PTNS and CMS' Misvalued Code Initiative - impact on Uroplasty

[Anonymous]

PTNS and CMS' Misvalued Code Initiative - impact on Uroplasty

According to CMS' proposed rule for 2014, "We are proposing CPT 64566 (Posterior tibial neurostimulation,
percutaneous needle electrode, single treatment, includes programming) as a potentially misvalued code because we think that the procedure typically is furnished by support staff with supervision as opposed to
being furnished by the physician. We are concerned that the current valuation is based on the procedure being furnished by a physician."

What could this mean for UPI?

Well, according to the comment letter that followed the proposed rule from Dr. Scott MacDiarmid (who is the co-author of a number of PTNS studies, including the STEP study):

"Having lectured nationwide on PTNS I believe that its current reimbursement is a significant barrier to Urologists beginning the treatment in their practice. I am afraid that lower reimbursement could threaten this even further limiting its access to patients."

What does CMS' position mean for Urgent PC, and therefore for UPI?

http://finance.yahoo.com/mb/forumview/?&v=m&bn=4a83b984-ebaf-3ee4-9565-d67c46bb32ca

 

[Anonymous]

PTNS and CMS' Misvalued Code Initiative - impact on Uroplasty

According to CMS' proposed rule for 2014, "We are proposing CPT 64566 (Posterior tibial neurostimulation,
percutaneous needle electrode, single treatment, includes programming) as a potentially misvalued code because we think that the procedure typically is furnished by support staff with supervision as opposed to
being furnished by the physician. We are concerned that the current valuation is based on the procedure being furnished by a physician."

What could this mean for UPI?

Well, according to the comment letter that followed the proposed rule from Dr. Scott MacDiarmid (who is the co-author of a number of PTNS studies, including the STEP study):

"Having lectured nationwide on PTNS I believe that its current reimbursement is a significant barrier to Urologists beginning the treatment in their practice. I am afraid that lower reimbursement could threaten this even further limiting its access to patients."

What does CMS' position mean for Urgent PC, and therefore for UPI?

http://finance.yahoo.com/mb/forumview/?&v=m&bn=4a83b984-ebaf-3ee4-9565-d67c46bb32ca

If you know the number of RVUs for physician time included in the reimbursement amount, you should be able to determine the approximate reduction in the reimbursement amount for the procedure. Each RVU is valued at about $30. So if the RVU for the physician time included in the reimbursement amount is 0.5, then the amount by which the reimbursement will be reduced is $15, if physician time is disallowed. So that would reduce the overall average reimbursement amount to about $105 per procedure.

If you know how to navigate the CMS site you should be able to find the info on RVUs for physician time included in the procedure. Or better yet, the folks in the Company's reimbursement department should have this info handy.

Let us know what you find out.

 

[Anonymous]

If you know the number of RVUs for physician time included in the reimbursement amount, you should be able to determine the approximate reduction in the reimbursement amount for the procedure. Each RVU is valued at about $30. So if the RVU for the physician time included in the reimbursement amount is 0.5, then the amount by which the reimbursement will be reduced is $15, if physician time is disallowed. So that would reduce the overall average reimbursement amount to about $105 per procedure.

If you know how to navigate the CMS site you should be able to find the info on RVUs for physician time included in the procedure. Or better yet, the folks in the Company's reimbursement department should have this info handy.

Let us know what you find out.

Time To Get Out Of Here

 

[Anonymous]

If you know the number of RVUs for physician time included in the reimbursement amount, you should be able to determine the approximate reduction in the reimbursement amount for the procedure. Each RVU is valued at about $30. So if the RVU for the physician time included in the reimbursement amount is 0.5, then the amount by which the reimbursement will be reduced is $15, if physician time is disallowed. So that would reduce the overall average reimbursement amount to about $105 per procedure.

If you know how to navigate the CMS site you should be able to find the info on RVUs for physician time included in the procedure. Or better yet, the folks in the Company's reimbursement department should have this info handy.

Let us know what you find out.

2014 Reimbursement from Medicare = $105.00 * 80% = 84.00
Co-payment from patient (if collected) =$16.00
Lead cost = $65.00

Physician profit $40.00 for blocking a room 45 minutes (vital check 5 minutes, 30 minutes TRx <once needle inserted> and room-flip 10 minutes)

The physician could do three 15-minute follow-ups for $65.00 each during this time period instead of PTNS.

 

[Anonymous]

2014 Reimbursement from Medicare = $105.00 * 80% = 84.00
Co-payment from patient (if collected) =$16.00
Lead cost = $65.00

Physician profit $40.00 for blocking a room 45 minutes (vital check 5 minutes, 30 minutes TRx <once needle inserted> and room-flip 10 minutes)

The physician could do three 15-minute follow-ups for $65.00 each during this time period instead of PTNS.

Does this reimbursement amount reflect the potential reduction if physician time is disallowed? My guess is that it does not, because that potential reduction is still under discussion.

Can you clarify if:

(1) 2014 reimbursement amount reflects the potential reduction if physician time is disallowed

(2) Also, are the 2014 reimbursement amounts finalized? In the past CMS has always proposed deep cuts, but then later scaled back the cuts.

 

[Anonymous]

The reduction, if reduced, will not be the full physician amount because someone still has to insert the needle. It would require an increase in the facility charge for labor for an RN, LPN, PA or MA to insert the needle. This would also eliminate the question of who can insert the needle. If the physician payment is eliminated or reduced, then CMS is telling the offices that anyone they deemed as qualified can do it. The procedure does not have to be done in a treatment room and can be done on multiple patients at the same time as in a shared medical appointment. All you doom and gloom thinkers can just stop trying to bash this product. It works as well as or better than anything else out there. It is well studied and proven to work. If it helps patients, offices will find a way to deliver it to their patients. If you are in sales and do not believe me, get out and let someone sell it who can.
signed,
A stock holder.

 

[Anonymous]

The reduction, if reduced, will not be the full physician amount because someone still has to insert the needle. It would require an increase in the facility charge for labor for an RN, LPN, PA or MA to insert the needle. This would also eliminate the question of who can insert the needle. If the physician payment is eliminated or reduced, then CMS is telling the offices that anyone they deemed as qualified can do it. The procedure does not have to be done in a treatment room and can be done on multiple patients at the same time as in a shared medical appointment. All you doom and gloom thinkers can just stop trying to bash this product. It works as well as or better than anything else out there. It is well studied and proven to work. If it helps patients, offices will find a way to deliver it to their patients. If you are in sales and do not believe me, get out and let someone sell it who can.
signed,
A stock holder.

Good point about some of the physician time reduction made up by increase in facility charge for labor for RN, LPN,..... However, net, net there would still be a reduction in the reimbursement amount because the value of RN, LPN,... time is less than that of the physician time.

As to performing procedures on multiple patients at the same time, that is nothing new, and do not see how that changes the picture. There is nothing stopping the practice from doing that currently, and some do so now.

I think the big unanswered question is how will a reduction in the reimbursement amount (say even $10 per procedure) affect new adoption of ptns and/or continued use in a practice. Let us face it, ultimately the physicians are driven by profits where they will weigh ptns against other use of their time and facility. Let us not be Pollyannaish.

 

[Anonymous]

The reduction, if reduced, will not be the full physician amount because someone still has to insert the needle. It would require an increase in the facility charge for labor for an RN, LPN, PA or MA to insert the needle. This would also eliminate the question of who can insert the needle. If the physician payment is eliminated or reduced, then CMS is telling the offices that anyone they deemed as qualified can do it. The procedure does not have to be done in a treatment room and can be done on multiple patients at the same time as in a shared medical appointment. All you doom and gloom thinkers can just stop trying to bash this product. It works as well as or better than anything else out there. It is well studied and proven to work. If it helps patients, offices will find a way to deliver it to their patients. If you are in sales and do not believe me, get out and let someone sell it who can.
signed,
A stock holder.

"Multiple patients" violates HIPPA. Would YOU want to hang out with an unknown patient for 30 minutes?

 

[Anonymous]

Depends on what she looks like. Course, when did I ever last 30 minutes with any woman?

 

[Anonymous]

"Multiple patients" violates HIPPA. Would YOU want to hang out with an unknown patient for 30 minutes?

Agree, multiple patients may violate HIPPA.

Would you want to be in a room where other people get to hear about your vitals and listen in on how many times you got up to pee last night or how often in the last week you wet your panties, or if you are still wearing diapers. And even if by chance such a practice did not violate HIPPA, there is something called patient dignity. Would reputable physicians' offices put their patients thru such indignity?

Are the reps being trained to tell the physicians to put their patients through such indignity? If so how can you live with yourself!!

 

[Anonymous]

Agree, multiple patients may violate HIPPA.

Would you want to be in a room where other people get to hear about your vitals and listen in on how many times you got up to pee last night or how often in the last week you wet your panties, or if you are still wearing diapers. And even if by chance such a practice did not violate HIPPA, there is something called patient dignity. Would reputable physicians' offices put their patients thru such indignity?

Are the reps being trained to tell the physicians to put their patients through such indignity? If so how can you live with yourself!!

As a practitioner who utilizes the shared medical appointment, it is not a HIPPA violation. All private matters are handled in private. The only part of the exam done together is the actual therapy. I can bill 5 patients utilizing one hour of time. The patients love chatting and being together, some share stories while other just sit quietly. It is not for everyone and some patients opt out.

As for the reduction in reimbursement, obviously it will hurt if it happens. I will continue to offer treatment because I believe in it. We will have to wait and see what happens.

 

[Anonymous]

As a practitioner who utilizes the shared medical appointment, it is not a HIPPA violation. All private matters are handled in private. The only part of the exam done together is the actual therapy. I can bill 5 patients utilizing one hour of time. The patients love chatting and being together, some share stories while other just sit quietly. It is not for everyone and some patients opt out.

As for the reduction in reimbursement, obviously it will hurt if it happens. I will continue to offer treatment because I believe in it. We will have to wait and see what happens.

Whatever...smoke in mirrors

 

[Anonymous]

As a practitioner who utilizes the shared medical appointment, it is not a HIPPA violation. All private matters are handled in private. The only part of the exam done together is the actual therapy. I can bill 5 patients utilizing one hour of time. The patients love chatting and being together, some share stories while other just sit quietly. It is not for everyone and some patients opt out.

As for the reduction in reimbursement, obviously it will hurt if it happens. I will continue to offer treatment because I believe in it. We will have to wait and see what happens.

You are a near exception to other physicians I encounter everyday, if you are going to offer the treatment simply because it works, without regard to profit. At least that is how I read your comments. God bless you.

I am sure there is a breaking point at which many physicians will not offer or will scale-back the treatments if the reimbursement amount is reduced. What I do not know is at what point that threshold is crossed. Would a $10 reduction in reimbursement per treatment, as one of the earlier post mentions, be sufficient reduction to cross the threshold?

 

[Anonymous]

As a practitioner who utilizes the shared medical appointment, it is not a HIPPA violation. All private matters are handled in private. The only part of the exam done together is the actual therapy. I can bill 5 patients utilizing one hour of time. The patients love chatting and being together, some share stories while other just sit quietly. It is not for everyone and some patients opt out.

As for the reduction in reimbursement, obviously it will hurt if it happens. I will continue to offer treatment because I believe in it. We will have to wait and see what happens.

It isn't an AA meeting. The physician is GETTING PAID for Trx. It isn't chemo where you are hanging out for 4 hours. You must be like the physician in TN who was scams Medicare and his nurse turned him in.

PTNS is going by the way side like Lupron injections. The nurse can handle it and the physician barely makes enough with the office visit to cover the procedure.

 

[Anonymous]

You are a near exception to other physicians I encounter everyday, if you are going to offer the treatment simply because it works, without regard to profit. At least that is how I read your comments. God bless you.

I am sure there is a breaking point at which many physicians will not offer or will scale-back the treatments if the reimbursement amount is reduced. What I do not know is at what point that threshold is crossed. Would a $10 reduction in reimbursement per treatment, as one of the earlier post mentions, be sufficient reduction to cross the threshold?

I do not know at what amount physicians start losing money on the treatment, but even if they make a (small) profit on ptns treatments, I think smart physicians will ask this question: Can I make more profit with alternate use of my time and facility.

 

[Anonymous]

I do not know at what amount physicians start losing money on the treatment, but even if they make a (small) profit on ptns treatments, I think smart physicians will ask this question: Can I make more profit with alternate use of my time and facility.

3 office visits is more profit than 1 PTNS procedure.

 

[Anonymous]

3 office visits is more profit than 1 PTNS procedure.

I do not think your math is correct.

For each PTNS Trx, the doc makes $55 profit ($120 reimbursement less $65 for the lead set), from which to cover office expenses such as nurse time, rent utilities, etc. I think it takes LESS than 3 office visits to make more profit than 1 PTNS Trx.

 

[Anonymous]

I do not think your math is correct.

For each PTNS Trx, the doc makes $55 profit ($120 reimbursement less $65 for the lead set), from which to cover office expenses such as nurse time, rent utilities, etc. I think it takes LESS than 3 office visits to make more profit than 1 PTNS Trx.

The physician makes $45.00 for a follow-up patient (15 minute) visit x 3 patients (for the 45 minutes the PTNS room is block. Yes, I know the TRX is 30 minutes once the needle is inserted after Patient History).

More money w/ follow-up visits vs 1 PTNS blocked room.

 

[Anonymous]

So this means no-go from NGS, which means States (MN, WI, IL, MA, ME, RI, NH & VT)which previously had PTNS coverage from Medicare will lose coverage. Big blow to central and NE regions.

http://finance.yahoo.com/news/uroplasty-provides-ptns-reimbursement-113000924.html

And we should know in 12 months the outcome of CMS' re-evaluation of the reimbursement amount for misvaluation of physician time involvement in the treatment. I do not know how to prejudge that outcome, but what is the thinking with field organization about this outcome.

 

[Anonymous]

The reduction, if reduced, will not be the full physician amount because someone still has to insert the needle. It would require an increase in the facility charge for labor for an RN, LPN, PA or MA to insert the needle. This would also eliminate the question of who can insert the needle. If the physician payment is eliminated or reduced, then CMS is telling the offices that anyone they deemed as qualified can do it. The procedure does not have to be done in a treatment room and can be done on multiple patients at the same time as in a shared medical appointment. All you doom and gloom thinkers can just stop trying to bash this product. It works as well as or better than anything else out there. It is well studied and proven to work. If it helps patients, offices will find a way to deliver it to their patients. If you are in sales and do not believe me, get out and let someone sell it who can.
signed,
A stock holder.

well, Mr. Stockholder, perhaps you haven't read the voiding diary data from the OrBiT or SuMiT trials at 12 weeks. Approx a mean reduction in voiding frequency of 20%. Barely a noticeable increase in voided volumes. Quite a bit different than the BS "80% response" crap this company espouses. So, when you say it works as well as anything else out there, you must be excluding Botox and Sacral Nerve stim who actually document much greater symptomatic improvement.

Here's a stock tip: Sell this dog, close your position NOW.