Via Disc

[bedrock]

I’ve been hit with several types of unsolicited marketing for Via Disc this week.

I’m not necessarily looking to do them.

However I’m wondering how strong is the evidence and relative risk of the procedure?

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[gaspasser127]

Risk is relatively low - biggest risk of course is diskitis. There are ways to mitigate this.

Their data isn’t the strongest. I can’t recall details completely but had a low ‘n’ and there was pretty significant improvement in pain score in the placebo group as well

 

[Agast]

it may need to be done at a hospital for the cost to work out. I think it’s Medicare only because they’re using clinical trial codes

 

[clubdeac]

how many wRVUs?

 

[oreosandsake]

Placebo arm was saline
Both arms improved



Fda said it was a drug so they are now running a acellular study with just NP

 

[gaspasser127]

how many wRVUs?

It’s a T code

 

[DrMDAware]

For those curious for the paper

https://www.painphysicianjournal.com/current/pdf?article=NzMxMg%3D%3D&journal=138

 

[oreosandsake]

For those curious for the paper

https://www.painphysicianjournal.com/current/pdf?article=NzMxMg%3D%3D&journal=138

Considering the 50 percent responder rate for NS, I’m offering 50 percent discount off the cost of the viadisc for NS injection

 

[Jcm800]

i was going to post about this. Intradiscal saline had 50% improvement... why do i feel like none of this "trials" results are truly reproducible or accurate.

 

[SpineandWine]

Doctor fee = 0.
Only makes sense if physicians were either wRVU compensated OR they collected facility fee.

 

[bedrock]

Wow. The audacity of a literal zero professional fee!

Really tired of seeing a nice facility fee and then only table scraps for the expertise and risk of the physician performing the procedure.

 

[Doctodd]

maybe they can pay nurses to do the procedure?

 

[Baron Samedi]

N = 1, colleague of mine did a case and pt did great. That zero prof fee is brutal, though.

 

[Magnus Acus]

i was going to post about this. Intradiscal saline had 50% improvement... why do i feel like none of this "trials" results are truly reproducible or accurate.

I thought it was weird that they did a NS injection as a control. Isn't the point of this procedure to add hydration/volume to a fibrotic and underhydrated disc? So why have a control arm that essentially does that?

Clearly intradiscal saline should not have a 50% improvement, but they aren't helping themselves by adding a control arm that's just a less efficacious treatment arm.

Possibly a sham injection? IDK.. the study heaps scepticism on itself for having such a high responder rate in the control arm for sure.

 

[DrMDAware]

View attachment 364541

Doctor fee = 0.
Only makes sense if physicians were either wRVU compensated OR they collected facility fee.

i could be wrong but I was told the wRVU was zero

 

[SpineandWine]

View attachment 364541

i could be wrong but I was told the wRVU was zero

I made an assumption. you’re prolly right

 

[BobBarker]

If you were frisky and had a good admin you could negotiate an RVU. Take the profit and divide it in half/convert that to units. I’m not frisky enough for that conversation of late.

 

[clubdeac]

Rvu should be 4.5. That’s what I’d make it

 

[gaspasser127]

Rvu should be 4.5. That’s what I’d make it

That’s not bad given the simplicity of the procedure

 

[drusso]

Wow. The audacity of a literal zero professional fee!

Really tired of seeing a nice facility fee and then only table scraps for the expertise and risk of the physician performing the procedure.

You have to be HOPD MD and get some juice on the SOS for this to work.

 

[lobelsteve]

You have to be HOPD MD and get some juice on the SOS for this to work.

Bad choice of words. Via disc won’t work. But you can make bank in a backroom deal.

 

[MitchLevi]

It's a cash procedure. One of the authors is one of my partners.

 

[RoloTomassi]

It's a cash procedure. One of the authors is one of my partners.

Do you think it works? I'm sure you have heard more anecdotes than most of us

 

[MitchLevi]

Well...I've never sent someone over to him nor have I looked to incorporate it into my practice. I've spoken to him about it loosely about 3 yrs ago. Unconvinced. Want nothing to do with it.

 

[DrMDAware]

It's a cash procedure. One of the authors is one of my partners.

Interesting
1. What’s a ballpark rate for it?
2. If it’s cash only why use ViaDisc and not other regenerative med injectates?

 

[MitchLevi]

Not sure on cost. To the other Q, if you're a believer in something you do it I guess.

Some people believe Medtronic and Nevro make effective stimulators...

 

[drusso]

Bad choice of words. Via disc won’t work. But you can make bank in a backroom deal.

Hospital Admin: "You scratch my back, I scratch yours..."

Vigorish - Wikipedia

en.wikipedia.org

 

[Baron Samedi]

So our group has done around 10 of these now, all with pretty remarkable results and no serious complications. Still a low number but it seems promising.

 

[MitchLevi]

How you getting it paid for?

 

[Baron Samedi]

How you getting it paid for?

Federal facility and pure salary so it's all monopoly money. I saw that it's a category III CPT code which explains why there is no professional fee. I wonder if/when they will change categories and how that will affect reimbursement.

 

[bedrock]

Federal facility and pure salary so it's all monopoly money. I saw that it's a category III CPT code which explains why there is no professional fee. I wonder if/when they will change categories and how that will affect reimbursement.

I thought you left the VA for private practice?

 

[Baron Samedi]

I thought you left the VA for private practice?

New gig is next summer

 

[bedrock]

New gig is next summer

Makes sense.

 

[bedrock]

How you getting it paid for?

How much does via disc treatment cost a patient all included (in cash)?

And is it repeated sometimes? How often?

 

[MitchLevi]

I'd guess 3k at least

 

[Baron Samedi]

Rep told me that the kit alone is like 5k(obviously can be negotiated) and most cash payments are around 8k.

 

[bedrock]

Rep told me that the kit alone is like 5k(obviously can be negotiated) and most cash payments are around 8k.

I'd guess 3k at least

That is nuts.
If it was my back I’d opt for intracept, anyway. Even cash for intracept would be more worth it because once and done.

 

[drusso]

Rep told me that the kit alone is like 5k(obviously can be negotiated) and most cash payments are around 8k.

The rule for engagement rings and cash-price medical procedures is 3 months' salary. Now, you've got a friend in the diamond business.