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From: christine.l.ayoub on 31 Mar 2008 14:27
On Mar 26, 10:34 am, "Howard McCollister" <nos...(a)nospam.net> wrote:
> "starwarsmum" <mum2my2b...(a)shaw.ca> wrote in message
>
> news:3a4d53fe-5cb5-4abc-a721-a1f755ca6a54(a)e6g2000prf.googlegroups.com...
>
> > Thank you for posting this info Howard, I had no idea how the new
> > procedures came into practice. Makes it rather difficult to get the
> > real information on how viable the procedure actually is!
>
> > You said that the insurance companies don't want more people having
> > the surgery - do the insurance companies cover the cost of PPIs? Or is
> > that separate? You'd think the cost of surgery would be worth it
> > compared to the cost of the drugs and ongoing care of a GERD patient.
>
> > Amy (in Canada)
>
> The payback on anti-reflux surgery is about 7 years. At the end of 7 years,
> an insurance company spends more on medical treatment than they would on
> surgical treatment. The problem is, the average patient stay with their
> health insurance plan or company for 2.8 years. So, if an insurance company
> can delay surgical intervention, after 2.8 years that patient will become
> some other insurance company's problem. I agree, it's fallacious reasoning,
> but that's how it works.
>
> HMc

Thanks for this updated information. It's scary when you think about
it! I am curious to know what the position paper, at Sages, will
say. In a way Esophyx sounds similar to a fundoplication. Please keep
us posted.

Christine
From: Howard McCollister on 1 Apr 2008 08:06

<christine.l.ayoub(a)intel.com> wrote in message
news:4b6759ce-5a07-4e76-85c3-ac89d5f53723(a)q27g2000prf.googlegroups.com...
On Mar 26, 10:34 am, "Howard McCollister" <nos...(a)nospam.net> wrote:
> "starwarsmum" <mum2my2b...(a)shaw.ca> wrote in message
>


In a way Esophyx sounds similar to a fundoplication. Please keep
us posted.

Christine






It *is* a fundoplication. The nature of the way it's done, though, prevents
the surgeon from addressing any laxity of the hiatus of the diaphragm.
Likewise, any associated hiatus hernia can't be fixed. That means that
Esophyx won't be useful in some percentage of patients who would otherwise
be candidates for antifeflux surgery.

I'm pretty confident that SAGES will endorse it, given that organization's
current interest in "natural orifice surgery". I am equally confident that
insurance companies (a significantly large number) will continue to label it
"investigational" no matter what SAGES says.

About 3 years before Stretta folded, Curon Medical was actually successful
in getting a whole new CPT code (43257) specifically for radiofrequency
modification of the LES. It didn't help. Too few patients were having
Stretta because too many insurance companies tended not to pay for it, Curon
lost too much money and went out of business.

Just because SAGES endorses the therapy, or just because there is a CPT code
for it, that doesn't mean the insurance companies have to pay it.

HMc



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