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TO; Judy

Posted by Peter R on 8/03/03 at 08:37 (126077)

I am not a medical expert however I do have consideable knowledge about podiatry from a close association with podiatry for over 35 years. I would prefer not to reveal in this community what my involment is and has been with ESWT however it is considerable. My 'advice' is based on information from research, conversations with many podiatrists, and information from equipment suppliers. I think it pretty much represents majority opinions or accepted technical information.

Re: TO; Judy

Dr. Z on 8/03/03 at 20:36 (126140)

I have a question . Based on your experience do you see low energy replacing high eneryg in the USA. 2nd quesion. When do you see the FDA removal or reducing ESWT classfication # 3 for high energy

Re: TO; Judy

Peter R on 8/04/03 at 06:50 (126158)

There will be very low energy devices that are marketed for use in physical therapy and chiropratic offices in a manner similar to ultrasound and electrical stimulation devices currently in use. I believe, however, that their effectiveness will be marginal on insertional tendionopathies. As for the FDA- I think that the class 3 regs. will remain as they are. I think the future of high energy ESWT in podiatric medecine is totaly in the hands of the insurance companies. They will mostly all eventually approve the modality but at such a low coverage rate that it's use will be uneconomical. I think that the situation for high energy ESWT in orthopedic applications, such as lateral epicondylitis is much different because the insurance companies will eventually provide better reembursement rates and large ortho practices will purchase their own equipment. This of course all depends on just how effective ESWT proves to be, long term, for applications other than PF. Part of the reason is that the insurance co's don't give the podiatric business the respect that it deserves.

If ESWT for PF is finally shown to be as effective as surgical intervention I see the insurance companies possibly forcing it's use (at a minimum coverage rate) by lowering coverage for surgical intervention to such a low point that no doctor will want to do it.

The bottom line is that the insurance companies don't want to pay a dollar more for treating PF than they are doing now. If they are paying $1,000,000 for 1000 PF surgeries and they think that they will see 1,000,000 ESWT procedures being done then they will want to pay $1.00/procedure.

These are just my early morning thoughts Dr. Z. What are yours?

Re: TO; Judy

Dr. Z on 8/04/03 at 10:51 (126192)

Sounds like a very accurate reality to Dr. Z

Re: TO; Judy

JudyS on 8/04/03 at 17:08 (126222)

Thank you for your reply, Peter. I was wondering if you might want to repeat it in the original thread on the ESWT board instead of here on the SS board. I fear this current thread may be misplaced.

Re: TO; Judy

Peter R on 8/05/03 at 11:41 (126268)

I think it belongs here>

Re: TO; Judy

JudyS on 8/05/03 at 12:59 (126276)

Peter, I disagree. My original question regarding the basis of your knowledge for advising a poster re: ESWT was in response to Q & A on the ESWT board, not here on the SS board. The thread was very specific to the ESWT board and the original questioner, and ensuing readers, had a right to know the genesis of your expertise given the authoritative manner in which you posted your evaluation of various ESWT's.