CHARLOTTESVILLE, VA (June 23, 2011) – Medical researchers have a critical role to play in gaining optimal health insurance reimbursement for MR-guided focused ultrasound. As Susan Klees, Director of Patient Access for the Focused Ultrasound Surgery Foundation, reports, “Scientific evidence is the key driver for reimbursement, and it all begins with the way studies are designed. Today, research priorities must be grounded in sound science as well as the realities of the marketplace.” 

Designing studies that address marketplace realities requires an understanding of what is valued by different groups. “We know that physicians are seeking cutting-edge treatment modalities to solve medical challenges, patients want to avoid complex surgery and lengthy recovery times and medical payers expect enhanced outcomes and efficiencies in treatment,” she explains.

Klees says that skyrocketing healthcare costs have prompted insurers to demand better results all around – increased value, improved quality outcomes, enhanced patient satisfaction and efficient care. In fact, many experts believe that today more proof is required to qualify for reimbursement than to receive regulatory approval for new medical devices. 

Although there has been reimbursement success in countries like Germany, Klees says private payers in the U.S. are not yet consistently covering focused ultrasound treatments for uterine fibroids. In fact, some have adopted ‘negative’ policies that actively seek to deny coverage.

“This is happening even though focused ultrasound is approved by the Food and Drug Administration as a treatment for uterine fibroids and has demonstrated important advantages over competing therapies,” she notes. “These advantages include being an outpatient procedure, offering quick recovery and preserving the potential for future fertility.”

Unconvinced by the current body of evidence, many American health insurers are asking for randomized comparative trials and long-term outcomes before reconsidering their stance on MR-guided focused ultrasound therapy.

To avoid such impasses in the future, the Focused Ultrasound Surgery Foundation is encouraging researchers, industry and other stakeholders to collaborate in setting priorities for investigating new focused ultrasound applications. Examples include essential tremor and Parkinson’s disease. “We’re pushing for studies that target the most commercially viable focused ultrasound applications, address safety and efficacy, and generate data that demonstrates the technology’s comparative superiority in long-term benefits, quality of life and cost-effectiveness,” Klees explains.

 

About the Focused Ultrasound Surgery Foundation

Driven by the desire to save lives, alleviate suffering and prevent disability, the Focused Ultrasound Surgery Foundation is devoted to advancing one of modern medicine’s most promising and game-changing technologies, noninvasive magnetic resonance-guided focused ultrasound (FUS).

Founded in 2006 and based in Charlottesville, Virginia, the Foundation is a high-performance, not-for-profit organization with global reach and an entrepreneurial spirit. To accelerate the availability and reimbursement of FUS treatments, we host symposia and workshops, fund research and fellowships, support the establishment of FUS Centers of Excellence, promote patient awareness and education, and serve as the nexus of a collaborative research network consisting of sites and investigators around the world. Our work is made possible by contributions from individuals, foundations and corporations.  For complete information, visit www.fusfoundation.org.

Media Contact:
Ellen C. McKenna
434-220-4993, ext. 207
This e-mail address is being protected from spambots. You need JavaScript enabled to view it.
 

CHARLOTTESVILLE, VA (June 22, 2011) On June 12, 2011, viewers of the CBS Evening News learned about Stephanie Small’s gripping story. Suffering from a large uterine fibroid, the 27 year-old was treated last December as part of a MR-guided focused ultrasound clinical trial at the University of Virginia in Charlottesville.

Small says her focused ultrasound treatment changed her life. She experienced symptom relief within a few days and reports that her quality of life has steadily and significantly improved.  “I think focused ultrasound surgery is amazing, and I believe that fears of incisions, scaring, complications and long painful recovery times are now concerns of the past with this new technology,” she says.

Small’s journey unfolded over many months, from the time she received her diagnosis and was advised to have a myomectomy. Fearful of the risks associated with that treatment, she began searching for other options. Surfing the web for information, she discovered the websites for the Focused  Ultrasound Surgery Foundation and its patient support organization, Fibroid Relief. What she learned there proved to be invaluable and convinced her to opt for MR-guided focused ultrasound treatment. She made arrangements to undergo the noninvasive outpatient procedure at a center near her home in eastern Pennsylvania.

However, a major stumbling block quickly surfaced: Small’s health insurer refused to cover her focused ultrasound treatment. Determined to proceed, she downloaded the Reimbursement Resource Toolkit from the Fibroid Relief website. A popular resource that has been downloaded 1350 times since its August 2010 debut, the toolkit contains sample letters and tips for appealing a health plan denial.

Faced with steadily increasing pain and disability, Small opted to participate in the UVA study rather than appeal her insurance company’s decision. She received two treatments on consecutive days just before Christmas, the second of which was taped by CBS News.

As an expression of her gratitude, Small has become an advocate for both focused ultrasound and patient empowerment, especially among young women like herself. Six weeks after treatment, she returned to Charlottesville for a follow-up visit at UVA and to participate as a panelist at the Focused ultrasound Surgery Foundation’s Fibroid Relief at Last event.

More recently, she posted an account of her illness, treatment and recovery on the Fibroid Relief website, which ends with a powerful personal message to others: “Knowledge is power. Educate yourself so you can play a more active role in your own healthcare.”

Click here to read Stephanie Small’s personal account of her illness, treatment and recovery.

Click here to watch CBS Evening News report, “Ultrasound replaces scalpel for some tumor ops.”

 

About the Focused Ultrasound Surgery Foundation

Driven by the desire to save lives, alleviate suffering and prevent disability, the Focused Ultrasound Surgery Foundation is devoted to advancing one of modern medicine’s most promising and game-changing technologies, noninvasive magnetic resonance-guided focused ultrasound (FUS).

Founded in 2006 and based in Charlottesville, Virginia, the Foundation is a high-performance, not-for-profit organization with global reach and an entrepreneurial spirit. To accelerate the availability and reimbursement of FUS treatments, we host symposia and workshops, fund research and fellowships, support the establishment of FUS Centers of Excellence, promote patient awareness and education, and serve as the nexus of a collaborative research network consisting of sites and investigators around the world. Our work is made possible by contributions from individuals, foundations and corporations.  For complete information, visit www.fusfoundation.org.

 

Media Contact:
Ellen C. McKenna
434-220-4993, ext. 207
This e-mail address is being protected from spambots. You need JavaScript enabled to view it.

 

 

The American Association of Physicists in Medicine (AAPM) will be conducting a joint meeting with the Canadian Organization of Medical Physicists (COMP) from July 31 through August 4 in Vancouver. The Focused Ultrasound Surgery Foundation is one of the supporters of a special symposium, Advances in Therapeutic and Diagnostic Ultrasound, being held during the meeting from August 1 to 3.

The special symposium will provide day-long programs dedicated to education, therapy and diagnoses. Scheduled for August 2, the session on therapy is being organized by Christian Diederich, PhD, Director of the Thermal Therapy Research Group at the University of California San Francisco. His collaborator is Stanley Benedict, PhD, Associate Professor and Director of Radiological Physics at the University of Virginia.

The special focus of the June 2011 Focused Ultrasound Surgery Foundation newsletter is reimbursement from health insurers, an important factor in ensuring the widespread adoption of MR-guided focused ultrasound therapies. First up is an interview with German radiologist Matthais Matzko, MD. He has not only created the most successful and busiest focused ultrasound center in Europe, but also convinced leading insurers to provide reimbursement for the uterine fibroid treatments he performs.

Next, is an interview with the Foundation's own Susan Klees. As Director of Patient Access, she has become immersed in the reimbursement conversation here in the U.S. In what may come as a surprise, she believes that the research community can play an important role in ensuring the success of the reimbursement process.

Finally, we provide a brief profile of Stephanie Small, the young and extremely gracious uterine fibroid patient who allowed CBS Evening News to tape her procedure last December. Denied coverage by her medical insurer, she downloaded the Reimbursement Resource Toolkit from the Foundation's Fibroid Relief website. Ultimately, Small decided to participate in a clinical trial rather than appeal her insurance company's decision. Now fully recovered, she has become an advocate for patients, especially young women like herself.

We will revisit the topic of reimbursement as the field of MR-guided focused ultrasound evolves. In the meantime, summer is upon us, and we hope your holidays are safe and enjoyable.