Stryker BVNA Product has Landed. Implications for Pain?

[drusso]

Stryker receives FDA clearance for OptaBlate® BVN Basivertebral Nerve Ablation System

Stryker’s first basivertebral nerve ablation system targets the basivertebral nerve to provide relief from chronic* vertebrogenic low back pain.

www.stryker.com

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[bedrock]

Stryker receives FDA clearance for OptaBlate® BVN Basivertebral Nerve Ablation System

Stryker’s first basivertebral nerve ablation system targets the basivertebral nerve to provide relief from chronic* vertebrogenic low back pain.

www.stryker.com

Interesting. 10G tools are nice. I wonder how much the infusion tech makes a difference?

Most importantly the Relievant reps will have to negotiate their prices now.

 

[Taus]

Given this and people using meritt, they will lose market share if they don’t get more competitive on prices. Also, if insurance coverage does not improve… This procedure is going to die. Outside traditional Medicare and anthem… Given the loss of Cigna coverage w the shift to evicore… no major national commercial insurance covers it. Appeals process is spotty at best.

 

[BobBarker]

Pro fee needs to get a lot better. But it won’t. All of these procedures pay about the same.

 

[Taus]

Pro fee needs to get a lot better. But it won’t. All of these procedures pay about the same.

Yep. I am a firm believer in the procedure… But unless you see a fair amount of the facility fee or commercial insurance starts to cover, where you have a decent contracted rate, it is a charity case for the time spent.

 

[drusso]

Yep. I am a firm believer in the procedure… But unless you see a fair amount of the facility fee or commercial insurance starts to cover, where you have a decent contracted rate, it is a charity case for the time spent.

 

[bedrock]

Pro fee needs to get a lot better. But it won’t. All of these procedures pay about the same.

Given this and people using meritt, they will lose market share if they don’t get more competitive on prices. Also, if insurance coverage does not improve… This procedure is going to die. Outside traditional Medicare and anthem… Given the loss of Cigna coverage w the shift to evicore… no major national commercial insurance covers it. Appeals process is spotty at best.

Agree pro fee is an issue. I wouldn’t offer this procedure at all if I wasn’t a co owner of our ASC.
That said, I refuse to do MCR intracept due to terrible pro AND ASC facility reimbursement. I send all MCR intracept to a HOPD doc a couple hours away.

losing Cigna was huge, though I’ve gotten a couple Cigna authed since on appeal. Our local exchange plan also covers it and pays well.
There a number of random state blue cross plans that cover intracept. I’ve gotten authed and paid on BCBS of MA, WY, and a state in the Midwest. The only state BCBS that has been an absolute no consistently so far is BCBS of TX.

All that said, it’s frustrating to bring this up to patients, get their hopes up, and then they may not get authed.

 

[SpineandWine]

Yep. I am a firm believer in the procedure… But unless you see a fair amount of the facility fee or commercial insurance starts to cover, where you have a decent contracted rate, it is a charity case for the time spent.

I see facility fee 9.5 k ASC and 12.8k hopd for 64628

Are you sure it’s charity and not margin case?
What’s the equipment usually cost
About to book my first intracept case

 

[Taus]

I see facility fee 9.5 k ASC and 12.8k hopd for 64628

Are you sure it’s charity and not margin case?
What’s the equipment usually cost
About to book my first intracept case

Pro fee about $400 for an hour of OR time (including case and turnover)…. So for me def a charity case. Granted, just about anything Medicare in the Asc or Hospital if you were seeing pro-fee only is charity care. I do >90% in office….

For asc/hopd… maybe there’s margin… don’t know in my case. ~7k equipt. Plus Staff/overhead. An hour of OR time.

Also… if you get an auth on a commercial patient who normally has solid contracted rates, where they have an experimental/investigational policy…. They are not obligated to pay at their contractual rates if it was approved via appeals. That has been the biggest kick in the nuts.

I am debating offering this in the office for self-pay, as it will be a lot less costly for patients without the facility fees and anesthesia.

 

[drusso]

Pro fee about $400 for an hour of OR time (including case and turnover)…. So for me def a charity case. Granted, just about anything Medicare in the Asc or Hospital if you were seeing pro-fee only is charity care. I do >90% in office….

For asc/hopd… maybe there’s margin… don’t know in my case. ~7k equipt. Plus Staff/overhead. An hour of OR time.

Why do you think the payment is engineered this way? Is it a glitch or by design?

 

[SpineandWine]

Pro fee about $400 for an hour of OR time (including case and turnover)…. So for me def a charity case. Granted, just about anything Medicare in the Asc or Hospital if you were seeing pro-fee only is charity care. I do >90% in office….

For asc/hopd… maybe there’s margin… don’t know in my case. ~7k equipt. Plus Staff/overhead. An hour of OR time.

Also… if you get an auth on a commercial patient who normally has solid contracted rates, where they have an experimental/investigational policy…. They are not obligated to pay at their contractual rates if it was approved via appeals. That has been the biggest kick in the nuts.

I am debating offering this in the office for self-pay, as it will be a lot less costly for patients without the facility fees and anesthesia.

400$/hour is 4 ESIs in hour, which is what I average.
Meh, if it helps, it helps
~~

For additional levels, is there a facility fee or does facility eat cost?
For example, any additional facility fee reimbursement for 64629

 

[RoloTomassi]

400$/hour is 4 ESIs in hour, which is what I average.
Meh, if it helps, it helps
~~

For additional levels, is there a facility fee or does facility eat cost?
For example, any additional facility fee reimbursement for 64629

No additional facility fee