C arm?

[jsaul]

hello all,

I am have recently graduated from fellowship and looking to start a practice.
Question- I looking to set up in office procedures, what kind of C arm should I buy. What is the best value out there in terms of cost reliabilty and quality. Is used ok? Where and how do I purchase these?

thank you all in advance

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[DOctorJay]

While the link below does not give info related to C-arm, it does delve into start up costs and I thought it might be helpful for you. Hopefully someone can answer your specific question. Best of luck in your practice!

http://www.algosresearch.org/Education/StartingPractice/Startupcosts.html

-J

 

[spinepain]

Hello,

I'm just starting a pain fellowship. One of the things that has struck me is the fairly low resolution of our C-Arm monitor (525 lines analog). I have read that the newer machines such as the OEC 9800 have much higher resolution video (1k X 1k digital).

For those who have used both - How important is this increased picture resolution?

Is anyone using large - e.g. 37" or 42" - High def LCD secondary monitors for fluoroscopy?

Thanks

 

[C Fiber]

I think it makes a big difference. With OEC 9800 I can see intravascular injections more often then the other low resolution models. It is also important to see your bony anatomy in the craniofacial area for your sphenopalatine, trigeminal blocks, also your AA and OA joints. Also I can see better anatomy with your cervical lateral views for you cervical ESI, facets, etc. Once you have used a good C arm, you won't want to use a old model again. Plus, it's nice to your flouro technicians' poor back. One of the old C arm I have used did not even have a slide option. The poor tech had to physically push the whole C arm forward in order to clear the bed to do a lateral view.

 

[Jared Leger]

I recommend the OEC 9800. If you are starting up office based procedures, I would buy refurbished with a warranty.

With the SOS diff, office based is a great way to go. I would recomemnd using a billing company.

Office based billing can be tricky.

JL

 

[Aether2000]

Much depends on your payor class mix as to whether office procedures under fluoro make any sense. Medicare pays 1/3 as much to do the same fluoro guided procedure in the office for pain management, but if your medicare and Anthem percentages are very low, then it makes more sense to buy into an ASC and do the procedures there. But if you are fast, and have a higher percentage of Medicare/Anthem/BC, then it does make sense to do the procedures in the office.
I would suggest NOT buying a new C-arm for the office initially. When starting a practice, the last thing one needs to worry about is the monthly payment on a $140,000 C-arm and a $25,000 pain table. There are other much less expensive alternatives to an OEC 9800 including Philips Pulsera or almost any refurbished C-arm.

 

[drusso]

What about leasing your equipment and just collecting the global professional fees and foregoing the facilities fees altogether?

 

[Aether2000]

There are no facility fees chargable in an office setting, but a small amount is paid by some insurers for the use of fluoroscopy. We are attempting to have the reimbursement for interlaminar blind epidural injections to be paid at the same rate as trigger point injections since there is no assurance the medicine is being placed in the epidural space. This should make fluoroscopy mandatory for all spinal injections as are the ISIS doctrine statements to that effect.
If one leases fluoro equipment, the writeoff is immediate, but current tax law allows up to around $105K as a cumulative equipment write off for the year. Therefore depending on the sum total of equipment bought in one year, one may be better leasing, but remember leasing will ultimately drive up the cost of the equipment due to interest paid on the lease.

 

[Jared Leger]

When looking into ASC versus in-office Fluoroscopy, I would look at each payor individually. Does this payor offer a site of service differential (SOS). Then look at the payor mix.

Next, I would look at the SOS Diff. versus the professional fee plus any ownership distributions in an ASC.

Next, I would do a formal proforma that includes the payor mix and then compares apples to apples, ASC vs. In-office.

I can almost guarantee, unless your procedure volume is very low, in-office Fluoro makes sense. If your volume is really high, then an ASC may make sense.

Remember in-office billing can be tricky.

JL

 

[C Fiber]

1. off the subject just a little: who do you use for billing? what do they charge?
2. how many procedures are you doing in your office per week? what is your payer mix?