buy and bill

[metadr]

Now that I have started my own practice I am faced with tough financial questions that I did not have to deal with before. One such question is viscosupplementation injections. For medicare patients where I would have to buy and bill for the medication, the j-code reimbursements are significantly lower than the actual cost of the medication.

Is there any specific discount programs or GPOs to get better pricing at least on par with medicare reimbursement or ideally lower than the medicare re-imbursement?

Same question for Botox.

I hate to give up on these procedures purely due to financials when these therapies can be a good options for some patients..

Any help is greatly appreciated!!

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[RoloTomassi]

Have you compared all the viscos? Some have much higher margins than others. GenVisc and Hymovis I believe are better ones

 

[metadr]

These are only ones I looked at so far:

Orthovisc - MCR reimbursement $134
COST FROM SUPPLIER = $160
COST FROM MCKESSON = $163

Monovisc - MCR reimbursement = $790
COST FROM SUPPLIER = $850
COST FROM MCKESSON = $896

 

[metadr]

Have you compared all the viscos? Some have much higher margins than others. GenVisc and Hymovis I believe are better ones

Thanks for the suggestion!! Do you know the cost/reimbursements for GenVisc and Hymovis?

 

[Ferrismonk]

I believe we had okay luck with Gelsyn and Supartz. Other option would be to give the patient a script and have them fill it at the pharmacy under their pharmacy benefits. Sometimes that works. You would only bill the 20611.

 

[nvrsumr]

i do not offer viscosupplementation anymore for this exact reason. The margins are super thin and takes only a couple no shows/wasted product to make it an actual loss over even multiple patients. Very little success getting it thru their pharmacy benefits

 

[DODOCSS]

I believe we had okay luck with Gelsyn and Supartz. Other option would be to give the patient a script and have them fill it at the pharmacy under their pharmacy benefits. Sometimes that works. You would only bill the 20611.

don't ever use supartz

 

[BobBarker]

Buy GelOne from the zimmer rep.

 

[Laryngospasm]

I also don’t do viscosupplementation anymore.

 

[metadr]

I believe we had okay luck with Gelsyn and Supartz. Other option would be to give the patient a script and have them fill it at the pharmacy under their pharmacy benefits. Sometimes that works. You would only bill the 20611.

Thanks for the suggestion! Do you know the cost/reimbursements for Gelsyn and Supartz?

 

[RoloTomassi]

Sorry I don't have the numbers. I actually don't do much anymore, I steer more towards PRP. I may have overstated when I said "much higher margins" but there are losers and there are small profit makers. Thing is each insurance has their preferred visco, so you can't just stock up on the one with the best margins, you have to have multiple, and then still get some through specialty pharmacy. Overall might not be worth the hassle like others have said.

 

[BobBarker]

Buy GelOne from the zimmer rep.

 

[NJPAIN]

I've done OK with Hymovis. You need to be VERY CAREFUL. I got burned with Durolane. Ins plan denied Hymovis. Sent me a list of "preferred" products (All Bioventus). Used Durolane. Worked great. Patient asked to do other knee. When I looked at the reimbursement I found out that I lost $400.

 

[pmrmd]

I have always had good luck with Supartz and its modestly profitable at about $90 per syringe. I have not had good result with any of the one-shot injections.

 

[Ferrismonk]

I don't like supartz per se, and I hate doing 5 injections on someone unnecessarily, however it was often the preferred one (because it was the cheapest I'm sure). Because it's the cheapest I believe it's possible to make money on it. Sorry I don't know the costs. However Supartz and Gelsyn are the same rep I believe.

 

[pmrmd]

You don’t have to do 5 Suoartz injections. Stop after 3 if the patient is improved. You will use the leftovers the next day probably.

 

[Agast]

I leave the HA injections to the ortho guys since it’s been their thing for so long, our analysis showed we had the highest profit margin on Synvisc sometimes Orthovisc. For some Medicare plans they write an Rx and the patient gets it at the pharmacy and brings it in to inject.

 

[SageCraft]

None of our local Ortho groups utilize HA anymore for this reason. They turf them all to us.

 

[mid|ine]

Durolane has been the only ones we have + margins on. Unfortunately, some of the insurances only seem to cover the ones with negative margins... hmmm,... wonder why?

 

[drusso]

Now that I have started my own practice I am faced with tough financial questions that I did not have to deal with before. One such question is viscosupplementation injections. For medicare patients where I would have to buy and bill for the medication, the j-code reimbursements are significantly lower than the actual cost of the medication.

Is there any specific discount programs or GPOs to get better pricing at least on par with medicare reimbursement or ideally lower than the medicare re-imbursement?

Same question for Botox.

I hate to give up on these procedures purely due to financials when these therapies can be a good options for some patients..

Any help is greatly appreciated!!

Have your admin keep a list of who pays and who doesn't and then just make it cash for the ones that don't pay.

 

[10KHertz]

Botox is a different ball game. Blue cross’s national pharmacy, Caremark pharm, doesn’t ship Botox anymore. So practices have to buy and bill . Overhead is high on this product. There is no real profit . Just procedural codes and major follow up on getting paid back on the injectate. Just more billing work in the end. Hopefully other insurances don’t follow suit . Otherwise Botox will become an obsolete option.

FYI if you haven’t noticed , Blue Cross is the financial bank for Medicare . They are the first to implement and influence health policy . It’s an unholy to big to fail marriage. Another monopoly allowed to go rogue …

 

[bedrock]

Botox is a different ball game. Blue cross’s national pharmacy, Caremark pharm, doesn’t ship Botox anymore. So practices have to buy and bill . Overhead is high on this product. There is no real profit . Just procedural codes and major follow up on getting paid back on the injectate. Just more billing work in the end. Hopefully other insurances don’t follow suit . Otherwise Botox will become an obsolete option.

FYI if you haven’t noticed , Blue Cross is the financial bank for Medicare . They are the first to implement and influence health policy . It’s an unholy to big to fail marriage. Another monopoly allowed to go rogue …

agree. I never buy and bill botox. I also avoid botox like the plague. If other physicians ask if I do it, I always say no.

I only offer to 1-2 patient/year that I really like, and I only do it if the botox comes through their pharmacy benefit and so I just bill the procedure. Otherwise they are out of luck.