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Boston Scientific Corporation Message Board

  • serious_investor serious_investor Dec 22, 1997 10:14 AM Flag

    Monorails not a factor in the U.S.?

    There seems to be a general consensus that monorails are the primary type of balloon in Europe while over-the-wire balloons are preferred in the U.S. Can someone explain why there is such a distinct difference between the two markets?

    Also, if monorails do not appeal tp physicians in the U.S., why did BSX spend so much money to develop the Express, Rally, etc., in addition to losing so much money is legal fees and judgments?

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    • Buzzmarr, check out this guy's prior messages. You'll understand better.

    • Really, you must be joking! May I ask what field you are in that you have insight reguarding this. Do you know if it is POSSIBLE to remove a stent? I tell all my patients that they will have them the rest of their lives.

    • Cheaper stents don't last as long and require removal and replacement yielding $$$ for Dr's.

    • You are absolutely correct...and this pertains to cardiologists much more than radiology concerning procedures..most of ours are outpatient.

    • >Doctors don't often want the perfect stent because they get paid per procedure. Hence imperfect stents yield more proc's and more $$$.<

      Mountain_man36, please clarify your position. The last time I looked, physicians get paid exactly the same whether they put in the cheapest stent or the most expensive stent. They are paid a professional fee for their services and, unless they are putting in stents within their offices, they don't pay for the stent. Thus, there's -0- opportunity for them to profit at the expense of the patient, relative to selecting one stent verses another.

    • Doctors don't often want the perfect stent because they get paid per procedure. Hence imperfect stents yield more proc's and more $$$.

    • I think you're right. Also, just hang in there, when the pricing war ends, the hospital is liable to be making money on stent procedures!

      However, I am curious as to Buzzmarr's situation. I hope he responds and clarifies if radiology is different than cardiology, and, if so, why?

    • I'm pretty sure the DRGs for stenting and PTCA are fixed price. Atherectomy whether rotational or directional has it's own separate DRG (which is less than stenting interestingly). If you could find a great $900 stent, you'd stent all the time. This is the cardiac situation

    • >Medicare will pay for the price of the stent.<

      Buzzmarr, I thought Medicare eliminated their cost-based, retrospective reimbursement approach when they implemented the prosepective DRG approach in 1983. The DRG concept is that you are paid a fixed amount. If the hospital's costs exceed the amount of the DRG, they lose. If the cost is less than DRG, they win.

      Of course, outpatient environment, I think, are still covered under the old cost-based system.

      Is there a difference between the way procedures are reimbursed in radiology vs. cardiology? Do your radiology procedures qualify as outpatient?

      If so, that would account for the difference.

      If not, how do you get the cost of the stent reimbursed outside the DRG?

    • I have nothing to support this but I think we'll see competition on price soon. The general feeling I've seen is that these companies are charging obscene amounts for their stents. The first company to offer even a moderate break on price (for a good stent, not that crummy GRII) would get my attention. Exactly what that price is I couldn't say. Another thing I'd like to see is similar prices on the stents regardless of length. That would be an attractive marketing tactic.

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