Pro Fee for BVNA and MILD

[drusso]

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Just wondering what people are seeing and if they think the juice is worth the squeeze.

 

[clubdeac]

Just wondering what people are seeing and if they think the juice is worth the squeeze.

I think our group is getting like 7-8 wRVU which comes out to about $500

 

[BobBarker]

Mild pays well for the time. Usually, around $800. But you can do a max of two cases an hour. It is probably closer to 3 cases in 2 hours.

BVNA is terrible. About $425.

 

[Taus]

Bvna on pro fee only is a charity case, lose money per time spent versus just about anything else we do.

Even when there are approvals on commercial payers via appeals… Where they still technically consider it experimental… Your practices contracted rate with that carrier doesn’t apply if it is not on their official approved list of codes. Has defaulted to mc rates. It was worthwhile when cigna had it on policy, paying contracted rates, before evicore took over their pain auths. Hopefully they will get that back and some other national commercial carriers come on board soon. As it stands, my local major blue has declined to pay retroactively after cases approved on appeals and completed. I still offer the procedure for patients whose insurance covers it on policy (traditional mc and Highmark) bc it truly works as advertised, but cap at two per month, as I can only do so much charity care.

Totally different if you are getting a piece of the facility fee. I do about 90% of my procedures in the office on global fee, only one day per month in the OR. I refer out more than I do…. Hospital docs on rvu who don’t care if case gets paid and how much.

 

[bedrock]

Bvna on pro fee only is a charity case, lose money per time spent versus just about anything else we do.

Even when there are approvals on commercial payers via appeals… Where they still technically consider it experimental… Your practices contracted rate with that carrier doesn’t apply if it is not on their official approved list of codes. Has defaulted to mc rates. It was worthwhile when cigna had it on policy, paying contracted rates, before evicore took over their pain auths. Hopefully they will get that back and some other national commercial carriers come on board soon. As it stands, my local major blue has declined to pay retroactively after cases approved on appeals and completed. I still offer the procedure for patients whose insurance covers it on policy (traditional mc and Highmark) bc it truly works as advertised, but cap at two per month, as I can only do so much charity care.

Totally different if you are getting a piece of the facility fee. I do about 90% of my procedures in the office on global fee, only one day per month in the OR. I refer out more than I do…. Hospital docs on rvu who don’t care if case gets paid and how much.

Mild pays well for the time. Usually, around $800. But you can do a max of two cases an hour. It is probably closer to 3 cases in 2 hours.

BVNA is terrible. About $425.

I've never been to a course, but isn't there a fair amount of extra radiation exposure with MILD? That makes me less interested.

It is unfortunate that these two procedures which really help patients avoid much more expensive and dangerous surgeries, pay so poorly.

Agree with Taus on intracept. My practice is over 10% cigna. It wasn't lucrative, but at least financially worthwhile to do Cigna intracept cases (while Cigna still paid for them). Now with Cigna mostly out of the picture, given the time it requires, intracept with any other payor is essentially charity care, which pays less than clinic. Medicare pays next to nothing and BCBS isn't much better.
This fall, I stopped offering intracept. I have a few cases pending auth that I will complete, but I'm not offering it to any more patients. If I do identify a good intracept candidate, I will still refer them to a HOPD employed doc who likes doing them, but I'm done offering intracept after this year. But not all areas have a physician ready to regularly provide intracept. In some places no one will offer intracept due to the poor pay, which results in unnecessary fusions (which are much more expensive than intracept). Maybe medicare and other insurances will eventually wake up to this financial boondoggle they’ve created.

Regarding piece of the ASC fee. I'm one of 8 partners with an equal share of ASC profits. In the past 12 months I've brought in $400,000 in facility fees from intracept alone. However, our ASC is not efficient (due to ortho) and so I figure I've only personally gained about $10,000 from the facility fees. And that 400K includes a number of cigna cases in the first 6 months, which paid much more than medicare or BCBS. Now that Cigna is almost impossible to auth, both pro and ASC payment is much worse, and I can make significantly more money doing bread and butter cases in the ASC.

 

[Ronin1]

I don’t mind doing bvn as an HOPD doc as we do it with sedation in our suite. It’s a 30 min slot for 7 wrvu pellets. Not terrible and it works. We negotiated 13 wrvu units for mild als in our suite but that’s usually an hour slot

 

[bedrock]

I don’t mind doing bvn as an HOPD doc as we do it with sedation in our suite. It’s a 30 min slot for 7 wrvu pellets. Not terrible and it works. We negotiated 13 wrvu units for mild als in our suite but that’s usually an hour slot

Glad you offer intracept. It can’t consistently be done in 30 min, particularly if you are treating 2 disc levels (3 nerves).

 

[Ronin1]

Glad you offer intracept. It can’t consistently be done in 30 min, particularly if you are treating 2 disc levels (3 nerves).

Agreed but I mostly do two nerves and I don’t go looking for referrals. Mainly my own patients so it’s at most one a week. Maybe the Stryker equipment will be faster with multi lesion capability

 

[thecentral09]

Do you guys know what the facility is being reimbursed for a single level basivertebral nerve ablation?

 

[RoloTomassi]

Do you guys know what the facility is being reimbursed for a single level basivertebral nerve ablation?

MC pays about 9.5k regardless of # levels

 

[MitchLevi]

L4-5 today was freaking brutal. Had to do 15 min both levels, posterior and couldn’t fix it.

Are yall using bevel or diamond initially?

 

[Taus]

L4-5 today was freaking brutal. Had to do 15 min both levels, posterior and couldn’t fix it.

Are yall using bevel or diamond initially?

Bevel. Allows much easier directional change in muscle and bone. Also, with the longer stylet tip on generation 3, changing halfway down the pedicle usually loses trochar access. You have to be fairly deep before you can exchange from diamond to bevel. I also like having having bevel for when you’re getting close to medial border, not quite in vb, turning bevel tip lateral gives you the extra room.

I’m same w Kypho. Bevel start to finish

 

[Taus]

L4-5 today was freaking brutal. Had to do 15 min both levels, posterior and couldn’t fix it.

Are yall using bevel or diamond initially?

Too posterior… you mean too anterior?

If going to posterior just put stylet back in, drive deeper, restart J.

 

[callmeanesthesia]

Diamond, but n of 5 for me. Access has been smooth so far though. I think I switched to the bevel twice?

 

[Ronin1]

First 5 cases I see the diamond. Then switched to bevel for next 75. It’s easier to use imo

 

[mdo1738]

Do you guys know what the facility is being reimbursed for a single level basivertebral nerve ablation?

Have not done any, looked into it a little, probably not going to end up doing the procedure. Per my hospital, the facility would get $12.9k total reimbursement from Medicare, and equipment cost is $5.9k.

$7k margin on a 7 RVU procedure.

 

[MitchLevi]

Too posterior… you mean too anterior?

If going to posterior just put stylet back in, drive deeper, restart J.

Posterior. Tried to bevel a little more, no change. Tried J again no joy.

 

[Taus]

Posterior. Tried to bevel a little more, no change. Tried J again no joy.

Happens. Need to remove J, replace diamond or bevel stylet, drive deeper in, then restart the J once deeper in vb

 

[RoloTomassi]

Posterior. Tried to bevel a little more, no change. Tried J again no joy.

If you do what Taus said but its still posterior that means you didn't go deep enough to create a new track for the J and is falling into the same groove.

With the wide angle of the pedicles at L5 you can drive very deep, almost all the way to midline, and not be too anterior.

Unless you're right up on the posterior cortex, posterior is usually a good thing.

 

[clubdeac]

Have not done any, looked into it a little, probably not going to end up doing the procedure. Per my hospital, the facility would get $12.9k total reimbursement from Medicare, and equipment cost is $5.9k.

$7k margin on a 7 RVU procedure.

Wow so hospital makes off with $6500 while the doc gets $500

 

[bedrock]

Wow so hospital makes off with $6500 while the doc gets $500

Yep. Only really makes sense if you’re a significant ASC shareholder, which I am currently. Our practice is 12% Cigna.
For the first 8 months I did intracept, Cigna was paying 22,000 for a facility fee and $1500 pro fee for 2 disc 3 nerve intracept. The ASC made 16k, after other expenses it was an extra $1200 to each partner. $2700 to me essentially per case. Cigna essentially stopped covering intracept and so now it’s just certain BCBS plans and Medicare.

Medicare is a far cry from those original payments. I make much more money seeing Medicare clinic patients than doing intracept on Medicare patients.

 

[Status Sciaticus]

Yep. Only really makes sense if you’re a significant ASC shareholder, which I am currently. Our practice is 12% Cigna.
For the first 8 months I did intracept, Cigna was paying 22,000 for a facility fee and $1500 pro fee for 2 disc 3 nerve intracept. The ASC made 16k, after other expenses it was an extra $1200 to each partner. $2700 to me essentially per case. Cigna essentially stopped covering intracept and so now it’s just certain BCBS plans and Medicare.

Medicare is a far cry from those original payments. I make much more money seeing Medicare clinic patients than doing intracept on Medicare patients.

what would you consider significant ownership?

 

[bedrock]

what would you consider significant ownership?

I’m one of 8 partners. I have a 12.5% ownership in the 4 room ASC.

 

[Status Sciaticus]

I’m one of 8 partners. I have a 12.5% ownership in the 4 room ASC.

Very nice. We picked up a 2 OR + 1 procedure room ASC several months ago that is supposed to open soon, and were looking to incorporate Intracept/BVN into the ASC. Hopefully its a net positive.