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Posted by Pauline on 6/01/04 at 19:30 (151740)

Knock, Knock. Who's There? Mobile ESWT!

Extracorporeal Shockwave Therapy (ESWT) is rapidly becoming a standard of care for the treatment of pain associated with plantar fasciitis (heel spurs) and Achilles tendonitis. But it is not necessarily cost effective to purchase a high-intensity ESWT machine (about $500,000) and train an ultrasound technician to use it.

Podiatrists can refer patients who would benefit from ESWT to a surgi-center; but now there is another option that brings this technology directly to the podiatrist's office and to patients in need.

What is ESWT?

Extracorporeal shock wave therapy (ESWT) is a non-invasive method of treating localized musculoskeletal pain, including plantar fasciitis and Achilles tendonitis. Shock waves administered through the skin stimulate the body's own repair mechanisms along with relieving pain. The treatment takes approximately 30 minutes under local anesthetic. Conducting gel is applied to the area to be treated. A therapy head, which houses the shock wave source, is placed on the treatment area. Using a hand-held monitor, a podiatrist administers shock waves by pushing a button on a control panel. The most common patient complaints during and after ESWT are pain and discomfort. Other side effects may include minor skin bruising, reddening and/or swelling for a brief period of time.

How It Works

Mobile ESWT programs are springing up all over the United States. One of the standouts is Shared Medical Therapies, Inc., the company that pioneered the mobile MRI service. Under its mobile ESWT program, a podiatrist can contract to have a Dornier high-intensity ultrasound machine brought to his or her practice for a half or full day at a time. The machine arrives by van and is wheeled by an ultrasound tech directly into a standard podiatry exam room. The ultrasound tech gets the machine ready while the podiatrist greets patients and prepares them for the therapy by administering a local anesthetic to the treatment area. When the anesthetic takes effect, the ultrasound tech assists the podiatrist with the procedure, which takes about 30 minutes per patient.

Unlike low-intensity ESWT machines commonly available in surgi-centers, the Dornier Epos Ultra required that patients undergo only one treatment, and pain relief can result as quickly as the first 24 hours following treatment. Healing continues for up to one year, according to Shared Medical Therapies' President Jeff Bergman, who reports that upwards of 75 percent of patients notice significant pain reduction after treating their pain with ESWT.


ESWT currently is not covered by Medicare, but it is generally paid for by private insurers, according to Bergman. Rates average about $2,000 to $2,500 but can go as high as $9,500, of which Shared Medical Therapies receives 75 percent. The balance ($625 on an average payment of $2,500) can net the podiatrist more than $3,000 for a half-day of ESWT therapy. Costs to the podiatrist include his/her time, administration of the anesthetic and the use of the exam room. There are no start-up costs.

Shared Medical Therapies pre-certifies all of its patients, ensuring that the therapy is medically necessary and will be covered by the patient's insurance. The company will not perform the therapy on patients who are not pre-qualified or pre-pay out-of-pocket. Shared Medical Therapies does all the billing for the ESWT and typically turns around payment to podiatrists within 60 to 120 days.

Decisions, Decisions

How do you know if a mobile ESWT program is right for your practice?

First, determine if you see an adequate number of patients who can benefit from this therapy. Shared Medical Therapies requires a five patient minimum per visit, all of whom must be scheduled consecutively in a morning or afternoon.

'If a podiatrist has two to three locations, he or she usually has enough patients for this program, said Shared Medical Therapies' marketing rep Robert Smith.

Bergman said that about 50 percent of plantar fasciitis patients are candidates for ESWT, so a podiatrist who sees 20-25 of these patients per month likely could benefit from the mobile ESWT service two to three times per month.

When choosing a mobile ESWT provider, look for a company with a solid reputation for service delivery. Make sure that the ultrasound equipment is high-quality and is serviced by the manufacturer. Bergman is partial to the Dornier Epos Ultra, which he called the 'gold standard, but he said other brands are also reliable and effective. Finally, make sure that the people operating the machine are qualified ultrasound technicians. The success of ESWT, like most therapies, depends as much on the precision with which it is performed as on the technology itself.

For more information:

Shared Medical Therapies, Inc.

6400 Brooktree Court, Suite 360

Wexford, PA 15090



724-933-3211 (fax)