Rx Perspective
Getting Comfortable with PDT
Two specialists' experiences help you know what to expect.

Medicare and other third-party payers have begun reimbursing physicians for providing ocular photodynamic therapy (PDT). At the same time, stories touting the success of this AMD treatment are widespread across all media. So, many macular degeneration patients are inquiring about Visudyne (verteporfin for injection) therapy.

These two factors make it a better time than ever to begin offering PDT to your patients. However, adding it to the armamentarium presents challenges. We hope that these selected points about our experiences will help you know what to expect if you adopt PDT.

OUR BIGGEST CHALLENGES

Make sure you consider:

• Time. In the beginning, expect to allot an hour or more per patient. That was the case in both of our practices; however, we now have qualified staff mix and inject the verteporfin. This has cut our per-patient treatment time to 20 minutes. Seeing more patients and becoming comfortable with the procedure also helped to decrease that time.
  Billing, especially for the first 10 cases, could take more than 1 hour per-patient because your staff members must make phone calls to insurance carriers and learn to use the proper codes. This time also decreases as you treat a steady stream of patients and staff become more familiar with the billing process. (For coding guidelines, see page 46 of the January 2001 Ophthalmology Management.)
• Volume. In a retrospective review of 1,000 patients by Margherio, Margherio and DeSantis (Retina 2000;20(4):325-330), 171 had predominantly classic subfoveal choroidal neovascularization secondary to AMD and would have been eligible for verteporfin therapy, compared with 99 patients who were eligible for traditional laser photocoagulation.
  They suggested that if their patient population was representative of the general population, 84,000 patients would be eligible for PDT in the United States per year, compared with 42,000 for laser photocoagulation. And that would mean 286,000 treatments per year if retreatments are considered.
  In Dr. Wu's practice, providing photodynamic therapy has increased volume approximately 10%. Dr. Bodine's practice has seen a considerable increase in the number of fluorescein angiograms performed. His schedule generally includes approximately one new case per week and a total of four PDT-related visits per week.
• Start-up costs. Some of the expenditures involved are:
  • For both practices, the cost of the laser to activate the verteporfin was approximately $30,000.
    When Dr. Wu first begin offering PDT, she used the laser at the hospital. The hospital, of course, was responsible for providing the equipment, nursing personnel and verteporfin, so the practice wasn't burdened with those costs.
    She was able to purchase her own laser once it was known in her community that her practice offered PDT and she had five to ten Visudyne patients per week. Reimbursement is the same, but time commuting to the hospital is saved.
  • The cost of the verteporfin is $1,200 per patient. It's reimbursed by Medicare, in addition to the laser procedure, at 95% of the Average Wholesale Price as defined in the Redbook. Note that there is no additional reimbursement for the intravenous infusion.
  • We each spent approximately $1,000 on our infusion pumps for introducing the drug into the patient's vein.
  • You'll need three needles, a sterile filter system, syringes and sterile water to prepare the verteporfin for injection.
  • To calculate the correct amount of verteporfin, you must have a scale that can weigh and measure the height of each patient.
  • When it's time to deliver the laser treatment, you'll use a macula contact lens and your fluorescein angiogram. If you don't already have this equipment, add it to the expenditure list.

RAISING YOUR LEVEL OF CARE

PDT does come with some practice management costs, but it gives a glimmer of hope to once-miserable patients, which is satisfying for us as well. And the new level of care it provides for some of these patients is priceless. 

Dr. Wu is a retina specialist in private practice in Brookline, Mass. Dr. Bodine is a retina specialist in private practice in Bronxville, N.Y. They trained together at the Massachusetts Eye and Ear Infirmary and Schepens Retina Associates.