Intracept

[PinchandBurn]

Anyone in private practice doing this?

I did about 10 cases.

I would say fair results


However ASC won't let me do this. Apparently in private practice ther roi isn't there for the facility especially for medicare. How do you deal with this as they have a monopoly..

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[interjectionreflection]

Might be a silly question but I'm still not sure how you wouldn't get the basivertebral nerve with the exothermic reaction with PMMA in a augmentation could that not provide similar results (I know no fracture an all but for arguments sake wouldn't the results be similar and could it be used for modic changes in the circumstance you described)?

 

[clubdeac]

Might be a silly question but I'm still not sure how you wouldn't get the basivertebral nerve with the exothermic reaction with PMMA in a augmentation could that not provide similar results (I know no fracture an all but for arguments sake wouldn't the results be similar and could it be used for modic changes in the circumstance you described)?

What? Sure it ablates the nerve but not worth the risks especially in a younger population. Juice definitely ain’t worth the squeeze

 

[CleanUp]

Clinically I have seen some home runs.

Financially zero home runs.

 

[Taus]

Anyone in private practice doing this?

I did about 10 cases.

I would say fair results


However ASC won't let me do this. Apparently in private practice ther roi isn't there for the facility especially for medicare. How do you deal with this as they have a monopoly..

Private practice.

Medicare facility margin is about 3k….. they have a problem with that? Commercial should be their typical contracted rate multipliers. Same with your professional fee.

 

[PinchandBurn]

Private practice.

Medicare facility margin is about 3k….. they have a problem with that? Commercial should be there typical contracted rate multipliers. Same with your professional fee.

2024.
Reimbursement went down for facility fyi

Factor OR time, Anesthesia, pre to post op...not 3k

 

[Taus]

I had not looked this year… Thanks. Just found the file. Attached.

I guess like anything else, you and your practice will starve if you see mainly Medicare.

 

[Ronin1]

It can be done fairly efficiently with local and iv sedation. My time is usually 25-30 minutes for two levels.

 

[MD87]

My ASC does not allow for advantage plans for this procedure. Regular Medicare and regular commercial plans only - “advantage” plans werent covering the kits, apparently.

 

[gdub25]

I had not looked this year… Thanks. Just found the file. Attached.

I guess like anything else, you and your practice will starve if you see mainly Medicare.

I see a lot of statements about Medicare being bad and being profitable is all about commercial payers. For us this just simply is not the case. Not only are our commercial rates not any better than Medicare, we do fairly well on Medicare rates.

2024.
Reimbursement went down for facility fyi

Factor OR time, Anesthesia, pre to post op...not 3k

This is true and what we determined at our facility. We identify candidates for this treatment every couple weeks and send them out to our competitors who work at the hospital. It has no role financially in our facility and have made it clear to the company that until their prices come down we will not offer it ourselves. striker and Medtronic both have product coming to the market Q3 or Q4 of this year reportedly and we plan to use those companies assuming they have more favorable pricing

 

[RoloTomassi]

Depends how fast you are and how fast your staff can turnover a room.

Medicare margin is not bad, about the equivalent of 7 TFESI. Again, depends how fast you are at Intracepts vs epidurals.

 

[Taus]

I see a lot of statements about Medicare being bad and being profitable is all about commercial payers. For us this just simply is not the case. Not only are our commercial rates not any better than Medicare, we do fairly well on Medicare rates.





This is true and what we determined at our facility. We identify candidates for this treatment every couple weeks and send them out to our competitors who work at the hospital. It has no role financially in our facility and have made it clear to the company that until their prices come down we will not offer it ourselves. striker and Medtronic both have product coming to the market Q3 or Q4 of this year reportedly and we plan to use those companies assuming they have more favorable pricing

I’ve never heard of commercial not paying better than Medicare. How common is that?

I knew re Stryker, not Medtronic. Interesting

 

[SC Tian]

Here in our state, intracept kit is not considered an implant, the state has an extra charge for it, and our ASC has a 20% handling fee across the board, making this procedure not profitable.

 

[RoloTomassi]

I’ve never heard of commercial not paying better than Medicare. How common is that?

I knew re Stryker, not Medtronic. Interesting

Didn't know about either. Any details on Stryker?

 

[PinchandBurn]

I see a lot of statements about Medicare being bad and being profitable is all about commercial payers. For us this just simply is not the case. Not only are our commercial rates not any better than Medicare, we do fairly well on Medicare rates.





This is true and what we determined at our facility. We identify candidates for this treatment every couple weeks and send them out to our competitors who work at the hospital. It has no role financially in our facility and have made it clear to the company that until their prices come down we will not offer it ourselves. striker and Medtronic both have product coming to the market Q3 or Q4 of this year reportedly and we plan to use those companies assuming they have more favorable pricing

Excellent v idea.. we are abandoning for now

 

[gdub25]

Depends how fast you are and how fast your staff can turnover a room.

Medicare margin is not bad, about the equivalent of 7 TFESI. Again, depends how fast you are at Intracepts vs epidurals.

You're not considering the metric of how profitable you are on a per hour basis. No way our facility is going to approve either of intracept or 7 ESIs to tie up an OR for an hour. If your OR is full of SCS, pump, SI fusion, PNS then there's no place for Intracept or ESIs.

I’ve never heard of commercial not paying better than Medicare. How common is that?

I knew re Stryker, not Medtronic. Interesting

Not sure how common it is, I don't have intimate knowledge of too many markets. OK, Texas, Arkansas and Missouri all seem pretty similar from what I've seen but the there are states like Nebraska where their lowest paying commercial insurer pays over double what Medicare does for pain procedures.

In Oklahoma BCBS represents over 60% of all commercially insured patients and they are able to set the rates. No one can afford to not accept them and it allows the other insurances to follow their lead.

 

[Taus]

Didn't know about either. Any details on Stryker?

Expected Q4. Burns are half duration as current, price expected lower. Don’t know much beyond that.

 

[RoloTomassi]

If your OR is full of SCS, pump, SI fusion, PNS

My OR is definitely not full of those

 

[RoloTomassi]

Expected Q4. Burns are half duration as current, price expected lower. Don’t know much beyond that.

Very interesting

 

[MitchLevi]

Expected Q4. Burns are half duration as current, price expected lower. Don’t know much beyond that.

Interesting

 

[Taus]

You're not considering the metric of how profitable you are on a per hour basis. No way our facility is going to approve either of intracept or 7 ESIs to tie up an OR for an hour. If your OR is full of SCS, pump, SI fusion, PNS then there's no place for Intracept or ESIs.




Not sure how common it is, I don't have intimate knowledge of too many markets. OK, Texas, Arkansas and Missouri all seem pretty similar from what I've seen but the there are states like Nebraska where their lowest paying commercial insurer pays over double what Medicare does for pain procedures.

In Oklahoma BCBS represents over 60% of all commercially insured patients and they are able to set the rates. No one can afford to not accept them and it allows the other insurances to follow their lead.

Interesting. I’ve literally never heard of commercial paying equal or similar to Medicare. Assumed it was universally higher.

 

[bedrock]

Interesting. I’ve literally never heard of commercial paying equal or similar to Medicare. Assumed it was universally higher.

not sure about intracept specifically, but in desirable coastal states such as CA and FL, Medicare is often the best payor. I don't know how non HOPD docs get by in those expensive states with such terrible reimbursement.

 

[bedrock]

I see a lot of statements about Medicare being bad and being profitable is all about commercial payers. For us this just simply is not the case. Not only are our commercial rates not any better than Medicare, we do fairly well on Medicare rates.





This is true and what we determined at our facility. We identify candidates for this treatment every couple weeks and send them out to our competitors who work at the hospital. It has no role financially in our facility and have made it clear to the company that until their prices come down we will not offer it ourselves. striker and Medtronic both have product coming to the market Q3 or Q4 of this year reportedly and we plan to use those companies assuming they have more favorable pricing

Excellent v idea.. we are abandoning for now

I just started offering intracept. I see my first patients back in July. I did one commerical and one medicare patient. I'm sure I will get faster, but it definitely took a while. After considering the mortage, staff, insurance, etc costs, we figure that the ASC makes $2,000 in profit on a medicare case, which is worse than me doing 5 ESI/MBB in a hour (I flip rooms). And $595 is not enough of a pro fee to me for an hours work in the ASC, as after overhead I only get $300. I can make more per hour seeing clinic patients, and intracept patients require much more handholding and staff hours than ESI/RFA patients, so I expect I'm actually making less than $300/hr on medicare intracept patients.

I plan to only offer intracept to patients with commercial insurance going forward unless Relievant significantly lowers their pricing. I welcome other companies entering the market this fall as competition should bring lower costs all around.

I will still send out the ideal intracept medicare candidates to HOPD docs, but I'm not going to bother discussing with patient or organizing a referral for moderate candidates.

One thing about most SCS companies, is that they will adjust their kit pricing for medicare vs commerical payors. Relievant needs to also do this.

It’s only far that we all profit together. It's not fair to ask physicians to do medicare intracept for pennies while relievant makes the same $$$ either way.
Doing a ton of medicare intracept isn't in the cards for my practice until Relievant becomes more reasonable with their medicare kit pricing. And still I would only do this for medicare patients because I'm one of the owners of the practice receiving ASC revenue. On pro fees alone I would never do a medicare intracept case.

 

[MitchLevi]

I’ve done one case, and my case yesterday was canceled by anesthesia 45 min prior. I have another few scheduled over the next week or two. After I’ve done a handful of them I’ll take a look at the financials considering we don’t know how profitable these are until we do a handful of them considering the time required to do it is an unknown right now.

There’s a learning curve with this procedure. It isn’t the easiest procedure to do depending on the pt.

I’m only able to do Medicare, Kaiser and Cigna.

 

[Orin]

It's a good procedure for the right patient. I'm not the best money person to talk to, but I would suggest looking into off label hardware for the Medicare patients if you don't want to send it to your local hospital based docs. There's similar hardware that uses RF energy to create a lesion around that nerve available from the cancer space.

Stryker's Optablate, Medtronic's Osteocool, and Merit Medical's STAR ablation system are all able to do this.

Merit Medical's STAR Ablation system is what I'm using as it's unipedicular/steerable. This is mainly due to approval/training from Intracept but also I use them for complex cancer pain intermittently. It's priced as an add on to a kyphoplasty with a lower CPT code 20982($6,501 for ASC) compared to 64628 ($9,418 for ASC) so margin should be higher in PP. The procedure is mostly the same between the two but a little more technically challenging due to the lack of a sheath to maintain the pathway, and with the harder bone, you'd need to use something like a sponge stick or cast spreaders to help remove the osteotome.

As they're all off-label for the indication, the reps aren't going to be able to help you out beyond providing hardware, so you would need to know your stuff with getting the RF probe to the right space safely.

 

[Dr. Ice]

not sure about intracept specifically, but in desirable coastal states such as CA and FL, Medicare is often the best payor. I don't know how non HOPD docs get by in those expensive states with such terrible reimbursement.

Nj is treated like ny, but it’s def not as fun, so we get ****ed all around, good times

 

[Taus]

I just started offering intracept. I see my first patients back in July. I did one commerical and one medicare patient. I'm sure I will get faster, but it definitely took a while. After considering the mortage, staff, insurance, etc costs, we figure that the ASC makes $2,000 in profit on a medicare case, which is worse than me doing 5 ESI/MBB in a hour (I flip rooms). And $595 is not enough of a pro fee to me for an hours work in the ASC, as after overhead I only get $300. I can make more per hour seeing clinic patients, and intracept patients require much more handholding and staff hours than ESI/RFA patients, so I expect I'm actually making less than $300/hr on medicare intracept patients.

I plan to only offer intracept to patients with commercial insurance going forward unless Relievant significantly lowers their pricing. I welcome other companies entering the market this fall as competition should bring lower costs all around.

I will still send out the ideal intracept medicare candidates to HOPD docs, but I'm not going to bother discussing with patient or organizing a referral for moderate candidates.

One thing about most SCS companies, is that they will adjust their kit pricing for medicare vs commerical payors. Relievant needs to also do this.

It’s only far that we all profit together. It's not fair to ask physicians to do medicare intracept for pennies while relievant makes the same $$$ either way.
Doing a ton of medicare intracept isn't in the cards for my practice until Relievant becomes more reasonable with their medicare kit pricing. And still I would only do this for medicare patients because I'm one of the owners of the practice receiving ASC revenue. On pro fees alone I would never do a medicare intracept case in a facility.

Yep. Granted, if someone is getting professional fees only and from doing majority of any pain procedures in Asc, they are getting hosed.

 

[Taus]

I’ve done one case, and my case yesterday was canceled by anesthesia 45 min prior. I have another few scheduled over the next week or two. After I’ve done a handful of them I’ll take a look at the financials considering we don’t know how profitable these are until we do a handful of them considering the time required to do it is an unknown right now.

There’s a learning curve with this procedure. It isn’t the easiest procedure to do depending on the pt.

I’m only able to do Medicare, Kaiser and Cigna.

It takes doing a bunch of them to get more efficient. Lots of little nuances to learn by doing, hopefully with a good rep.

That said, although this is a routine procedure in my hands at this point… should be 15 minutes, 20 max, skin to skin per vert body….. I still get occasional cases that are challenging and take much longer than they should, sometimes needing to re-access contralateral pedicle to get proper bvn targeting.

 

[Dr. Ice]

Yep. Granted, if someone is getting professional fees only and from doing majority of any pain procedures in Asc, they are getting hosed.

Agreed, only a bright eyed bushy tailed dummy who was so young and naive would have made a then physician owned “hospital” a ton of money, for a pat on the head and then get totally ****ed afterwards.

Only a young, naive fresh out of fellowship dummy would do so. But then again, those are the best ones to pay $225k for the “privilege” of working for such an institution

 

[Taus]

Agreed, only a bright eyed bushy tailed dummy who was so young and naive would have made a then physician owned “hospital” a ton of money, for a pat on the head and then get totally ****ed afterwards.

Only a young, naive fresh out of fellowship dummy would do so. But then again, those are the best ones to pay $225k for the “privilege” of working for such an institution

Yeah, that is not ideal at all.

I now do 25-30 office fluoro procedures 2x/week, including rfa. Asc/hopd only 1-2x/month. Works out well. Better late than never to see the light for both of us.

 

[bedrock]

Yeah, that is not ideal at all.

I now do 25-30 office fluoro procedures 2x/week, including rfa. Asc/hopd only 1-2x/month. Works out well. Better late than never to see the light for both of us.

Which procedures do you still do at an ASC/HOPD?
Are there any procedures you must do at HOPD?

 

[Taus]

Which procedures do you still do at an ASC/HOPD?
Are there any procedures you must do at HOPD?

Intracept, scs trials (going to work on moving them to office fluoro shortly - I finally got rfa set up in office) and patients who want to wait 1-2 months for IV sedation. Granted, I don’t do too many trials, maybe 10/year. I don’t do scs implants anymore and anything else can and should be done in office. A few commercial carriers pay similar in office and facility for basic injections, but they’re the exception in my region. Out of pocket cost for patients is also much higher in facility, so it’s truly better for all to be in office.

 

[Dr. Ice]

Yeah, that is not ideal at all.

I now do 25-30 office fluoro procedures 2x/week, including rfa. Asc/hopd only 1-2x/month. Works out well. Better late than never to see the light for both of us.

I’m glad my misfortune helped pave the way for more equitable treatment.

It helped you greatly that you had a chief really had your back..

And now the same chief that I had is now chief again but from what I hear he’s too old and beaten now to care and enforce his antiquated beliefs

 

[bedrock]

Intracept, scs trials (going to work on moving them to office fluoro shortly - I finally got rfa set up in office) and patients who want to wait 1-2 months for IV sedation. Granted, I don’t do too many trials, maybe 10/year. I don’t do scs implants anymore and anything else can and should be done in office. A few commercial carriers pay similar in office and facility for basic injections, but they’re the exception in my region. Out of pocket cost for patients is also much higher in facility, so it’s truly better for all to be in office.

Intracept of course must be facility.

It’s nice that you’re moving stim trials to the office. Will definitely pay more and is doable on 99% of patients. In the six years at my first job, I did a couple hundred office based stim trials with just Xanax and Percocet.
I also did over a thousand RFA in office with just Xanax, and less than 20 RFA in an ASC during those six years.

The only office based procedure for which I gave Percocet was stim trials. In retrospect, I did a dozen cervical RFA in ASC, that could have been done in office, if I gave both a benzo + opioid.

I’d suggest you offer a Vicodin/Percocet + Xanax for cervical RFA on non elderly patients. I bet you could move even more of your RFA to office, further increasing your revenue.

Are you doing Kyphoplasty? As you know you’re getting hosed if that’s not done in office. Maybe you could do it with nitrous and PO opioid like bob barker.
Who is doing your SCS implants? Surgeons, or other pain docs at your facility?

 

[Dr. Ice]

Intracept, scs trials (going to work on moving them to office fluoro shortly - I finally got rfa set up in office) and patients who want to wait 1-2 months for IV sedation. Granted, I don’t do too many trials, maybe 10/year. I don’t do scs implants anymore and anything else can and should be done in office. A few commercial carriers pay similar in office and facility for basic injections, but they’re the exception in my region. Out of pocket cost for patients is also much higher in facility, so it’s truly better for all to be in office.

Wow…he must really not give a **** anymore if he’s gonna “allow” rf and stim trials in office. With advanced age comes realization of defeat of your antiquated ideology. I guess the “chief” status is cause no one else wants to do it.

Or maybe it’s cause ortho just sucks ass mostly and they finally realize the juice isn’t worth squeeze.

 

[Taus]

Intracept of course must be facility.

It’s nice that you’re moving stim trials to the office. Will definitely pay more and is doable on 99% of patients. In the six years at my first job, I did a couple hundred office based stim trials with just Xanax and Percocet.
I also did over a thousand RFA in office with just Xanax, and less than 20 RFA in an ASC during those six years.

For cervical rfa… I can usually judge this with the MBB. Most are elderly, except the occasional young/whiplash. So far it’s been fine with PO benzo and 25g track needle w lido skin to bone before rfa cannula on all, even the younger ones. May try the combo med next time have a particularly sensitive patient on mbb. Same w scs.

I haven’t done a kyphoplasty since fellowship. I send out to a couple local small private practice doc colleagues or IR. Same with scs implants…. Several excellent local pain docs and neurosurgeons who do a solid job on them and happy to have the referral. None of the ortho spine surgeons in my group implant scs.

The only office based procedure for which I gave Percocet was stim trials. In retrospect, I did a dozen cervical RFA in ASC, that could have been done in office, if I gave both a benzo + opioid.

I’d suggest you offer a Vicodin/Percocet + Xanax for cervical RFA on non elderly patients. I bet you could move even more of your RFA to office, further increasing your revenue.

Are you doing Kyphoplasty? As you know you’re getting hosed if that’s not done in office. Maybe you could do it with nitrous and PO opioid like bob barker.

Who is doing your SCS implants? Surgeons, or other pain docs at your facility?

 

[bedrock]

There’s a learning curve with this procedure. It isn’t the easiest procedure to do depending on the pt.

I’m only able to do Medicare, Kaiser and Cigna.

No Anthem in your area?

 

[MitchLevi]

Lose money on Anthem.

I’ve said for a very long time now that contracts with payers are second only to pt volume in deciding how successful you’ll be in practice, and this Intracept roll out has proven it true yet again.

I’m really tired of trying to offer new treatment options that I hear so much buzz about, only to find out I can’t do it.

 

[PinchandBurn]

Intracept of course must be facility.

It’s nice that you’re moving stim trials to the office. Will definitely pay more and is doable on 99% of patients. In the six years at my first job, I did a couple hundred office based stim trials with just Xanax and Percocet.
I also did over a thousand RFA in office with just Xanax, and less than 20 RFA in an ASC during those six years.

The only office based procedure for which I gave Percocet was stim trials. In retrospect, I did a dozen cervical RFA in ASC, that could have been done in office, if I gave both a benzo + opioid.

I’d suggest you offer a Vicodin/Percocet + Xanax for cervical RFA on non elderly patients. I bet you could move even more of your RFA to office, further increasing your revenue.

Are you doing Kyphoplasty? As you know you’re getting hosed if that’s not done in office. Maybe you could do it with nitrous and PO opioid like bob barker.
Who is doing your SCS implants? Surgeons, or other pain docs at your facility?

Love this idea

I am going to try to do kypho with hydrocodone and nitrous. plus local.

currently doing IV RN sedation.

However 2 weeks ago did xanax plus norco and they did great. ONly downside is sometimes late onset of action adn then getting them off the table. IV meds easier to titrate...But I would prefer not having to start and IV that the MA misses 3 times..

 

[Taus]

Lose money on Anthem.

I’ve said for a very long time now that contracts with payers are second only to pt volume in deciding how successful you’ll be in practice, and this Intracept roll out has proven it true yet again.

I’m really tired of trying to offer new treatment options that I hear so much buzz about, only to find out I can’t do it.

Wow. Another example of what I did not even think was possible. Is your contract with anthem subpar for everything or just the way it works with this procedure?

 

[PinchandBurn]

I just started offering intracept. I see my first patients back in July. I did one commerical and one medicare patient. I'm sure I will get faster, but it definitely took a while. After considering the mortage, staff, insurance, etc costs, we figure that the ASC makes $2,000 in profit on a medicare case, which is worse than me doing 5 ESI/MBB in a hour (I flip rooms). And $595 is not enough of a pro fee to me for an hours work in the ASC, as after overhead I only get $300. I can make more per hour seeing clinic patients, and intracept patients require much more handholding and staff hours than ESI/RFA patients, so I expect I'm actually making less than $300/hr on medicare intracept patients.

I plan to only offer intracept to patients with commercial insurance going forward unless Relievant significantly lowers their pricing. I welcome other companies entering the market this fall as competition should bring lower costs all around.

I will still send out the ideal intracept medicare candidates to HOPD docs, but I'm not going to bother discussing with patient or organizing a referral for moderate candidates.

One thing about most SCS companies, is that they will adjust their kit pricing for medicare vs commerical payors. Relievant needs to also do this.

It’s only far that we all profit together. It's not fair to ask physicians to do medicare intracept for pennies while relievant makes the same $$$ either way.
Doing a ton of medicare intracept isn't in the cards for my practice until Relievant becomes more reasonable with their medicare kit pricing. And still I would only do this for medicare patients because I'm one of the owners of the practice receiving ASC revenue. On pro fees alone I would never do a medicare intracept case in a facility.

Agreed

I am done with doing Intracept for Medicare.

THe other thing you didnet mention is anesthesia! In my market anesthesia (CRNA) is about 275/hr!. So if you think pre/intra/post that's about 2 hrs. That cuts into the $2k margin. Although this number maybe higher. ASC operation costs including electric, trash, RNs,etc is about $2500/hr(we still have loans to pay).

 

[bedrock]

Lose money on Anthem.

I’ve said for a very long time now that contracts with payers are second only to pt volume in deciding how successful you’ll be in practice, and this Intracept roll out has proven it true yet again.

I’m really tired of trying to offer new treatment options that I hear so much buzz about, only to find out I can’t do it.

Wow! Is anthem worse than Medicare for you with other procedures too?

I believe I get double the Medicare pro fee for anthem intracept and our ASC receives an extra $3500 for anthem compared with Medicare, making Anthem viable for intracept in my area.....though I'm going to double check those numbers, now.

 

[MitchLevi]

Off the top of my head on a Sunday I don't remember, and the last time I looked at everything it was awhile ago. I sort of stopped caring about it a year or two ago because in my mind I do what's medically appropriate and don't really care about the financials. I make plenty of money for myself and my practice, I'm able to gift my team bonuses and if I eat a procedure or two who cares.

I do charity cases too, and at times in an ASC.

One commercial payer (Aetna?) pays 2/3 Medicare for cervical RFA. Honestly, there is an ethical conflict of interest on some level.

However...Intracept is different. It requires a lot of time to do the procedure in many cases (I've done only one so far), and I am seriously limited to Medicare, Cigna, KP and work comp. I'm just not sure it's worth investing all the time it will take to get good at this thing. I have a few more cases scheduled for the next week or two, so we will see what happens. The kit is expensive; it is time consuming.

I do, however, like the fact I'm the only one in my area doing it because its a competitive advantage for our practice, but damn man...I'm not sure.

 

[BobBarker]

Yes, intracept is definitely harder than you thing it would be. It can be quite frustrating.

 

[gdub25]

Off the top of my head on a Sunday I don't remember, and the last time I looked at everything it was awhile ago. I sort of stopped caring about it a year or two ago because in my mind I do what's medically appropriate and don't really care about the financials. I make plenty of money for myself and my practice, I'm able to gift my team bonuses and if I eat a procedure or two who cares.

I do charity cases too, and at times in an ASC.

One commercial payer (Aetna?) pays 2/3 Medicare for cervical RFA. Honestly, there is an ethical conflict of interest on some level.

However...Intracept is different. It requires a lot of time to do the procedure in many cases (I've done only one so far), and I am seriously limited to Medicare, Cigna, KP and work comp. I'm just not sure it's worth investing all the time it will take to get good at this thing. I have a few more cases scheduled for the next week or two, so we will see what happens. The kit is expensive; it is time consuming.

I do, however, like the fact I'm the only one in my area doing it because its a competitive advantage for our practice, but damn man...I'm not sure.

I think this is where many of us are at. I also do things for free or break even routinely because it's the right thing and it's easier than having the frustrating conversation about why insurance isn't covering. It's more difficult to knowing adopt a new treatment like intracept when it's borderline not profitable and we have to jump through hoops to get trained by the company and you have to jump through hoops to get authorization. For us it's just easier to send the cases out.

 

[Ronin1]

Intracept gets exponentially easier after the first 5 cases or so. Don’t give up. You do get faster and more efficient. That being said I wouldn’t do them if I had to take them to an or just from a time suck point of view

 

[bedrock]

Intracept gets exponentially easier after the first 5 cases or so. Don’t give up. You do get faster and more efficient. That being said I wouldn’t do them if I had to take them to an or just from a time suck point of view

Appreciate your perspective.

I don’t want to admit how long it took to complete my first two intracept cases!

 

[Centurion38]

Appreciate your perspective.

I don’t want to admit how long it took to complete my first two intracept cases!

Agree it will get a lot better. The hang up for a lot of folks is how posterior you have to be. Much different thought process compared with Kyphoplasty, even though you are still traversing the pedicle. Once you figure out the angles, you can almost always make adjustments, switch to bevel tip etc. It becomes second nature and you'll be doing 7 minute burns for 90% of your levels.

 

[MitchLevi]

Agree it will get a lot better. The hang up for a lot of folks is how posterior you have to be. Much different thought process compared with Kyphoplasty, even though you are still traversing the pedicle. Once you figure out the angles, you can almost always make adjustments, switch to bevel tip etc. It becomes second nature and you'll be doing 7 minute burns for 90% of your levels.

My case last Friday that anesthesia canceled 30 min prior to start time was a large man I was doing L3-S1. That’s 4 burns and prob would have taken me 2 hrs to do, but I was going to suck it up and use that procedure to get better (4 levels = good experience).

That’s a financial loss IMO. In 2 hrs I can do A LOT of bread and butter procedures with minimal to no support.

 

[Ronin1]

You probably should focus on 2 level cases to begin with. It will be less frustrating