The patient needed back surgery.
The hospital rep checked her insurance, told her the hospital is “in network”, the surgery was covered, and her out of pocket would be $1300.
Post surgery, the hospital submitted the claim, insurance said nope (but paid $70k?).
The hospital then demanded the patient pay the difference- almost $300K.
The patient disagreed, litigated, and the case wound its way all the way to the Colorado Supreme Court.
(*This KHN article links to MSM headlines:)
Court: Patient Doesn’t Have To Pay Gigantic Surprise Bill https://khn.org/morning-breakout/court-patient-doesnt-have-t… The Colorado Supreme Court ruling said internal hospital chargemaster rates “have become increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual costs, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals."
While this ruling is specific to CO, it provides a precedent that can be used in other states via something called “persuasive authority”. 13:00 to 13:30 in this YouTube. https://youtu.be/GKygdWivreE
Therefore, this ruling can be influential nationwide.
Spinal-fusion in one of the most lucrative areas of medicine.
Billions of dollars a year for hospitals.
Serious questions on how helpful this procedure is for patients. Just like the coronary-by-pass surgery. Medicare should ONLY pay for evidence based medicine.
Spinal-fusion in one of the most lucrative areas of medicine.
Billions of dollars a year for hospitals.
Serious questions on how helpful this procedure is for patients. Just like the coronary-by-pass surgery. Medicare should ONLY pay for evidence based medicine. "
I do find it funny that there is a paywall blocking the link.
Howie52
Maybe it is just the way the world twists and turns.
Within the medical device industry, it has been well chronicled how companies use consulting ties and other financial relationships to try to gain favor with the surgeons using their devices. But critics are especially troubled by the emerging trend in spinal devices, which so far has occurred largely under the radar.
Doctors’ taking significant ownership stakes in spinal parts makers, critics say, provides an extra financial incentive for a doctor to recommend a surgery. It may be one of the most distinct examples yet of the way monetary considerations can play a role in the way doctors practice medicine.
Sorta like doctors owning labs.
Serious questions on how helpful this procedure is for patients. Just like the coronary-by-pass surgery.
Years ago, after my cardiologist retired, I had to find a new one. He had me do a stress test and I had a bit of a pain. He recommended an angiogram to find out what the problem was. I asked for an estimate which was quite hefty. I also asked who would be doing the procedure. The doctor who recommended the procedure. This set off the red warning lights! My previous cardiologist, who was also a sailing friend, had told me that angiograms should only be used as a last resort because they damage the arteries (years later he recommended an angioplasty and I still have the J&J stent in my heart).
The above set me on the search of a second opinion which was “It is the recommended procedure.” OK, rule out malpractice. Then I asked, “Is it urgent?” “No.”
“The recommended procedure” is a great way to create traffic and revenue even when it is not really necessary!
Patient Heal Thyself: A Remarkable Health Program Combining Ancient Wisdom with Groundbreaking Clinical Research Paperback – March 29, 2016 by Jordan S. Rubin (Author)
Finally there’s help for those with Heart Disease, Cancer, Arthritis, Diabetes, Irritable Bowel Syndrome, Asthma and more using ancient principles borrowed from history’s healthiest people.
Not a book I read I highlighted the ones I got rid of with a change of lifestyle…
The parts can be highly profitable. A single screw that goes into the spine, for example, sells for about $1,000 — at least 10 times the cost of making it.
Check out the price of a “medical” razor blade. About ten times what we men use for shaving.
The disposable stapling gun they used on my back surgery cost an arm and a leg. Why disposable?
A acquaintance of mine in Caracas made electrical equipment for hospitals which sold for ten times the price of ordinary fixtures. She said they had to have special safety features. “Like grounding?”
People are so paranoid about their immortality that they create a market that will bear ridiculous prices. Just read how paranoid METaR is about Covid! (The Captain is getting the second booster shot on Wednesday, May 25).
I was involved in process equipment design cleaning systems - the costs for cleaning devices
frequently exceeds the price of the original equipment. Then the wear and tear on the device
being dismantled, cleaned, inspected, rinsed and re-packaged for storage until ready to be reused
can be rather involved.
The government standards are extensive and influence the price of items up and down the line for
the pharma industry, the medical device industry and the users of the equipment.
Then in addition there are the regulations for the rooms, the labs ---- there are very good reasons
for the regulations - but there is a price that must be paid - for equipment, supplies and labor.
Then in addition there are the regulations for the rooms, the labs ---- there are very good reasons for the regulations - but there is a price that must be paid - for equipment, supplies and labor.
Thanks for the reply!
But… why not use the old fashioned stitching that worked pretty good?
My dad used to say that the most painful surgical procedure is the walletectomy.
But… why not use the old fashioned stitching that worked pretty good?
Because then they wouldn’t be able to charge usurious rates for things the patient doesn’t need or can’t agree to, even if they have money coming out the wazoo https://www.youtube.com/watch?v=oftjwYmlfoA
Serious questions on how helpful this procedure is for patients.
From conversations with various physicians, my own readings, personal experience, etc…
…once you have back surgery, you are more or less doomed to have more, even it is the new robotic/micro incision type. Have known several people that have had 3+ surgeries with pain relief maybe lasting a few years.
…last study I read, majority of back pain resolves on its own in 8 weeks or less. An extreme example case study many years ago, high school football player complained of worsening back pain. MRI had a couple of herniated discs, surgery was recommended, patient opted for conservative therapy with meds and physical therapy. One month later, follow up MRI, no herniated discs and back to playing.
…the main reason to have back/neck surgery, if you have an acute deficit with a known cause. Something like sudden foot drop with associated herniated disc with nerve impingement.
But… why not use the old fashioned stitching that worked pretty good?
Not that you read my posts Captain…the infection rate is high with good old fashioned stitching. The legal bills would mounts up faster. Patient outcomes would be much worse at times.
I like reading the posts here when there is intelligent information. I wish people would post more of that instead of only their ideas on entertaining us.
the infection rate is high with good old fashioned stitching.
Then the immediate question is “Why?” Needles through the autoclave, thread in the microwave, an iodine-impregnated butterfly/patch over top after stitching is complete. Doesn’t seem like rocket science to make sure the stuff being used is sterile, and infection-prevention is a pretty well-known thing at this point.
the infection rate is high with good old fashioned stitching.
Then the immediate question is “Why?” Needles through the autoclave, thread in the microwave, an iodine-impregnated butterfly/patch over top after stitching is complete. Doesn’t seem like rocket science to make sure the stuff being used is sterile, and infection-prevention is a pretty well-known thing at this point.
Because one can’t control what a patient does after they leave the hospital.
Then the immediate question is "Why?" Needles through the autoclave, thread in the microwave, an iodine-impregnated butterfly/patch over top after stitching is complete. Doesn't seem like rocket science to make sure the stuff being used is sterile, and infection-prevention is a pretty well-known thing at this point.
Because one can’t control what a patient does after they leave the hospital.
How do staples help with that? Infection rate, then, cannot be the reason for using staples instead of old fashioned stitching.
How do staples help with that? Infection rate, then, cannot be the reason for using staples instead of old fashioned stitching.
Everything I’ve heard discussed over the years on staples vs stitches basically comes down to convenience and speed. Obviously faster doing staples than sewing stitches. However, there are several scenarios where it is proven that stitches are far superior, primarily where closing strength is needed and cosmetic looks. Staples are a plus if you think you are going to have to re-operate soon, easy to take out.
As far as infection rates: comes down to some basic things beyond hygiene. Diabetics, obesity, and poor circulation have higher rates on infection. Then there are the unfortunate few that get colonized by difficult bugs that you don’t know you have till you’re sick. And not necessarily hospital acquired. The shower/locker room at your gym is a prime suspect these days.
