Are Regenerative Treatments Cost Effective?

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Interviewer: Doctor and the treatments that you offer that we've talked about, the PRP, prolotherapy, stem cells, most people want to know what the cost is compared to getting an anti inflammatory or something like that. Obviously, it might be a safer option for them, but is it cost effective as well? 

Dr. Joel Baumgartner: Right. So, if you look at a lot of stuff we do has great insurance coverage whether it's different types of injections, epidurals, pain injections, we do a lot of work with different nerves and nerve blocks and getting nerves to function more healthy again. Those are all covered by insurance. When it comes to the (?) procedures like the prolotherapy, the PRP, and the stem cells, at this point they're not covered by insurance. It might be soon that the PRP could be covered. 

PRP was actually covered very well for a few years, but on the orthopedic side of it there was some lobbying going against it. They were doing less orthopedic surgeries and so because they're doing less orthopedic surgeries, they didn't want the PRP to be covered. So, there's some lobbying now that the PRP code got put onto the kind of non-covered code. When it goes to that code it stays there for two years. 

If you look at all the recent evidence from 2010 to 2013, I gave a recent talk on PRP and where it is with the research. The resales were overwhelming. Even the newest 2013 studies are showing that this outperforms the cortisone shots which are covered by insurance. It outperforms some of the lubricating shots which are covered by insurance, so it's outperforming them. 

If you look at the cost between the two, for example, somebody comes in to do PRP on their knee. Our cost for the PRP on the knee is about $600 we charge to the patients. If that patient would come in to just see me and have a cortisone shot, that shot would probably be about 6 to $700 going to their insurance or if they have a copay they may be responsible for the 6 or $700. If they came in to see me and got a lubricating shot which is like, (?) parts of the (?) injection we may have heard a little bit about. It's just a lubricating joint. We do a lot of those as well, but that's going to cost their insurance anywhere from 8 to $1200 just for that one injection. 

So, from a dollar for dollar perspective you're getting a lot more with (?) procedures. It's going to do more for you in the long run. It's actually less expensive to have it done. 

Interviewer: This might be a hard question to answer, but let's stick with the knee again. If I have a problem with the knee and I choose prolotherapy, is it one office visit? On average, I guess if you can, is it once a week, for a month? How often until you don't see anybody for awhile? 

Dr. Joel Baumgartner: Right. So, you come in. You have moderate knee arthritis in your knee or you have an ACL that's loose or meniscal [SP] tear. With prolotherapy we're usually talking anywhere from three to five treatments separated by about four to six weeks. 

Interviewer: Okay. 

Dr. Joel Baumgartner: With the PRP because it's a little more powerful, it's usually going to be two or three treatments separated about four to six weeks. With the stem cell because that's the most powerful of the procedures, that might be one round and then you're done. So, each one gets a little more powerful as far as the levels of procedures.

Are newer treatments like stem cell therapies and prolotherapy expensive? Dr. Joel Baumgartner explains the cost and role of insurance when it comes to those treatments versus more traditional treatments like cortisone injections.

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