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patient-owned ESWT machines

Posted by scott r on 8/20/02 at 11:03 (092989)

I should have thought of this earlier, but maybe I could get a group of patients together to buy an ESWT machine and give it to a podiatrist. He/she would be limited to a profit of something like $200 per treatment (both feet!). The original group of 50 or so patients who put the $3,500 down for the machine would be guaranteed (along with, say, 2 friends) unlimited lifetime treatments. Then I could bill it as a patient-owned machine offering the lowest-cost treatments in the country. It would be in Atlanta because of the international airport and close to heelspurs.com LLC. The goal would be less than $400 treatments. The only negative would be the airplane cost and heel sufferers having to navigate airports.

Re: patient-owned ESWT machines

Dr. Zuckerman on 8/20/02 at 12:51 (092994)

Hey I will move to Atlanta. So why do I only get $200 . Let's talk about buddy. After all I am the Wizard. !!!. I bet that patients would go for this.

Re: patient-owned ESWT machines

scott r on 8/20/02 at 13:50 (092998)

Since low-power machines require several treatments over several days, it might be best to put it on a beach somewhere so that patients could make it a relaxing vacation. Otherwise, maybe high-power is best. If I can 50 get people pay $2000, then heelspurs.com LLC could pay the rest, but then the cost of treatments would have to rise to reimburse heelspurs.com LLC. My goal is to bring cost down, not up, which is why 100% patient-owned would be best.

Re: patient-owned ESWT machines

Ed Davis, DPM on 8/20/02 at 19:09 (093016)

Interesting idea. There would be a lot of arguments about locations though. Perhaps someplace central like Chicago.
Ed

Re: patient-owned ESWT machines

BrianG on 8/20/02 at 20:48 (093029)

Hi Scott,

There seems to be something missing here. What do the original investors get for their $3,500, besides a few treatments? You must be assuming the insurance companies will not be paying for ESWT, any time soon. Also, will any profits be shared after the machine is paid off? Or, will their be no profits, other than the Pod's $200 stipend?

BrianG

PS: I also see more, less expensive ESWT machines on the horizon. Will you be able to compete with them?

Re: right

elliott on 8/20/02 at 22:51 (093041)

Unlimited lifetime treatments have limited value when the literature says that two complete (sets of) treatments are the most anyone would need.

One more thing: any pod who would be part of such an enterprise would probably lose his credentials from the pod organizations for undercutting the rest and hence would be unable to legally administer the treatment.

--

Re: before buying such an expensive machine, don't you want to wait to see...

elliott on 8/20/02 at 22:54 (093042)

the FDA report? :-)

Re: patient-owned ESWT machines

Dr. Marlene Reid on 8/21/02 at 01:53 (093047)

I like the Chicago idea!

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 06:58 (093058)

There would be no profits other than the $200 for the physician unless heelspurs.com LLC has to pay half of it. The original investors get treated for $3,500 instead of having to pay $10,000 or more for multiple treatments. They also get the knowledge that other patients won't have to be ripped off. I guess there might be another plan to follow, like a 'multi-level marketing' plan where you sell treatments to the highest bidder on ebay and the first buyers are also buying stock in the machine.

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 06:59 (093059)

Hi Marlene, do you want to be the Pod involved? You OK with $200 per treatment including evaluating the patient?

Re: before buying such an expensive machine, don't you want to wait to see...

Dr. Zuckerman on 8/21/02 at 07:31 (093065)

I like your thinking.!!!. I will be in touch in person tommorrow with someone who should have the report

Re: patient-owned ESWT machines

Ed Davis, DPM on 8/21/02 at 15:20 (093110)

Brian's concerns are really the same that any physician investor has to think of. All investments have risks. One of the big risks is involved in investing a lot of money in a rapidly changing technology. The equipment would need to have sufficient use to recoup the investment in a reasonable amount of time, that is, an amount of time before the technology is supplanted by a cheaper one.
Ed

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/21/02 at 17:57 (093132)

Scott R. You can resolve the location problem of the machine by having it moved to different locations on a scheduled basis. For instance, three months in Atlanta then three months in Chicago and so on. The hard part is complying with all the legal requirements. Or you can solicit more investors and get multiple machines and set yourself up as a non-profit corporation.

Re: patient-owned ESWT machines

JudyS on 8/21/02 at 19:53 (093144)

Hold on there a second, Drs! Chicago, as swell as it is, is only central to the midwest! But it is a good air-travel center....
How about somewhere in Kansas? :)

Re: patient-owned ESWT machines

JudyS on 8/21/02 at 20:02 (093146)

So Scott, are you looking at this as something of a social service given the horribly high cost of ESWT?
Here's another take on your idea; given the evolving nature of ESWT (better machines, probable insurance coverage, etc) why not actually use this patient-owned machine as an investment? We could still charge much less than is charged now and, with insurance coverage, should be able to turn a profit.

Re: patient-owned ESWT machines

Dr. Zuckerman on 8/21/02 at 20:21 (093155)

I would be very happy to help you set this up if you are serious.?
I am not sure if patients can set up ESWT groups or own medical equipment but if you are serious then I will help you . We can call the company Heel pain misery gone without surgery or something like that

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 20:44 (093159)

The physician wouldn't invest anything in the machine, so there aren't any costs to recoup.

Re: before buying such an expensive machine, don't you want to wait to see...

Scott R on 8/21/02 at 21:12 (093163)

Good idea Rob, but having to deal with more than one pod might be cumbersome. I would be happiest to not be involved in the money aspect. I hear being a non-profit is a great deal of trouble to set up. As far as getting the legal requirements satisfied, maybe I could let Dr. Z take responsibility for that. Patients could give the machine to Dr. Z. It would be one of those HMT machines from the U.K. identical to the FDA-approved machine that passes FDA heel pain requirements and are ignoring HMT's legal responsibility to their american distributor, thereby selling the machine for $175,000 instead of $500,000.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:31 (093195)

Expensive equipment. I was at the Baptist Health Center this morning. There MRI section has 3 machines that run from 7am to 11pm 6 days a week and are fully scheduled. I estimate revenue at around 2.5 million per year for these machines. Of course they have tremendous overhead.

Interesting when I asked them about the new Open Machines. They said they had just got rid of the one they had because they were not producing as good a image as the tube type. Another facility in town also got rid of their open machine for the same reason.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:38 (093198)

Judy: I think the geographical center of the U.S. is located somewhere in Kansas so right you are. How about Wichita? I lived there and enjoyed it.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:41 (093199)

There are Farmers Co-Ops and Electrical Co-Ops so why not a EPOS,Sonnocur,Etc Co-OP. Actually most hospital do not own their expensive equipment such as an MRI but lease it from a middle man either on a per use basis or fixed charge. The middle man is sometimes a group of investors who you guessed it are a group of doctors.

Re: patient-owned ESWT machines

Pauline on 8/22/02 at 10:43 (093206)

John,
Three MRI machines all located and housed in ONE hospital. Remember that picture. This is a picture of America without Socialized Medicine.

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/22/02 at 17:30 (093248)

I would be concerned over HealthTronics slapping a lawsuit by not buying through them. I think it is not HMT selling the Ossatron behind HealthTronic's back but more likely HMT selling it to someone in Europe then that entity turning around and selling it to someone in the U.S. That would keep HMT in legal compliance yet still get the units in this country. It is a legal technocality, but an important one. By the way, is there a spellcheck feature on this board? I need it badly!

Re: patient-owned ESWT machines

rob. a on 8/22/02 at 17:46 (093251)

I think if you are serious about finding the right locations then some of the more important factors are; states that have a large number of insurance carriers that will cover ESWT(so the fewest number of people have to pay out of network expenses), airports that have competitive rates to get there (usally a non-hub airport to any of the major airlines),an area with reasonable hotel and car rental rates (not Chicago or Atlanta) and states that do not have Certificate Of Need requirements (they limit the number of machines allowed and it takes an act of congress to set up in those areas, unless of course, you have a doctor or facility that already has a CON).

Re: before buying such an expensive machine, don't you want to wait to see...

Scott R on 8/22/02 at 18:07 (093258)

Sorry, the system doesn't have a spell check. I, the patients, nor the pods have an agreement with HealthTronics, so they couldn't sue (successfully) over anything. It's kind of like HealthTronics has a right to be upset if it happens, but I believe the only entity doing something wrong if it does happen is HMT for not having agreements in place with all buyers that would protect HealthTronics. Even if HealthTronics wasn't smart enough to get a solid contract with HMT that protects itself, the intent of the agreement seems clear that HMT should not allow end runs around HealthTronics, and they could sue HMT based on intent of the contract. However, if the contract implies in any way that HealthTronics got the distributorship for the purpose of helping HMT to keep prices down or to distribute more rapidly or freely, then it would be HealthTronics who has broken the contract or its intent, assuming a contract exists. If HMT has agreements with buyers to protect healthtronics, then it would be the U.K. company or whoever who is liable for HealthTronics losses through HMT. Either way, the purchaser(s) and users of the machine are not liable and could only be blocked if there is something in FDA regs that I'm not aware of.

Re: patient-owned ESWT machines

Glynis B on 8/22/02 at 18:15 (093261)

Hey,an even better idea would be for you to bring it to Southwestern Ontario where it would be really needed and appreciated since health benefits here are always behind the times. I am not aware of any Ontario plans covering ESWT. And hey, your U.S. dollars go a long way here!

Re: patient-owned ESWT machines

Sunny Jacob - Bayshore on 8/22/02 at 20:36 (093273)

Glynis,

Based on your idea, if the 'co-op equipment' from heelspurs is placed in South-Western Ontario, who is going to cover the operating cost and what
benefit do the patients get from their original investment? If this theory works, why can't one start a whole hospital?

We operate two ESWT clinics in the Toronto area and would gladly start one in South-Western Ontario. However, just to cover the basic expenses, i.e. labour, equipment financing, space, insurance and related overhead one needs a minimum of 10 new patients per month. Do you realistically think one can expect so many patients from that area, especially since the treatment is not covered by OHIP and only a few Canadian third party insurances pay for the treatment. Although we would treat not only PF and tennis elbow, but also Patellar tendonitis, Achilles tendonitis, rotator cuff tendonitis and bursitis, based on our demographic and market studies, the patient flow from that area alone would not be enough to break even.

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/23/02 at 05:35 (093287)

I'm not implying that you would be doing anything wrong. I just wanted you to be aware that in most cases when a lawsuit is initiated, all partys are usually mentioned from the initial distributor to the end user. It might simply cost some money for legal protection or service could be suspended by court order until the issues are resolved. If service is suspended, any overhead still would have to be covered and that could deplete monatery reserves of the company. I think you have a very good idea. Patient co-ops might even be the wave of the future for some treatments and diagnostic equipment for all I know. Just looking out for your well being. This concept needs deeper evaluation medically, leagally and finacially.

Re: patient-owned Ontario machines

Scott R on 8/23/02 at 06:39 (093290)

Hi Glynis,
The idea wouldn't work in Canada because bayshore is already charging competitive rates. It's needed for the U.S. and would have a lot of customers because the cost is so much here.

Re: patient-owned ESWT machines

john h on 8/23/02 at 18:32 (093358)

Sunny: Did Dr. Gordon complete the study he was engaged with on ESWT. I never did read his paper he delivered in Europe???

Re: patient-owned ESWT machines

john h on 8/23/02 at 18:46 (093363)

Pauline: We have at least 10-15 MRI machine in the Little Rock area Pauline and they all run 6 days a week full blast. I would not be supprised if NFL teams do not own their own and have it in the stadium. Thinking back to when they first came on the market it was not easy to get insurance approval to get an MRI and the cost was very very expensive. Now all insurance companies and Medicare cover them and the cost has come way down. Let us hope ESWT equipment will have the same fate.

I attended a seminar with the Bonati Institute who perform arthroscopic surgery on the spine, shoulders, etc. It was interesting to hear that most insurance (no out of area HMO's) including Medicare will cover their cost except for the hospital room and all cost associated with it. The reason being that they do not use a general anasthetic in any of their procedures. Everything is done under a local and their are no overnight stays. This does not fit the protocol for back surgery under Medicare so they will pay the Doctor, the rehab, but no hospital cost. Is that weird or what??

Re: patient-owned ESWT machines

Dr. Marlene Reid on 8/23/02 at 21:36 (093376)

We could talk.

Re: patient-owned ESWT machines

Sunny Jacob - Bayshore on 8/24/02 at 19:45 (093433)

John,
The study we are doing is a double blind study for which the patients are selected at random. It is a comparison study for low and high energy ESWT. and is continuing. To get a sufficient number of patient groups for various tendinopathies will take some time.
There were three other papers on ESWT presented by Dr. Gordon in Switzerland, including Pseudarthrosis. They were published by ISMST and can be requested from them directly.Their email address is (email removed)

Re: right

Joe S on 8/25/02 at 23:10 (093534)

Also I believe that any physician who is part owner in this device would be breaking the law by violating the Stark Laws. It could be considered a kickback by some.

Re: right

Dr. Zuckerman on 8/25/02 at 23:48 (093536)

Don't worry this specific arangement is very unlikely. The Stark law wouldn't apply to any ESWL/ESWT machine. They are part of the safe habor
exclusion. Now fraud and abuse is something else

Re: right

Pauline on 8/26/02 at 10:27 (093545)

How does safe habor and the Stark laws apply to ESWT if a physician is soliciting for patients then referring them to his partners if all partners share ownership of the same treatment center? Does exclusion for one circomstance exclude ESWT for all others?

Re: patient-owned ESWT machines

john h on 8/26/02 at 10:48 (093549)

Sunny: the market place has a way of working things out in the long run when it comes to efficiency. sometimes middle men disappear, new products appear, and eventually water seeks its own level. if there is a place for a co-op eswt equipment it will eventually surface but I doubt it.

Two page article in Sunday paper on insurance problems in our country driving doctors and hospitals out of business and into other specialities. An obstectrics specialist in the Miami area now pays $250,000 per year for liabilty coverage. A hospital group near Philadelphia had their liability premium jump to $32 million dollars annually. Many hospitals are closing their trauma centers and in particular birth centers as these are high risk for law suits. Last year the average jury award was around $3 million dollars for malpractice and one was $40 million. Doctors continue to order every test available to protect themselves from lawsuits. Some hospital no longer have neurosurgeons or even an orthopedic surgeon on staff. Hospitals on border states with Mexico are being totally overwhelmed as they by law are forced to treat illegal aliens who cross the border for free treatment. Even the legal farm workers use the emergency rooms as their primary care facility. Many hospital face bankruptcy. Border state senators are pleading with the federal government for money to cover the cost to cover illegals and legals. Many doctors are moving to states that have a cap on law suits for pain and suffering. I am appaled at the TV advertising by Lawyer who seek people to sue just about anyone for anything. Our law profession has sunk to a new all time low in my opinion.

Re: patient-owned ESWT machines

Pauline on 8/26/02 at 12:53 (093560)

I'm appaled at the federal government forcing U.S. citizens in border states and elsewhere to continually pay the health costs for illegals in this country.

Citizens in Calif. and other border states can't keep up with the illegals crossing the border and all the costs associated with it.

Re: patient-owned ESWT machines

JudyS on 9/01/02 at 10:55 (094127)

And the latest, Pauline, is our CA governor, G. Davis, proposing that undocumented immigrants (formerly 'illegal aliens') be granted driver's licenses. Last year a proposal was floated to allow the same folks tuition-free status (as CA residents) to the state's university system.

Re: patient-owned ESWT machines

Pauline on 9/01/02 at 12:07 (094131)

Judy,
Why do Californian's settle for this? The sad thing is that people not living in border state really has how this impacts the Calif Citizen. We live in a different part of the U.S. untouched by these things and don't seem to care what is happening before our very eyes.

I hope the proposals your talking about and all other similar proposals fail. If they don't soon our undocumented immigrants will have more rights and benefits that those provided to our own citizens especially those in our aging population. I'd say it's time for people to wake up. What's happening in California will eventually spread to every state.

How do you cope?

Re: patient-owned ESWT machines

john h on 9/01/02 at 21:35 (094177)

Judy: One thing California got out in front on is capping pain and suffering awards to $250,000 in medical malpractice suits. You can still be awarded what ever it takes for actual damages but your doctors are not leaving the state because of malpractice insurance. As a matter of fact Doctors from Nevada are headed your way. I read that recently in Las Vegas there were no emergency rooms open for a period of time.because of a lack of Doctors (mal practice claims again).

Re: patient-owned ESWT machines

Dr. Zuckerman on 8/20/02 at 12:51 (092994)

Hey I will move to Atlanta. So why do I only get $200 . Let's talk about buddy. After all I am the Wizard. !!!. I bet that patients would go for this.

Re: patient-owned ESWT machines

scott r on 8/20/02 at 13:50 (092998)

Since low-power machines require several treatments over several days, it might be best to put it on a beach somewhere so that patients could make it a relaxing vacation. Otherwise, maybe high-power is best. If I can 50 get people pay $2000, then heelspurs.com LLC could pay the rest, but then the cost of treatments would have to rise to reimburse heelspurs.com LLC. My goal is to bring cost down, not up, which is why 100% patient-owned would be best.

Re: patient-owned ESWT machines

Ed Davis, DPM on 8/20/02 at 19:09 (093016)

Interesting idea. There would be a lot of arguments about locations though. Perhaps someplace central like Chicago.
Ed

Re: patient-owned ESWT machines

BrianG on 8/20/02 at 20:48 (093029)

Hi Scott,

There seems to be something missing here. What do the original investors get for their $3,500, besides a few treatments? You must be assuming the insurance companies will not be paying for ESWT, any time soon. Also, will any profits be shared after the machine is paid off? Or, will their be no profits, other than the Pod's $200 stipend?

BrianG

PS: I also see more, less expensive ESWT machines on the horizon. Will you be able to compete with them?

Re: right

elliott on 8/20/02 at 22:51 (093041)

Unlimited lifetime treatments have limited value when the literature says that two complete (sets of) treatments are the most anyone would need.

One more thing: any pod who would be part of such an enterprise would probably lose his credentials from the pod organizations for undercutting the rest and hence would be unable to legally administer the treatment.

--

Re: before buying such an expensive machine, don't you want to wait to see...

elliott on 8/20/02 at 22:54 (093042)

the FDA report? :-)

Re: patient-owned ESWT machines

Dr. Marlene Reid on 8/21/02 at 01:53 (093047)

I like the Chicago idea!

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 06:58 (093058)

There would be no profits other than the $200 for the physician unless heelspurs.com LLC has to pay half of it. The original investors get treated for $3,500 instead of having to pay $10,000 or more for multiple treatments. They also get the knowledge that other patients won't have to be ripped off. I guess there might be another plan to follow, like a 'multi-level marketing' plan where you sell treatments to the highest bidder on ebay and the first buyers are also buying stock in the machine.

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 06:59 (093059)

Hi Marlene, do you want to be the Pod involved? You OK with $200 per treatment including evaluating the patient?

Re: before buying such an expensive machine, don't you want to wait to see...

Dr. Zuckerman on 8/21/02 at 07:31 (093065)

I like your thinking.!!!. I will be in touch in person tommorrow with someone who should have the report

Re: patient-owned ESWT machines

Ed Davis, DPM on 8/21/02 at 15:20 (093110)

Brian's concerns are really the same that any physician investor has to think of. All investments have risks. One of the big risks is involved in investing a lot of money in a rapidly changing technology. The equipment would need to have sufficient use to recoup the investment in a reasonable amount of time, that is, an amount of time before the technology is supplanted by a cheaper one.
Ed

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/21/02 at 17:57 (093132)

Scott R. You can resolve the location problem of the machine by having it moved to different locations on a scheduled basis. For instance, three months in Atlanta then three months in Chicago and so on. The hard part is complying with all the legal requirements. Or you can solicit more investors and get multiple machines and set yourself up as a non-profit corporation.

Re: patient-owned ESWT machines

JudyS on 8/21/02 at 19:53 (093144)

Hold on there a second, Drs! Chicago, as swell as it is, is only central to the midwest! But it is a good air-travel center....
How about somewhere in Kansas? :)

Re: patient-owned ESWT machines

JudyS on 8/21/02 at 20:02 (093146)

So Scott, are you looking at this as something of a social service given the horribly high cost of ESWT?
Here's another take on your idea; given the evolving nature of ESWT (better machines, probable insurance coverage, etc) why not actually use this patient-owned machine as an investment? We could still charge much less than is charged now and, with insurance coverage, should be able to turn a profit.

Re: patient-owned ESWT machines

Dr. Zuckerman on 8/21/02 at 20:21 (093155)

I would be very happy to help you set this up if you are serious.?
I am not sure if patients can set up ESWT groups or own medical equipment but if you are serious then I will help you . We can call the company Heel pain misery gone without surgery or something like that

Re: patient-owned ESWT machines

Scott R on 8/21/02 at 20:44 (093159)

The physician wouldn't invest anything in the machine, so there aren't any costs to recoup.

Re: before buying such an expensive machine, don't you want to wait to see...

Scott R on 8/21/02 at 21:12 (093163)

Good idea Rob, but having to deal with more than one pod might be cumbersome. I would be happiest to not be involved in the money aspect. I hear being a non-profit is a great deal of trouble to set up. As far as getting the legal requirements satisfied, maybe I could let Dr. Z take responsibility for that. Patients could give the machine to Dr. Z. It would be one of those HMT machines from the U.K. identical to the FDA-approved machine that passes FDA heel pain requirements and are ignoring HMT's legal responsibility to their american distributor, thereby selling the machine for $175,000 instead of $500,000.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:31 (093195)

Expensive equipment. I was at the Baptist Health Center this morning. There MRI section has 3 machines that run from 7am to 11pm 6 days a week and are fully scheduled. I estimate revenue at around 2.5 million per year for these machines. Of course they have tremendous overhead.

Interesting when I asked them about the new Open Machines. They said they had just got rid of the one they had because they were not producing as good a image as the tube type. Another facility in town also got rid of their open machine for the same reason.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:38 (093198)

Judy: I think the geographical center of the U.S. is located somewhere in Kansas so right you are. How about Wichita? I lived there and enjoyed it.

Re: patient-owned ESWT machines

john h on 8/22/02 at 09:41 (093199)

There are Farmers Co-Ops and Electrical Co-Ops so why not a EPOS,Sonnocur,Etc Co-OP. Actually most hospital do not own their expensive equipment such as an MRI but lease it from a middle man either on a per use basis or fixed charge. The middle man is sometimes a group of investors who you guessed it are a group of doctors.

Re: patient-owned ESWT machines

Pauline on 8/22/02 at 10:43 (093206)

John,
Three MRI machines all located and housed in ONE hospital. Remember that picture. This is a picture of America without Socialized Medicine.

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/22/02 at 17:30 (093248)

I would be concerned over HealthTronics slapping a lawsuit by not buying through them. I think it is not HMT selling the Ossatron behind HealthTronic's back but more likely HMT selling it to someone in Europe then that entity turning around and selling it to someone in the U.S. That would keep HMT in legal compliance yet still get the units in this country. It is a legal technocality, but an important one. By the way, is there a spellcheck feature on this board? I need it badly!

Re: patient-owned ESWT machines

rob. a on 8/22/02 at 17:46 (093251)

I think if you are serious about finding the right locations then some of the more important factors are; states that have a large number of insurance carriers that will cover ESWT(so the fewest number of people have to pay out of network expenses), airports that have competitive rates to get there (usally a non-hub airport to any of the major airlines),an area with reasonable hotel and car rental rates (not Chicago or Atlanta) and states that do not have Certificate Of Need requirements (they limit the number of machines allowed and it takes an act of congress to set up in those areas, unless of course, you have a doctor or facility that already has a CON).

Re: before buying such an expensive machine, don't you want to wait to see...

Scott R on 8/22/02 at 18:07 (093258)

Sorry, the system doesn't have a spell check. I, the patients, nor the pods have an agreement with HealthTronics, so they couldn't sue (successfully) over anything. It's kind of like HealthTronics has a right to be upset if it happens, but I believe the only entity doing something wrong if it does happen is HMT for not having agreements in place with all buyers that would protect HealthTronics. Even if HealthTronics wasn't smart enough to get a solid contract with HMT that protects itself, the intent of the agreement seems clear that HMT should not allow end runs around HealthTronics, and they could sue HMT based on intent of the contract. However, if the contract implies in any way that HealthTronics got the distributorship for the purpose of helping HMT to keep prices down or to distribute more rapidly or freely, then it would be HealthTronics who has broken the contract or its intent, assuming a contract exists. If HMT has agreements with buyers to protect healthtronics, then it would be the U.K. company or whoever who is liable for HealthTronics losses through HMT. Either way, the purchaser(s) and users of the machine are not liable and could only be blocked if there is something in FDA regs that I'm not aware of.

Re: patient-owned ESWT machines

Glynis B on 8/22/02 at 18:15 (093261)

Hey,an even better idea would be for you to bring it to Southwestern Ontario where it would be really needed and appreciated since health benefits here are always behind the times. I am not aware of any Ontario plans covering ESWT. And hey, your U.S. dollars go a long way here!

Re: patient-owned ESWT machines

Sunny Jacob - Bayshore on 8/22/02 at 20:36 (093273)

Glynis,

Based on your idea, if the 'co-op equipment' from heelspurs is placed in South-Western Ontario, who is going to cover the operating cost and what
benefit do the patients get from their original investment? If this theory works, why can't one start a whole hospital?

We operate two ESWT clinics in the Toronto area and would gladly start one in South-Western Ontario. However, just to cover the basic expenses, i.e. labour, equipment financing, space, insurance and related overhead one needs a minimum of 10 new patients per month. Do you realistically think one can expect so many patients from that area, especially since the treatment is not covered by OHIP and only a few Canadian third party insurances pay for the treatment. Although we would treat not only PF and tennis elbow, but also Patellar tendonitis, Achilles tendonitis, rotator cuff tendonitis and bursitis, based on our demographic and market studies, the patient flow from that area alone would not be enough to break even.

Re: before buying such an expensive machine, don't you want to wait to see...

rob. a on 8/23/02 at 05:35 (093287)

I'm not implying that you would be doing anything wrong. I just wanted you to be aware that in most cases when a lawsuit is initiated, all partys are usually mentioned from the initial distributor to the end user. It might simply cost some money for legal protection or service could be suspended by court order until the issues are resolved. If service is suspended, any overhead still would have to be covered and that could deplete monatery reserves of the company. I think you have a very good idea. Patient co-ops might even be the wave of the future for some treatments and diagnostic equipment for all I know. Just looking out for your well being. This concept needs deeper evaluation medically, leagally and finacially.

Re: patient-owned Ontario machines

Scott R on 8/23/02 at 06:39 (093290)

Hi Glynis,
The idea wouldn't work in Canada because bayshore is already charging competitive rates. It's needed for the U.S. and would have a lot of customers because the cost is so much here.

Re: patient-owned ESWT machines

john h on 8/23/02 at 18:32 (093358)

Sunny: Did Dr. Gordon complete the study he was engaged with on ESWT. I never did read his paper he delivered in Europe???

Re: patient-owned ESWT machines

john h on 8/23/02 at 18:46 (093363)

Pauline: We have at least 10-15 MRI machine in the Little Rock area Pauline and they all run 6 days a week full blast. I would not be supprised if NFL teams do not own their own and have it in the stadium. Thinking back to when they first came on the market it was not easy to get insurance approval to get an MRI and the cost was very very expensive. Now all insurance companies and Medicare cover them and the cost has come way down. Let us hope ESWT equipment will have the same fate.

I attended a seminar with the Bonati Institute who perform arthroscopic surgery on the spine, shoulders, etc. It was interesting to hear that most insurance (no out of area HMO's) including Medicare will cover their cost except for the hospital room and all cost associated with it. The reason being that they do not use a general anasthetic in any of their procedures. Everything is done under a local and their are no overnight stays. This does not fit the protocol for back surgery under Medicare so they will pay the Doctor, the rehab, but no hospital cost. Is that weird or what??

Re: patient-owned ESWT machines

Dr. Marlene Reid on 8/23/02 at 21:36 (093376)

We could talk.

Re: patient-owned ESWT machines

Sunny Jacob - Bayshore on 8/24/02 at 19:45 (093433)

John,
The study we are doing is a double blind study for which the patients are selected at random. It is a comparison study for low and high energy ESWT. and is continuing. To get a sufficient number of patient groups for various tendinopathies will take some time.
There were three other papers on ESWT presented by Dr. Gordon in Switzerland, including Pseudarthrosis. They were published by ISMST and can be requested from them directly.Their email address is (email removed)

Re: right

Joe S on 8/25/02 at 23:10 (093534)

Also I believe that any physician who is part owner in this device would be breaking the law by violating the Stark Laws. It could be considered a kickback by some.

Re: right

Dr. Zuckerman on 8/25/02 at 23:48 (093536)

Don't worry this specific arangement is very unlikely. The Stark law wouldn't apply to any ESWL/ESWT machine. They are part of the safe habor
exclusion. Now fraud and abuse is something else

Re: right

Pauline on 8/26/02 at 10:27 (093545)

How does safe habor and the Stark laws apply to ESWT if a physician is soliciting for patients then referring them to his partners if all partners share ownership of the same treatment center? Does exclusion for one circomstance exclude ESWT for all others?

Re: patient-owned ESWT machines

john h on 8/26/02 at 10:48 (093549)

Sunny: the market place has a way of working things out in the long run when it comes to efficiency. sometimes middle men disappear, new products appear, and eventually water seeks its own level. if there is a place for a co-op eswt equipment it will eventually surface but I doubt it.

Two page article in Sunday paper on insurance problems in our country driving doctors and hospitals out of business and into other specialities. An obstectrics specialist in the Miami area now pays $250,000 per year for liabilty coverage. A hospital group near Philadelphia had their liability premium jump to $32 million dollars annually. Many hospitals are closing their trauma centers and in particular birth centers as these are high risk for law suits. Last year the average jury award was around $3 million dollars for malpractice and one was $40 million. Doctors continue to order every test available to protect themselves from lawsuits. Some hospital no longer have neurosurgeons or even an orthopedic surgeon on staff. Hospitals on border states with Mexico are being totally overwhelmed as they by law are forced to treat illegal aliens who cross the border for free treatment. Even the legal farm workers use the emergency rooms as their primary care facility. Many hospital face bankruptcy. Border state senators are pleading with the federal government for money to cover the cost to cover illegals and legals. Many doctors are moving to states that have a cap on law suits for pain and suffering. I am appaled at the TV advertising by Lawyer who seek people to sue just about anyone for anything. Our law profession has sunk to a new all time low in my opinion.

Re: patient-owned ESWT machines

Pauline on 8/26/02 at 12:53 (093560)

I'm appaled at the federal government forcing U.S. citizens in border states and elsewhere to continually pay the health costs for illegals in this country.

Citizens in Calif. and other border states can't keep up with the illegals crossing the border and all the costs associated with it.

Re: patient-owned ESWT machines

JudyS on 9/01/02 at 10:55 (094127)

And the latest, Pauline, is our CA governor, G. Davis, proposing that undocumented immigrants (formerly 'illegal aliens') be granted driver's licenses. Last year a proposal was floated to allow the same folks tuition-free status (as CA residents) to the state's university system.

Re: patient-owned ESWT machines

Pauline on 9/01/02 at 12:07 (094131)

Judy,
Why do Californian's settle for this? The sad thing is that people not living in border state really has how this impacts the Calif Citizen. We live in a different part of the U.S. untouched by these things and don't seem to care what is happening before our very eyes.

I hope the proposals your talking about and all other similar proposals fail. If they don't soon our undocumented immigrants will have more rights and benefits that those provided to our own citizens especially those in our aging population. I'd say it's time for people to wake up. What's happening in California will eventually spread to every state.

How do you cope?

Re: patient-owned ESWT machines

john h on 9/01/02 at 21:35 (094177)

Judy: One thing California got out in front on is capping pain and suffering awards to $250,000 in medical malpractice suits. You can still be awarded what ever it takes for actual damages but your doctors are not leaving the state because of malpractice insurance. As a matter of fact Doctors from Nevada are headed your way. I read that recently in Las Vegas there were no emergency rooms open for a period of time.because of a lack of Doctors (mal practice claims again).