For regen practitioners - how do you broach the subject of cost?

[Agast]

I’d like to start offering PRP injections. I hate that it’s so expensive. When you discuss it with your patients and they express interest, how do you break it to them that it’s not covered by insurance? Do you leave it to your staff to discuss, give them a pricing brochure, etc. Any strategies to make it more affordable?

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[Dr. Ice]

I’d like to start offering PRP injections. I hate that it’s so expensive. When you discuss it with your patients and they express interest, how do you break it to them that it’s not covered by insurance? Do you leave it to your staff to discuss, give them a pricing brochure, etc. Any strategies to make it more affordable?

What is your definition of so expensive? There are practices charging thousands for it, and then there are those of us who are not. The kits cost $200-250.

I would submit that there are those of us who believe in the benefits who are not trying to break anyone’s bank by offering it

 

[Agast]

What is your definition of so expensive? There are practices charging thousands for it, and then there are those of us who are not. The kits cost $200-250.

I would submit that there are those of us who believe in the benefits who are not trying to break anyone’s bank by offering it

Most of my Medicare patients are on fixed income, so anything over $100 they’re saving up for. Anything over $300 and I will hear a lot of grumbling. So if the kit is $250, are most people charging $400?

 

[RoloTomassi]

I tell them it's a newer technique that has a growing body of evidence. Insurance is slow to cover new treatments. Insurance is cheap and always looks for a reason to not pay for things. Offer articles if they'd like. Set reasonable expectations. Staff can give exact pricing.

A lot of the big name regen guys don't use kits. They get a standard centrifuge and pipette it out themselves or have tech/RN do it. Costs <$10. Kit is for convenience.

I use kits. Price is kit price + self pay price for the procedure. You can go as low as you want, to whatever your break-even number is that will cover overhead.

 

[lobelsteve]

Any evidence kits are better than centrifuge?

 

[bedrock]

Most of my Medicare patients are on fixed income, so anything over $100 they’re saving up for. Anything over $300 and I will hear a lot of grumbling. So if the kit is $250, are most people charging $400?

They will have to pay more. though many seniors have a limited income, they also budget for other items. They do love to complain about it, but they have more resources that they let on.

I had two medicare patients who were complaining about this and that financially this week, but at the end of the visit, one discussed her upcoming tropical vacation and the other, that she had just paid over a thousand dollars for surgery on her dog.

So take their complaining with a grain of salt. You need to make a fair profit too. In LA people routinely charge $1200 for PRP. Now in the Rockies I charge $750 but that includes the kit, which is around $220.

If you take the time to do your own PRP, I would charge no less than $400 for it. Personally, I plan to charge $500-600 once we start making our own PRP.

These patients definitely take extra time and work compared to quick ESI/hip injections under insurance and you need to cover your time and expenses in addition to extra staff time/expense.

 

[Agast]

Am I correct in saying you can’t bill the CPT code for the joint injection to their insurance, because the injectate is experimental

 

[TIVAndy]

Am I correct in saying you can’t bill the CPT code for the joint injection to their insurance, because the injectate is experimental

Correct

 

[Doctodd]

Buy the Emcyte centrifuge and use their kits until you and your staff are comfortable enough to make it on their own. Back in the day Emcyte gave me the centrifuge for free if you bought enough kits. That being said, the centrifuge is only about $1500 and made by ependorff. The buckets in the centrifuge can hold various size disposables. Some companies do not allow you to use anything else but their kit in their centrifuge.

I have plenty of established patients who I give it pro bono. But I usually charge $500-800.

If you want I can ask my office manager which disposables she buys from McKesson.

 

[Doctodd]

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[drusso]

Am I correct in saying you can’t bill the CPT code for the joint injection to their insurance, because the injectate is experimental

When does something no longer become experimental? Not everything covered by insurance works (like arthroscopy for meniscus repairs) and not everything that works is covered by insurance.

Frame the cost in terms of their deductible, facility fees, SOS, etc. When you look at it in the big picture, it's a bargain.

 

[drusso]

I’d like to start offering PRP injections. I hate that it’s so expensive. When you discuss it with your patients and they express interest, how do you break it to them that it’s not covered by insurance? Do you leave it to your staff to discuss, give them a pricing brochure, etc. Any strategies to make it more affordable?

I'm curious why someone wants to start offering this NOW? Do you know reputable regen doctors you can refer to?

 

[nvrsumr]

Is reputable Regen Med doctor an oxymoron? I kid.

 

[drusso]

Is reputable Regen Med doctor an oxymoron? I kid.

You raise a good point. Those of us who were early adopters--I remember watching my attendings do PRP injections over 15+ years ago--have taken *A LOT* of heat for being Quacks, conducting Nazi-like human experimentation, etc. Now, you got a little bit of EBM and everyone and their brother--the DC's, ND's, PT's, etc want to start injecting PRP? If they cared about patients, where were these folks 15 years ago? Would you rather go to someone who's been at this a while or someone who just picked it up "on the side," never taken a Regen course, any certification, etc? Seems like people are just chasing $$.

 

[nvrsumr]

Market forces. Will eventually be good for patients if more access. if an efficacious treatment the more the merrier.

Ive been doing for over 10 years but I still say no to more patients than yes. In my neck of the woods including Longmont CO that is unheard of.

 

[lobelsteve]

You raise a good point. Those of us who were early adopters--I remember watching my attendings do PRP injections over 15+ years ago--have taken *A LOT* of heat for being Quacks, conducting Nazi-like human experimentation, etc. Now, you got a little bit of EBM and everyone and their brother--the DC's, ND's, PT's, etc want to start injecting PRP? If they cared about patients, where were these folks 15 years ago? Would you rather go to someone who's been at this a while or someone who just picked it up "on the side," never taken a Regen course, any certification, etc? Seems like people are just chasing $$.

Meh. Post makes you sound more like a salesman. Unless you can differentiate yourself to the public from the chiro down the street injecting DBD for $4000 per joint, it’s moot. Not to mention your sub lackluster EBM.

 

[RoloTomassi]

Any evidence kits are better than centrifuge?

Not really. There's so much heterogeneity in PRP between different kits. Emcyte is one of the few companies that has third party analysis of their PRP, so that's a big reason I use it. Like to know what I'm actually injecting. Self centrifuge, I'd have to send in samples for analysis.

 

[drusso]

Meh. Post makes you sound more like a salesman. Unless you can differentiate yourself to the public from the chiro down the street injecting DBD for $4000 per joint, it’s moot. Not to mention your sub lackluster EBM.

The chiropractor injecting DBD is committing fraud.

The pain doctor who last week was content to just inject triamcinolone in your joints until your arms and legs fall off, but then read a GIGO meta-analysis on PRP and has now “seen the light” is just either a) pretending to the throne; b) chasing $$.

 

[Dr. Ice]

I don’t offer PRP as first line treatment. I think there is a lot of hyperemotionality on this forum. One may say, then why do you watch and post, and to that I would say..hmm..you’re right I’m a hypocrite to a degree I suppose.

If someone is desperate for help and they have been through everything and are not surgical, I will have the discussion. I’m honestly surprised by the results. Been doing it for 6 years now. So, not saying I’m a guru, but have attended courses, read a ton, have even been asked to teach the spine course at a reputable conference and can say that I believe in it. I guess the argument could be that I’m nice enough and people have faith, but if they are in genuine pain, I’m not sure they would come back to me to have their other body parts treated with PRP if what I did for them before didn’t work.

I also don’t live and die by big data, live in the gray, and hate hoppy beers..

 

[thecentral09]

So I guess I have to ask… what all are u guys injecting with PRP?

 

[Dr. Ice]

So I guess I have to ask… what all are u guys injecting with PRP?

Tendons, peripheral joints, epidural space, facet joints..dare I say..intra..nope won’t say it..

 

[Ronin1]

I tell my patients that the EBM doesn’t really support PRP etc except in a few areas. If they are still interested I send them along to a local guy that is a believer. If I told them I thought it would work they would pay for it mostly. I’m just not there based on the available data quality.

 

[DOctorJay]

Am I correct in saying you can’t bill the CPT code for the joint injection to their insurance, because the injectate is experimental

I believe you’re correct but I know of docs doing this.

 

[Doctodd]

I tell my patients that the EBM doesn’t really support PRP etc except in a few areas. If they are still interested I send them along to a local guy that is a believer. If I told them I thought it would work they would pay for it mostly. I’m just not there based on the available data quality.

this has never made sense to me....the PRP doesnt know where you are putting it. If it works in a ligament or a tendon or a joint, it doesnt know if it is being put in the shoulder or the facet or the knee. That is where the variability lies and as a physician you have to pick your patients and place it correctly.

 

[SSdoc33]

The chiropractor injecting DBD is committing fraud.

The pain doctor who last week was content to just inject triamcinolone in your joints until your arms and legs fall off, but then read a GIGO meta-analysis on PRP and has now “seen the light” is just either a) pretending to the throne; b) chasing $$.

ugh.

enough

 

[drusso]

ugh.

enough

What do you dispute?

Back in the day, I'm talking about the days of the early '00s, the OG Regen guys were flying by the seat of their pants. They didn't have half a dozen meta-analyses of Level 1 studies like now, just 30 years' worth of experience and data from derm and wound care and the power of their convictions to guide them. Now, it's easier to find PRP than a coin-op car wash and you've got lines of triamcinolone-loving mo-fo's wanting in on the action. They didn't care about your cartilage and tendons 10 minutes ago, but *NOW* they want to talk to you about steroid-sparing interventions, anti-inflammatory diets, and graduated eccentric loading of tissues? It strains credulity.

 

[SSdoc33]

What do you dispute?

Back in the day, I'm talking about the days of the early '00s, the OG Regen guys were flying by the seat of their pants. They didn't have half a dozen meta-analyses of Level 1 studies like now, just 30 years' worth of experience and data from derm and wound care and the power of their convictions to guide them. Now, it's easier to find PRP than a coin-op car wash and you've got lines of triamcinolone-loving mo-fo's wanting in on the action. They didn't care about your cartilage and tendons 10 minutes ago, but *NOW* they want to talk to you about steroid-sparing interventions, anti-inflammatory diets, and graduated eccentric loading of tissues? It strains credulity.

unbearable

...or just your general point of view towards everybody.

Wedding Crashers (2005) clip with quote ...or just your general point of view towards everybody. Yarn is the best search for video clips by quote. Find the exact moment in a TV show, movie, or music video you want to share. Easily move forward or backward to get to the perfect clip.

getyarn.io

 

[Ducttape]

Seems like people are just chasing $$.

that seems to sum up the majority of the ads you see out there.

i refer out and do not do my own. continue to review the data, and some of it is good and supportive, and some not.

while some post about how the data is out there, it is not convincing enough and there is enough conflict of interest to make most studies invalid.



and ive been told meta-analyses are GIGO, unless they support the poster's point of view.....

 

[drusso]

unbearable

...or just your general point of view towards everybody.

Wedding Crashers (2005) clip with quote ...or just your general point of view towards everybody. Yarn is the best search for video clips by quote. Find the exact moment in a TV show, movie, or music video you want to share. Easily move forward or backward to get to the perfect clip.

getyarn.io

You can have your own opinions, but not your own facts.

 

[SSdoc33]

You can have your own opinions, but not your own facts.

you rail against anyone who doesnt set up his own shop.

yet you are endorsing increasingly esoteric, non-proven, cash-only treatments

i wonder why that i$ ?

you can sell your snake oil, but don't try to pretend like you are somehow better than somebody who gives a medicaid patient a cortisone shot in their knee

this is why your posts are "unbearable"

 

[drusso]

you rail against anyone who doesnt set up his own shop.

yet you are endorsing increasingly esoteric, non-proven, cash-only treatments

i wonder why that i$ ?

you can sell your snake oil, but don't try to pretend like you are somehow better than somebody who gives a medicaid patient a cortisone shot in their knee

this is why your posts are "unbearable"

The Medicaid patient is just getting Government Cheese health care. The Government doesn't care about their cartilage either.

 

[SSdoc33]

The Medicaid patient is just getting Government Cheese health care. The Government doesn't care about their cartilage either.

government cheese keeps you alive. and provides calories. your post reeks of elitism.

they aren't going to get Camembert from a boutique Oregon pain practice for free, are they?

and since when did steroids suddenly become agent orange for cartilage? about the same time you bought all those centrifuges?

 

[Ducttape]

The Medicaid patient is just getting Government Cheese health care. The Government doesn't care about their cartilage either.

patients who have medicaid either get this, for which there may be some data of benefit over conservative treatment, or purely conservative treatment.

you have belittled CBT and other conservative treatments in the past.

government cheese has its role.



a large majority of the population cannot afford regenerative procedures, regardless of cost. yes bedrock - medicaid, not medicare, but many medicare patients can also not afford PRP.

 

[drusso]

patients who have medicaid either get this, for which there may be some data of benefit over conservative treatment, or purely conservative treatment.

you have belittled CBT and other conservative treatments in the past.

government cheese has its role.



a large majority of the population cannot afford regenerative procedures, regardless of cost. yes bedrock - medicaid, not medicare, but many medicare patients can also not afford PRP.

How does CBT help arthritis?

Psychological treatment for pain has a very narrow indication. People slather patients with mu-shoo psych treatments all the time, but treatment effect for psychotherapy for most indications is small. I don’t see how it will help arthritis, spinal stenosis, or tendinitis.

It’s be pissed if someone told me my arthritis was in my head.

 

[Orin]

It's hard to imagine insurance has been sitting on a 20 year old therapy that could help them avoid massive medical/surgical costs associated with joint pain. It's not that there isn't a signal in the noise on the data, but there's a good reason why it hasn't made it into insurance.

 

[Doctodd]

if only Pfizer and JJ would do some studies to prove that PRP worked instead of NSAIDs.

 

[drusso]

It's hard to imagine insurance has been sitting on a 20 year old therapy that could help them avoid massive medical/surgical costs associated with joint pain. It's not that there isn't a signal in the noise on the data, but there's a good reason why it hasn't made it into insurance.

Not everything that works is covered by insurance and not everything covered by insurance works.

 

[drusso]

government cheese keeps you alive. and provides calories. your post reeks of elitism.

they aren't going to get Camembert from a boutique Oregon pain practice for free, are they?

and since when did steroids suddenly become agent orange for cartilage? about the same time you bought all those centrifuges?

You're a terrible debater because you're too emotional.

All I'm saying is that it's ironic that everyone's jumping into Regen now because they see data. They're just monetizing the science. The effectiveness of PRP does not vary under conditions of "no data" versus "data." And, there is no guarantee that insurance pays for "the best" treatment. Insurance doesn't care about quality or cost--they just care about collecting premiums. Not everything that works is covered by insurance, and not everything covered by insurance works. That goes for Medicaid too. There is no "free."

Long-term Benefit of Steroid Injections for Knee Osteoarthritis Challenged

Among people with osteoarthritic knees, repeated steroid injections over two years brought no lon

www.niams.nih.gov

MRI measurements revealed thinning of knee cartilage in both groups by the end of the study. But loss of cartilage in the steroid group was significantly greater than in controls, with the average change in cartilage thickness being -0.21 mm and -0.10 mm respectively. This more rapid thinning may be due to the known effects of corticosteroids on tissue breakdown. While the faster loss of cartilage in the steroid-treated group did not correlate with more pain over the 2-year period, it may have a long-term negative impact on the health of the joint.

“Use of corticosteroid injections to treat knee OA is based on the medicine’s capacity to reduce inflammation, but corticosteroids have also been reported to have destructive effects on cartilage,” said Dr. McAlindon. “We now know that these injections bring no long-term benefit, and may, in fact, do more harm than good by accelerating damage to the cartilage.”

 

[Nodolor]

So is Regenerative therapy ...PRP, Stems meant to be repeated or more of a one time treatment?

 

[Ferrismonk]

It's hard to imagine insurance has been sitting on a 20 year old therapy that could help them avoid massive medical/surgical costs associated with joint pain. It's not that there isn't a signal in the noise on the data, but there's a good reason why it hasn't made it into insurance.

I've been in practice 4 years. Not forever, but I have not seen ANY new pain procedure get added to insurance coverage. Best I've seen is new devices/procedures that can squirrel into an old CPT code, but even then they usually limit coverage and fight tooth and nail.

 

[TIVAndy]

I've been in practice 4 years. Not forever, but I have not seen ANY new pain procedure get added to insurance coverage. Best I've seen is new devices/procedures that can squirrel into an old CPT code, but even then they usually limit coverage and fight tooth and nail.

Generally agree. I think vertiflex may have added coverage/cpt over last 5 yrs

 

[RoloTomassi]

I have not seen ANY new pain procedure get added to insurance coverage.

Hopefully Intracept in 2022

 

[drusso]

Does anyone know how the fusion CPT codes are working out?

 

[Ducttape]

How does CBT help arthritis?

Psychological treatment for pain has a very narrow indication. People slather patients with mu-shoo psych treatments all the time, but treatment effect for psychotherapy for most indications is small. I don’t see how it will help arthritis, spinal stenosis, or tendinitis.

tell me, which of our procedures cures arthritis?

you of all people know that the common denominator for pain is the CNS. without interpretation of the signal, there is no pain. modulation of pain at the front end does not eliminate the perception of the signal at the backend.

It’s be pissed if someone told me my arthritis was in my head.

no, the arthritis is in your knee/hip/finger. how it makes you feel is.

You're a terrible debater because you're too emotional.

All I'm saying is that it's ironic that everyone's jumping into Regen now because they see data. They're just monetizing the science. The effectiveness of PRP does not vary under conditions of "no data" versus "data." And, there is no guarantee that insurance pays for "the best" treatment. Insurance doesn't care about quality or cost--they just care about collecting premiums. Not everything that works is covered by insurance, and not everything covered by insurance works. That goes for Medicaid too. There is no "free."

if you do not use data to guide your decision making on whether to advocate for a procedure, then you are no better than a chiropractor or a prolotherapist.

5-6 years ago, my posts clearly show that I did not believe in PRP for any indication.

I am not making any money at all out of PRP, yet I am referring some of my patients to someone who does, based purely on the evolving science - that you have posted. in fact, I am losing money because I'm not doing steroid injections, etc.

 

[Nodolor]

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[lobelsteve]

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Shut up and take my money.

 

[Agast]

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How hands-on are we talking here

 

[lobelsteve]

How hands-on are we talking here

It is hands in for gspot shot

 

[oreosandsake]

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[Doctodd]

some very good speakers.....Buford is ortho and seems pretty sharp. He was at the IOF conferences as a speaker the last few years.