Objection List - CTR Flashcards
$1049 is too much
The potential value to you, your patients, and the healthcare system is significant. With a little information from your biller, I can generate a detailed report like this one to show you how over 150 sites have made this work. There are a few key areas where ultrasound and the ultraguidectr can save your facility money, often offsetting the price of the device. Who in billing would it be best for me to speak to.
$1049 is too much Second answer: (Hospital/ASC)
Surgical Suite (OR) time has been documented in multiple studies to cost nearly $1,000 per hour. CTR-US can be safely performed in a procedure room with just one, non-sterile assistant. Procedure rooms are very low cost and are typically underutilized in most facilities. By shifting the procedure to this lower cost setting, the facility may offset the cost of the device or a significant portion of the device. Because of the fast recovery, physicians that have adopted CTR-US are seeing significant increases in their volume so the hospital benefits from a procedure that delivers nearly the same net revenue with the potential to increase volume significantly.
$1049 is too much Second Answer: (Office)
“Do you know how much your average patient pays out of pocket today? The average high deductible plan can be $4,400 and physicians tell us it is climbing every year. Because of how our healthcare system works, its usually not possible for a physician’s office to know what a patient will pay out of pocket for a surgery performed in a facility. The economics of CTR-US in the office are very patient friendly. We see many practices using a “hybrid” insurance and cash pay approach in the office setting. The physicians that do this report that the patient’s insurance is billed for the procedure, and the patient purchases the device out of pocket (i.e., the device cost is not submitted to insurance). Although the cost of the device will not go towards the patient’s deductible, they can still use an FSA or HSA to pay for any out-of-pocket costs from insurance and for the device. Depending on charges and insurance coverage, this avenue can have a lower out of pocket cost for your patient compared to having a CTR performed in the facility setting.
I don’t have an ultrasound machine.
We have several very cost effective options for you to incorporate ultrasound into your practice:
-I will bring in a machine for us to do the preliminary scanning sessions with. This will allow you to build your ultrasound capabilities and verify you are going to be able to visualize the anatomy with confidence.
-I can offer a daily rental at $100 a day. We can double check with the US reimbursement codes to verify that even after paying the rental, you are still coming out ahead. If you diagnose two patients with CTS you will break even on the rental.
Konica Minolta has an ultrasound machine that is used in many of our labs and purchased by many physicians like yourself for around 23k or leased for 500 a month. I can connect you with a current user or I would be happy to schedule a demo with the Konica rep
One use per day can easily generate $2000 plus in billing per month making this a cash positive investment from month 1.
How do I know that CTR-US is safe?
There have been no device related adverse events reported in literture or commercially. The very low complication rates are due to the ability to visualize all of the critical anatomy with real-time ultrasound guidance. As of March 2023: there have been over 19,000 procedures commercially. there has not been a single complication due to the performance of the device reported to Sonex health. The procedural complications that have been reported so far are: 13 infections, all resolved without issue, with no impact to patient care. 6 nerve injuries, all resolved without issue with no impact to patient care, and 2 tendon injuries, all resolved without issue, with no impact to patient care.
If you can see it in real time, why would you cut it?
There are 21 published papers of CTR-US (8 of which are UltraGuideCTR specific papers) with over 2000 wrists treated. No complications have been reported and 1 late recurrence reported at 12 months.
If you are still having any doubts I can connect you with a colleague regarding safety. When are good times for a quick call, after patients or on the weekend?
I dont think I can learn Ultrasound
Yes you can. We commonly hear this concern from physicians with little to no US experience that are interested in adopting CTR-US. Most surgeons that have been through our training program and are treating patients had zero US experience. We pride ourselves on delivering world class professional education and training on MSK ultrasound. Let’s set up a scanning session or I can connect you with a surgeon who initially had the same concerns?
How are the outcomes with CTR-US better than endoscopic? The incisions are about the same size.
The data shows that patients who have CTR-US with UltraGuideCTR typically return to normal activities within 3-6 days. While there are currently no head-to-head studies comparing the outcomes of CTR-US vs endoscopic, the rapid recovery seen with CTR-US can be associated with less tissue manipulation acheived by the hydrodissection of the carpal tunnel, Gentle tissue dissection using the low-profile blunt tip of the UltraGuideCTR, and the balloons which gently expand to enhance your safe zone. Also the ultrasound helps you to see the anatomy throughout the procedure which allows users to be more delicate around critical anatomy. Many surgeons who have adopted CTR-US were offering endoscopic previously. How about I connect you with one of them to hear the difference in outcomes they see with their own patients.
I am already performing miniopen in the office, why should I switch to CTR-US
That is great. Your colleagues that have adopted CTR-US tell us their patients appreciate the opportunity to get back the use of their hand within 3-6 days. Given the incision is only 4-5mm and the site of that incision is in the wrist as opposed to the palm, the patient post-procedure experience with CTR-US is why your colleagues have adopted the technology in the office over a mini-open.
How can I be sure it was a complete release?
There are 2 ways to confirm a complete release. First, position the transducer at the hamate level in transverse view and use the dilator to lift the TCL and demonstrate the gap in the ligament. Second, in the longitudinal view you will run either a dilator or an elevator from the distal taper of the TCL to the proximal aspect, While doing this you will apply gentle pressure palmarly with the tip of the instrument making sure that you didnt leave any strands of TCL behind. The advantage of using ultrasound is that you can visualize all of this and confirm whether you have fully released the TCL.
I was trained to cut the Fascia proximal to the incision site to relieve pressure on the nerve.
You can still do that if you wish. there are 21 published papers on CTR-US, over 2000 wrists involved and the data shows that patients get better 3-6 days after having the release done. In this data, none of the patients ha a fascia relaease proximal to the incision site, but again, this is your choice.
I will make less money with this than with ECTR
The professional payment component of utilizing ECTR versus CTR-US is very comparable, with ECTR having the slight advantage. However your peers that have already converted from ECTR to CTR-US have found the following:
1, our top 10 physicians by volume experienced an average of 400% increase in procedural volume after implementing CTR-US
2, many physicians have reduced their visits per episode of care from 5 to 1 1/2
3, There is also an opportunity to approach your payers for an office/asc carveout with superior clinical outcomes.
