Iovera- anyone doing it?

[deleted993114]

Iovera is a cruo procedure performed on the superficial innervation of the knee designed to reduce post op pain meds and improve post op PT. Surprisingly, this works very well for the patient, but is time consuming- (takes about 35 minutes). It is kind of taking one for the team, as patients who have had the other knee done without state that it really helped them.

This is a super easy procedure that you could probably have your NP do (they would like it), as it is somewhat boring, yet useful. I have thought about combining that with genicular rf to provide even better relief, but that would take quite a long time for both.

Any thoughts?

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[Ligament]

Iovera is a cruo procedure performed on the superficial innervation of the knee designed to reduce post op pain meds and improve post op PT. Surprisingly, this works very well for the patient, but is time consuming- (takes about 35 minutes). It is kind of taking one for the team, as patients who have had the other knee done without state that it really helped them.

This is a super easy procedure that you could probably have your NP do (they would like it), as it is somewhat boring, yet useful. I have thought about combining that with genicular rf to provide even better relief, but that would take quite a long time for both.

Any thoughts?

I think it is a great idea. I have a full size cryo machine but not an iovera, so I'm coming from the other end of the picture than you. Thinking of also getting an Iovera to use their short probes to freeze the cutaneous fibers in the skin.

My question; is it profitable? I own a business and cannot do anything at a loss. The probes cost around $300 last time i checked, and and takes 35 minutes, AND cryoablation is not even covered by insurers in many states. How would you justify the overhead?

 

[NJPAIN]

I think it is a great idea. I have a full size cryo machine but not an iovera, so I'm coming from the other end of the picture than you. Thinking of also getting an Iovera to use their short probes to freeze the cutaneous fibers in the skin.

My question; is it profitable? I own a business and cannot do anything at a loss. The probes cost around $300 last time i checked, and and takes 35 minutes, AND cryoablation is not even covered by insurers in many states. How would you justify the overhead?

I’m in a similar “small business owner” situation. Every company promises you that their wonderful device will reimburse well. Then you do one or two and find out that you lost money. I guess that works if you are just worried about wRVU but not if you are paying to keep the lights on.


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[callmeanesthesia]

I think it is a great idea. I have a full size cryo machine but not an iovera, so I'm coming from the other end of the picture than you. Thinking of also getting an Iovera to use their short probes to freeze the cutaneous fibers in the skin.

My question; is it profitable? I own a business and cannot do anything at a loss. The probes cost around $300 last time i checked, and and takes 35 minutes, AND cryoablation is not even covered by insurers in many states. How would you justify the overhead?

Direct quote from an email correspondence I had with one of their sales reps:

“As long as your practice has a good payer mix you won’t lose any money.”

I decided not to pursue it any further.

 

[deleted993114]

Direct quote from an email correspondence I had with one of their sales reps:

I decided not to pursue it any further.

It is a good procedure for your NPs to do. Why?

1. Great PR
2. Great service for the orthopods
3. It is practical if your NPs do it
4. Too much time for a doc
5. Great for the patients

You could have the NPs do iovera, then you do genicular rf

 

[callmeanesthesia]

It is a good procedure for your NPs to do. Why?

1. Great PR
2. Great service for the orthopods
3. It is practical if your NPs do it
4. Too much time for a doc
5. Great for the patients

You could have the NPs do iovera, then you do genicular rf

Because in private practice the cost of the supplies is a wash at best with the reimbursement. Even if I had a tech do it, it’s a waste of time and money. I just do the genicular ablation.

 

[Ligament]

It is a good procedure for your NPs to do. Why?

1. Great PR
2. Great service for the orthopods
3. It is practical if your NPs do it
4. Too much time for a doc
5. Great for the patients

You could have the NPs do iovera, then you do genicular rf

If we don't employ midlevels, do you see any viability in offering it?

 

[deleted993114]

If we don't employ midlevels, do you see any viability in offering it?

I think it would be impractical. It takes me about as long to do one as it does for a perm stim, so it is painful for me to see the time consumed. That being said, I am an employee now and the hospital wants me to do it (for a number of reasons), so I do it.

I guess if you just only did them from like 7;15 - 8:00 am, it would not rob from the rest of your practice. You would certainly make the orthopods and the hospital happy. We have enough volume (you can even do it on post-op knees) to keep an NP busy full time. I would imagine this would be the case in any large metro area.

It works VERY WELL to reduce hospital stay, med use, and facilitate PT. It's kind of one of those things that is too good to be true, but it is.

I guess possible outside reimbursement ideas would be getting paid by the hospital as a contract fee for doing it or talking to them about the benefits (HUGE) for their aco. With all the savings there, you might be able to cut a deal that would make it a good deal for you. Just the procedural reimbursement alone would probably not cut it, unless in a hospital based pain setting.

A genicular rf is treating an entirely different part of the knee, and thus Iovera produces different results. It seems to work in damn near 100% of the patients, so that is cool. As I said earlier, it would be a good way to gain genicular rfs as well, which would probably then be worth it.

 

[callmeanesthesia]

I think it would be impractical. It takes me about as long to do one as it does for a perm stim, so it is painful for me to see the time consumed. That being said, I am an employee now and the hospital wants me to do it (for a number of reasons), so I do it.

I guess if you just only did them from like 7;15 - 8:00 am, it would not rob from the rest of your practice. You would certainly make the orthopods and the hospital happy. We have enough volume (you can even do it on post-op knees) to keep an NP busy full time. I would imagine this would be the case in any large metro area.

It works VERY WELL to reduce hospital stay, med use, and facilitate PT. It's kind of one of those things that is too good to be true, but it is.

I guess possible outside reimbursement ideas would be getting paid by the hospital as a contract fee for doing it or talking to them about the benefits (HUGE) for their aco. With all the savings there, you might be able to cut a deal that would make it a good deal for you. Just the procedural reimbursement alone would probably not cut it, unless in a hospital based pain setting.

A genicular rf is treating an entirely different part of the knee, and thus Iovera produces different results. It seems to work in damn near 100% of the patients, so that is cool. As I said earlier, it would be a good way to gain genicular rfs as well, which would probably then be worth it.

A guy where I trained would mark and anesthetize the spots, and then his RN would sit there and move the probes around to freeze the nerves. Not sure if this was above board or not but it could solve your problem.

 

[Orin]

Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?: a case report - PMC

Cryoneurolysis entails using low temperatures to reversibly ablate nerves, with a subsequent analgesia duration measured in weeks or months. Previously, clinical applications for acute pain were limited because treatment originally required exposing ...

www.ncbi.nlm.nih.gov

The Iovera's freeze cycles for a genic would be 3 minutes + 2 minutes of defrosting per target. I have thought about using it but the reimbursement question is a problem and the unit itself is not made for small hands. It seems like the consumable cost would be about the same as a Cooled RFA kit, but you're limited to 10 maximum cycles. You're also limited in your ability to move/place multiple needles while freezing another site due to the need to hold things steady.

The short probes are really limited to shallow nerves. There's also the risk of skin freezing in skinnier people.

You could probably come up with some system where the patient is on a stretcher, you place angiocaths at the targets, and someone comes behind you to freeze things, cutting your time with the patient down to 5 - 10 minutes

 

[cowboydoc]

They have a new 90 mm probe, so you could actually get the geniculars. I think we paid $6k for 2 units and the probes are about $300/case. User dependent on u/s skills but pretty easy overall. Not viable in pp. Getting some clarification on new codes that are supposed to go live 1/2020 (can you bill genicular *3 or only once).

Getting about 3-6 months relief in non-op patients, a few tka patents raved about it, but I see very few of them back.

I only use the superficial trident probe on really lean people, strongly prefer the 90mm tip for direct visualization with u/s.

 

[deleted993114]

They have a new 90 mm probe, so you could actually get the geniculars. I think we paid $6k for 2 units and the probes are about $300/case. User dependent on u/s skills but pretty easy overall. Not viable in pp. Getting some clarification on new codes that are supposed to go live 1/2020 (can you bill genicular *3 or only once).

Getting about 3-6 months relief in non-op patients, a few tka patents raved about it, but I see very few of them back.

I only use the superficial trident probe on really lean people, strongly prefer the 90mm tip for direct visualization with u/s.

Cool-

Yep- I am using the long single probe on geniculars, occipitals, and suprascapulars.

I think it blows that it is not practical in a private practice office, as I think it is a procedure that really helps patients. The only way it could be viable would be if NPs were doing it, or an office guy was given a special carve out reimbursement. It sure saves a lot of money and is pretty satisfying for the patient.