as are the lipotriptors. my acquaintenance and the doctors involved have all become mult-millionaires. i do not know if this is good or bad for the public but it is just the way it is.

Re: ESWT reimbursement

john h on 8/24/01 at 19:28 (057872)

barb: i did not look but i would not be supprised if they ran on 120volts.

Re: ESWT reimbursement

Barbara TX on 8/24/01 at 20:54 (057884)

Probably 120 volts. You and I should go into business together. After seeing it done so much I think I could find and shock the ol' F2's as well as the next guy. B.

Re: ESWT reimbursement

Dr. Marlene Reid on 8/24/01 at 21:30 (057889)

Well, nothing is ever rock solid! The protocol I was taught does seem to work. Soft sole shoes with a little heel (no flats), as the first few days only and STRETCH, STRETCH, STRETCH. Dr. Kosova had 4 patients last night that were all 2 weeks after their only Ossatron procedure and all were 100% better. That's not to say they will stay that way. But usually if the don't take a nose dive by the 10th or 12th day the results usually hold. I am finding that people fall into 3 groups. The first third does great from day one and pretty much stays that way, the second does great then nose dives at day 10-12 and then slowly does better and the third just does slowly better. We've only had to do 3 redos, and 2 of those were on a different spot.

A few interesting notes,

I spoke at length to a ultrasonic physician in Chicago who has seen a lot of pre and post ESW for achilles tendonitis and he has not seen any of the healing inflammatory changes you would expect to see post treatment. Not sure why. He also said it does take a few months until the reduction of inflammation can be measured. We have been doing in office ultrasound exams to measure the inflammation as well and did notice some change at the 8 week point and more at the 12 week point.

A few notes from the meeting in Chicago -

Dr. Roumpe (sp??) from Germany found devascularisation using ESW for the achilles and was not encouraged. Dr. Weil, jr found his results for the achilles to be less then for PF, somewhere at 60%. Personally, I am not doing it as healthtronics does NOT want the Ossatron used off label.

In discussing off label use, the problem is there isn't a standard or studies to back up the amount being used. This IS different then using Rx drugs off label, as the dosages are already proven and its usually the affects that are appreciated in different ways. For those that are using ESW off label, what studies are you basing your technique on?? What controls are you using? That IS EXACTLY way we have an FDA in the US.

Also, you all should be clear on the FDA approval of each of the machines. The Ossatron is still the ONLY ESW machine FDA approved to use specifically on PF!!! I am also begining to hear of some complications occuring to the plantar musculature, confirmed by high resolution ultrasound, so I am still convinced that the ESW is not to be used abstractly on body parts without that particular machine being tested. Sorry, I don't have much more information, my source would not devulge any info such as which machine, what settings, etc.....although I am tempted to use it on a few non surgical candidates that have achilles tendonitis....

Re: ESWT reimbursement

Dr. Zuckerman on 8/24/01 at 22:00 (057891)

It is my understanding that you should not use high energy machines such as the ossatron for Achilles tendonitis due to the high energy out put

Does the ossatron have any animal studies showing its effect on bone. The
orbasone did do animal studies on bone which showed that there was no damage to the bone.

Very important to be able to use low energy and not high energy with the
achilles tendon. This is one of the major draw back for the ossatron and why it may not be the machine to be used for achilles tendonitis.

To date the only machine that I am aware of that has maybe caused pf rupture is the ossatron. I am hearing that ESWT certified trained doctors are using whatever ever kv they want. I just read Dr. Smith's article in
Podiatry today where he is going past 20 and 21 kv.

So where is the FDA role in doctor's using the kv setting past what was done the original FDA plantar fasciitis studies

All I have seen is increased costs with FDA studies . Safety is extremely
important and I would like to see any animal studies if they were ever done
or required by the FDA.

Dr. Reid are you aware of any animal studies that were done for the ossatron and are you aware of any limits on kv useage with the ossatron.

Re: ESWT reimbursement

john h on 8/25/01 at 10:37 (057914)

Dr Reid: what stretch do you suggest? Perhaps the runners stretch of the calf and achilles?

Re: ESWT reimbursement

john h on 8/25/01 at 10:39 (057915)

barb i think you and i could easily operate the machine and probably have seen enouhg to place it in the correct spot but we would probaly be administering shock waves to people with gall bladder problems.

Re: ESWT reimbursement

Nancy N on 8/25/01 at 12:07 (057926)

Are they using ESWT (or its relatives) on gallstones now? Wow, that sure would have been more pleasant than surgery, and I would still have a gall bladder now! Or maybe it is better to take it out so that the problem doesn't recur? (Or did you mean kidneys and not gall bladder? :) )

Re: ESWT reimbursement

john h on 8/28/01 at 18:37 (058290)

nancy: they do remove gallstones through a scope these days and it is not near the deal it once was. i think it is in and out in 1 day.