Botox reimbursement

[Sanchik]

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I'm thinking of trying to build a niche in spasticity management once I graduate (considering SCI fellowship first). Im talking multidisciplinary with PT/OT, oral meds, Botox, Baclofen pumps. I realize that it would take a few years to build up a practice and a name. what I want to know is how feasable this is from the financial/practical standpoint. Im in NYC. Thanks!

 

[RUOkie]

If you are going to do such a thing, I would advise being affilitated with a hospital/clinic with good pricing for injectables. The reimbursement for injectable drugs is supposed to be 105% of ARP (average retail price). For the last few years though, I found that I lost $10/vial on BoTox. I now write Rx. for it and make the patient take the risk. Solo practice oncologists have taken a bath on their chemo for the same reason.

Also, spasticity is not a covered dx. for Allergan's pt. assistance program (no FDA approval), so no help there. Hopefully soon. The reimbursement for the injections is fairly good, talk to the fiscal intermediary about whether EMG guidance is covered (in Oklahoma it is not).

 

[axm397]

I have a friend who is doing exactly that - he did a TBI fellowship and is now in private practice if u pm me with your contact info, i can give u his info.

 

[PMR 4 MSK]

I've been working on doing this for > 10 years. I cannot for the life of me figure out how to get people to send me anyone other than CP kids on public aid for spasticity. Most of the spasticity patients I see are sent for other things.

If you look at it statistically, the average PCP might see 150 - 200 patients per week, and maybe 1 has spasticity issues. Trying to get them to think of you for that one patient is hard.

I've tried marketing to primary care, specialty care, the public, disability interest groups. None of it has been fruitful for me.

 

[buddy 2004]

Have you looked into attaching yourself to a stroke program? The spasticity needs there may be minor compared to TBI or SCI, but in general stroke units in hospitals are more sophisticated and it might be possible to latch on to their followup protocols.