ASRA follow up

[cameroncarter]

Musings and frustrations as I sit in my gate waiting to fly home.

It seems like there is a growing and blatant disregard for SCS appropriateness.
How are physicians in small rural areas implanting more SCS than my whole group in a large metropolitan area?
More frustrating is that a whole generation of trainees seems to be woefully uninformed of how poor real world SCS outcomes can be.

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[TheLoneWolf]

Schmoney

The rumor is that Tim Deer had been giving talks on appropriateness of SCS implantation and suggesting that reimbursement will get axed if overutlized. Probably happening bow

 

[GlowInTheDark]

Musings and frustrations as I sit in my gate waiting to fly home.

It seems like there is a growing and blatant disregard for SCS appropriateness.
How are physicians in small rural areas implanting more SCS than my whole group in a large metropolitan area?
More frustrating is that a whole generation of trainees seems to be woefully uninformed of how poor real world SCS outcomes can be.

Fat pigs get slaughtered. CMS/OIG can swing a painful stick.

 

[cameroncarter]

Schmoney

The rumor is that Tim Deer had been giving talks on appropriateness of SCS implantation and suggesting that reimbursement will get axed if overutlized. Probably happening bow

If reimbursements decrease, there’s no doubt that over-utilization will correct.

 

[Agast]

Are there any stats out there showing the usage of SCS over the last two decades?

Young people will learn soon enough to be disappointed by SCS. I think it took me about 2 years into practice.

 

[GlowInTheDark]

Are there any stats out there showing the usage of SCS over the last two decades?

Young people will learn soon enough to be disappointed by SCS. I think it took me about 2 years into practice.

Spinal Cord Stimulation Trends of Utilization and Expenditures in Fee-For-Service (FFS) Medicare Population from 2009 to 2018 - PubMed

The analysis of spinal cord stimulators in the FFS Medicare population from 2009 to 2018 showed explosive increases of trials, implants and overall costs.

pubmed.ncbi.nlm.nih.gov

 

[MitchLevi]

Young people will learn soon enough to be disappointed by SCS. I think it took me about 2 years into practice.

I've said it repeatedly, and even on this forum I've had ppl say it's one of the more effective treatments they offer.

LOL.

BS.

It underperforms in an amazing way.

 

[Ducttape]

i agree that i feel like it is being overutilized.

from my perspective, the issue is more likely that the thresholds used to determine implantation are too lenient, and of course finances play a primary focus

 

[Ferrismonk]

Schmoney

The rumor is that Tim Deer had been giving talks on appropriateness of SCS implantation and suggesting that reimbursement will get axed if overutlized. Probably happening bow

Of all the people I would expect to complain about overutilization, Deer would be at the bottom of that list.

 

[TheNolano]

As a current fellow who attended for the first time this year, I was kinda shocked. I thought ASRA was the more science-based and less industry-y conference. If this was ASRA I can't imagine what NANS must be like.

I was especially surprised that the President's Award for best presentation at a Medtronic-funded conference went to a Medtronic-funded study showing Medtronic's new SCS was massively superior to the traditional Medtronic SCS. Maybe I should not have been surprised. When they highlighted that "100% of subjects were satisfied or very satisfied with DTM SCS at 12-months" my bull**** meter went crazy. I cannot imagine 100% of my patient population being satisfied with anything. But maybe my program just needs to put in way more SCS.

Also, as a current pain fellow looking for jobs my sense is that the pain market is rather saturated, or at least compared to the once-in-a-lifetime anesthesia market. I was surprised by the lack of pain recruitment going on compared to the meat market of ASA.

On a positive, I thought Neuronoff looked very promising. Sprint without an externalized lead looks fantastic.

I would be kinda sad if after this whole fellowship process I end up taking an anesthesiology job for $500k with 12 weeks off. My wife would probably prefer it though.

 

[Ducttape]

you might consider doing anesthesia to start with, and part time pain, and as you get older, transition to full time pain.

nights and weekends will wear you out.

 

[nvrsumr]

On a positive, I thought Neuronoff looked very promising. Sprint without an externalized lead looks fantastic.

Just googled it. looks interesting. any other info on it.

 

[DOctorJay]

As a current fellow who attended for the first time this year, I was kinda shocked. I thought ASRA was the more science-based and less industry-y conference. If this was ASRA I can't imagine what NANS must be like.

I was especially surprised that the President's Award for best presentation at a Medtronic-funded conference went to a Medtronic-funded study showing Medtronic's new SCS was massively superior to the traditional Medtronic SCS. Maybe I should not have been surprised. When they highlighted that "100% of subjects were satisfied or very satisfied with DTM SCS at 12-months" my bull**** meter went crazy. I cannot imagine 100% of my patient population being satisfied with anything. But maybe my program just needs to put in way more SCS.

Also, as a current pain fellow looking for jobs my sense is that the pain market is rather saturated, or at least compared to the once-in-a-lifetime anesthesia market. I was surprised by the lack of pain recruitment going on compared to the meat market of ASA.

On a positive, I thought Neuronoff looked very promising. Sprint without an externalized lead looks fantastic.

I would be kinda sad if after this whole fellowship process I end up taking an anesthesiology job for $500k with 12 weeks off. My wife would probably prefer it though.

NANS has actually improved a bit as many of the KOL types went to ASPN but what you're saying about ASRA surprises me.

 

[TheNolano]

Just googled it. looks interesting. any other info on it.

They are coming to market in 2024 ideally. They have done a lot of animal studies and are doing human trials now.

Their team at ASRA seemed very reasonable. Not overly markety or over-hyped (unlike SPR and Nevro). The people at their booth seemed to actually understand the science of their product, and were very interested in having people be hands on.

Seems easy to deploy, and unlike Sprint it won't get pulled out, and it would be easier for patient's to wear the generator only when they need it.

Possible downsides pointed out by the team, is that depending on which nerve you target, there can be some cutaneous sensation from the trans-cutaneous energy transmission. Also placement of the tip very close to the nerve is likely more important than Sprint since they cannot match Sprint's max amplitude due to the trans-cutaneous transmission.

The fact that the people at their booth were willing to discuss its limitations earned them huge points in my book.

That was in stark contrast to the Nevro rep who stopped just short of telling me every single patient needs a Nevro trial but did tell me that after one or two interventions fail I should just try a Nevro on anyone from CRPS to axial back pain. Maybe he's right, but felt like an aggressive pitch to put devices in people.

Maybe I am still a bit disillusioned from ASRA.

ETA - The Neuronoff Injectrode people also gave me a sick slinky for my son. He is playing with it now. So they have to be good people.

 

[nvrsumr]

Will be curious to see the reimbursement. Looks totally like an office type procedure to piggyback on another thread.

 

[Tboned]

On a positive, I thought Neuronoff looked very promising. Sprint without an externalized lead looks fantastic.

Looks interesting. Thanks for sharing!