Innovation in Hemorrhoid Treatment
Challenges:
Many American Gastroenterologists are spending greater than 50% of their time preparing for and performing colonoscopies. Over the last few years, reimbursement has dropped approximately 60% while physician hours in procedures have increased to help make up lost revenues.
Well over 50% of all colonoscopies done present at least one hemorrhoid that is Grade 1 and treatable.
10 million self reported incidences of hemorrhoids yearly, peak incidence being 45 to 65 years of age (Zhifei, Migaly 2016).
Benefits:
- Non-Surgical; no anesthetic
- ALL 4 grades of internal or mixed hemorrhoids
- Minimal discomfort and safe 5-15 minute
procedure - Patented, FDA Cleared, in 48 nations
- CE and N.I.C.E Cleared (one new test remaining)
- Full insurance reimbursement
A Proactive Approach to Hemorrhoid Treatment
What if you could treat all new patients up front at the time of their screening colonoscopy and obliterate a small Grade 1 or 2 hemorrhoid before it becomes a real problem in a few years at a Grade 3 or 4?
What if you could help mitigate those disruptive symptoms of itching, irritation, bleeding, swelling and pain UP FRONT before they became a real problem in a matter of minutes?
What if you could help reduce the number of hemorrhoidectomy procedures and the complications and risks that go along with that procedure by treating up front?
NOW YOU CAN!
These are a few of the reasons why just a few extra minutes in a colonoscopy, where a patient is already sedated, can be a huge benefit to your patient and your practice by treating it up front and helping improve their quality of life!
You can treat in the same procedure and save the patient time and money!
HemWell’s proprietary technology Quickly and safely treats ALL GRADES of internal and mixed hemorrhoids – with no surgery!
A Doctor holds a low level direct current probe against the hemorrhoid base, with no tissue penetration.
This causes a chemical reaction in the hemorrhoid, triggering ligation within the vascular feeding vessels.
The hemorrhoid begins to shrink immediately during the procedure, continuing for 7 to 10 days.
As the hemorrhoid shrinks, symptoms are relieved and relief often begins immediately after the first procedure.
- The number and extent of procedures are determined by number and severity of their hemorrhoids.
The HemWell® Procedure
HemWell® is a fully U.S. Patented and FDA cleared Class B(2) medical device. Its 5-15 minute procedure can be administered by a physician who has been trained in the procedure during a short training session.
Unlike other treatments that cut out the vein, cauterize it, or scar it, HemWell works with the body in a natural and non-invasive manner.
Direct Current Electrotherapy Of Internal Hemorrhoids:
An Effective, Safe and Painless Outpatient Approach
Daniel A. Norman, M.D., F.A.C.P., Ronald Newton, B.S., and Glenn V. Nicholas, D.C.
University of Nevada, School of Medicine, Reno, Nevada and Barton Memorial Hospital, South Lake Tahoe, California
METHODS: One hundred twenty consecutive patients with symptomatic hemorrhoid disease completed d.c. electrotherapy. All underwent historical review, and visual and digital examination. No bowel preparation, oral or parenteral medication therapy was required. Digital and anoscopy were performed with Hinkle-James rectal speculum with an operative port exposing one-eighth of the circumference of the anal canal. Subjects with source other than hemorrhoid disease accounting for their symtomatology were excluded from the study.
No major complications occurred in the treatment of 590 diseased hemorrhoid segments. Minor complications were noted in two patients. One patient experienced a vasovagal episode with syncope for 10 s after treatment with out apparent sequelae. He returned for additional treatment without adverse effect. One patient experienced rectal pain after treatment, which resolved in hours with a sitz bath. This did not occur with subsequent treatment. Direct current therapy of hemorrhoid disease is a safe treatment approach.
Direct current offsets many concerns raised with other hemorrhoid therapies. It is successful on all grades of internal and mixed hemorrhoid disease. Properly applied the procedure is painless. No bowel preparation, anesthetic, or medication is required. Patients are able to resume normal activities immediately after therapy. No major and only rare minor complications without sequelae dictate the safety of the procedure. Apparent sustained symptom resolution can be expected, and patient acceptance is good. However, more than one treatment is required in about one-fourth of the patients.
Comparison of Electrotherapy, Rubber Band Ligation and Hemorrhoidectomy in the Treatment of Hemorrhoids: A Clinical and Manometric Study
A Izadpanah, 1 ,* SV Hosseini, 2 and M Mahjoob 1
METHODS: A total of 150 patients with symptomatic grades II or III internal hemorrhoids were randomly assigned to three groups. Group A underwent Ferguson hemorrhoidectomy, group B were treated with rubber band ligation (RBL) and group C were treated with direct current electrotherapy.
CONCLUSION: We conclude that electrotherapy is a safe, effective and simple method of treating grades II and III uncomplicated internal hemorrhoids. This procedure is associated with little postoperative pain and complications, and has the least changes in anorectal manometric characteristics. Therefore electrotherapy maybe recommended as a treatment of choice for grades II and III uncomplicated internal hemorrhoids.
RBL, despite the lack of significant effect on anorectal manometry seems to be inferior to the electrotherapy method due to the presence of rare, but major side effects and more pain associated with this modality. Finally, we determined that electrotherapy is a good choice for the treatment of grades II and III internal hemorrhoids due to its high success rate, low cost, ease of procedure, lack of significant side effects, significantly less postoperative pain, and most importantly, minimal anorectal physiological change. Thus, we can recommend this procedure as one of the options of choice for treating internal hemorrhoids.
Evaluating the safety, efficacy and complications of electrotherapy and its comparison with conventional method of hemorrhoidectomy
Payam Nikooiyan,1 Hamzeh Mohammadi Sardo,2 Bahram Poursaeidi,3 Motahareh Zaherara,4 and Bijan Ahmadi5
Patients and methods:
This randomized clinical trial was performed on patients with hemorrhoids referring to hospitals affiliated to the Kerman University of Medical Sciences during 2014-2015. One hundred and twenty patients presented with symptomatic hemorrhoids grade I, II, III, and IV were randomized into two groups. Group 1 (60 patients) underwent electrotherapy using 30 mA direct current and group 2 (60 patients) were submitted to Ferguson hemorrhoidectomy. The groups were compared regarding postoperative pain severity and complications, including recurrent symptoms, infection and recovery time to return to normal activities. The p≤ 0.05 was considered statistically significant.
Results:
More than 70% of patients in group 2 complained of severe pain, but in group 1, no more than 30% of patients experienced severe pain up to 6 hours post-surgery and 70% complained of mild pain 2-3 days post-surgery. Twenty four-hour hospitalization in group 2 and group 1 were 97% and 78%, respectively, whilst patients in electrotherapy group could be treated as outpatients. The mean return time to usual activities was 15 and 1.5 days for group 2 and 1, respectively.
Conclusion:
Electrotherapy with a direct current of 30 mA significantly reduce postoperative pain and the recovery period. This method showed a good success rate and less complication than the Ferguson method. As a result, because of more effectiveness, less pain, as well as shorter recovery time and getting back to normal activities, we recommend this procedure for the treatment of symptomatic hemorrhoids grade I, II, and III.
EXAMPLE 1: HemWell – HEMORRHOIDECTOMY WITHOUT COMPLEMENTING PROCEDURES
CPT code 46946 is used if the physician treated two or more hemorrhoid columns. If only one hemorrhoid column is treated, then CPT code 46945 applies.
Facility Billing: Medicare Outpatient Hospital Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid
columns/groups - APC 0149
- Payment: $2,237.33
- Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid
column/group - APC: 0149
- Payment: $2,237.33
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid
columns/groups - Payment: $1,100.20
- Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid
column/group - Payment: $1,100.20
Professional Billing: Medicare Physician Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber
band; 2 or more hemorrhoid columns/groups - Total RVUs
- Non-Facility: 8.79
- Facility: 6.38
- Payment:
- Non-Facility: $349.93
- Facility: $349.93
- Hemorrhoidectomy, internal, by ligation other than rubber band;
single hemorrhoid column/ group - Total RVUs
- Non-Facility: 8.59
- Facility: 6.36
- Payment:
- Non-Facility: $309.06
- Facility: $309.06
EXAMPLE 2: HemWell HEMORRHOIDECTOMY WITH COLONOSCOPY
Facility Billing: Medicare Outpatient Hospital Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; single
hemorrhoid columns/groups - APC 0149
- Payment: $2,237.33
- Payment (With Multi-Procedure Adjustment): $2,237.33
- Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
collection of specimen(s) by brushing or washing, with or without colon
decompression (separate procedure) - APC: 0143
- Payment: $724.89
- Payment (With Multi-Procedure Adjustment): $352.45
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; a single
hemorrhoid columns/groups - Payment: $1,100.20
- Payment (With Multi-Procedure Adjustment): $1,100.20
- Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
collection of specimen(s) by brushing or washing, with or without colon
decompression (separate procedure) - Payment: $363.42
- Payment (With Multi-Procedure Adjustment): $181.71
Professional Billing: Medicare Physician Reimbursement
- Hemorrhoidectomy, internal, by ligation other
than rubber band; single hemorrhoid
columns/groups - Total RVUs
- Non-Facility: 8.79
- Facility: 6.38
- Payment:
- Non-Facility: $309.06
- Facility: $309.06
- Payment (With Multi-Procedure Adjustment):
- Non-Facility: $309.06
- Facility: $N/A
- Colonoscopy, flexible, proximal to splenic flexure;
diagnostic, with or without collection of
specimen(s) by brushing or washing, with or
without colon decompression (separate
procedure) - Total RVUs
- Non-Facility: 11.03
- Facility: 6.19
- Payment:
- Non-Facility: $339.96
- Facility: $193.08
- Payment (With Multi-Procedure Adjustment):
- Non-Facility: $165.42
- Facility: $96.54
EXAMPLE 3: HemWell HEMORRHOIDECTOMY WITH COLONOSCOPY
Facility Billing: Medicare Outpatient Hospital Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or
more hemorrhoid columns/groups - APC 0149
- Payment: $2,237.33
- Payment (With Multi-Procedure Adjustment): $2,237.33
- Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
collection of specimen(s) by brushing or washing, with or without colon
decompression (separate procedure) - APC: 0143
- Payment: $724.89
- Payment (With Multi-Procedure Adjustment): $352.45
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
- Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or
more hemorrhoid columns/groups - Payment: $1,100.00
- Payment (With Multi-Procedure Adjustment): $1,100.00
- Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
collection of specimen(s) by brushing or washing, with or without colon
decompression (separate procedure) - Payment: $363.42
- Payment (With Multi-Procedure Adjustment): $181.71
Professional Billing: Medicare Physician Reimbursement
- Hemorrhoidectomy, internal, by ligation other
than rubber band; 2 or more hemorrhoid
columns/groups - Total RVUs
- Non-Facility: 8.79
- Facility: 6.38
- Payment:
- Non-Facility: $391.93
- Facility: $391.93
- Payment (With Multi-Procedure Adjustment):
- Non-Facility: $391.93
- Facility: $391.93
- Colonoscopy, flexible, proximal to splenic flexure;
diagnostic, with or without collection of
specimen(s) by brushing or washing, with or
without colon decompression (separate
procedure) - Total RVUs
- Non-Facility: 11.03
- Facility: 6.19
- Payment:
- Non-Facility: $339.96
- Facility: $193.08
- Payment (With Multi-Procedure Adjustment):
- Non-Facility: $165.42
- Facility: $96.54
Sample Endoscopy Center ROI
Average Monthly Cases (Pre Covid): 1,200
Average Monthly Colons (60% Total Cases): 720
Estimated Utilization Rate of 30% Monthly: 216
Average Reimbursement Per Case: $1,100
Per Case Usage Charge from HemWell: $250
Net Revenue Gain Per Case: $850
216 Colons/Month X Net Revenue $850: $183,600
Yearly Facility Revenue at 216/Month (Average):
Physician Reimbursement Per Case (46945 only):
Yearly Physician Revenue at 216/Month (Average):
1,200
720
216
$1,110
$250
$850
$183,600
$2,203,200
$309.06
$801,08
*NO CAPITAL OUTLAY
*Does not include additional higher revenue reimbursements from system in hospital Endo suite ($ 2,237 Medicare)
Compare Fees and See How Much MORE You can Earn
with HemWell
Colonoscopy with HemWell (Medicare)
Facility Fee for the ASC, 46945: $ 1,100.00
Facility Fee for ASC, 45378 (2nd Procedure @1/2 or $363.42 * ½): $ 181.71
Total Facility Fee Reimbursement: $1,281.71
(Device cost $ 250): $1,031.71 Net
Physician Fee
Professional Fee for 46945: $309.06
Professional Fee for 45378 (2nd Procedure @1/2 or $193.08 * ½): $ 96.54
Total Professional Fee: $405.60
Colonoscopy with Banding
(Medicare National Average)
Facility Fee for the ASC, 45398: $507.42
Cost of Banding Device (approx.): $ 100.00
Total Facility Fee Net: $407.42 Net
Physician Fee
Professional Fee for 45398: $246.49
Difference in Revenue:
Facility: Net gain of $624.29
Physician Fee: Net gain of $159.11
Colonoscopy with HemWell (Medicare)
Facility Fee for the ASC, 46945: $1,100.00
Facility Fee for ASC, 45378
(2nd Procedure @1/2 of $363.42 * ½): $181.71
Total Facility Fee Reimbursement $ 1,281.71
(Device Cost $ 250): $1,031.71 Net
Physician Fee
Professional Fee for 46945: $309.06
Professional Fee for 45378
(2nd Procedure @1/2 or $193.08 * ½): $96.54
Total Professional Fee: $405.60
Colonoscopy with Sclerotherapy
(Medicare National Average)
Facility Fee for the ASC, 45378: $ 363.42
Facility Fee for the ASC, 46500
(2nd Procedure @1/2 of $235.67 * ½): $117.84
Combined procedure reimbursement $ 481.26
Cost of Banding Device (approx.): $75.00
Total Facility Fee Net: $406.26 Net
Physician Fee
Professional Fee for 45378: $193.08
Professional Fee for 46500: $83.21
Total Professional Fee: $276.29
Difference in Revenue:
Facility: Net gain of $625.45
Physician Fee: Net gain of $129.31
Colonoscopy with HemWell (Medicare)
Facility Fee for the ASC, 46945: $1,100.00
Facility Fee for ASC, 45378
(2nd Procedure @1/2 or $363.42 * ½): $181.71
Total Facility Fee Reimbursement $ 1,281.71
(Device cost $250): $1,031.71 Net
Physician Fee
Professional Fee for 46945: $309.06
Professional Fee for 45378
(2nd Procedure @1/2 or $193.08 * ½): $96.54
Total Professional Fee: $405.60 Net
Colonoscopy with Sclerotherapy
(Medicare)
Facility Fee for the ASC, 45378: $363.42
Total Facility Fee Net: $363.42 Net
Physician Fee
Professional Fee for 45378: $193.08
Professional Fee for 46221 (OFFICE): $250.00
Cost of Banding device (approx.): $100.00
Total Professional Fee: $343.08 Net
Difference in Revenue:
Facility: Net gain of $668.29
Physician Fee: Net gain of $62.52
How do We RETREAT A Patient
In the ASC…
HemWell (Medicare)
Facility Fee for the ASC, 46945: $1,100.00
Total Facility Fee Reimbursement $ 1,100.00 (Device cost $250): $850.00 Net
Physician Fee
Professional Fee for 46945: $309.06
Total Professional Fee: $309.06 Net
Banding in the Office (Medicare)
Professional Fee for 46221 (OFFICE): $250.00
Cost of Banding device (approx.): $100.00
Total Professional Fee: $150.00 Net
Difference in Revenue:
Facility: Net gain of $850.00
Physician Fee: Net gain of $159.06
If you would like to get started with HemWell or would like a more in-depth discussion about HemWell can grow your practice…
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personal information. The following outlines our privacy policy.
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We are committed to conducting our business in accordance with these principles in order to ensure that the confidentiality of personal information is protected and maintained.
HemWell MD, LLC
A breakthrough FDA-cleared technology that applies a micro-electric current to the base of a hemorrhoid. This patented technology quickly and painlessly heals hemorrhoids by producing a natural reaction within the hemorrhoid. The hemorrhoid shrinks and is removed by the body. Most patients experience no or minimal pain and are able to return to work immediately after the procedure.
Hemwell MD B.V.
The Tafelbergweg 47
1105 BD Amsterdam, The Netherlands
Email: Info@HemWellMD.com
Tel: +31-(0)20-2117868