SUMMER 2019 • Osteoarthritis Relief • Practice Revenue Program
Covered in the office by Medicare, most Medicaid, and many major insurance plans!
Covered in the office by Medicare, most Medicaid, and many major insurance plans!
Osteo-Arthritis Practice Revenue Program • Frequently Asked Questions:
Q: What is the insurance coverage on the program?
A: Medicare, Medicaid, Commercials, HMO and Workers Comp now require that patients try and fail as least one round of visco-supplementation prior to being authorized for a TKA (total knee replacement surgery). Insurance covers both knee and shoulder injections. INSURANCES REIMBURSE even HMO however they need pre-authorizations. This means that if your doctor is not doing the injections, then the doctor down the street is!
Q: What is the Cost for the Doctor?
A: There is no payment for the first 90 days or any upfront charge for the doctor. A monthly payment of $3,200/month (which is less than the profit per patient) for 60 months would need to be paid. Financing is also available.
Q: I already use ultrasound, how is this different?
A: Insurance bundles the sonography with the injection procedure, making this method a marginal procedure. Use of fluoroscopy means the physician is able to bill an additional code for the procedure resulting in approximately $350 revenue per joint.
Q: How safe is the fluoroscope?
A: Radiation does not scatter meaning that there is no need for lead lining or aprons. The radiation is highly targeted. This improves visibility into the joint capsule to the level where ripples can be seen as the visco-supplement is injected providing evidence of accurate placement.
Q. Why should I do this?
A: The ageing population and obesity is increasing the prevalence of OA in the knees. Knee replacement is a last resort and demands that visco-supplementation be performed first. This protocol means the patient gets comprehensive care in the form of visco-supplementation, bracing and physical therapy providing complete and comprehensive care for the patient. It provides an end to end solution, where any medical practice can add this as a service and profit center for their practice. The revenue from this program is significant enough to have a major impact on the practice profitability. The volume of demand for this osteoarthritis treatment service is likely to continue for the next 2 decades.
Q: Who are the primary targets?
A: Family practice, Internal Medicine, General Physicians, Pain Management, and Orthopedic's if they have a preventative mind set. Any physician that is business minded, as this can essentially run as a separate OA clinic inside their existing clinic. The family practice physician would normally refer the patient to an Orthopedic or Pain specialist, now the family physician can keep the patient in house, get great reimbursement and hopefully prevent or prolong the need for a total knee replacement.
Q: What is time frame on the outcome?
A: 5 weeks. Although this is a 5 week injection cycle, patients start feeling the relief and medical benefits after 2-3 of the 5 injections. One of recent stories from our accounts, had a patient’s daughter running to her father’s room to check on him thinking he had died, because after the second injection she realized she hadn't heard him groaning in pain the whole day! They both were amazed at how these injections were helping!
Q: What is the resistance from Physicians?
A: Physicians who previously attempted visco-supplementation were losing money on the medication, as their pricing was higher than what insurances reimbursed. This was a big deterrent! We have incredible pricing due to the volume we produce and therefore, we have the same pricing as the government as $61 per syringe. This allows them to actually make roughly $30 on the medication alone. With 1 patient a month, a practice will cover more than the monthly payment.
Q: At any-time when the C-arm is not being used, what other procedures can the Physician use it on?
A: X-ray, except for spin and hips. Chiropractors love it as they can use it live on the neck to see range of motion.
Q: Who takes care of the Repair and Maintenance of the device over the course of time?
A: All new Ortho-Scans come with a 1-year fill parts and labor warranty. They are maintenance free as they are flat detector technology (cathode) not gas filled tube radiation source like previous x-ray and floor technology. We've actually dropped one off a loading dock once, and besides a scratch, the unit worked just fine! Extended warranty is $6,000 per year but the units are very sturdy and not needed.
Q: Who provides the training once the doctor signs up for the program?
A: We do it all, 2 days on site training with the physcian’s clinic.
Q: What is the differences between Supartz® hyaluronic acid that you have vs. Synvisc®?
A: Supartz is all natural, lowest cost. Synvisc® is synthetic. 5 injections hyaluronic acid products have also shown to also have higher clinical outcomes than those doing only 3 injections as well as those using a single synthetic injection. This virtually eliminates any contraindications to the medication since it is natural. It is a fluid taken from the roosters comb so the only allergy for the patient would be chicken, feathers or eggs. More on Synvisc® vs. Supartz® hyaluronic acid.
Q: When the Nurse Practitioner is performing the procedure, does the Supervising MD Physician have to be present?
A: Depends on the state. For example in Texas the NP can perform the injections without the doctor in the clinic. However the doctor would need to be in the building with a PA.
Q: How many clinics are currently doing this program and how many patients do they treat every month?
A: There are over 150 clinics. One of the clinics is averaging 25 injections per day and others around 5-10 per day.
Q: How long does it take to fully implement the program in a practice?
A: It can take up to a month to get our team in a clinic for training.
Q: When does the 90 day period start for the doctor?
A: Once the doctor does his verbal with the finance company the 90 days will start.
Q: How does the Financing work for the doctor?
A: They can finance it with whomever they prefer. We work with a finance company that can offer a 90-day deferred or even a 6 month deferred with a little payment.
Q: How much does it cost to replenish inventory?
A: At present Supartz® costs $61 to the doctor, reimburses around $92. The practice will need syringes, 21 gauge needles and gloves. This is typical office stuff for injections.
Q: Does the regeneration product have to be included in the package?
A: The package comes with 5 PRP kits and a centrifuge. This helps get the doctor interested in the regen aspect.
Q: If the Practice is already doing Supartz® injection, can we set up just DME Braces?
A: Yes. We can set the practice up for the DME Accrediting application and billing for braces.
A: Medicare, Medicaid, Commercials, HMO and Workers Comp now require that patients try and fail as least one round of visco-supplementation prior to being authorized for a TKA (total knee replacement surgery). Insurance covers both knee and shoulder injections. INSURANCES REIMBURSE even HMO however they need pre-authorizations. This means that if your doctor is not doing the injections, then the doctor down the street is!
Q: What is the Cost for the Doctor?
A: There is no payment for the first 90 days or any upfront charge for the doctor. A monthly payment of $3,200/month (which is less than the profit per patient) for 60 months would need to be paid. Financing is also available.
Q: I already use ultrasound, how is this different?
A: Insurance bundles the sonography with the injection procedure, making this method a marginal procedure. Use of fluoroscopy means the physician is able to bill an additional code for the procedure resulting in approximately $350 revenue per joint.
Q: How safe is the fluoroscope?
A: Radiation does not scatter meaning that there is no need for lead lining or aprons. The radiation is highly targeted. This improves visibility into the joint capsule to the level where ripples can be seen as the visco-supplement is injected providing evidence of accurate placement.
Q. Why should I do this?
A: The ageing population and obesity is increasing the prevalence of OA in the knees. Knee replacement is a last resort and demands that visco-supplementation be performed first. This protocol means the patient gets comprehensive care in the form of visco-supplementation, bracing and physical therapy providing complete and comprehensive care for the patient. It provides an end to end solution, where any medical practice can add this as a service and profit center for their practice. The revenue from this program is significant enough to have a major impact on the practice profitability. The volume of demand for this osteoarthritis treatment service is likely to continue for the next 2 decades.
Q: Who are the primary targets?
A: Family practice, Internal Medicine, General Physicians, Pain Management, and Orthopedic's if they have a preventative mind set. Any physician that is business minded, as this can essentially run as a separate OA clinic inside their existing clinic. The family practice physician would normally refer the patient to an Orthopedic or Pain specialist, now the family physician can keep the patient in house, get great reimbursement and hopefully prevent or prolong the need for a total knee replacement.
Q: What is time frame on the outcome?
A: 5 weeks. Although this is a 5 week injection cycle, patients start feeling the relief and medical benefits after 2-3 of the 5 injections. One of recent stories from our accounts, had a patient’s daughter running to her father’s room to check on him thinking he had died, because after the second injection she realized she hadn't heard him groaning in pain the whole day! They both were amazed at how these injections were helping!
Q: What is the resistance from Physicians?
A: Physicians who previously attempted visco-supplementation were losing money on the medication, as their pricing was higher than what insurances reimbursed. This was a big deterrent! We have incredible pricing due to the volume we produce and therefore, we have the same pricing as the government as $61 per syringe. This allows them to actually make roughly $30 on the medication alone. With 1 patient a month, a practice will cover more than the monthly payment.
Q: At any-time when the C-arm is not being used, what other procedures can the Physician use it on?
A: X-ray, except for spin and hips. Chiropractors love it as they can use it live on the neck to see range of motion.
Q: Who takes care of the Repair and Maintenance of the device over the course of time?
A: All new Ortho-Scans come with a 1-year fill parts and labor warranty. They are maintenance free as they are flat detector technology (cathode) not gas filled tube radiation source like previous x-ray and floor technology. We've actually dropped one off a loading dock once, and besides a scratch, the unit worked just fine! Extended warranty is $6,000 per year but the units are very sturdy and not needed.
Q: Who provides the training once the doctor signs up for the program?
A: We do it all, 2 days on site training with the physcian’s clinic.
Q: What is the differences between Supartz® hyaluronic acid that you have vs. Synvisc®?
A: Supartz is all natural, lowest cost. Synvisc® is synthetic. 5 injections hyaluronic acid products have also shown to also have higher clinical outcomes than those doing only 3 injections as well as those using a single synthetic injection. This virtually eliminates any contraindications to the medication since it is natural. It is a fluid taken from the roosters comb so the only allergy for the patient would be chicken, feathers or eggs. More on Synvisc® vs. Supartz® hyaluronic acid.
Q: When the Nurse Practitioner is performing the procedure, does the Supervising MD Physician have to be present?
A: Depends on the state. For example in Texas the NP can perform the injections without the doctor in the clinic. However the doctor would need to be in the building with a PA.
Q: How many clinics are currently doing this program and how many patients do they treat every month?
A: There are over 150 clinics. One of the clinics is averaging 25 injections per day and others around 5-10 per day.
Q: How long does it take to fully implement the program in a practice?
A: It can take up to a month to get our team in a clinic for training.
Q: When does the 90 day period start for the doctor?
A: Once the doctor does his verbal with the finance company the 90 days will start.
Q: How does the Financing work for the doctor?
A: They can finance it with whomever they prefer. We work with a finance company that can offer a 90-day deferred or even a 6 month deferred with a little payment.
Q: How much does it cost to replenish inventory?
A: At present Supartz® costs $61 to the doctor, reimburses around $92. The practice will need syringes, 21 gauge needles and gloves. This is typical office stuff for injections.
Q: Does the regeneration product have to be included in the package?
A: The package comes with 5 PRP kits and a centrifuge. This helps get the doctor interested in the regen aspect.
Q: If the Practice is already doing Supartz® injection, can we set up just DME Braces?
A: Yes. We can set the practice up for the DME Accrediting application and billing for braces.