German Radiologist Leads the Way in Surmounting FUS Reimbursement Barriers


Clinician interview: Matthias Matzko, MD, Amper Kliniken AG, Dachau, Germany

Matthias Matzko, MD has emerged as a leading European advocate for MR-guided focused ultrasound. In his native Germany, he has also played a key role in eliminating one of the most challenging barriers to widespread adoption of the promising medical technology: reimbursement.

Head of Interventional and Diagnostic Radiology at the 450-bed Amper Kliniken AG in Dachau, Matzko learned about focused ultrasound in 2008 from a colleague. He admits to becoming “kind of infected” with enthusiasm for the technology after visiting Wladyslaw Gedroyc, MD at St. Mary’s Hospital in London.

Matzko immediately recognized the potential of focused ultrasound and wanted to offer it at his hospital’s Myomzentrum, a center for the treatment of uterine myoma (fibroids), which had opened in June 2008. The center was already performing uterine artery embolization, myomectomy and hysterectomy.

“When I came back from London, I was very excited about the technology, and I was thinking about how to implement this in our environment,” he recalls. “Talking with the hospital administration, they were unsure about investing in the risk of a new method.”

Matthias Matko, MD

De-risking equipment acquisition

So strong was his conviction, the business-savvy Matzko offered to rent a focused ultrasound system through an imaging company he heads and have it set up in the hospital. “I took the risk off the hospital administration,” he says. Arrangements were made through GE Financial to lease an ExAblate System from InSightec, Ltd.

At first, Matzko and his team performed focused ultrasound procedures only on Wednesdays and Saturdays, during time slots when the Myomzentrum’s MRI was made available to them. They performed five to ten treatments a month. As more patients learned about the availability and benefits of focused ultrasound, the center’s monthly treatment volume increased to 10-12 patients. “Our machine was fully booked in advance for about a four-month period of time,” Matzko explains.

Careful patient selection aids reimbursement

From the start, Matzko and his colleagues were convinced that careful patient selection was essential to achieving good results with focused ultrasound. Only a third of their uterine fibroid patients met the treatment criteria. “When you want to have reimbursement for such a new method, you have to produce good results, and that’s why you have to select patients very carefully,” he says.

With good results and patient satisfaction documented, Matzko and colleagues applied for reimbursement from Techniker Krankenkasse (TK), one of the largest insurance companies in Germany. Company representatives visited Amper Kliniken and focused ultrasound treatment sites in Berlin and Bochum.

Matzko says two factors were of greatest interest to the insurance company: 1) that only patients suited for focused ultrasound were treated with it; and 2) the Myomzentrum’s interdisciplinary team, which includes a gynecologist who provides both treatment and information to patients.

Although pleased with both the clinic’s results and services, the insurance company raised a red flag. The capacity to treat only three patients a week seemed too limited to qualify for reimbursement from a nationwide insurer.

Rather than a barrier, this objection became the basis of collaboration between the clinic, the insurance company and – ultimately – Amper Kliniken’s administration. Together, they planned the expansion of the existing focused ultrasound center. By this point, Matzko explains, “The hospital administration was convinced about the method of focused ultrasound and convinced about the business model.” 

The expanded center opened in March 2010 with a fully dedicated MRI and ExAblate 2000. By then, the two largest German medical insurers were covering MR-guided focused ultrasound treatments. With all the pieces in place, the center’s monthly treatment volume quickly doubled.

The Dachau clinic continues to be on the leading edge of focused ultrasound technology. In November 2010, it became one of the first sites in the world to install the ExAblate One, the second generation system developed by GE Healthcare and InSightec. In the future, Matzko plans to expand treatment offerings to include new applications of the technology.

Marketing is another key to success

Matzko acknowledges that marketing was initially a challenge for the focused ultrasound center. “We started in a typical radiological manner,” he says. “We did marketing to referring physicians, and we informed all of our gynecologist colleagues in the south of Germany, in Switzerland, in Austria about our new center. The result was very poor.”

Recognizing that a strategy switch was in order, the center began marketing directly to patients via a new website and the use of Google ads. Increased patient requests for information led to the creation of a 24-hour hotline staffed by two patient managers knowledgeable about uterine fibroid treatment options. “Our aim is to figure out the ideal method to treat the personal situation of the patient,” Matzko explains. 

In addition to Germany, Austria and Switzerland, the Dachau clinic is attracting patients throughout Eastern Europe and elsewhere. “They come from Poland, from Russia, from Bulgaria and even we had one patient coming in from Dubai,” Matzko notes. “We now have, in a small hospital like ours, an international customership.”