Reimbursement for Extracorporeal Shockwave Therapy

In spite of the fact that Extracorporeal Shockwave Therapy for chronic orthopedic indications is under study for nearly 10 years worldwide, with many publications in professional and scientific medical magazines, there has been so far not a widespread acceptance for various reasons:

1. the experimental nature of the physical variables applied and empirical treatment protocols of the initial clinical studies gave ambiguous and non-consistent results leading to discussions and confusion as to effectiveness of the method,

2. no clear understanding of the correlation between physical parameters of a shockwave and the bio-medical reaction intended to achieve a positive clinical stimulus and outcome, did not produce a forward direction to provide an answer to the clinical success rates,

3. initial low scientific research content invested by both the industry and medical research institutions into the dose-energy-effect relation created a focus on the clinical outcome of the study in stead of understanding of the process and its variables with the purpose to  achieve reproduce-ability of results,  

4. the over-attention given by some Meta-analyses to a few publications which showed a similar outcome for Placebo and Verum-group in case of multiple procedures with low energy protocols, led to a generalization statement that shockwave therapy is not effective 

5. the conflicting nature of the published results, in particular relating to multiple protocols and low energy systems,  gave reason to the Health Insurance entities to reject inclusion in their reimbursement scheme, thereby nullifying the positive effects shockwave therapy has had with carefully selected patient-group who satisfied the inclusion criteria as defined by the ISMST.                                                                     (see http://www.hmtbr.com.br/apresentacoes_gerais.html as example)

6. the excellent results obtained with shockwave therapy in the Meidling clinic in Austria with non- and delayed healing unions, are bypassed by insurance providers, with exception of Austria, although there is a direct financial cost-benefit advantage and a simple and fast recovery for the patient, freeing hospital space; in short a win situation for all.

7. traditional health care cost reduction programs which do not allow for an extension of the medical procedure schemes

This shows that there is a certain reluctance to include shockwave therapy in the service package to patients suffering from chronic orthopedic diseases, in spite of economic benefits in both soft tissue and bone procedures, and the clinical results obtained with patients suffering from these chronic diseases for over 6 months without having a relief from various alternatives.                                                                                                            (criteria as laid down by the ISMST ).

This attitude may differ per country, but in general this means that shockwave therapy for chronic orthopedic indications has still a long way to go before it has become a "Treatment of  Choice"; combined, international efforts and proven clinical results on the basis of high quality and controlled studies may change this frame of reference, and offer the patient who is victimized of deficient health policies, relief and a definite solution.