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Posted by dave r on 8/13/02 at 07:33 (092340)

I will be having my second eswt treatment at doctor Z's office on the 24th of this month. I feel that i improved about 20% overall from the first treatment. Its been 20 weeks since my first treatment. I believe that i have evaluated the time frame farely well. I know that John has mentioned to me that 6 months is enough time to reevaluate where your pain threshold is at. Doctor Z has been very helpful in with feedback since my first treatment. i know that there are still some non believers out there. But for myself i strongly think i no longer have any more options except for going under the knife. For those of you that dont know me i have been a silent part of this message board for a long time. I have been suffering with pf for the better part of five years. Wish me luck.

Re: eswt

Pauline on 8/13/02 at 08:18 (092344)

Dave,
I firmly believe any option that will keep someone from undergoing P.F. surgery is a chance worth taking no matter what the cost. Just because a surgical procedure is covered by insurance doesn't guarantee in any way that it will provide pain relief, cure the problem, or not create additional ones.

Currently, the is no reason in the U.S. for anyone who is an ESWT provider to lower their price. My suggestion, would be for anyone in the U.S. close to the Canadian border, that might be considering surgery, go to Canada for this treatment and take advantage of the exchange rate. I know it's out of pocket money and not everyone will be able to afford to do this, but the option is there. If they get relief they might save themselves a whole lot of needless suffering from a surgical procedure that holds even less of a promise.

Re: Cost of ESWT...getting lower

David L on 8/13/02 at 11:20 (092357)

Pauline,
Regarding lower costs for ESWT, I think you'll find that now that there is a low energy alternative on the market (Siemens Sonocur) that costs have already been reduced from thousands per treatment into the hundreds per treatment. Since low energy doesn't require anesthesia and has lower disposible costs, it is able to be delivered at a fraction of the cost. Sonocur was approved by the FDA on July 19 and already there are over 30 locations where it is currently available or they are waiting for the device to be delivered. See. http://www.sonorex.com/us for locations. More are being added each day. Press coverage has been significant already. There was a story that was on CBS Sunday Morning as well as a number of other local stations. It can be seen at
http://www.newstream.com/assets/2002/08/06/20020806ML6107/08MC02-0075_V_Preview.ram

As for insurance, I understand that many patients have already been preapproved as low energy offers an incentive to the insurance companies to cover ESWT as it is now a cheaper alternative that many other treatments. I heard from a friend of mine at an orthopedic clinic in Baltimore that they've had their machine for just over a week and they are considering getting another one already.

The next little while is going to be very interesting to watch the proliferation of ESWT devices as costs become lower, and patients and insurance companies become educated about wonderful technology that everyone on this board has known about for years.

Re: Cost of ESWT...

Dr. Zuckerman on 8/13/02 at 11:31 (092359)

Hi David

What plans does the soncur have for getting FDA approval for pf. All of the pateints on this board suffer from Pf. It is my understanding that as a podiatrist I won't beable to purchase the soncur due to lack of FDA approval in the USA for Pf. How as a podiatrist can I bill for a non-approved procedure . I have also been told that the three treatment protcol on the USA will run about $2000. Any information you may have to our posters is appreciated

Re: Cost of ESWT...getting lower

Pauline on 8/13/02 at 11:32 (092360)

David,
This certainly is good news for the patient. I remember the postings about Sonocur being FDA approved, but I don't remember any actual treatment cost in $$$ to the patient. Maybe I just missed the posting.

When you speak in hundreds do you have any actual price figures? Elliott's article about Emory Clinic mentioned $1000 for the Dornier and Dr. Z posted his at I think $2500 per foot. Are you saying the new machine is already undercutting these prices in the U.S. Wow!

Re: Cost of ESWT...getting lower

David L on 8/13/02 at 11:51 (092364)

I don't have any specific figures as each location charges different prices depending on their market and their individual situations and overhead. The devices are in existing orthopaedic clinics. As for the cost of the Dornier treatment at the Emory Clinic, do you know if that includes physicians fees, anesthesia fees etc? I know that the 'hundreds' range that I mentioned is an all-inclusive fee that encompasses professional and technical fees.

Re: Cost of ESWT...

David L on 8/13/02 at 11:56 (092366)

Dr. Z.
Here is the text of the Food & Drug Act relating to your question:

SEC. 906 PRACTICE OF MEDICINE. --

Nothing in this Act shall be construed to limit or interfere with the authority of a health care practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship. This section shall not limit any existing authority of the Secretary to establish and enforce restrictions on the sale or distribution, or in the labeling, of a device that are part of a determination of substantial equivalence, established as a condition of approval, or promulgated through regulations. Further, this section shall not change any existing prohibition on the promotion of unap- proved uses oflegally marketed devices.

I would assume that doctors would be billing under the CPT code 0019T which is extracorporeal shock wave therapy; involving the musculoskeletal system. (http://www.ama-assn.org/ama/pub/article/3885-4897.html)

Re: Cost of ESWT...

BrianG on 8/13/02 at 22:02 (092409)

Hi David,

I think I had a little trouble understanding your quote. Can you tell me who can legally use the Sonocur ESWT machine for PF? Any doctor? An Ortho? A Pod? John Doe, the Veterinarian?

Thanks
BrianG

Re: eswt

john h on 8/14/02 at 11:08 (092449)

Dave: i like your choice. i think we are getting caught up in a lot of stats, studies, and data when the bottom line is if your feet are really putting a hurt on you then you need to do something. eswt has been around long enough to know the risk of harm is very very minimal so if you can afford it go for it. it just might work. what is 10 years or a lifetime of pain worth in dollars and cents?

Re: Cost of ESWT...getting lower

rob. a on 8/15/02 at 14:26 (092580)

I agree 100% of what you say! Artificially inflated prices don't usually last long once more competition enters the market.

Re: eswt

Pauline on 8/13/02 at 08:18 (092344)

Dave,
I firmly believe any option that will keep someone from undergoing P.F. surgery is a chance worth taking no matter what the cost. Just because a surgical procedure is covered by insurance doesn't guarantee in any way that it will provide pain relief, cure the problem, or not create additional ones.

Currently, the is no reason in the U.S. for anyone who is an ESWT provider to lower their price. My suggestion, would be for anyone in the U.S. close to the Canadian border, that might be considering surgery, go to Canada for this treatment and take advantage of the exchange rate. I know it's out of pocket money and not everyone will be able to afford to do this, but the option is there. If they get relief they might save themselves a whole lot of needless suffering from a surgical procedure that holds even less of a promise.

Re: Cost of ESWT...getting lower

David L on 8/13/02 at 11:20 (092357)

Pauline,
Regarding lower costs for ESWT, I think you'll find that now that there is a low energy alternative on the market (Siemens Sonocur) that costs have already been reduced from thousands per treatment into the hundreds per treatment. Since low energy doesn't require anesthesia and has lower disposible costs, it is able to be delivered at a fraction of the cost. Sonocur was approved by the FDA on July 19 and already there are over 30 locations where it is currently available or they are waiting for the device to be delivered. See. http://www.sonorex.com/us for locations. More are being added each day. Press coverage has been significant already. There was a story that was on CBS Sunday Morning as well as a number of other local stations. It can be seen at
http://www.newstream.com/assets/2002/08/06/20020806ML6107/08MC02-0075_V_Preview.ram

As for insurance, I understand that many patients have already been preapproved as low energy offers an incentive to the insurance companies to cover ESWT as it is now a cheaper alternative that many other treatments. I heard from a friend of mine at an orthopedic clinic in Baltimore that they've had their machine for just over a week and they are considering getting another one already.

The next little while is going to be very interesting to watch the proliferation of ESWT devices as costs become lower, and patients and insurance companies become educated about wonderful technology that everyone on this board has known about for years.

Re: Cost of ESWT...

Dr. Zuckerman on 8/13/02 at 11:31 (092359)

Hi David

What plans does the soncur have for getting FDA approval for pf. All of the pateints on this board suffer from Pf. It is my understanding that as a podiatrist I won't beable to purchase the soncur due to lack of FDA approval in the USA for Pf. How as a podiatrist can I bill for a non-approved procedure . I have also been told that the three treatment protcol on the USA will run about $2000. Any information you may have to our posters is appreciated

Re: Cost of ESWT...getting lower

Pauline on 8/13/02 at 11:32 (092360)

David,
This certainly is good news for the patient. I remember the postings about Sonocur being FDA approved, but I don't remember any actual treatment cost in $$$ to the patient. Maybe I just missed the posting.

When you speak in hundreds do you have any actual price figures? Elliott's article about Emory Clinic mentioned $1000 for the Dornier and Dr. Z posted his at I think $2500 per foot. Are you saying the new machine is already undercutting these prices in the U.S. Wow!

Re: Cost of ESWT...getting lower

David L on 8/13/02 at 11:51 (092364)

I don't have any specific figures as each location charges different prices depending on their market and their individual situations and overhead. The devices are in existing orthopaedic clinics. As for the cost of the Dornier treatment at the Emory Clinic, do you know if that includes physicians fees, anesthesia fees etc? I know that the 'hundreds' range that I mentioned is an all-inclusive fee that encompasses professional and technical fees.

Re: Cost of ESWT...

David L on 8/13/02 at 11:56 (092366)

Dr. Z.
Here is the text of the Food & Drug Act relating to your question:

SEC. 906 PRACTICE OF MEDICINE. --

Nothing in this Act shall be construed to limit or interfere with the authority of a health care practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship. This section shall not limit any existing authority of the Secretary to establish and enforce restrictions on the sale or distribution, or in the labeling, of a device that are part of a determination of substantial equivalence, established as a condition of approval, or promulgated through regulations. Further, this section shall not change any existing prohibition on the promotion of unap- proved uses oflegally marketed devices.

I would assume that doctors would be billing under the CPT code 0019T which is extracorporeal shock wave therapy; involving the musculoskeletal system. (http://www.ama-assn.org/ama/pub/article/3885-4897.html)

Re: Cost of ESWT...

BrianG on 8/13/02 at 22:02 (092409)

Hi David,

I think I had a little trouble understanding your quote. Can you tell me who can legally use the Sonocur ESWT machine for PF? Any doctor? An Ortho? A Pod? John Doe, the Veterinarian?

Thanks
BrianG

Re: eswt

john h on 8/14/02 at 11:08 (092449)

Dave: i like your choice. i think we are getting caught up in a lot of stats, studies, and data when the bottom line is if your feet are really putting a hurt on you then you need to do something. eswt has been around long enough to know the risk of harm is very very minimal so if you can afford it go for it. it just might work. what is 10 years or a lifetime of pain worth in dollars and cents?

Re: Cost of ESWT...getting lower

rob. a on 8/15/02 at 14:26 (092580)

I agree 100% of what you say! Artificially inflated prices don't usually last long once more competition enters the market.