Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

United Healthcare Insurance

Posted by Dr. Z on 2/20/03 at 13:20 (110059)

Dr. Z is now part of UHC and they cover ESWT. So we will accept UHC for ESWT . If you have any questions please e-mail Dr. Z at any time . I hope this help all chronic plantar fascia posters

Re: United Healthcare Insurance

Dr. A on 2/20/03 at 21:53 (110148)

I'm glad UHC finally came around in your area. They have covered ESWT in St. Louis area for 4 months now and more insurance carriers will follow the lead. GHP also covers the service in my area. Blue Cross/Blue Shield is already covering it in some areas and we are trying to get the coverage pushed through here. The walls of resistance are starting to crumble and positive changes are on the horizon. This will decrease the number of surgical procedures and increase the quality of life for my patients.
Its about time!

Re: United Healthcare Insurance

Dr. Z on 2/20/03 at 22:02 (110149)

We are still struggling with the Blue. The real issue will be when full coverage comes into play controlling proper utilizaiton

Re: United Healthcare Insurance

Dr. A on 2/20/03 at 22:18 (110152)

Dr. Z, you have been dealing with the insurance companies so long, you are starting to sound like them. Usually, they will place guidelines that limit utilization such as 6 months of failed conservative therapy by three different modalities. This is what has happened here. I believe this is not unreasonable. I would like to see this lowered to 3 months.

Re: United Healthcare Insurance

Dr. Z on 2/20/03 at 23:24 (110153)

Sorry. I meant Patient demand for this procedure. There is going to be such a demand that patients will have to wait months to get pre-certification or what they require. I am not talking about over-utilization

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 2/21/03 at 14:45 (110190)

Dr. Z:
The Blues have been problematic in my area too. They actually claim coverage for ESWT but the allowance is less than the cost price of performing Ossatron. As a consequence, the local limited partners will not allow use of the machine on Blue Shield patients.

By the way, a mobile Dornier unit will be comming to WA State. United Shock Wave Therapies is the company bringing it in. Have you heard of them?
They are holding a seminar on Monday, Feb. 24.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr. Z on 2/21/03 at 17:37 (110218)

I have heard of United Shockwave Therapy Company. I did some training for them in Va-Maryland sometime last summer. I am not sure of their arrangement. After the seminar let me know what you think of them.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Bill on 2/26/03 at 07:32 (110803)

Dr Davis,

You will find the presentation from United Shock Wave Therapies very interesting. They will offer to sell podiatrists shares in their company for $5,000 each and you can purchase up to 5 shares. They will show you how you will get a return of 40% in the first three months. They will state that they routinely receive $5,000 per case for each ESWT service and that their experience in Chicago gives them the edge. They looking to monopolize the market and use this power to get high prices for ESWT.

However, CMS has stated that ESWT is a covered by the Stark Law. This law prohibits physicians from referring patients covered by government insurance to companies that they are invested in.

If anyone wonders why insurance companies are reluctant to cover ESWT, consider that companies like United Shockwave Therapies are actively working to force companies to pay $5,000 per treatment, claiming that it costs a lot of money to offer ESWT. Then these same companies distribute excessive profits to their podiatrist owners. How can a $5,000 investment that returns 40% in three months be a fair market investment? Is it a payment for referral? Who benefits from this kind of organization?

By the way, if the treatment is not covered by insurance, then United Shockwave Therapies charges $500. Imagine, this pricing strategy creates an incentive for insurance companies to tell their patients that ESWT is not covered but the insurance company will contribute $500 to any treatment that the patient receives. Why should insurance companies cover ESWT and pay $5,000 per procedure when they can deny coverage and pay $500?

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr. Z on 2/26/03 at 12:24 (110850)

CMS removed ESWT from the physical Therapy Catagory, It is therefore my understanding that it isn't under the Stark Laws at this very moment. I guess this is one time that UNITED we stand UNITED we fall doesn't apply My sources tell us that CMS will revisit the ESWT pricing and placement into physical therapy

Re: Stark laws

Ed Davis, DPM on 2/26/03 at 15:37 (110885)

Bill:

One of the lecturers was a company rep from Dornier named 'Bill.' I was wondering but guess you are not him.

The investment is distributed among all the machines placed by United as opposed to only the machines placed in a locale or state. As such, there is sufficient dilution of the investment to come under a 'safe harbor' with respect to Stark.

They did not promise any specific return but implied the return would be substantial and seemed very 'gung ho.' My feeling is that such returns would only be possible over a short term basis. They made analogies to the renal lithotripsy market which is where United got started. The rapid rate of information flow these days will even out market 'inefficiencies' in much shorter periods of time than in the past, in my opinion.
Ed

Re: Stark laws- only applies to medicare and medicaid

Dr. Z on 2/26/03 at 15:50 (110888)

So if you don't treat these patients you aren't under the Stark laws

Re: Stark laws- only applies to medicare and medicaid

Ed Davis, DPM on 2/26/03 at 16:19 (110900)

Dr. Z:

That is true. Although, even with Medicare and Medicaid, there are 'safe harbors' ( a euphemistic term for loopholes). Most LPs in healthcare have healthcare attorneys scrutinize contracts based on that and would assume United has done their homework.

By the way, do you generally using the medial appraoch to the fascia recommended by Dornier? The plantar approach? Are you comfortable that the medial approach will not at times cause paresthesia of the medial calcaneal nerves?
Ed

Re: Stark laws- only applies to medicare and medicaid

Dr. Z on 2/26/03 at 17:49 (110909)

Hi,

I do use the medial approach with the dornier. I have tried the plantar ,it is painful just like the ossatron could be with only a local. I am comfortable with the approach however it was something that at first I had to get use too. With the big O and Little Ossatron I was just so use to the plantar approach.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 2/26/03 at 19:22 (110920)

Bill,
Interesting post and one that we should follow.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Bill on 2/26/03 at 20:27 (110927)

Dr Z.

If you look at the Federal Register from December 31, 2002, you can see that 0020T is covered by Stark. You are right that ESWT is currently not covered by Medicare but Stark applies to any Federal program. Covereage applies to patients with Champus, TriCare, and many others.

The Federal Register link is http://cms.hhs.gov/providerupdate/regs/cms1204fc_2.pdf

Dr Davis,

By the way, Stark does not have safe harbors per se. The language of safe harbors belongs to the Federal Fraud and Abuse Law. The Federal Fraud and Abuse Law prohibits excessive returns on investment when the investment is designed to solicit referrals of Federal patients. These two laws are complex and independent of each other. If you read United's investment documents you will see that they believe that the ESWL exemption may apply to ESWT. I do not believe that ESWL and ESWT are equal in the Government's eyes.

There is one bright ray for the investing podiatrists. If United can grow big enough and fast enough then the investment will likely be exempt from Stark on size grounds.

Finally, it is worth considering that the founders of United reached a settlement agreement with the Federal Trade Commission for price fixing in the lithotripsy business in Chicago. You can read all about it on http://www.ftc.gov/opa/1998/9801/parkside.htm

Maybe they can price fix nationwide for ESWT?

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr. Z on 2/26/03 at 20:42 (110928)

Hi Bill ESQ

Thanks for the information. I am not aware of any federal programs that covers ESWT at this point in time. Here is a question. Did the Stark laws knick in because Medicare reviewed 0020T and then placed the 0020T into physical Therapy Grouping or is the Medicare Review completely separate from Stark.? My question why did the 0020T even become a review item ?

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 2/28/03 at 21:19 (111229)

Bill:

I sort of glanced over the statement in which you stated that 'CMS has stated that ESWT is covered by the Stark law.' Is that a written position and, if so, do you have a reference?
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 2/28/03 at 21:26 (111230)

Pauline:

Bill certainly has an amazing depth of knowledge in this area, from technical specifications to legal aspects. He is obviously involved either in the industry or regulation so his input here is appreciated.
I would even feel comfortable witih him remaining anonymous as the 'deep throat' (the Watergate, not the porno kind) of the industry giving us interesting inside information if I was a bit more comfortable with some of his biases based on older posts.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/01/03 at 06:36 (111245)

Ed,
I think we can and should feel comfortable with Bill. He seems to be a wealth of knowledge in this area.

Let someone prove him wrong if there is doubt. He's throwing the information out, if someone can prove otherwise let them challenge Bill with facts and references on the subject matter not with interrogation of Bill.

Re: Re:BCBS insurance covering Ossatron

Lynn S on 3/01/03 at 09:51 (111262)

Ed, I have Anthem Insurance (Blue Cross Blue Shield)in the US. My insurance covered the Ossatron treatment - in Greeley, CO. The Ossatron company - Advanced Medical Procedures agreed to accept the fees my insurance company would pay. I had bilateral treatment in August 02. When I needed to have the treatment repeated again only on one foot in December 02 there was no charge. Lynn

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/01/03 at 11:59 (111272)

Pauline:

To some extent, when an individual presents information, especially controversial information, the burden of proof is on the presenter.
Those who reveal their identities have a reputation to protect and readers know where they are coming from. Just knowing that I am a doctor gives readers a good idea where my bias lies -- we all have biases and perspectives related to our occupations. An individual who insists on being anonymous gives us no clue as to any inherent biases. I would 'lower the bar' for Bill if he would just tell us what industry or regulatory body he represents without actually revealing his true name or identity.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/01/03 at 13:28 (111293)

Dr. Ed,
I understand your point, but what if he represents no regulatory body or industry? What if he just does his own research and posted the facts. My question would still have to be can anyone dispute what he is saying?

To me it doesn't matter if Bill is an attorney, FDA official,
doctor, or Joe Millionaire. If his facts are correct, then he is providing the reader with true, honest information.

Anyone interested in proving that what he is posting is incorrect or completely biased needs to do the research and post their proof.

Stark law is easily explained to anyone by federal agencies. Those in doubt should just call.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 10:33 (111374)

Pauline:

Please keep in mind that there are a lot of newbies on this board, individuals reading the board who don't post as well as a lot of people who just are not as inquisitive as some of the regulars such as yourself.
Many of the 'professionals' on the boards feel an obligation to help protect the integrity of information on the board (as opposed to just influencing opinion) so we really need to ask for some substantiation of information sources. An anonymous person is like someone you don't know walking up to you on the street and giving you advice on a subject -- you have no idea where he is coming from, if he/she has your best interest at heart of if that person really knows what he/she is talking about. If that anonymous person at least states where he works or can give us some info. about his/her background then some credibility is established.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 10:48 (111378)

Ed. If it who I think it is don't worry the guy really knows his stuff
in all areas of ESWT. I don't think he can come out due to competitive reasoning. So I guess we just take what we can from him. Here are areas that I have found him to be an expert.
legal aspects of ESWT
ESWT equipment
All the competitive companies out there.
Research/studies
Experience in the industry.

So don't worry about this guy. I am trying to get him to come out. I think I know who he is but he won't admit it to me yet!!

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 11:48 (111398)

Dr. Ed,
I hear you and can appreciate your point of view. I see things much differently because I still feel it's the sole responsibility of the person receiving the information to do the appropriate research
before they take anything as gospel on this site, on others or on the street.

There is no way you or anyone else can insure the intregerity of the person posting. Just because you get someone to tell you what YOU want to hear gives us no guarantee what he is saying is any more truthful than the information he is posting.

Perhaps an FBI check into his background or anyone else for that matter on the internet may give one a sense of security, but even that may not be enought to insure what you are seeking.

What ever anyone posts still have to be checked for accuracy. Most web sites with doctors posting all carry disclaimers telling readers to seek the advice of their own physician and that the site is not meant to be a substitute for personal follow up medical care. Here is an example of one of those disclaimers.

'Ask Dr. Charles Usage Agreement
IN ORDER TO ASK DR. CHARLES, PLEASE READ THE FOLLOWING TERMS, AND INDICATE YOUR ACCEPTANCE BY CLICKING THE BUTTON AT THE BOTTOM OF THE PAGE.

Medical licensing rules may prohibit physicians from providing medical advice to patients in states and countries where they are not licensed. In some cases these rules provide that the communication of medical advice by E-mail constitutes the practice of medicine in the state or country where the patient is located when the E-mail is received. As Dr. Charles is not licensed to practice medicine in all jurisdictions and he has no way to determine where you will receive his E-mail replies, he cannot and will not provide medical advice by E-mail even if he has physically examined you or reviewed medical records provided by your health care provider.

In light of the above, you acknowledge and agree that:

Submitting a web form or sending E-mail to Dr. Charles and/or receiving E-mail from Dr. Charles WILL NOT establish a doctor-patient relationship. If you have, or suspect that you may have, a health problem, please consult with your health care provider immediately.

Dr. Charles' replies ARE NOT INTENDED as medical advice. Accordingly, you agree not to rely on them as a diagnosis of your medical condition, as a confirmation of your medical diagnosis, or as a recommendation of one or more treatments.

Dr. Charles' replies to your inquiry MAY INCLUDE instructions on referrals to physicians, general information about retinal, macular, or vitreous problems tailored to address your specific inquiry, and general information about recognized treatments and surgical procedures tailored to address your specific inquiry. RELIANCE ON ANY INFORMATION PROVIDED BY DR. CHARLES IN HIS E-MAILS OR THROUGH HIS WEB SITE IS AT YOUR OWN RISK. IN NO EVENT SHALL CHARLES RETINA INSTITUTE, STEVE CHARLES, M.D., OR ANY OF THE OTHER DOCTORS OR STAFF ASSOCIATED WITH CHARLES RETINA INSTITUTE, HAVE ANY LIABILITY UNDER ANY THEORY WHATSOEVER FOR PERSONAL INJURY, DEATH OR OTHER DAMAGES OF ANY TYPE OR NATURE ARISING OUT OF OR IN CONNECTION WITH YOUR USE OR RELIANCE ON ANY INFORMATION THAT IS SO PROVIDED.

E-mail sent by Dr. Charles is not encrypted and therefore, like all unencrypted E-mail, may be intercepted and viewed by others. Accordingly, you agree not to send or request information by web form or E-mail that you consider confidential or sensitive in nature, consent to Dr. Charles responding to your inquiries by E-mail, and agree that neither Dr. Charles nor Charles Retina Institute shall be liable for any breach of confidentiality or privacy that may result from interception of such E-mail by any third person.

This Usage Agreement shall be governed and construed in accordance with the laws of the State of Tennessee, U.S.A. applicable to contracts wholly executed and performed within the state.'

Scott may or may not have something similar, but surely the doctors posting here should have one.

Who Bill is doesn't really bother me because the subject matter he is usually discussing isn't of interest to newbies. His discussions are usually more at the doctor level and that's why I think it bothers you so much.

I still say if what he is posting is incorrect one of the doctors could prove him wrong and set the record stright. If they are not willing to do this then so be it.

You notice Bill isn't concerned about our discussion. I have confidence that you or the other doctors can provide proof if what he is saying is not correct. If you don't it's not Bill's problem. He is innocent until proven guilty of providing incorrect information. If you can do it than do so, if not than the man goes free.

Did all the doctors here provide a corrdinated usage agreement for this site in accordance with medical licensing rules? How are you all covered here?

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 11:52 (111401)

D. Z:

Why will he at leat not tell us about his background without revealing his identity?
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 12:01 (111405)

Pauline:
The disclaimers you have quoted are there for legal reasons.

One of the biggest problems we have in ESWT is having patients gain access due to lack of information or lack of third party reimbursement/affordability issues. Europe and Canada have solved that by offering low energy ESWT at prices that most can afford. Bill had taken a strong stand against low energy so readers in need of treatment may be dissuaded by an individual with a hidden agenda. Is he doing that for financial reasons? Who knows? Particularly if he will not tell us more about himself.

You are taking somewhat of a caveat emptor (let the buyer beware) viewpoint on this and as an individual I generally favor that but as a doctor, my protective instincts come into play.
Ed

Re: Re:BCBS insurance covering Ossatron

Ed Davis, DPM on 3/02/03 at 12:06 (111407)

Lynn:

I have run into problems with payment on repeat treatment. It sounds like Advanced Medical Procedures is being generous. I don't want to criticize the local owners of the Ossatron though because I cannot compare the iniotial payments. In other words, if Anthem payed Advanced in a sufficiently generous fashion to allow them to do repeat treamtnets at no cost. I know for a fact that our local Blues barely allow the Ossatron owners to cover the cost of treatment and, as such, they cannot allow use of their machine at no cost for a second round.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 12:40 (111419)

Ask him. I see a lynch mob out trying to make noise about nothing. Instead of complaining about who Bill is, give us proof about his posts.

It's far easier to try and discredit someone by ripping them apart than it is to prove what he is saying is incorrect.

My political jab. I think Clinton used the same technique with his girlfriends. He sought to discredit them. He never proved what they were saying was not true. That's how I remember it.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 13:14 (111421)

Dr. Ed,
I believe your protective instincts, but I find no Puritans among us.
Someone once wrote that ESWT is all about money and if anyone tries to tell us differently they are lying.

I personally believe this statement. I'm not saying that doctors are not trying to help patients, but ESWT has $$$$ signs attached that we haven't begun to see. At full maturity it will become the next Lasik surgery, but just like Lasik the individual must be responsible for doing the research.

The truth of the matter is that this should be buyer beware world. People need to take responsibility for all their health care from head to toe.
They need to do their all their homework before they make their decisions and this site is the beginning of their research not the end.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 13:20 (111423)

Dr. Ed,
Since the doctors here are posting advice do all of you have to have to provide the same type of disclaimers on this board? How is that covered here?

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 13:20 (111424)

Good point Dr. Ed. Where did get this very impressive debating skill. I am impressive with your fact to back of your view points. I am one of your lurking fans on the Social Board. Dr. Ed is right Pauline. Bill does have a strong view point regarding low energy ESWT which is sitting in the background competing with high energy ESWT.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 13:22 (111426)

Good point. If I was 100% sure who is was I would reveal him. I am really not sure why he is taking this in the dark approach. I do have an idea, but I can't reveal until I know. He is someone who no ones but does know Dr. Z

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 13:25 (111428)

Pauline,

This is just different. Bill should reveal who is . When have we ever had
anyone on this board avoid identifying themself.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 18:08 (111479)

Pauline:

I agree with you wholeheartedly in principle about people taking responsibility for their healthcare decisions. The problem is that we have gone through about a 30 year period in which people became accustomed to government and employer sponsored health care plans making health care decisions for them. It is a hard habit to break.

Every service and commodity on earth is about money invariably as some value excahnge must take place. Nevertheless, ESWT is cost effective and could be extremely affordable to all if much of the politics was out of the equation. It is about $, not $$$$ signs for most providers. Lasik is not a reimburseable service as refractory errors of eyes have limited coverage (not really sure why). Coverage has always existed for tendinopathies and enthesopathies so it is my expectation, and the expectation of patients that coverage is forthcoming or should be.

The reason for $$$$ on ESWT is the inflated prices for equipment caused by the politics of the FDA. I have seen phenomenal results from my referrals to the Sonocur treatment center in Vancouver, B.C. Their fee for 3 treatments is $750 Canadian or about $530 US. No one is making big bucks at that level of fees and their is no logical reason for this to be a multi-thousand dollar service in the US other than politics ( that which Bill seems seems to support).
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 18:41 (111481)

Ed,

A few years ago I preached the re-classification of ESWT to this board, to the FDA and to Pauline. She was in favor of the FDA present system and with it the very high cost of ESWT machines. On another note I do believe that they are making big bucks in Canada with the Soncur system. They do almost 50 treatment per day . That was my last conversation with Heidi who is no longer there. Low energy treatment take about seven to eight minutes per session. There is no physician requirement for low energy treatment . It might be considered a physical therapy. It this the way to go.
Maybe.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 19:06 (111488)

Dr. Z,
What does anyone know about me???? I've been on the board for over 2 years do you think you really know me?

You've made assumptions about me, but you don't know me. You have formulated some ideas, and opinions but you don't know me.

Just as we don't know the author of his book simply by his printed word we don't know the people who post on this board. Heck at times we admit we have no idea what context the poster even intended.

I'd have to say at best we know of each others existance and how we interact in terms of this site.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 19:27 (111491)

I have no idea what you are talking about. I do remember the very very strong outspoken opinions you had about changes in the FDA and the Big O which now represents the very hight costs of ESWT machines that Dr. ED is talking about. What does knowing you have to do with anything. The only way that ESWT cost will come down is when machines come down and this will only happen with classification changes. This is what I have saying and you have been very outspoken against. This has nothing to do with knowing you. I respect you opinion but I don't have to agree with it.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 19:50 (111496)

Dr. Z,
I was in favor of all ESWT machines being approved in the same FDA classification whether it be a I or a III. It made no difference to me which classification they chose for it.

What I did not approve of was the slight of hand that Norland appeared to pull by mis-labeling its machine, the big 'O', knowing full well as a class I medical device it would get through the FDA system quickly without all the required studies. They called it a viberator got it approved as a Class I medical device, but went out and marketed it to doctors as a ESWT machine. It was no longer a viberator.

I personally believe it may have been marketed as a ESWT medical device to Podiatrist at their convention possibly signing them on to purchase it because they knew the speed it would pass through the FDA as a Class I device. It was a sweet deal for both.

To the best of my knowledge, Norland knew Healthronics Ossatron, was already in the system as a Class III device and by law if they had presented their machine as a ESWT medical device it would have to go through in the same classification as the Ossatron a Class III. This would mean they could not get to market first which seemed to be their goal. $$$$. They had already impressed the Pods.

The slight of hand was caught by the cries from Healthronics and the FDA acted to stop the import and all marketing of the big 'O' for what they called a mislabeled medical device.

The rest is history with the doctors who had jump at the chance to purchase the big 'O' because as a Class I medical device Norland had received pre-approval for sales.

The practice of having all like medical devices go through in the same classification was not a new procedure installed just for ESWT machines. It had been around for a while.

One could call this the Tortoise and the Hare story. The Tortoise won the race to market.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 20:09 (111503)

The same would hold true for Bill. We can respect his opinions regardless of WHO he is, but we will never really know Bill no matter what he chooses to post about himself. I say assume the worst if you want, all the alternaive motives he my have for what he posts, but it still doesn't disprove what he is saying. At best it only provides a label for him the same as Clinton provided for his girlfriends. We will still have to wait and see the outcome of High vs Low machine and how much income is generated.

What I find interesting is that so much dialog among three readers can be generated by one single poster called BILL and to what benefit?

Cheers to Bill. If he wanted notariety he got it. Pages of it.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 20:11 (111504)

its your same argument and is still the same reason why there is going to be high eswt machine costs. I am not going to argue the facts with your opinion with what really went on. I was there . I met the FDA . I read all the facts. I saw all of the letter, memo's that the FDA sent to What was then Norland. I am asking to re-argue your opinion. I am just saying this is what is the reason for high eswt machine costs. Thanks to your
opinion my very expensive investment is safe for some time.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 20:16 (111507)

I really don't care if Bill is Pauline or if Bill is the president of Dornier or whatever. But in we must have rules to have order and therefore we should know who someone represents. I personally find Bill's gallery of information on ESWT amazing!!

Re: Pauline I have a question

Dr Z on 3/02/03 at 20:28 (111510)

Do you know where you saw the FDA regulation that all ESWT machines that are used for plantar fasciitis have to be classified the same way. I would appreciate it if you could me to this information. Thanks

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 21:34 (111526)

Dr. Z:

I think that the ideal situation lies somewhere in between the two systems. At least, people in Canada are getting access.
Our costs and the patient costs will obviously be higher. I expect the physician to perform or least closely supervise the treatment. We will perform the treatments in our office at a much higher frequency than we do now as it should be a common 'bread and butter' procedure.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 21:38 (111527)

Dr. Z,
You probably already check that one out with Scott. I'm not Bill. Besides I have hospital records that show I was in an ICU unit when Bill first appeared on this board.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

BGCPed on 3/02/03 at 21:39 (111528)

Thats a good point. Some hit and run name change poster did that to me on the orthotic/insert board. They tried to blast my credibilty regarding the answer I gave to a direct question. Rather than back it up or respond they just left a lame message. They called themself concerned practitioner.

I know when a person wont reveal the complete agenda or background it makes one suspect. I would say let him keep posting and others keep asking questions and let the cream rise to the top so to speak

Re: FDA classification

Ed Davis, DPM on 3/02/03 at 21:40 (111529)

Pauline:
Class 3 devices include all those devices necessary to sustain human life; eg. pacemakers. Renal lithotripsy machines are only class 2 and they are more powerful (potentially more dangerous) and applied over a vital organ. I can see no logic at all to the use of class 3 for ESWT.
The other issue is the tendon by tendon approach of approval. It will take over 100 years to be able to use ESWT machines on a body wide basis at the current rate. Obviously, a change will occur at some point.

Canada is very much into protection of consumers and patients so I need to respect their approval process. At some point the 'protection' process can start hurting people when it causes restriction of access to necessary devices and drugs or increases costs to the point where large percentages of our population cannot afford treatment.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 21:46 (111530)

Pauline:

You generally post in a conversational manner without appearing to take a position of authority. You often have strong opinions but don't dig in your heels on a position. Presented with evidence, you will generally acknowledge it. Your approach contrasts with Bill in those manners.
Ed

Re: FDA classification

Dr Z on 3/02/03 at 21:48 (111531)

Good job Ed. You are wasting you time. When Pauline had the opportunity to support this she was only interested in attaching Big O,not why was there a class three in the first place. This is just another round of something that I am going to be honest shouldn't be changed at this time.
I spoke with the FDA and they just continued to support one manufactor's interest. It will take years for the change. We are now pass the point of no return for class three devices. There are just too many manufactors in the process of getting class three approval.

Re: FDA classification

Ed Davis, DPM on 3/02/03 at 21:51 (111532)

Dr. Z:

One really has to question how good a job the FDA is doing. Eventually the manufacturers, though, are going to want body wide approval as it will expand usage exponentially. I think that will be the time they will consider asking for reclassification to 'lower the bar.'
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Dr Z on 3/02/03 at 21:54 (111533)

It can't happen at this point in time. Until all of the manufactors have come into the USA market and made their money there will no re-classification. We can thank Healthronic for this one. As far as the Soncur I don't see much podiatric involvement with this machine at this point in time. I would proababy have problems in my state with the State Board of Medical Examiners with using a machine that has no FDA approval for any podiatric use.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/02/03 at 22:01 (111534)

Pauline:

Good question. It is one I would rather not answer though. It is somewhat new legal territory. It is a reason that we are a little nervous and protective of the boards. It is also a reason many docs do not post here.

We are not specifically diagnosis or treating patients here but offering general information in the manner which many of the doctors who are newspaper columnists do. It is not impossible, considering the current legal environment, that some challenge to our role occur some day. I hope there will be some degree of tort reform or better balance in the system before that or we will be relegated to the role of occasional anonymous posters -- phantom docs.
Ed

Re: FDA classification

Pauline on 3/02/03 at 23:10 (111537)

Dr. Ed,
I just read on the FDA web site that a manufacturer can apply for a change of classification, however, that too affects all of the other similar ESWT devices.

I wonder if one manufacturer could hold up a classification change by showing cause to the FDA that putting such a device in a lower classification while making the case that some how it could cause harm to patients while meaning it could cause harm to their pockets if they held the marketing edge.

An interesting thought, but I don't know if it is possible.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 23:12 (111538)

Dr. Ed,
I try to provoke thought on the subject because I find it more interesting.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/02/03 at 23:44 (111540)

Dr Ed,
It might be to the doctors benefit if they checked to see if there should be some kind of statement coming directly from them on this site.

I don't think Scott's small one on 'ask the doctor' would go to far in a legal environment I thought this was interesting.

'At first blush, it is easy to argue that the Web environment is unable to foster the traditional physical presence requirement for a patient-physician relationship. But the element of physical presence, traditional as it may be, is not the essence of the patient-physician relationship. Rather the existence of the relationship rests on whether the service being provided falls within the scope of medical practice.

Medical practice generally includes treatment, prescribing, diagnosis and/or offering patient-specific medical advice and information such as prognostic information. Just as a telephone call can be a vehicle to create a professional relationship if a physician is providing information that fits within the scope of medical practice, so too can the Web.

Hopefully there will never be a problem.

Re: FDA classification

Pauline on 3/03/03 at 00:13 (111542)

No true Dr.Z, I was interested in the fact that the big 'O' did not have FDA approval as an ESWT medical device and you were promoting it as such.

It made no difference to me if it was Class I, II, or III as long as the FDA had approved it for use in specifically treating P.F. It did not.

The FDA was saying it was presented to them mislabeled as a Class I device and when they found out how it was being marketed they stopped the import and sale of it until the manufacturer agreed to conform to it's set regulation for this type of machine.

You insisting all along that the big 'O' was FDA approved for ESWT, but it was only approved as a Class I vibrator the way it was labeled never as a ESWT medical device specifically for the treatment of P.F.

From what you've said it is currently going through FDA approval and there are test sites for it. You declined to participate in the studies choosing to purchase the Dornier instead.

Re: FDA classification

Ed Davis, DPM on 3/03/03 at 01:23 (111547)

Pauline:

I have little doubt that the thing you are wondering about actually happened.
Ed

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

john h on 3/03/03 at 11:09 (111588)

Pauline: I think I recently read where there are now some or proposed facilites that will offer treatment online. I do not know how this would work but it is either being proposed or already in the works. Obviously there are many limits to this type of treatment but if you are a sheep farmer in Wyoming and a 100 miles from medical treatment and locked in for the winter by snow then I would be happy to talk to a Doctor on line.

Re: FDA classification

Dr. Z on 3/03/03 at 11:13 (111589)

The FDA approved its use as a pain management system without any specific application for pf. It was the FDA that determined the vibrator not Norland. I never insisted that it was approved for ESWT. The FDA doesn't approve ESWT they approve systems for useage and the Big O did have a class one approval . That is a fact . This is so boring

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

john h on 3/03/03 at 11:21 (111592)

I am not supprised at Bill's depth of knowledge at all Dr. Z because he is very knowledgeable on the subject. I still I think I know who the ellusive Bill is. He will be back.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Pauline on 3/03/03 at 14:17 (111610)

John,
What cyber doctors consider before setting out to practice. Some doctors I imagine wouldn't even venture in.

Physician Websites: Practice Enhancement or Practice Liability?

November 2001

Medical websites are proliferating at click speed. Websites can increase practice visibility and allow access to patients and consulting physicians worldwide. It allows patients to find a doctor whose practice focuses on a certain medical condition or offers a particular medical treatment. Physician websites can inform and educate while others may initiate medical intervention. Your legal liability depends upon the content and use of your website. Some of the critical points to consider regarding your medical website are:

Static website vs. Interactive website – Many physicians have a ‘static' website, one that only informs and does not permit the visitor to email the physician. An ‘interactive' site permits the visitor to send an email to the physician. Offering medical advice over the Internet could be viewed as practicing medicine without a particular state's license and does create a physician- patient relationship subject to the traditional standards of care and legal liabilities. In consideration of the HIPAA privacy regulations, it is highly recommended that prior to a website visitor or patient submits an email, terms of electronic communication be read and the acceptance be acknowledged with a hard copy consent form. It is advised to treat all medically related email communications with the same level of care and confidentiality as a private in-office conversation.

Disclaimers -All websites should have an obvious disclaimer regarding the intent and purpose of the information posted on the website. It should be clear that the information posted is not intended to substitute for seeking medical care and email is not to be used for urgent medical questions. State and professional guidelines should be considered when writing your website disclaimer.

Patient education - Websites often provide information for visitors regarding medical news, procedures or treatments. Information posted must be kept current to ensure that a visitor does not rely on out dated medical information.

Practice marketing - Many states have professional codes regarding physician advertising limitations and professional ethics, therefore, it is best to check your state code of ethics prior to posting a website for this purpose. Beware of exaggerated claims on websites, such as 'We are the best doctors to treat this disease'.

Legal jurisdiction – Most states have laws referring to the cyber practice of medicine and what is considered practicing medicine without a license in their state. Some states actually permit a physician to obtain a limited license to practice medicine for cyber purposes. Federal laws are already in place and rapidly developing for application to the practice of telemedicine. At present, in addition to the individual states, the FTC, FCC and the FDA all have laid claim to potential governance of Internet communications and the IRS is trying to determine how to tax cyber transactions.

Virtual medical office administration – A website may seem an efficient method for certain practice administrative activities, such as gathering patient information, obtaining a description of the main complaint for the medical visit, insurance information and identification numbers. However, State medical records, informed consent and confidentiality statutes, as well as the HIPAA regulations, can limit the collection of this information due to confidentiality concerns. A method to expedite yet protect your patient's personal information, may be to have the patient print out the administrative form and bring it with them to your office or fax it to the office prior to their visit.

Have an experienced health lawyer review your website to minimize potential legal liability.

Back to top

Cyber-Medicine: Some Real Risks in Virtual Medicine
June 2001

Cyber medicine has changed the manner in which medicine can be practiced from the traditional face-to-face physical examination encounter to an impersonal cyber communication. Practicing medicine on the Internet includes patient provider emails, interactive websites, diagnosis, medical advice and dispensing pharmaceuticals over the Net. There are those who view cybermedicine as empowering and collaborative and others who see potential liability and unprofessional conduct.

There are many medical, ethical and legal parameters to consider when you participate in cyber medicine personally or under contract. When does the cyber physician-patient relationship begin? How will the duty of care be defined in the practice of cyber medicine? What will the standard of care become? Who will be held liable if due to a cyber breach/glitch a malpractice action is filed? Will physicians be held liable for negligence if they do not take advantage of a cyber consult? One court says yes.

Practicing medicine without the appropriate state license is an essential issue. Most states have laws that regulate who can practice cyber medicine in their state and under what circumstances.

Who really is the patient? There are critical veracity and reliably issues related to giving medical advice to someone you've never seen or met. Informed consent and confidentially issues are at the forefront.

How to maintain privacy in an essentially non-confidential medium as the Internet. How can you protect your patient's privacy with an electronic medical record transmission? New basis for medical negligence claims have been created as diagnoses are made based on poor electronic images. What assurances do you have of the provider who is offering advice is within their scope of practice or even licensed to practice medicine at all?

Traditional malpractice coverage did not contemplate the coverage of cyber medicine activities and this must be explored. Check with your malpractice carrier if you want to participate in cybermedicine and get a written acceptance of coverage for your practice plans. There are yet many legal uncertainties regarding the practice of cyber-medicine.

Re: United Healthcare Insurance, Blues, Dornier, DR. Z

Ed Davis, DPM on 3/04/03 at 10:02 (111720)

Pauline:

I believe that the key question to ask is if a physician-patient relationship has be established. That can be a grey area but I would tend to say no. Also consider that no fees are being asked for our 'service' here. The minute one requests any kind of financial renumeration, the nature of that relationship would change.
Ed