Double booked surgeries

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One of the ******ed things of our system is the ridiculous surgery reimbursements vs everything else. From above article "The top 2 neurosurgeons EACH billed more than $75 million in 2015." An anesthesiologist covering 4 CRNAs working 24/7 will not even bill 75M in 1 year or come close. Nor will a internist or non procedural specialty. The fact that two neurosurgeons each billed >75M in 1 year needing whistleblowers before raising a red flag is concerning. There needs to be better balance.

There are plenty of surgeons making 7 figures. There needs to be increase of pay in other specialties.
 
anbuitachi said:
One of the ******ed things of our system is the ridiculous surgery reimbursements vs everything else. From above article "The top 2 neurosurgeons EACH billed more than $75 million in 2015." An anesthesiologist covering 4 CRNAs working 24/7 will not even bill 75M in 1 year or come close. Nor will a internist or non procedural specialty. The fact that two neurosurgeons each billed >75M in 1 year needing whistleblowers before raising a red flag is concerning. There needs to be better balance.

There are plenty of surgeons making 7 figures. There needs to be increase of pay in other specialties.
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The O.R. factory | Quantity of care


But I bet the anesthesia billings for those 2 neurosurgeons were well into the milllions, maybe more than $10mil. That's why they played along. They were huge revenue generators for that entire hospital system.
 
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Swedish double-booked its surgeries, and the patients didn’t know

If these guys are routinely doing 9-10 hr fusions , they probably suck and their patients probably have a lot of complications. One guy did 2 long (9-10hr) simultaneous cases overlapping 89% of the time. Does that mean they were dicking around with "noncritical portions" of surgery for 8hrs in each case? In residency we had a spine surgeon who would routinely have 3 simultaneous 7am starts. The surgeon's name was prominently displayed at the foot of each gurney. One astute patient seeing her surgeon's name at the foot of another patient's gurney said to me, "I thought I was Dr G's patient." I said, "Let me get Dr. G for you". She did proceed with the procedure after speaking to him.
 
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Possibly many levels? Thought its kind of ******ed to have such overlap for major spine surgery.
Anesthesia payment for spine is one of the better ones but more than 10 million each????? If they work 5 days a week, each anesthesiologist would have to bill 38400$ per day to reach 10m in a year

If the neurosurgeon does 2 large spine cases a day. That's roughly 200k a day, getting you 52m. If you do a couple smaller spines also, that'll bring you close to 75m. part of that probably also come from post op care and clinic and stuff.. so 75m doesn't sound that farfetched.
 
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nimbus said:
The O.R. factory | Quantity of care


But I bet the anesthesia billings for those 2 neurosurgeons were well into the milllions, maybe more than $10mil. That's why they played along. They were huge revenue generators for that entire hospital system.
Click to expand...
Agree. My very good buddy (lifetime friend since freshman year in college and med school)in Texas

He was working like a dog 60-70 hours a week with ob call. MD for what was great money ($800k) q5 call.

But now he sees the light. Just talked to him last night. He provides anesthesia primarily for spine and ortho. Works on average 35 hours a week. 1.1 million last year alone for him. No nights. No weekends. Bills a ridiculous (and collects $400/unit out of network in Texas). Like $12-15k for anesthesia collections per spine case.

It's a symbiotic relationship. Neurosurgeons/ortho spine docs rake in millions. And anesthesia goes along for the ride. 14 units to start the case. 5 units for induced hypotension. 3-5 units for a line in every case with use of ultrasound charge. 1 extra unit for asa 3.

Just like healthcare in general.

That's why our system is so F'd up.
 
aneftp said:
Agree. My very good buddy (lifetime friend since freshman year in college and med school)in Texas

He was working like a dog 60-70 hours a week with ob call. MD for what was great money ($800k) q5 call.

But now he sees the light. Just talked to him last night. He provides anesthesia primarily for spine and ortho. Works on average 35 hours a week. 1.1 million last year alone for him. No nights. No weekends. Bills a ridiculous (and collects $400/unit out of network in Texas). Like $12-15k for anesthesia collections per spine case.

It's a symbiotic relationship. Neurosurgeons/ortho spine docs rake in millions. And anesthesia goes along for the ride. 14 units to start the case. 5 units for induced hypotension. 3-5 units for a line in every case with use of ultrasound charge. 1 extra unit for asa 3.

Just like healthcare in general.

That's why our system is so F'd up.
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Induced hypotension? People still do that for spines?? Hahaha. How low does it have to be to bill for that??
 
anbuitachi said:
Induced hypotension? People still do that for spines?? Hahaha. How low does it have to be to bill for that??
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Document surgeon wants map 70 for case.

That justifies 5 units. (5 x $400) is $2000. Plus the a line with ultrasound (3 u it's). $1200. That's $3200 extra in billing

Many practices are leaving money on the table here. Of course my brother in California says many insurers won't pay extra for those billing. But some other states will.

Just like the freaking Emergency room dept management company charged my wife $75 after 10pm "surcharge"

So it's just not anesthesia doing these creative bullings and collections. Everyone does it.
 
aneftp said:
Agree. My very good buddy (lifetime friend since freshman year in college and med school)in Texas

He was working like a dog 60-70 hours a week with ob call. MD for what was great money ($800k) q5 call.

But now he sees the light. Just talked to him last night. He provides anesthesia primarily for spine and ortho. Works on average 35 hours a week. 1.1 million last year alone for him. No nights. No weekends. Bills a ridiculous (and collects $400/unit out of network in Texas). Like $12-15k for anesthesia collections per spine case.

It's a symbiotic relationship. Neurosurgeons/ortho spine docs rake in millions. And anesthesia goes along for the ride. 14 units to start the case. 5 units for induced hypotension. 3-5 units for a line in every case with use of ultrasound charge. 1 extra unit for asa 3.

Just like healthcare in general.

That's why our system is so F'd up.
Click to expand...

Check your ethics at the OR door.
 
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aneftp said:
Agree. My very good buddy (lifetime friend since freshman year in college and med school)in Texas

He was working like a dog 60-70 hours a week with ob call. MD for what was great money ($800k) q5 call.

But now he sees the light. Just talked to him last night. He provides anesthesia primarily for spine and ortho. Works on average 35 hours a week. 1.1 million last year alone for him. No nights. No weekends. Bills a ridiculous (and collects $400/unit out of network in Texas). Like $12-15k for anesthesia collections per spine case.

It's a symbiotic relationship. Neurosurgeons/ortho spine docs rake in millions. And anesthesia goes along for the ride. 14 units to start the case. 5 units for induced hypotension. 3-5 units for a line in every case with use of ultrasound charge. 1 extra unit for asa 3.

Just like healthcare in general.

That's why our system is so F'd up.
Click to expand...

Is he looking for new partners?
 
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We've sort of lost the initial topic. Getting back to it, my last case in residency (which I only did on call to be nice to my junior colleagues rather than going to sleep) was a 55yom s/p hemorrhagic stroke 5 days prior coming in for a trach. Surgeons saw us roll into the room, took 40 minutes to show up and another 10+ minutes to scrub and approach the pt (he was on the phone when he finally wandered in). After the surgery was progressing and they were approaching the trachea, the pt had a massive PE, right heart failure, sats, BP, ETCO2 bottom out. He got multiple rounds of CPR, eventual emergent thrombolectomy by IR since he couldn't be anticoagulated. MICU had him withdrawn from care and terminally extubated within 3 hrs of arrival. Now you can't say that general anesthesia caused this, but no one will ever be able to tell me that extra unnecessary anesthesia time (about an hour in this case) doesn't present a risk to patients.
 
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Until hospitals begin to recognize capitation of their income is based on the hospitalization rather than the procedure time, there is no incentive to hold surgeons accountable. If the hospitals wanted to optimize their income they would 1. require the surgeon be physically present in the OR at induction and not leave until the skin is closed 2. penalize the surgeons for not showing up on time or requiring the OR team to wait. Perhaps in the future....
 
Pharmado said:
We've sort of lost the initial topic. Getting back to it, my last case in residency (which I only did on call to be nice to my junior colleagues rather than going to sleep) was a 55yom s/p hemorrhagic stroke 5 days prior coming in for a trach. Surgeons saw us roll into the room, took 40 minutes to show up and another 10+ minutes to scrub and approach the pt (he was on the phone when he finally wandered in). After the surgery was progressing and they were approaching the trachea, the pt had a massive PE, right heart failure, sats, BP, ETCO2 bottom out. He got multiple rounds of CPR, eventual emergent thrombolectomy by IR since he couldn't be anticoagulated. MICU had him withdrawn from care and terminally extubated within 3 hrs of arrival. Now you can't say that general anesthesia caused this, but no one will ever be able to tell me that extra unnecessary anesthesia time (about an hour in this case) doesn't present a risk to patients.
Click to expand...

Were you doing chest compressions on your way to IR? hahaha
 
Pharmado said:
We've sort of lost the initial topic. Getting back to it, my last case in residency (which I only did on call to be nice to my junior colleagues rather than going to sleep) was a 55yom s/p hemorrhagic stroke 5 days prior coming in for a trach. Surgeons saw us roll into the room, took 40 minutes to show up and another 10+ minutes to scrub and approach the pt (he was on the phone when he finally wandered in). After the surgery was progressing and they were approaching the trachea, the pt had a massive PE, right heart failure, sats, BP, ETCO2 bottom out. He got multiple rounds of CPR, eventual emergent thrombolectomy by IR since he couldn't be anticoagulated. MICU had him withdrawn from care and terminally extubated within 3 hrs of arrival. Now you can't say that general anesthesia caused this, but no one will ever be able to tell me that extra unnecessary anesthesia time (about an hour in this case) doesn't present a risk to patients.
Click to expand...

Waiting 40 min in the OR with a patient who’s been intubated in ICU for 5 days probably didn’t change the outcome in any way. If he had a big DVT, it didn’t just form while waiting for the surgeon.
 
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Crazy to hear from somebody who went through a double-booked surgery. And a Red Sox player at that.
 
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