I started a cochlear implant program last year at a small not-for-profit community hospital (~350 beds) in a fairly small town of around 70K, although our service area encompasses around 400,000. I am a hospital employee and do not work for a private practice, my situation is somewhat similar to yours. I would offer the following from my experience.
The bottom line for the surgeon isn't the problem. Your private practice could very well make money on cochlear implants. The issue is the hospital. Any way you slice it they are not going to make money and probably stand to loose a little bit. The reimbursement for the device and everything that goes with it is not going to be completely paid for by insurance. The hospital is going to buy the device from the company and pass on the cost to the patient's insurance provider, which in most cases is Medicare. The surgeons fee, anesthesia fees, hospital admission (if necessary) will be covered and no one will lose money on those aspects. The loss comes from the cost of the device (both externals and internal device). Last I heard, my hospital is loosing around 10K per implant.
I've done 21 implants in 8 months. I've been able to get away with for a few reasons. 1) My hospital is a not-for-profit and is OK with taking a loss on certain ventures if they see it as a community benefit, which they obviously do. 2) Since I'm employed, the hospital gets my fee. They also get the anesthesia fee, the CT scan I order, and my E/M fee. I don't know this for certain, but if all of these things were taken into account I'm sure I don't lose them that much with each surgery. 3) It's good publicity for the hospital.
I would encourage you to get the ball rolling as soon as possible. It took 9 months for my hospital to work on contracts and get things in motion. My cochlear reps say that is the fastest they have seen a program get off the ground. These contractual negotiations between device companies and hospitals are complex and can take a very long time.
I choose to start my program with Cochlear Americas for the simple reason that they are bigger and have more resources to help a small country ENT doc like me. They have been instrumental in helping my audiologists learn programming and taking care of educating hospital staff in the purchasing department and surgery department. I also simply prefer their electrodes. The slim-modiolar electrode is fantastic. Once your program grows you can branch out to include the other device makers, but start with one.
One of the reasons my hospital is loosing money is because my patients get two processors. Most academic programs are including a back-up processor for their patients, and this increases the cost substantially. That is one corner that could be "cut" but it will put you at a disadvantage compared to your nearest university. Honestly, I'm not sure patient's will care. Most of this patient population is old and just wants to get the device implanted and programmed as close to home as possible.
Finally, I encourage you to do this. Our field needs to bring cochlear implants to the population in the same manner that orthopedic surgeons provide hip/knee replacements. One of the biggest factors impeding the ability to get an implant is travel. I guarantee the need is present in your community. I've done 21 in 8 months with almost zero advertising. The patients are everywhere, it's just a matter of getting the hospital on board.
