Dr. Jason Kim

Well, I've always been pretty aggressive about offering minimally invasive therapies in my practice.

I want patients to get better, so I've always tried to do as soon as possible.

Yeah, it's an interesting question.

I don't know if I've had ideal.

I am so into shared decision-making, I discuss the pluses and minuses with patients.

However, I do think that the ideal patient is someone who understands the risks of urinary retention.

who is able to come to the office on average twice a year, who I think would have the dexterity to perform intermittent catheterization.

I know I'm talking about catheterization, but it's so rare, but the patient has to have the ability to do it even though it's transient.

So if the patients want to accept that, I think they'd be the candidate for Botox injections.

I do.

And it's interesting to see how practices will evolve.

Are you aware of the latest Medicare coverage changes that happened about two weeks ago?

You know, we're struggling with that right now because for all our idiopathic patients, we typically start with 100 units.

And I usually bring them back somewhere at the two to four week mark to check for a postpartum residual the first time.

And then we might bring him back at three to four months to see how they're doing.

If the patient hasn't responded within a month, I used to add a maybe bolstering dose of 100 units.

And then with the understanding, if that worked, when it wore off, I would go to 200 units.

If they got a few months, I might consider going up to 200 units or if they were doing OK on 100 units, but things worsened over time.

I might offer them 200 units.

Unfortunately, now with the new Medicare changes, we can only offer 100 units.