Availability of Price of Bunion Surgery

Discussion in 'Podiatry Students' started by ldsrmdude, 09.21.14.

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  1. ldsrmdude

    ldsrmdude Pod Mod 'Dude Gold Donor SDN Administrator 7+ Year Member

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    I came across this article and thought that it brought up some interesting points. I was hoping to get some of your thoughts on it. Do you think that we should be upfront with patients and tell them how much their surgery is going to cost? Should patients choose their surgeon/surgery center based upon the cost? Also, although it's not the focus of the article, what do you think about the costs of the surgeries themselves? Let me know if any of you have trouble getting access to the article
     
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  3. g squared 23

    g squared 23 made it out alive 5+ Year Member

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    It would definitely kill almost all instances of bunions (and other simple surgeries) being done at hospitals, and maybe would be a positive. Patients, even for more involved procedures, would more often choose MAC over general. "Surgeon shopping" would be commonplace; I'm not sure if that would be an overall good or bad thing, but it would allow even some of the less talented or reputable surgeons a chance to undercut the competition.
     
    Last edited: 10.02.14
  4. Ankle Breaker

    Ankle Breaker Senior Member 5+ Year Member

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    You can't put a price tag on good outcomes. If a crappy surgeon wants undercut the competition then that will only last for so long. Word of mouth spreads quickly, especially with social media. I feel it would all even out eventually.
     
  5. NatCh

    NatCh Senior Moment 7+ Year Member

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    I don't have the article but I read the abstract.

    If a patient requests a quote we give them the price we likely will bill based on anticipated CPT codes, without guarantees that it's the final price. We also give them the phone number to the surgery center and anesthesia group for their quote. If they don't ask then we don't provide a quote.* It's worthwhile to note that we can bill any amount we want but insurance will pay whatever they want anyway. We just end up with more write-offs if we bill higher. There is a formula in which you multiply the RVU for each code by a conversion factor to get the target charge. Medicare allowable is less than private insurance allowable. We review our prices annually to see how close they are to insurance paid amounts. If there is a code for which you regularly get paid 100% then you should raise your price to maximize how much you get paid.

    When the data was released earlier this year on how much Medicare paid doctors, we took a look at average paid amounts for the other docs in our area and found out we were were all in the same ballpark. There was some minor difference that could have been due Meaningful Use and e-prescribing penalties perhaps, but basically we all got paid the same per code.

    Who knows what makes a patient choose the surgeon they do? It could be personal referral, doctor referral, your bedside manner, or they really liked the shoes you wore that day. If they want to choose based upon the quote then I guess that's up to them. Final decision is up to the patient.

    *Edit: If they don't ask then we don't provide a quote of what dollar amount we think we will bill, but we let all surgery candidates know preoperatively what their insurance situation is. In other words, we tell them how much of their deductible they've met, and what their expected contribution will be after insurance has paid. Lately most patients have been asking approximately what they might expect to pay, which is fine with me. We're now seeing a lot of $5000 deductibles with 70%/30% contribution after the deductible has been met. Frankly, I'd rather have them know beforehand and not schedule an elective surgery than find out after surgery that they can't afford it and end up in collections.
     
    Last edited: 10.02.14
  6. g squared 23

    g squared 23 made it out alive 5+ Year Member

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    You'd think this to be true, but at every program I rotated at, there were terrible surgeons consistently booking cases, and it's unlikely the patient had heard about all of their great outcomes. It was that the patient liked and trusted the surgeon. Being likable is more important (for BASIC procedures) than being supremely talented. Complicated procedures change the game considerably, but since the topic is bunions....
     
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  7. ldsrmdude

    ldsrmdude Pod Mod 'Dude Gold Donor SDN Administrator 7+ Year Member

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    One of the things I found really interesting about this article is the wide range of costs that were shown. For those that don't have access to the article, essentially they called a bunch of offices (both academic centers and private practice) and asked for the cost of a bunion surgery, both surgeon fee and bundled price. There was no significant difference between academic and private practice for either bundled price of physicians fee. The mean physician fee was around $2500 and the mean bundled price was ~ $15,000 for academic and ~ $20,000 for private practice. The range for the bundled surgery was $3542 - $52,207. That is a really wide range of cost. I can't imagine that if those prices were widely advertised that the physician/surgery center charging over $50k would have more business than the place charging less than $4k.
     
  8. NatCh

    NatCh Senior Moment 7+ Year Member

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    $50K for a bunion surgery would be outrageous.
     

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